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

Data Element

Additional Information

Average Blood Pressure
Description
Mean value of two or more blood pressure readings in a specified time period. Usage note: Must include both systolic and diastolic components of the mean and specify the relevant time period of measurements.

Applicable Vocabulary Standard(s)

Applicable Standards
Both standards are required.
  • Logical Observation Identifiers Names and Codes (LOINC®) version 2.73
  • The Unified Code of Units for Measure, Revision 2.1
 

Comment

Trinity Health supports adding average BP to USCDI v4

Thank you for recognizing the key clinical role for an average blood pressure data element and adding it to the draft USCDI v4. The patients of Trinity Health, one of the nation's largest non-profit health systems, have been beneficiaries of the AMA's MAP BP program for hypertension management and urges ONC to adopt this data element into the final USCDI v4.  Such an element is critical to the accurate measurement of blood pressure and, thus, is essential in driving clinical decisions. Dan Weiswasser, MD, Vice President/Chief Medical Officer, Medical Groups and Clinical Integration, Trinity Health

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. I strongly urge ONC to adopt this data element into the final USCDI v4 as it is critical to meaningful measurement of blood pressure and more importantly, essential in driving clinical decisions. Peter Basch, MD, MACP, FRCP Senior Director IT Q&S, MedStar Health

Avoid the use of the word "mean" in the USCDI in ABP definition

Current definition: Mean value of two or more blood pressure readings in a specified time period. Usage note: Must include both systolic and diastolic components of the mean and specify the relevant time period of measurements. Proposed definition: The average systolic value and the average diastolic value of two or more blood pressure readings in a specified time period. Usage note: Must specify the relevant time period of measurements. -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Mean Blood Pressure (or more accurately) Mean arterial blood pressure is a very specific calculated blood pressure reading often continuously  measured in ICUs, but often shortened in hand-off or report outs to "Mean BP", Just retain the "average" in the defintion.
  • https://www.ncbi.nlm.nih.gov/books/NBK538226/#:~:text=A%20common%20method%20used%20to,%2B%201%2F3(PP)
  • Mean arterial pressure is determined using the following formula: MAP = DP + 1/3(SP – DP) or MAP = DP + 1/3(PP)
 

Average Blood Pressure (ABP) added to draft USCDI v4

The American Heart Association appreciates the opportunity to provide public comment in support of adding the Average Blood Pressure (ABP) Level 2 data element to the draft USCDI v4.   High blood pressure impacts more than 120 million people in the US and is the leading modifiable risk factor for preventing death from cardiovascular disease. The accurate measurement and interpretation of blood pressure is vital for diagnosing high blood pressure and assessing effectiveness of treatment.   Over 20 years of clinical evidence and guidelines have shown that ABP, as defined in the AMA’s level 2 submission as obtaining 2 or more blood pressure readings and then averaging, is a better indicator of blood pressure status than individual readings alone. ABP should be used to drive clinical decision making regardless of whether a patient is in an office setting or measuring their blood pressure at home. Recent efforts have also improved the standardization of ABP. In August 2022, LOINC included a revised term description that clarifies the meaning of ABP codes. Moreover, consistent communication of ABP is critical for addressing hypertension nationwide.   Physicians need health IT systems that can store and exchange ABP separate and apart from individual readings. This can help with documentation and enable physicians to use this specific information in their clinical decision making. Laying a groundwork for the consistent communication of needed patient information is a fundamental aspect of the USCDI. Including ABP in the USCDI v4 will enable interoperability of blood pressure information among sites of care, within care teams, and with patients. AHA requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.   Thank you, Eduardo Sanchez, MD, MPH, FAHA Chief Medical Officer for Prevention American Heart Association

