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


(click to enlarge)

This is the next panel in the series on 21st Century Blood Pressure management. This covers workflow, from the patient perspective, regarding diagnosis. Given that 20% of the time, a patient is inappropriately diagnosed as having high blood pressure in the office, and at least 10% of the time, inappropriately diagnosed as not having high blood pressure, the best way to confirm is via home measurement.

Because there is already a CPT code that covers an older type of blood pressure management outside the office, it’s possible (and reasonable) to reimburse a practitioner’s office for the time spent training a patient, and the cognitive work to make the determination. This is especially important considering that the determination means a lifelong diagnosis and treatment path.

As always comments welcomed. I especially welcome comments regarding how this might be applied in safety-net populations, based on the excellent discussion started on the last post.


I love this! I've been delinquent, not keeping up with my Teddings. It's incredible how well this worked for me at first glance, with the different dimensions sprinkled in with different visual metaphors.

An example is the billing code – a concern I often hear mentioned, but about which I have nothing to offer, and which is rarely handled in other discussions.

I especially love that this moves both responsibility and ability into the hands where it belongs: the patient. Don't I love empowerment!

It's inspiring to see someone building fully-implemented real-world point solutions, while SOME of us are zooming in and out trying to wrap our minds around this giant thing. Thanks for sharing!

I just read your exchange with Joe Sucher on the previous post. I keep getting tripped up by different semantics attached to the phrase "safety-net populations."

Sometimes we generically mean pts who've "fallen through" the protections that the majority have, generally those who don't have health insurance and/or thus don't have a medical home. Other times we're referring to the lower socioeconomic classes; other times it's those who don't have Internet access.

A Venn diagram of those populations would have a big middle section, but if I talk about one portion and my listener's thinking about another, we can miss connections. But when I pick one, particular questions come to light. Example, choosing just the economic aspect:

Susannah Fox at Pew has often mentioned that in the lower strata, the phone is the platform – not a PC with broadband. How does that work for the kind of online BP monitor in this cartoon? Can those upload via a Bluetooth phone?

Hey Dave,

Exactly – I would not focus on the device, but just on the idea that the information is collected by the patient and the patient is asked to provide it (their blood pressure, which is their body's condition), rather than the other way around (the doctor telling the patient what is going on with the patient's body).

And, I don't think it has to be as complicated as bluetooth cellphones – imagine a device tweeting the daily pressure somewhere, including your doctor, friends and family (or whoever you choose). Twitter represents an incredible barrier lowering tool for cell phone/sms communication,


Well, I might focus on the device. I keep getting tripped up with the word "access". In the health literacy world, it is the access of understanding. In the health IT world, it is the technology. Yet there are other access angles, including preferences and – for lack of a better word – usability.

These cartoons can be delivered without a computer or phone but through a comic book (targeted to adult and say, sitting in a waiting room). Just a bit more length and intrigue..

Best devices for information exchange are on several channels!

Ted Eytan, MD