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

Abstract

PURPOSE Evidence shows the value of home blood pressure (BP) monitoring in hypertension management. Questions exist about how to effectively incorporate these readings into BP follow-up visits. We developed and implemented a tool that combines clinical and home BP readings into an electronic health record (EHR)-integrated visualization tool. We examined how this tool was used during primary care visits and its effect on physician-patient communication and decision making about hypertension management, comparing it with home BP readings on paper. METHODSWe video recorded the hypertension follow-up visits of 73 patients with 15 primary care physicians between July 2018 and April 2019. During visits, physicians reviewed home BP readings with patients, either directly from paper or as entered into the EHR visualization tool. We used conversation analysis to analyze the recordings. RESULTSHome BP readings were viewed on paper for 26 patients and in the visualization tool for 47 patients. Access to home BP readings during hypertension management visits, regardless of viewing mode, positioned the physician and patient to assess BP management and make decisions about treatment modification, if needed. Length of BP discussion with the visualization tool was similar to or shorter than that with paper. Advantages of the visualization tool included ease of use, and enhanced and faster sense making and decision making. Successful use of the tool required patients' ability to obtain their BP readings and enter them into the EHR via a portal, and an examination room configuration that allowed for screen sharing.CONCLUSIONS Reviewing home BP readings using a visualization tool is feasible and enhances sense making and patient engagement in decision making. Practices and their patients need appropriate infrastructure to realize these benefits.

Visualization of Patient-Generated Health Data: A Scoping Review of Dashboard Designs

“…21 Most studies recorded data passively, although some used blood pressure measurements actively entered by patients. 19,22,28 One study required patient data entry into a portal. 28 Another required patients to send their blood pressure measurement by text message.…”

“…Individual users also will have their own preferences, and usability heuristics indicate that flexibility should be allowed for users to customize data display for their specific needs. 18,20,28,32 5. Availability for Other Purposes (e.g.…”

“…Line graph variations Line connecting data points, seven-day moving average, 17 smoothed line, 19,28 lines of each day's maximum and minimum value 24,25 Multiple variables on same plot with different y-axis labels 29 Different by source (home vs. clinic blood pressure) 28 Each day over same plot to show blood glucose trends by time of day 25 Visualization of summary statistics Box plots of day's range of values 27 Circle plots of percent time spent in states (e.g. activity types; 24 high, low, or target blood glucose 25 )…”

Uplifting Primary Care Through the Electronic Health Record

“…1,2 We highlight 4 papers in this issue that allow us to understand the current state of EHR use, identify unmet needs, provide evidence on their potential to uplift clinical practice and research, and their future potential to improve patient outcomes and address the perpetual problem of the "forgetful health system". [3][4][5][6] Although numerous studies have focused on assessing clinician experience with their EHR systems, few have in parallel obtained the patient's perspective. Meltzer et al, 3 in a survey of health practitioners and their patients from 2 primary care sites, finds discrepancies in experience and attitudes regarding EHR use between patient and clinician.…”

“…Developing single national EHR systems such as in Iceland, or mandating interoperability throughout the health system as done by the US Center for Medicare and Medicaid Services are a few possible solutions to facilitate ease in sharing of health records among clinicians. 7 Another study in this issue by Cohen et al 5 assesses the usability of an EHR-integrated home blood pressure visualization tool and provides evidence of the benefits of having out-of-office health monitoring data link to EHR systems. Through use of video recording, the study shows that such tools can be timesavers in patients with controlled disease, giving clinicians and patients time to discuss other health concerns.…”