Inclusion of Average Blood Pressure to USCDI v4

As a primary care physician and Senior Medical Director for Quality with Mount Sinai Health Partners, I appreciate the opportunity to provide public comment in support of adding the Average Blood Pressure (ABP) Level 2 data element to the draft USCDI v4. High blood pressure impacts more than 120 million people in the US and is the leading modifiable risk factor for preventing death from cardiovascular disease. The accurate measurement and interpretation of blood pressure is vital for diagnosing high blood pressure and assessing effectiveness of treatment. Over 20 years of clinical evidence and guidelines have shown that ABP, as defined in the AMA’s level 2 submission as obtaining 2 or more blood pressure readings and then averaging, is a better indicator of blood pressure status than individual readings alone. ABP should be used to drive clinical decision making regardless of whether a patient is in an office setting or measuring their blood pressure at home. Recent efforts have also improved the standardization of ABP. In August 2022, LOINC included a revised term description that clarifies the meaning of ABP codes. Moreover, consistent communication of ABP is critical for addressing hypertension nationwide. Physicians need health IT systems that can store and exchange ABP separate and apart from individual readings. This can help with documentation and enable physicians to use this specific information in their clinical decision making. Laying a groundwork for the consistent communication of needed patient information is a fundamental aspect of the USCDI. Including ABP in the USCDI v4 will enable interoperability of blood pressure information among sites of care, within care teams, and with patients. I request that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Inclusion of Average BP to USCDI v4

Cook County Health appreciates the opportunity to provide public comment in support of adding the Average Blood Pressure (ABP) Level 2 data element to the draft USCDI v4. Over 20 years of clinical evidence and guidelines have shown that ABP, as defined in the AMA’s level 2 submission as obtaining 2 or more blood pressure readings and then averaging, is a better indicator of blood pressure status than individual readings alone. ABP should be used to drive clinical decision making regardless of whether a patient is in an office setting or measuring their blood pressure at home. Recent efforts have also improved the standardization of ABP. In August 2022, LOINC included a revised term description that clarifies the meaning of ABP codes. Moreover, consistent communication of ABP is critical for addressing hypertension nationwide. Physicians need health IT systems that can store and exchange ABP separate and apart from individual readings. This can help with documentation and enable physicians to use this specific information in their clinical decision making. Laying a groundwork for the consistent communication of needed patient information is a fundamental aspect of the USCDI. Including ABP in the USCDI v4 will enable interoperability of blood pressure information among sites of care, within care teams, and with patients. Cook County Health requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Need average blood pressure to implement high quality HTN care

As a cardiometabolic quality improvement leader at San Francisco Health Network, I appreciate the opportunity to provide public comment in support of adding the Average Blood Pressure (ABP) Level 2 data element to the draft USCDI v4.   High blood pressure impacts more than 120 million people in the US and is the leading modifiable risk factor for preventing death from cardiovascular disease. The accurate measurement and interpretation of blood pressure is vital for diagnosing high blood pressure and assessing effectiveness of treatment.   Over 20 years of clinical evidence and guidelines have shown that ABP, as defined in the AMA’s level 2 submission as obtaining 2 or more blood pressure readings and then averaging, is a better indicator of blood pressure status than individual readings alone. ABP should be used to drive clinical decision making regardless of whether a patient is in an office setting or measuring their blood pressure at home. Recent efforts have also improved the standardization of ABP. In August 2022, LOINC included a revised term description that clarifies the meaning of ABP codes. Moreover, consistent communication of ABP is critical for addressing hypertension nationwide.   Physicians need health IT systems that can store and exchange ABP separate and apart from individual readings. This can help with documentation and enable physicians to use this specific information in their clinical decision making. Laying a groundwork for the consistent communication of needed patient information is a fundamental aspect of the USCDI. Including ABP in the USCDI v4 will enable interoperability of blood pressure information among sites of care, within care teams, and with patients. As a hypertension quality improvement leader at San Francisco Health Network, I request that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Support for adding Average Blood Pressure to the USCDI

