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Project Overview

Problem: 

  • Hypertension affects 115 million adults in America.
    • 85% of African-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.

Description: 

  • 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

Goal:  

  • 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 January Community Meeting on 1/9: Here

Register for our March CardX Community Meeting on 3/13: Here

Check out the HTN Use Case Segment in the CodeX Fall Newsletter: Here

HTN Use Case Resources:

CardX - Hypertension (HTN) Management (Member page)

Hypertension Management One-Pager

CardX Master Slide Deck 

HTN Supporting Materials 




Meeting Cadence 

MeetingDescriptionTime
CardX Community Meetings Sharing monthly updates on the CardX Domain and Hypertension use case and open discussions to ask questions, provide insight into the progression of the use case.2nd Monday in March, May, July, September, November 1pm-2pm ET
CardX HTN Use Case Team Planning Meeting Develop critical mass on initial areas of focus in order to develop and scope HTN use case Thursdays 11am-12pm ET (weekly) 


Project Plan

COMPLETE   IN PROGRESS  DELAYED

Phase

Milestone

Timeline

Discovery

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- December 2023

IN PROGRESS...
Planning

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 

January 2023- April 2023

IN PROGRESS...

Execution

Phase 1

Proof-of-Concept 

  • Specify 1st batch of data requirements as FHIR profiles
  • Develop synthetic test data
  • Validate against existing FHIR IGs
  • Internal validation in developer/ implementer systems
  • Solidify plans for adoption and scalability
April 2023- September 2023

Execution

Phase 2

Pilot with CHC 

  • Specify 2nd batch of data requirements as FHIR profiles, synthetic test data
  • Intermediary normalizes BP data and sends into EHR in outpatient production environment
  • Produce operational implementation guidance for CHCs
October 2023- May 2024


Use Case Leadership Team

RoleName Organization
ChampionJames Tcheng, MDDuke University/Center for Intelligent Health Care
ChampionHilary WallCDC Million Hearts
Champion John Windle, MD Center for Intelligent Health Care
Use Case Co-CoordinatorMelissa Christian, RNUniversity of Nebraska Medical Center - Center for Intelligent Health Care
Use Case Co-CoordinatorRute MartinsMITRE
TerminologistTom WindleUniversity of Nebraska Medical Center - Center for Intelligent Health Care
Government AgencyMaria MichaelsCDC
PayerDavid BrickEvicore
Device ManufacturerAndy IversonMedtronic
Health IntermediaryBecky MetzgerTelligen
EHR VendorWill Dark, Daniel RutzEpic
Medical SocietyMaria Isler, Sara O'KaneAHA
Medical SocietyCorey Smith, Monique van BerkumAMA

If you'd like to learn more about this use case, please contact Melissa Christian (melchristian@unmc.edu) or Rute Martins (rute@mitre.org).



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