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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2020

01-12-2020 | Hypertension | Research article

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

Authors: Richelle J. Koopman, Shannon M. Canfield, Jeffery L. Belden, Pete Wegier, Victoria A. Shaffer, K. D. Valentine, Akshay Jain, Linsey M. Steege, Sonal J. Patil, Mihail Popescu, Michael L. LeFevre

Published in: BMC Medical Informatics and Decision Making | Issue 1/2020

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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.
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Metadata
Title
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs
Authors
Richelle J. Koopman
Shannon M. Canfield
Jeffery L. Belden
Pete Wegier
Victoria A. Shaffer
K. D. Valentine
Akshay Jain
Linsey M. Steege
Sonal J. Patil
Mihail Popescu
Michael L. LeFevre
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2020
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-020-01194-y

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