Do Alerts of Elevated BP Measurements on Remote Monitoring Impact Clinician Decision-Making?

Clinicians act on about two-thirds of alerts of elevated blood pressure (BP) on remote monitoring received through the electronic health record (EHR), according to findings published Jan. 14 in JAMA Network Open.

Natalie S. Lee, MD, MPH, MSHP, et al., used data from a randomized clinical trial of remote BP monitoring with 162 patients. In the trial, clinicians received a direct message in their EHR inbox when patients submitted at least three elevated BP readings. The researchers found that clinicians acted on 62.1% of 552 EHR alerts for persistently elevated BP home readings using a mix of remote- and office-based management. Common responses included reconciling medications and assessing adherence, verifying BP measurement techniques, as well as requesting appointments and seeing the patient in a subsequent office visit. About 17.4% of EHR alerts resulted in medication changes; half of these changes were remote, and the other half were visit-based.

Although telemonitoring initiatives for chronic conditions such as hypertension are growing in use, the evidence needed to guide where and how telehealth information should be transmitted is insufficient. The findings of this study suggest that the EHR may be an appropriate place to transmit abnormal telemonitored BP values to clinicians, but further research is needed to understand how to best integrate telehealth data in clinically helpful ways.

For example, while remote transmission of hypertension data to the clinician did not always lead to care plan changes – as was the case for 37.9% of all alerts – inferred or explicit clinical reasons for that included improving BP trends or anticipated improvement because of recently implemented medication changes. As such, future EHR alerts may need to be more sophisticated and account for clinically meaningful BP trends or recent management changes.

“Our observations suggest that, overall, EHR alerts for persistently elevated home BP readings were reasonably effective in prompting a clinical response,” wrote the investigators.

Clinical Topics: Prevention, Hypertension

Keywords: Chronic Disease, Telemedicine, Hypertension, Blood Pressure, Electronic Health Records

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