Data Element

Comment

Include additional data for ABP

An average blood pressure should include the following information whether it is self-measured or in a clinical setting: Device identification (e.g., identifier for the device or manufacturer/device name), Method, and BP Body Position (i.e., the body position of the patient while measuring the blood pressure).

CMS-CCSQ/CDC Joint USCDIv4 Priority: ABP

CDC and CMS agree that Average Blood Pressure should move forward as part of USCDI V4. However, in the draft final USCDIv4 ABP data element description, ONC has defined ABP as “Mean value of two or more blood pressure readings in a specified time period.” CDC and CMS strongly recommend clarifying the language to say either “average” to eliminate any confusion end-users could have with using mean arterial pressure or “arithmetic mean” to differentiate between other types of means (e.g., geometric, harmonic).

Support Average Blood Pressure for USCDI v4

The American Medical Association (AMA) appreciates the opportunity to provide public comment in support of adding the Average Blood Pressure (ABP) Level 2 data element to the final USCDI v4.  

 

High blood pressure impacts more than 120 million people in the United States. It is the leading modifiable risk factor for preventing cardiovascular disease and premature death. The accurate measurement and interpretation of blood pressure for diagnosing and assessing the effectiveness of treatment is imperative to improving the health of the nation.  

 

The value and improved accuracy of an average blood pressure compared to a single blood pressure reading has been demonstrated repeatedly through clinical evidence over the last 30 years (Chen et al., 2018). Due to physiologic variability, single blood pressure readings are suboptimal for clinical decision making. It is clear and affirmed in clinical practice guidelines (Whelton et al., 2018; Williams et al., 2018), scientific statements (Muntner et al., 2019), and policy statements (Shimbo et al., 2020) that obtaining two or more BP readings and calculating the average is a more accurate and representative measurement of an individual’s blood pressure compared to a single BP reading.  

 

Although there are several different methods of measuring BP, the individual readings from each method should be averaged to make them clinically useful. Due to this, the definition of the average blood pressure data element purposely does not define requirements for a protocol that must be used to calculate an average.  

 

Physicians need health IT systems that can store and exchange Average Blood Pressure separately from individual readings. This will lay the groundwork for consistent communication of needed patient information by facilitating documentation and enabling physicians to use this specific information in their clinical decision making.  

 

We support the Health Information Technology Advisory Committee and subsequent Interoperability Standards Workgroup recommendation to include Average Blood Pressure in the USCDI v4. AMA strongly urge ONC to adopt Average Blood Pressure data element into the final USCDI v4 as it is critical for the accurate measurement of blood pressure and essential in driving clinical decisions.  

Average Blood Pressure for USCDI v4

Guideline Central supports inclusion of Average Blood Pressure for USCDI v4 as it further aids in implementation and adoption of clinical practice guidelines.

CDC's Consolidated Comment for USCDI v4

“We greatly appreciate ONC’s continued 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. SMBP and other types of out-of-the-office blood pressure monitoring rely on using average blood pressure (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. Blood pressure naturally fluctuates so average values are more representative of a patient’s true blood pressure, regardless of the technology used. 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 final USCDIv4. ONC has defined ABP as “value of two or more blood pressure readings in a specified time period.” We respectfully request clarifying the language to say either “average” to eliminate any confusion end-users could have with mean arterial pressure or using or “arithmetic mean” to differentiate between other types of means (e.g., geometric, harmonic). CardX represents a wide cross-section of stakeholders working to improve hypertension control by leveraging FHIR-based interoperability through the Hypertension Management. The Hypertension Management use case team is actively working on leveraging and extending existing standards to represent Average Blood Pressure in accurate, meaningful, and actionable terms for clinical decision making "

Comments from NACCHO: NACCHO supports the inclusion of this data element. We would also encourage an inclusion of a specified time period. This will reduce confusion for providers on what to submit as an average.

Support Average Blood Pressure for USCDI v4

The HL7 CodeX FHIR Accelerator Cardiovascular Health Domain (CardX) enthusiastically supports the addition of Average Blood Pressure to the draft USCDI v4. We strongly urge ONC to adopt the Average Blood Pressure data element into the final USCDI v4 as it is critical in driving evidence-based clinical decisions.

CardX represents a wide cross-section of stakeholders working to improve hypertension control by leveraging FHIR-based interoperability. Our Hypertension Management use case team (https://confluence.hl7.org/display/COD/CardX+-+Hypertension+Management) is actively working on leveraging – and extending – existing standards to represent Average Blood Pressure in accurate, meaningful and actionable terms for clinical decision making.

We note that the concept of Average Blood Pressure is not the same as the concept of Mean Arterial Pressure. We urge ONC to clarify the data element definition to specifically refer to “arithmetic mean”.

Signatory CodeX members participating in CardX’s Hypertension Use Case:

American Heart Association, American Medical Association, eviCore healthcare, Guideline Central, Medtronic, MITRE Corporation, Story Health, and the University of Nebraska Medical Center – Center for Intelligent Health Care

Average blood pressure in USCDI v4

Thank you for recognizing the need for Average Blood Pressure as a data element. This will very much facilitate the appropriate and evidence-based use of home blood pressure monitoring to guide clinical decision making about hypertension. Last year, I wrote an article in Health Affairs Forefront describing the importance of ensuring regulatory policies around blood pressure management including CQMs and remote monitoring codes are consistent with evidence-based guidelines (https://www.healthaffairs.org/do/10.1377/forefront.20220517.440131) . Inclusion of an average blood pressure as a data element is a very big step in this direction. Cara Litvin MD

Average Blood Pressure as a useful health metric

Thank you for recognizing the key need and vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. PALM Associates, Inc. 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.

 

PALM Associates, Inc.  note that the concept of Average Blood Pressure is not the same as the concept of Mean Arterial Pressure. We urge ONC to clarify the data element definition to specifically refer to “arithmetic mean”.

Thank you for recognizing…

Thank you for recognizing the vital functionality of the Average Blood Pressure data element and adding it to the draft USCDI v4. Prisma Health, a large integrated health delivery system in South Carolina with a clinically integrated network 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. The addition of this variable will allow for better assessment of patient care delivery, risk reduction and improvement of the care of our population.

 

Log in or register to post comments