Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs

Abstract

Background: Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness. Methods: A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management. Results: Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure 'story' and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care. Conclusions: Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users' needs, and addressing additional stakeholders' needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.

Digital health technology and hypertension management: a qualitative analysis of patient and specialist provider preferences on data tracking

“…Previous studies examined patients' understanding and perceptions of home BP self-monitoring; few studies examine patient understanding and preferences of data tracking for standardized PROMs and other health metrics that are being increasingly used in self-management tools and clinical assessments. Further, most patient selfmanagement digital tools are patient-facing, but these tools can provide valuable health information to care providers [21] , especially hypertension specialists who provide care for challenging and complex hypertension cases [10] . This study provides novel comparisons between patients' and hypertension specialists' understanding and perceptions of data tracking for patient self-management.…”

Home blood pressure data visualization for the management of hypertension: using human factors and design principles

“…A more traditional and comprehensive thematic analysis [22] of the qualitative data was conducted by RJK and SMC, using a deductive realist approach. Additional details regarding the data collection and analysis, and the interview guide, can be found in a related paper [17]. Each of the quotes we selected to present here were chosen for two reasons: (1) the quotes represented common positions held by focus group participants; and…”

“…Previously, we reported our efforts to determine the informational needs of patients and physicians to engage in shared decision making around hypertension using a single data display [17]. In that work, we reported the results of several focus groups with patients and healthcare providers on the informational needs of both groups, specifically what data would need to be present in a display so patients and providers could engage in shared decision making around hypertension management.…”

“…We aimed to address several problems currently plaguing patients and physicians about the display of blood pressure measurements: (1) patients lack clarity about goal BP values; (2) patients are concerned by outlier values despite the average BP being in the goal range and considered "controlled"; (3) patients' overdependence on the most recent BP values; and (4) patients not understanding the temporal connection between medication changes and BP response, as BP and medications are typically not on the same screen, and onset of action delay is different for each medication. We used an iterative, rapid-prototyping, user-centred design methodology, involving both our core research team and the focus groups reported in the previous work [17]. We focused on visual cognition and human factors principles to drive the design of prototype displays, with many decisions being made based on feedback from patients and providers.…”

Impact of Home Blood Pressure Data Visualization on Hypertension Medical Decision Making in Primary Care

“…This tool's development and function have been described elsewhere. 13,[19][20][21] Briefly, patients manually populate the EHR, via a portal, with home BP readings. These values are incorporated with in-clinic BP readings and a corresponding medication timeline.…”