Work- and dataflows for managing hypertension outside of the doctor’s office

I am still working with The California Healthcare Foundation to support consumer connectivity to their personal health information in California. As part of that work, I developed these work/dataflows for an organization that might transition the management of hypertension from an office-based approach (shown to be mostly ineffective) to a home-based approach, for which a significant body of evidence is accumulating for its effectiveness.

The problem this is working to solve is the one where a physician will say, “you should monitor your blood pressure at home,” (which many do today) but without any specifics. How often? What to do with the readings? How is the physician / care team involved in managing the data? These workflows seek to address that.

Reimbursement: There are already reimbursement considerations for home monitoring, approved by most health plans and Medicare. The problem with them is that they specify an outdated technology (so-called “Ambulatory monitoring,” much like a holter monitor) instead of modern, more cost-effective technology (digital home monitors). The good news is that the rationale for reimbursing has been worked out for this service, which could potentially benefit 1/3 of the United States population.

Questions? Comments? Feedback? Happy to hear them.

2 Replies to “Work- and dataflows for managing hypertension outside of the doctor’s office”

  1. I went through three days in a cardiovascular ward while the medical team tried to identify what was wrong with me (a whole different story). I have hypertension and have my own digital home monitoring device.

    Periodically during my hospital stay I used my monitoring device approximately 5 minutes after medical staff would check my BP, sometimes changing arms, sometimes on the same arm.

    The systolic reading on my machine was often 10 points higher and once 23 points higher. The diastolic reading was much less pronounced in comparison (3-7 points).

    Although I asked my nurses why the discrepancies, no one gave me an answer. I never had enough time to ask the doctor who would come in, say a few words and briefly respond to one or two questions (max) that I might think in the moment was most crucial.

    It was not until my second follow up with my primary care physician at my local medical clinic that the nurse taking my BP suggested I "re-calibrate" my machine.

    Not being mechanical in any way, that suggestion never occurred to me.

    I don't know if that is the actual problem with my machine but I thought I would share this with you, as obvious as it must be to you.

    I've had my machine for over 3 years, I don't know where the original manual is, and perhaps in that lost manual there might have been something about re-calibrating, I don't know. I plan to bring it back to the store I bought it from to ask them about it.

    Moral of the story: Kindly provide some basic, peace of mind Q&A for the uninformed/ less-informed, such as myself to reference.

  2. Hi Nedrra,

    Thank you for taking the time to post your story – your experience is a really important contribution to this discussion.

    The reference for this algorithm is the May, 2008 American Heart Association Position Paper (I posted about it on this blog at this link). It provides information about the algorithm for checking blood pressure at home, AND it includes information about how to do calibration with patients before beginning a home-monitoring program.

    As you point out, the information that doctors typically provide ("measure your BP at home" is most of it) is insufficient to get a good outcome. This is why it is important that the CPT code referenced above includes payment for providing instruction and calibration. So if the CPT code reference were to change (from "Ambulatory monitoring" to "Home monitoring") it would include payment for the services to provide patients this information for successful self-monitoring.

    I've been posting a lot about hypertension over the last few months because it's really an ideal condition to look at for changing the locus of control from doctor to patient. You can access all the related posts here.

    Does this help?

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