The members of the US Blood Pressure Validate Device Listing Independent Review Committee (IRC) appreciate the opportunity to provide public comment in support of adding the Average Blood Pressure (ABP) Level 2 data element to the draft USCDI v4. This opinion is our own and does not necessarily represent the views or opinions of the organizations for which we work. High blood pressure impacts more than 120 million people in the US and is the leading modifiable risk factor for preventing death from cardiovascular disease. The accurate measurement and interpretation of blood pressure is vital for diagnosing high blood pressure and assessing effectiveness of treatment. Over 20 years of clinical evidence and guidelines have shown that ABP, defined in the AMA’s level 2 submission as obtaining 2 or more blood pressure readings and then averaging, is a better indicator of blood pressure status than individual readings alone. ABP should be used to drive clinical decision making regardless of whether a patient is in an office setting or measuring their blood pressure at home. Recent efforts have also improved the standardization of ABP. In August 2022, LOINC included a revised term description that clarifies the meaning of ABP codes. Moreover, consistent communication of ABP is critical for addressing hypertension nationwide. Our medical community needs health IT systems that can store and exchange ABP separately and apart from individual readings. This can help with documentation and enable physicians to use this specific information in their clinical decision making. Laying a groundwork for the consistent communication of needed patient information is a fundamental aspect of the USCDI. Including ABP in the USCDI v4 will enable interoperability of blood pressure information among sites of care, within care teams, and with patients. These IRC members strongly support the request that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4. Atul Bali, MD, Tammy M. Brady, MD, PhD, Jennifer L. Cluett, MD, Jordana Cohen, MD, Richard Dart, MD, Beverly B. Green, MD, MPH, Stephen P. Juraschek, MD, PhD, Tim Plante, MD, MHS, Sandra Taler, MD, George Thomas, MD, Ray R. Townsend, MD, Wanpen Vongpatanasin, MD

