eHealth Blood Pressure Control Program

Health Information Technology (IT) can enable patient-centered care and the overall quality of care by exchanging health information data between the patient’s home and the medical office. Hypertension represents an ideal condition to test this model of patient-centered eHealth enabled care because hypertension is common, largely treated by primary care physicians, and, when uncontrolled is associated with significant morbidity and mortality.          

This pilot study compared the use of home blood pressure monitoring (HBPM) to a health IT enabled eHealth blood pressure (BP) system of care that integrated HBPM into a provider’s electronic medical record (EMR) via a Web portal. The project took place at a community-based safety-net hospital where a “high-tech” solution was thought to problematic due to a digital divide. A digital divide occurs when some patients do not have the opportunities or skills to enable them to benefit from digital resources. As such, a patient navigator-training program was developed as part of the study in order to assist patients with a “high-tech/high-touch” approach to HBPM.           

The specific aims of this project were to:

• Develop and refine a Web-based patient-centered decision support system for BP control using an iterative, user-centered design process so that it meets standards of feasibility and acceptability for patient navigators and participants.
• Determine the appropriate and acceptable patient motivators (i.e., engaging content, social media, and incentives) leading to use of the eHealth BP control program (BP device, personal health record, Web portal, patient navigator).
• Develop and begin to field-test a patient navigator-training program, a manual of procedures for the patient navigators, and a measure of patient navigator adherence to the training manual.
• Test the functionality, security, and fidelity of the secure data exchange between the HBPM device, personal health record, Web-based portal, and EMR interface engine in both test and live (enterprise) environments.
• Determine the degree of adoption by participants of the four intervention components (HBPM, personal health record, Web portal, patient navigator).
• Estimate the effect sizes of the four-component program relative to the three-component program with regard to patient activation, self-care activities, medication adherence, reduced clinical inertia, and improved BP control with implementation of the eBP control program.

Ninety percent of the enrolled patients (n=28) were able to upload BP readings to the Web portal. Approximately half of the patients required some technological support in order to use the system. The percentage of controlled patients at the first research visit was 46 percent, which increased to 65 percent at the final research visit. When the patient navigator was engaged, 75 percent of all recruited patients were controlled.          

The project team concluded that integration of a HBPM program in primary care settings is feasible and accepted by patients, providers, and the health care team. The program appeared to be effective in controlling BP in previously uncontrolled patients. Although the existence of a digital divide is a barrier, this study showed that the use of a patient navigator appears to be able to overcome this.