By Dr. Patrick Dunn, Program Director, American Heart Association Center for Health Technology and Innovation
Population health is a key part of the American Heart Association’s mission of being a relentless force for a world of longer and healthier lives. COVID-19 has accelerated the adoption of technology outside of the healthcare setting not only to reduce exposure to the virus, but also to improve access to care. As a result, health technology has advanced to the level that key biometrics, such as blood pressure, glucose, physical activity, and even heart rhythm, can be captured through wearables and connected devices outside of the healthcare setting and accessed by the care team.
An SMBP platform can bridge between the BP device and the EHR and solve the problem of manual data entry and selective reporting.
An effective population health approach using health technology is one that is high volume, high impact, cost-effective, and promotes health equity. A successful population health/data integration strategy is defined by a positive health metric and an economic value. The strategy must be both scalable and sustainable, so if it does not meet both criteria, it will not be seen as a success. Key elements for successful digital health outcomes include using a trusted source and a scientific approach, connecting to a healthcare delivery system, providing a secure technology and digital solutions platform that allows delivery to very large groups, providing an intuitive, consumer/patient-facing interface, and having the ability to continuously monitor data to evaluate usage and outcomes. In addition, there are numerous gaps throughout the system that make this challenging, including the digital divide, lack of trust and science/validation gaps.
A classic example of population health utilizing a data integration strategy is self-measured blood pressure (SMBP), which is the person taking blood pressure (BP) readings at home, connected to a secure cloud, and integrated into the electronic health record (EHR). Nearly half of the 116 million adults in the US with hypertension do not have their BP under control. Rates of BP control are disproportionately lower among racial, ethnic, and socio-economic groups. High BP is associated with an increased risk of heart disease and stroke and is a vital indicator of overall health. Achievement of BP control is associated with better health outcomes and is cost-effective.
The American Heart Association’s Center for Health Technology and Innovation has been at the forefront of digital solutions for BP control, including community and home-based strategies such as Check.Change.Control and National Hypertension Control Initiative and the Self-Measured Blood Pressure Digital Health Platform Provider Landscape, which provides best practices for BP control, especially in under-resourced communities.
The management of high BP has been based on measurements taken in the healthcare setting. Regular out-of-office BP measurements provide a better picture of the individual’s blood pressure trends and has the added benefit of allowing the patient to be more active participant in their care. An SMBP platform can bridge between the BP device and the EHR and solve the problem of manual data entry and selective reporting. The process begins with the patient being identified for SMBP by a healthcare professional. The patient has access to a secure portal and a validated BP device. The patient takes BP readings at home and returns to the clinic for follow-up. The BP device must be accessible and compatible with the portal. In addition to uploading the data to the EHR, the patient must also be given access to the readings for feedback. The professional must be able to access the readings in a manner that does not break their clinical workflow. The professional must be able to monitor the individual’s progress and evaluate the success of the overall program. To be sustainable, the data must also integrate with the EHR, billing and reporting systems.
The mere existence of home BP monitoring does not lead to blood pressure control. Relaying the readings to a healthcare professional remains a critical step to inform clinical decision-making and action, to diagnose, and optimize pharmacologic and non-pharmacologic treatment plans. Methods of data transfer range from low and non-tech approaches that are paper-based, to intermediate and hybrid approaches of connecting the blood pressure device to an app or cloud-based data portal, to a fully integrated solution from the BP device to the EHR.
The Food and Drug Administration’s approval to market a BP device does not imply that it has been validated to deliver clinically accurate and useful blood pressure readings and the Centers for Medicare and Medicaid require the use of a validated device for reimbursement. The accuracy and utility of SMBP depend on the use of a device that has been validated for accuracy, such as those on the US Blood Pressure Validated Device Listing. Data capture can be from the device, a patient portal, or a mobile application. The data can be shared with the healthcare professional by showing the data during an office visit, via email or external dashboard, or within the EHR. Once the healthcare professional has access, the data must be validated and presented to meet minimum acceptable standards for clinical decisions.
A key challenge is presenting the information to the user in a way that they understand and can use to make good, well-informed decisions, and to the healthcare professionals in a manner, they can trust. For the end-user, this is done by presenting the information in a clear and concise manner with actionable steps. For the healthcare professional, this is done by taking a science and evidence-based approach and providing context. For end-users and health professionals, data security and storage, as well as access and privacy are always important, while interoperability and integration into the EHR is also an important factor. The desired outcome is improved BP control, resulting in improved quality of life for patients and healthcare professionals, and a more accessible, cost-effective, and equitable healthcare system.