Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs
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-patie...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-020-01194-y |
| _version_ | 1818148683508613120 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Richelle J. Koopman |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T12:55:02Z |
| format | Article |
| id | doaj.art-4c7ef43e82d745ac9b130cd7c2c01919 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-11T12:55:02Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-4c7ef43e82d745ac9b130cd7c2c019192022-12-22T01:06:36ZengBMCBMC Medical Informatics and Decision Making1472-69472020-08-0120111510.1186/s12911-020-01194-yHome blood pressure data visualization for the management of hypertension: designing for patient and physician information needsRichelle J. Koopman0Shannon M. Canfield1Jeffery L. Belden2Pete Wegier3Victoria A. Shaffer4K. D. Valentine5Akshay Jain6Linsey M. Steege7Sonal J. Patil8Mihail Popescu9Michael L. LeFevre10Department of Family & Community Medicine, University of Missouri-ColumbiaDepartment of Family & Community Medicine, University of Missouri-ColumbiaDepartment of Family & Community Medicine, University of Missouri-ColumbiaDepartment of Family & Community Medicine, University of TorontoDepartment of Psychological Sciences, University of Missouri-ColumbiaHealth Decision Sciences Center, Massachusetts General HospitalDepartment of Electrical & Computer Engineering, University of Missouri-ColumbiaSchool of Nursing, University of Wisconsin-MadisonDepartment of Family & Community Medicine, University of Missouri-ColumbiaDepartment of Health Management & Informatics, University of Missouri-ColumbiaDepartment of Family & Community Medicine, University of Missouri-ColumbiaAbstract 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.http://link.springer.com/article/10.1186/s12911-020-01194-yData visualizationElectronic health recordHome blood pressure monitoringHypertension |
| spellingShingle | 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 Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs BMC Medical Informatics and Decision Making Data visualization Electronic health record Home blood pressure monitoring Hypertension |
| title | Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs |
| title_full | Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs |
| title_fullStr | Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs |
| title_full_unstemmed | Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs |
| title_short | Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs |
| title_sort | home blood pressure data visualization for the management of hypertension designing for patient and physician information needs |
| topic | Data visualization Electronic health record Home blood pressure monitoring Hypertension |
| url | http://link.springer.com/article/10.1186/s12911-020-01194-y |
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