Project Overview


  • Hypertension affects 115 million adults in America.
    • 85% of Black Americans will develop hypertension in their lifetime.
  • There is a lack of adherence to clinical guidelines to diagnose, treat, and manage hypertension.
    • Over 30% of people do not know that they have hypertension.
    • Only 25% of patients with a diagnosis of hypertension achieve blood pressure control.
  • Home blood pressure monitoring is the standard for hypertension monitoring, however there are no standards to capture in the EHR.
    • There is a lack of open communication between patient-facing and clinician EHR systems
    • There is a lack of consistent vocabulary and associated data standards for data exchange
    • There is a lack of technical standards for interoperability between home blood pressure monitoring devices, EHR, and Personal Health Intermediaries.


  • Patients are recommended to use a home blood pressure monitoring system by clinicians and are instructed on how to correctly measure blood pressure at home
  • From a device vendor gateway, home measured blood pressure data and metadata will be exchanged with a Personal Health Intermediary using a standard FHIR-based API
  • Separate FHIR-based exchanges will connect the the Personal Health Intermediary with the EHR 
    • The Personal Health Intermediary will exchange data collected by the patient with the EHR that is relevant to clinicians
    • The EHR will provide relevant information gathered in the clinic to the Patient Health Intermediary to create a guidelines-based care plan


  • Create integrated, automated, vendor-agnostic hypertension standards by developing FHIR resources and open APIs that enable interoperable, scalable, and accessible hypertension management both at home and in the clinic
  • To improve the awareness of guidelines, identification of disease, and management of individuals with hypertension.
  • Increase the proportion of individuals with hypertension who are treated to goal. 
  • Define the methodology to enable data liquidity between home blood pressure measurement devices, Personal Health Intermediaries, and EHR devices.
  • Harmonize HTN vocabulary (demographics, VS, diagnoses, assessments, labs, meds, care plan)
  • Develop device data exchange standards (“plug and play”) for:
    • Home BP device data
    • Communication between patient-facing and clinician EHR systems

Potential Impact: 

  • Provide patients, physicians, APPs, nurses, medical assistants, pharmacists, and dietitians with the tools needed to adhere to hypertension guidelines.
  • Increase data liquidity between blood pressure measurements captured at home with those captured in the clinic.
  • Personal Health Intermediaries will be able to easily send and receive data to enhance a patient's ability to be part of their own care team. 
  • EHR vendors will enable a service that will help clinicians treat patients.

Quick Links

HTN Use Case Updates: 

View a recording and meeting notes of our August CardX Public Meeting Here

Register for our November CardX Public Meeting on 11/6: Here

HTN Use Case Resources:

CardX - Hypertension (HTN) Management (Member page)

Hypertension Management One-Pager

CardX Master Slide Deck 

HTN Supporting Materials 

Meeting Cadence 

CardX Public Meetings Sharing quarterly updates on the CardX Domain and Hypertension Management Use Case and open discussions to ask questions, provide insight into the progression of the use case.Quarterly, typically on a Monday from 1pm-2pm ET
CardX HTN Use Case Leadership MeetingConvening of the decision-making body for the Use Case to align on priorities and finalize next steps for the Use Case.Bi-weekly, Mondays from 1pm -2pm ET
CardX HTN Use Case Team Planning Meeting Discuss challenges, opportunities, next steps, and develop critical mass on subtopics for the HTN management use case Thursdays 11am-12pm ET (weekly, alternating with Technical meetings) 
CardX HTN Use Case Team Technical Meeting 

Review and discuss details of the technical specification. Develop critical mass on technical requirements for the specification and related artifacts.

Thursdays 11am-12pm ET (weekly,  alternating with Planning meetings)

Project Plan






Use case identification 

  • Develop description of problems/challenges, proposed solution/workflow
  • Identify scope and potential impact of the use case
  • Develop high level timeline for planning phase and initial stages of execution phase

Convening of use case members

  • Identify at least 1 "Champion", who commits to leading concept and planning alignment, engagement of stakeholders, etc.
  • Identify and gain commitment from at least 1 organization for each key stakeholder group
  • Engage the community through public CodeX meetings to discuss use case, develop a proposed solution/workflow, and identify end goal

July 2022 - March 2023


Plan out high-level project plan, deliverables, success measures, high level timeline, key stakeholders with consensus from the CardX community

  • Update use case description, scope, and potential impact as necessary
  • Provide more detailed solution/workflow with alignment from use case members (and those committed to join) 
  • Define detailed workflows
  • Prioritize data requirements
  • FHIR/FHIR IG gap analysis
  • Formalize HL7 project/balloting plan
  • Solidify plans for demonstration for proof of concept and pilot(s)
  • Draft high-level plan for scalability

Growing the CardX Community 

  • 1 or 2 "Champions", who commit to lead the use case into Executing, including driving work and engaging additional stakeholders to participate
  • Identify and gain commitment from hypertension Subject Matter Experts and additional stakeholders
  • Plan to engage and align with outside initiatives 

March 2023 - 



Phase 1


  • Specify 1st batch of data requirements (SMBP) as FHIR profiles
  • Develop synthetic test data
  • Internal validation in developer/ implementer systems
  • Solidify plans for adoption and scalability
  • Participate in HL7 Connectathon

September 2023 - January 2024



Phase 2

Pilot with CHC 

  • Specify 2nd batch of data requirements as FHIR profiles, synthetic test data
  • Intermediary sends BP data into EHR in outpatient production environment, and returns feedback from the EHR to the intermediary
  • Refine operational implementation guidance for CHCs
February 2024 - May 2024

Use Case Leadership Team

RoleName Organization
ChampionJames Tcheng, MDUniversity of Nebraska Medical Center - Center for Intelligent Health Care
ChampionHilary WallCDC Million Hearts
Champion John Windle, MD University of Nebraska Medical Center - Center for Intelligent Health Care
Use Case LeadMelissa Christian, RNUniversity of Nebraska Medical Center - Center for Intelligent Health Care
Use Case SupportKaren BatesMITRE
TerminologistTom Windle and  Monique van BerkumUniversity of Nebraska Medical Center - Center for Intelligent Health Care and AMA
Government AgencyMaria MichaelsCDC
PayerDavid Brick, Ellen Anderson, Paula MinnesotaEvicore
Device ManufacturerAndy IversonMedtronic
EHR VendorWill Dark, Daniel RutzEpic
Medical SocietyMaria Isler, Sara O'KaneAHA
Medical SocietyCorey Smith, Monique van BerkumAMA
Medical SocietyRichard Kovacs, MDACC
EHR VenderHeather DewhirstOracle/Cerner

If you'd like to learn more about this use case, please contact Melissa Christian ( or Karen Bates (

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