Submitted by emaclaug on 2023-03-11
|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.
|Estimated number of stakeholders capturing, accessing using or exchanging||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|
|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|
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.”
|Number of organizations/individuals with which this data element has been electronically exchanged||2-3|
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.
|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 4 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
|Maturity – Standards/Technical Specifications||Level 1/2 - Must be represented by a vocabulary standard or an element of a published technical specification|
|Maturity - Current Use||Level 2 - Used at scale in more than 2 different production environments|
|Maturity - Current Exchange||Level 2 - Demonstrates exchange between 4 or more organizations with different EHR/HIT systems|
|Breadth of Applicability - # Stakeholders Impacted||Level 2 - Used by a majority of patients, providers or events requiring its use|
Submitted by DrWanpen on 2023-03-15
Support Average Blood Pressure for USCDI v4As 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