21st Century Blood Pressure Diagnosis and Treatment: Workflow, in Cartoon


(click to enlarge)

I am going to share some work on this blog that I completed for the California Healthcare Foundation around new models of treatment for chronic illness, in this case high blood pressure, over the next few days.

As I have detailed here previously, there’s a great opportunity with this condition to change the locus of care closer to the patient, with greater accuracy and efficiency for patients, families, their employers, and communities.

Because this way of doing things (patient in control) seemed to be such a change from standard care, I decided to portray the workflow in cartoon format, to show what this might look like in practice.

This is the first set of panels, and shows the different ways that a patient’s suspected high blood pressure might come to the attention of themselves and their doctor. The series will hopefully show how a new model might change things around quite a bit….

Feel free to let me know what you think of the workflow, and of the approach to communicating what is really a big change in the way we manage a condition that is in the United States the #1 reason for a visit to the doctor.


Where is the cartoon for the much larger community of people in the lower socioeconomic class who don't have the education, money or ability to fully engage in this "way of doing things (patient in control)".

I am very much a proponent of the so-termed "Health2.0" future with personal health records, functional EHRs and computerized clinical decision support. But I am concerned that I am not seeing the blogosphere talk about the larger group of patients who don't have the resources to engage in this new world.

What is your opinion?


Hi Joseph!

Thanks for commenting, and glad you're a proponent. I've written about this issue quite a bit previously on my blog, visited many safety net medical centers, and have honestly walked away with the concern that "the larger group of patients who don't have the resources" just isn't as large as people think. Additionally, I think that this sentiment prevents potential innovation and may hasten the development of disparities moving forward. In very large personal health record installations, there's early evidence of equality of access of people of different ages and education.

I've tagged the articles I've written on this issue, and you can read them by clicking here.

So that's my opinion – let me know what your thoughts are as you review some of this information, two-way interaction on this subject is good,



I agree that expressing my viewpoint can lead to pessimistic obstructionism. That really isn't what I mean to do. I appreciate your experience, and can only debate with my own anecdotal viewpoint.

I practice acute care surgery and surgical critical care. Therefore my vantage point may be through a narrow window that does not reflect the true reality. However, I am also practicing in the largest medical center in the world, and therefore I would suspect that the patient population that I encounter may be a bit more likely to engage in these new tools. Additionally, my own family and social circles (both of which would be in the middle to upper socioeconomics) have not utilized anything more than a google search as it pertains to healthcare.

I therefore derive that if these people have sub-optimal utilization patterns of these newer tools, then it is even more likely that those of lower socio-economic classes will do so at even a lower rate.

You also claim that the larger group of patients "isn't as large as people think". I can't agree with that. Clearly the data would show that people of lower socio-economic class have more acute and chronic health issues than those of higher education and income.

All that being said. I agree with you! Really. I don't want my opinions to be used as an argument against technology. In fact, I am trying to advocate for the people who I think need it most. Fortunately, I believe that the efforts of groups like the AHRQ being directed at the large population that needs the most help. Check out what they are funding. I applaud their efforts (despite the fact that they are not funding the research that I am most interested in).

Thank you for giving me the opportunity to express my thoughts. I appreciate your opinions and look forward to reading more of what you have to say.



And I agree with you – well said on the above. I think on the "isn't as large as people think" phrase that I meant regarding their internet access rather than their health challenges – thanks for clarifying that.

So you mentioned the kind of research that you are interested in – what are you hoping AHRQ to fund? I'm interested because I think it's impressive and very important to have surgeons and all specialists interested in these issues. This is not just for primary care… Thanks for stopping by,


Ted Eytan, MD