Electronic Clinical Measures Point to EHRs Potential to Monitor Blood Pressure Control

About 1 of 3 U.S. adults—67 million people—have high blood pressure, also called hypertension. High blood pressure increases the risk for a variety of diseases, including stroke, coronary artery disease, peripheral vascular disease, heart and kidney failure, and atrial fibrillation. High blood pressure is also called the “silent killer” because it often has no warning signs or symptoms, and many people do not know they have it.

The Department of Health and Human Services, through its national Million Hearts® initiative, has set a goal to prevent 1 million heart attacks and strokes by 2017. Million Hearts® is working with providers to reach clinical targets that could improve population health. For example, health care providers are encouraged to have 70 percent or more of their patients with hypertension control their blood pressure, which could be done by self-monitoring.

During National High Blood Pressure Education Month (May 2015), HHS’ Office of the National Coordinator for Health IT (ONC) and the Centers for Disease Control and Prevention (CDC) are emphasizing the important impact that electronic health records (EHRs) are having through the ability for patients and providers to interchangeably share blood pressure data.

New research about the Million Hearts® electronic clinical quality measures (eCQMs) included in the Medicare EHR Incentive Programs was published today in the Morbidity and Mortality Weekly Report (MMWR) in the article “Morbidity and Mortality Weekly Report: Using Meaningful Use Clinical Quality Measures for Million Hearts Surveillance.”  The report shows that, for the first time, data reported as part of the incentive programs, or meaningful use, could improve the timeliness and possibly completeness of data used to track issues of public health concern.

Health IT is on the Quality Team

With a primary focus on the reporting of the Million Hearts® hypertension measures, the research published today shows that:

• Among providers that started in 2011, the very first year of CMS’ EHR Incentive Program, the average proportion of patients with hypertension in control remained unchanged at 62-63 percent over 3 years.
• About one-third (36 percent) of reporting providers met the Million Hearts® clinical target of 70 percent or more of their patients with hypertension under control.

The findings show that an EHR is a tool that should make providing better health care easier, but it cannot do so in isolation. Health IT is on the quality team, which means that patient-centered, team-based approaches to care, coupled with the use of certified health IT, can move the health system towards meeting the very important Million Hearts® targets. These strategies should also help clinicians guide patients to achieve safe blood pressures and avoid preventable death and disability.

Quality Reporting is a Powerful Tool for Population Health Surveillance

With the Health IT Dashboard: Office-based Physician Health IT Adoption, discrete blood pressure data, documented and captured electronically, are now available to help us understand hypertension trends and identify steps to accelerate progress. The first three years of the meaningful use program yielded electronic clinical quality measures data from 63,000 health care providers and about 17 million patients with hypertension, which represents large portions of health care provider and patient populations. The eCQM data reported as part of that program demonstrates that continuous quality improvement can be used to track national progress towards an important health goal – preventing 1 million heart attacks and strokes by 2017.

Health Information to Help Coordinate Patient Care

The eCQM data can also help individual physicians target appropriate interventions that can help to manage patients’ health in an effort to better coordinate care. To do that, clinicians make it a priority to be aware of their patient’s health status, and an interoperable health care system can help make this a reality, with reporting on eCQMs being just one part of the picture. Facilitating the flow and exchange of electronic information allows for improved coordination of care across the care continuum by making sure that a patient has the health information they need, when they need it. This is a challenge because health data comes from many different sources. Consider this scenario:

Julia, diagnosed and treated initially for hypertension by her primary care clinician, has noted that her readings are still not in the optimal range. She is referred to a hypertension specialist for further evaluation and management. She is pleased to see her blood pressure reach and stay in good control. Unfortunately, though this achievement is well-documented in her personal paper health diary and in the specialist’s EHR, her primary care clinician is left out of the loop.

This situation happens frequently, but is not a model for coordinated care. Ideally, Julia’s specialist would update her primary care provider on a regular basis. However, we know that sharing, receiving, and using electronic information is not always easy. To reach a level of care coordination necessary to promote better health – and in this case to help address a patient’s high blood pressure – the entire health system must move towards an interoperable, learning health system. The exchange and use of electronic information by all health care providers on the care team is necessary to improve health and health care while decreasing costs.

The optimal use of EHRs should accommodate a provider’s workflow and take advantage of patient-generated data when available. Health information comes from a variety of sources, and eCQMs may not maximize the available data. For example, the blood pressure control measure does not capture:

• Patient-generated data, such as measurements from a home blood pressure cuff
• Clinical notes stored as free text in the EHR.

Improving and enhancing eCQMs, and making sure that health IT can use health data from a variety of sources, are key components of the federal health IT strategic plan, and the draft interoperability roadmap.

We still have work to do. To continue to make progress to achieve this goal for more patients, we must work together to reach an interoperable health system that facilitates information exchange across the care continuum, and that enables care transformation.