Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.

Data Element
Average Blood Pressure
Description

Arithmetic average of systolic and diastolic components of two of more blood pressure readings in a specified time period or according to a specified algorithm or protocol.

Examples include but are not limited to 3-day morning and evening home monitoring, clinical encounter repeat average, and 24-hour ambulatory measurement.

Applicable Vocabulary Standard(s)

Applicable Standards

Both standards are required.

  • Logical Observation Identifiers Names and Codes (LOINC®) version 2.74
  • The Unified Code of Units for Measure, Revision 2.1
Submitted By: Matt Reid / American Medical Association
Data Element Information
Rationale for Separate Consideration USCDI has Diastolic Blood Pressure and Systolic Blood Pressure, but it does not have average (computed) blood pressures for each.
Use Case Description(s)
Use Case Description Use Case #1
Submitted by AMA
Over 85 million adults in the United States have high blood pressure. Average blood pressure readings can guide the diagnosis and treatment of hypertension.
The M.A.P. (Measure Accurately, Act Rapidly and Partner with Patients) BP Improvement Program is an integral part of Target: BPTM, a national initiative formed by the American Heart Association and the American Medical Association in response to the rising incidence of uncontrolled BP. Guidance in the M.A.P. Program includes:
• For those with an initial screening blood pressure reading above the cut-off threshold, the average of two or more BP readings is recommended.
• For those doing self-measured blood pressure (SMBP) monitoring the M.A.P. Program also provides a protocol for measuring an average blood pressure over the course of a week.

Use Case #2
Submitted by CDC: The CDC Division for Heart Disease and Stroke Prevention and the Million Hearts® 2022 Hearts national initiative (co-led by the Centers for Medicare & Medicaid Services) uses this data as it is available for monitoring and evaluation to prevent 1 million heart attacks and strokes in 5 years. Furthermore, the CDC plans to leverage this data further in the future for surveillance and epidemiology studies if advanced through policy and available from EHRs. The Multi-state EHR-based Network for Disease Surveillance (MENDS) pilot will use electronic health record (EHR) data collected in clinical settings leading to a real-time, chronic disease surveillance model to plan and evaluate short-term outcomes of policies and program interventions.
Estimate the breadth of applicability of the use case(s) for this data element Use Case #1
Over 85 million adults in the United States have high blood pressure. Average BP measurements can be used by thousands of physicians to better diagnose and manage hypertension.
Link to use case project page https://targetbp.org/patient-measured-bp/how-it-works/ https://targetbp.org/wp-content/uploads/2017/08/Target-BP-Participant-Webinar-Measure-Accurately-8-10-2017.pdf
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) SNOMED CT has:
723232008 |Average blood pressure (observable entity)|
314453003 |Average diastolic blood pressure (observable entity)|
314440001 |Average systolic blood pressure (observable entity)|
LOINC (version 2.69):
96607-7 Blood pressure panel unspecified time mean
96608-5 Systolic blood pressure unspecified time mean
96609-3 Diastolic blood pressure unspecified time mean
Additional Specifications The data element is included in the HL7 FHIR® Implementation Guide: Vital Signs, Release 1- US Realm (1st Standard for Trial Use Ballot) which went through the ballot cycle in September 2020. After this submission was accepted by USCDI in October 2020 as Level 2, the Vital Signs Implementation Guide has completed the ballot process and anticipates reaching STU1 in 2021.
Current Use In limited use in production environments
Supporting Artifacts Cerner, Epic and Higi use Average Blood Pressures (systolic and diastolic).
Submission of this data element is also rooted in the information cited in:
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
For example, the cited document states, “BP is categorized into 4 levels on the basis of average BP measured in a healthcare setting (office pressures): normal, elevated, and stage 1 or 2 hypertension.”

https://pubmed.ncbi.nlm.nih.gov/29133354/
Extent of exchange 2-3
Supporting Artifacts To our knowledge, there are production implementations that exchange Average Blood Pressure information using FHIR. Specifically, we are aware that at least Higi and Cerner exchange this data through a SMART Application.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) N/A
Restrictions on Use (e.g. licensing, user fees) N/A
Privacy and Security Concerns We support expanding the USCDI and the overall goal of getting meaningful information into the hands of clinicians and patients. However, we stress that the USCDI coupled with increased access to this information (both inside and outside HIPAA), could create a conduit for bad actors to syphon sensitive data from patients. We believe there should always be a balance between more information and strengthening patients’ trust in how the information is used.

