EHR alerts from remote BP monitoring often led to med adjustments, appointments in a single-center study
However, about a third of the electronic health record (EHR) alerts indicating multiple elevated blood pressure (BP) readings in patients with hypertension did not lead to changes in care plans.
Electronic health record (EHR) alerts for elevated blood pressure (BP) during remote monitoring were effective in prompting a mix of remote and office-based management, a study found.
Researchers studied primary care teams of 28 attending physicians, nurse practitioners, residents, and nurses who cared for 162 patients in a text-based clinical trial of remote BP monitoring. Clinicians received a message in their EHR inbox when patients submitted at least three elevated BP readings. The study was conducted from May 2018 to August 2019 at a single urban academic family practice site in Philadelphia. Results were published Jan. 14 by JAMA Network Open.
During the study, 552 alerts required clinical action, and clinicians acted on 343 (62.1%). Common remote activities in response to alerts were to reconcile medications and assess medication adherence (120 of 552 alerts [21.7%]) and verify BP measurement technique (65 of 552 alerts [11.8%]). Clinicians also commonly asked the patient to schedule a follow-up appointment (120 of 552 alerts [21.7%]) and/or saw the patient in the office (114 of 552 alerts [20.7%]). Ninety-six alerts (17.4%) resulted in medication changes, half of which were made remotely and half of which were made at visits. For 209 of 552 alerts (37.9%), no changes were made to the care plan, typically without documentation of clinical rationale (196 of 209 instances [93.8%]). The researchers reviewed the EHR to infer potential clinical rationale for 106 (54.1%) cases, but there wasn't enough information to do so for the other 90 (45.9%).
Remote BP reporting was an effective strategy for transmitting data to clinicians, with some limitations, the study authors noted. While the alerts were effective in prompting management, the plan of care often remained unchanged, which suggests a need for more refined alerts and improved clinician support, they said. “Alerts based on simple thresholds may lack clinical utility, because clinical action was often not necessary for the alerts generated,” the authors wrote. “Other times, inaction was not justified, and further research is needed to understand how best to integrate telehealth data in clinically helpful ways.”