CDC's USCDI v4 comments on including Average BP

We greatly appreciate ONC’s leadership on the USCDI. Interoperability in the clinical space is key to optimizing many processes including the inclusion of self-measured blood pressure monitoring (SMBP) into patient care. SMBP is an evidence-based strategy for reducing blood pressure and improving control among patients with hypertension and has the potential to address hypertension-related equity issues. Numerous federal agencies and national organizations including CDC, HRSA, HHS/OMH, the Office of the Surgeon General, the Federal Hypertension Control Leadership Council, Million Hearts, the American Medical Association, the American Heart Association, the National Association of Community Health Centers, the National Forum for Heart Disease & Stroke Prevention, the Preeclampsia Foundation, and the National Hypertension Control Roundtable support widespread implementation of SMBP to improve blood pressure control and improve maternal health.[1] Millions of dollars have been put into the field for state and local departments of health and health centers to implement SMBP.[2],[3],[4] From a health equity standpoint, SMBP has an important role in bringing care to underserved patients who need it most. Over 116M adult Americans have hypertension and, among those recommended to be on antihypertensive medication, 74% do not have their blood pressure controlled, putting them at risk for heart attacks, strokes, heart and kidney failure, dementia, and other sequelae. People from racial/ethnic minority groups, people living in rural areas, and people with lower incomes have higher hypertension prevalences and are less likely to have their blood pressure controlled than their counterparts. In many cases, these same populations are less likely to have the means to regularly access health care due to barriers related to cost, transportation, proximity, or inability to take time off from work. SMBP has the potential to facilitate better equity in blood pressure control by eliminating or lessening many of these barriers and improving engagement of marginalized patients.[5] As stakeholders have worked towards widespread implementation of SMBP, health information technology (HIT)-related barriers continue to stymie progress.1,[6] Efforts are underway to improve the interoperability of transmitting SMBP readings from patients to clinicians. In order for those data to be successfully incorporated into the clinical workflow for use in care planning, quality improvement, clinical decision support, and quality reporting there must be a structured field to capture the usable output of SMBP – average blood pressure (ABP). Research has shown that an ideal SMBP protocol is for patients to capture 2 readings in the morning and 2 readings in the evening for 7 days (with a minimum of 3 days) yielding up to 28 readings per instance of SMBP. Theoretically, electronic health records (EHRs) could capture the 28 blood pressure readings and process them as averages but many have failed to do so to date. Our work with the Public Health Informatics Institute has shown that physicians do not want, nor do they have the capacity, to store, process and act upon the multiple blood pressure readings taken for SMBP.5 Currently, there are a handful of blood pressure telemonitoring software solutions that are improving the interoperability pathway for SMBP (e.g., Sphygmo, Verify Health, BPCorrect). These products process SMBP readings and generate an ABP for clinicians (as well as making outlier values, highest/lowest values, and/or all patient-generated values available per clinician preferences).  For the 500 health centers that are trying to implement technology-based SMBP through the HRSA/OMH National Hypertension Control Initiative3,4, their EHRs, to date, have not had the ability to capture the ABP values needed for care. Furthermore, blood pressure measurement techniques such as 24-hour ambulatory blood pressure monitoring (ABPM) and automated office blood pressure (AOBP) also rely on using ABP to provide a representative blood pressure value. A structured field in the EHR that captures ABP (and related metadata) is essential for enabling these technologies to be properly incorporated into care pathways.  Over 20 years of clinical evidence and guidelines have shown that ABP is a better indicator of blood pressure status than individual readings alone. ABP is defined in the American Medical Association’s level 2 USCDI submission as obtaining and averaging 2 or more blood pressure readings. While this may seem like a lack of definition specificity, this allows the data element to be used to capture the spectrum of averages that could be generated related to blood pressure – from SMBP, ABPM, and AOBP – and accommodate their associated averaging protocols. Knowing how many values were incorporated into the average is less important than knowing a blood pressure value represents an average of multiple readings. Blood pressure naturally fluctuates so average values are more representative of a patient’s true blood pressure, regardless of the technology used. References: [1] Wall HK, Wright JS, Jackson SL, et al. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Addressing Barriers Beyond the Published Literature. Am J Hypertens. 2022;35(3):244-255. [2] Centers for Disease Control and Prevention. Diabetes, Heart Disease, and Stroke: State Programs – Improving the Health of Americans through Prevention and Management of Diabetes and Heart Disease and Stroke CDC-RFA-DP18-1815. https://www.cdc.gov/chronicdisease/about/foa/1815/index.htm. Accessed 9/21/22. [3] HRSA. FY 2021 Supplemental Funding for Hypertension (NHCI-HC). https://bphc.hrsa.gov/funding/funding-opportunities/fy-2021-supplemental-funding-hypertension-nhci-hc. Accessed 9/21/22. [4] US Department of Health and Human Service Office of Minority Health. National Hypertension Control Initiative: Addressing Disparities among Racial and Ethnic Minority Populations (HTN Initiative). https://www.minorityhealth.hhs.gov/omh/Content.aspx?ID=18513&lvl=2&lvlid=12. Accessed 9/21/22. [5] Khoong EC, Commodore-Mensah Y, Lyles CR, Fontil V. Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity [published online ahead of print, 2022 Aug 24]. Curr Hypertens Rep. 2022;1-15. [6] Public Health Informatics Institute. Self-Measured Blood Pressure Monitoring (SMBP): Key Findings from a National Health Information Technology Landscape Analysis. September 2021. https://phii.org/SMBP-Health-IT-Landscape. Accessed 9/21/22.   Physicians need health IT systems that can store and exchange ABP separately and apart from individual readings. Including ABP in the USCDI v4 will enable interoperability of blood pressure information among sites of care, within care teams, and with patients. It will also improve clinicians’ abilities to use these data for quality reporting, clinical decision support, and quality improvement efforts. Because of the reasons articulated above, CDC requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4. References: [1] Wall HK, Wright JS, Jackson SL, et al. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Addressing Barriers Beyond the Published Literature. Am J Hypertens. 2022;35(3):244-255. [2] Centers for Disease Control and Prevention. Diabetes, Heart Disease, and Stroke: State Programs – Improving the Health of Americans through Prevention and Management of Diabetes and Heart Disease and Stroke CDC-RFA-DP18-1815. https://www.cdc.gov/chronicdisease/about/foa/1815/index.htm. Accessed 9/21/22. [3] HRSA. FY 2021 Supplemental Funding for Hypertension (NHCI-HC). https://bphc.hrsa.gov/funding/funding-opportunities/fy-2021-supplemental-funding-hypertension-nhci-hc. Accessed 9/21/22. [4] US Department of Health and Human Service Office of Minority Health. National Hypertension Control Initiative: Addressing Disparities among Racial and Ethnic Minority Populations (HTN Initiative). https://www.minorityhealth.hhs.gov/omh/Content.aspx?ID=18513&lvl=2&lvlid=12. Accessed 9/21/22. [5] Khoong EC, Commodore-Mensah Y, Lyles CR, Fontil V. Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity [published online ahead of print, 2022 Aug 24]. Curr Hypertens Rep. 2022;1-15. [6] Public Health Informatics Institute. Self-Measured Blood Pressure Monitoring (SMBP): Key Findings from a National Health Information Technology Landscape Analysis. September 2021. https://phii.org/SMBP-Health-IT-Landscape. Accessed 9/21/22.

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