As with any personal information, there is a need to ensure patients are comfortable sharing such data with their physicians. Thus, we encourage ONC to expand the USCDI to include average blood pressure data elements while concurrently coordinating with standards development organizations working to ensure data is shared with appropriate protections, including when it is accessed by third parties outside of the health care system.
Estimate of Overall Burden Unknown
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by DrWanpen on

Support Average Blood Pressure for USCDI v4

As a practicing cardiologist and a hypertension specialist and the clinical director of our Hypertension Center, I am writing to strongly urge the ONC to adopt this data element into the final USCDI v4. Being able to use Average Blood Pressure (ABP) is critical to the our ability to provide evidence-based care for our patients with hypertension and is essential in driving clinical decisions regarding medication titration. To me , it will be a game changer !

Thank you for your consideration.

Wanpen Vongpatanasin, MD

Submitted by emaclaug on

Support for adding Average Blood Pressure to USCDI v4

Thank you for considering adding "average blood pressure" as a standard electronic health record data element. This data element would provide critical information on which to base evaluation and treatment decisions. I strongly support its inclusion and would urge the ONC to include it in the final USCDI.

Submitted by Drew Mills on

Support for ABP to be added to USCDI v4

Comment submission on behalf of Dr. Michelle Albert, AHA President (2022-2023).

The American Heart Association (AHA) supports the addition of the draft data element for Average Blood Pressure into the final U.S. Core Data for Interoperability (USCDI) v4. Thank you for recognizing the vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. The AHA strongly urges ONC to adopt this data element into the final USCDI v4 as it is critical to the accurate measurement of blood pressure and essential in driving clinical decisions.

Submitted by Sigmundcd on

Support Average Blood Pressure for USCDI v4

Thank you for recognizing the vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. As as hypertension researcher and Chair of the AHA Council on Hypertension, I strongly urge ONC to adopt this data element into the final USCDI v4 as it is critical to the accurate measurement of blood pressure and essential in driving clinical decisions.”

Submitted by rpadwal on

Average Blood Pressure addition long overdue

For reasons already articulated, average BP should always be used for clinical decision making, as it directly aligns with the foundational evidence in the filed.  I would strongly urge adoption of this metric for better patient care.

Raj Padwal, University of Alberta

President, Canadian Hypertension Specialists Society

Past Chair, Hypertension Canada Clinical Practice Guidelines

Submitted by bgallagher51 on

Inclusion of Average Blood Pressure to USCDI v4

Thank you for recognizing the vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. I strongly urge the ONC to adopt this data element into the final version as it is essential in driving clinical decisions regarding blood pressure management.

Submitted by elizabeth.campbell on

HCCH inclusion of Average BP to USCDI v4

Thank you for recognizing the vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. [High Country Community Health strongly urges ONC to adopt this data element into the final USCDI v4 as it is critical to the accurate measurement of blood pressure and essential in driving clinical decisions.  We have worked hard to implement a program supporting our patients in self-measured blood pressure.  Clearly charting their average blood pressure in a Structured Field (1) accurately reflects who has controlled hypertension and who does not, (2) gives our providers the confidence to intensify treatment, and (3) motivates our patients to self-measure because it shows we value the data they are collecting.

Submitted by joshua1160 on

Average blood pressure

Thank you for recognizing the vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. As a practicing cardiologist for Einstein Healthcare Network now part of Jefferson Health, I strongly urge ONC to adopt this data element into the final USCDI v4 as it is critical to the accurate measurement of blood pressure and essential in driving clinical decisions. Our data elements should encourage following best practices for blood pressure measurement. Without this adddition, best practices are actually discouraged.

Submitted by jurasche on

Need for high quality BP measurement in the electronic record

Thank you for support averages BP measurements in the electronic record. This additional will send an important signal to clinical practices on the importance of standardized and accurate blood pressure measurements in the clinic setting. It will also enhance the quality of data available for analyze of trends in blood pressure in clinic settings throughout the country.

I strongly support this initiative!

 

Stephen Juraschek

Voting member of the AMA's validatebp blood pressure monitor registry, voting member of the AAMI Sphygmomanometer Committee, and research director of the HCA Hypertension Center of Excellence at Beth Israel Deaconess Medical Center.

 

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