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

Data Element
Average Blood Pressure
Description (*Please confirm or update this field for the new USCDI version*)

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 (*Please confirm or update this field for the new USCDI version*)

Both standards are required.

  • Logical Observation Identifiers Names and Codes (LOINC®) version 2.77
  • 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
ASTP 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 Jennifer Cluett on

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

Submitted by nedragarrett_CDC on

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.

Submitted by nachcinformatics on

Average Blood Pressure for HTN Management in Primary Care

The National Association of Community Health Centers (NACHC) 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. Understanding and measuring average BP contributes to the accurate diagnosis of hypertension and decision support that would lead clinicians to the appropriate treatment and risk algorithms. Tighter management of blood pressure reduces cardiovascular and neurologic events that are a primary cause of death in the United States.

 

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. NACHC requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Submitted by mattreid on

Average Blood Pressure (ABP) added to draft 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 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 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. Moreover, consistent communication of average BP is critical for addressing hypertension nationwide.

 

Below is a summary of the clinical evidence and guidelines:

  • Average Blood Pressure (systolic and diastolic) is the average of two or more blood pressure readings in a specified time period or according to a specified algorithm or protocol. During clinical encounters two or more blood pressures should be averaged to more accurately assess a person’s blood pressure status (published in Hypertension, March 2019). When patients are self-monitoring blood pressure, the American Heart Association recommends (published in Hypertension, March 2019) a minimum of 12 readings collected over at least 3 days should be averaged to more accurately assess a person’s blood pressure status. According to the European Society of Hypertension (published in the Journal of Hypertension, July 2021), “The adverse cardiovascular consequences of hypertension, including events and mortality, largely depend on increased average BP values. Thus, decision-making in hypertension is based on average values of several BP readings obtained in and out of the office.”

 

Additionally, AMA has worked closely with the Regenstrief Institute team to include supportive information and context in LOINC to facilitate ABP interoperability. The most recent update of LOINC in August 2022 includes a revised term description that clarifies the meaning of ABP codes.

 

Physicians need health IT systems that can store and exchange average BP 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.

 

AMA requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Submitted by Michael_Cui on

Rush University Medical Center Supports including average BP to

Rush University Medical Center 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. As one of the associate chief medical informatics officers and the institutions hypertension quality improvement champion, I fully support inclusion of ABP into USCDI.

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. Without the inclusion of ABP data element, it is has been difficult to encourage adoption of ABP into our clinical workflow. 

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. Rush University Medical Center requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Submitted by Delgleli on

Adding ABP Level 2 data element to draft USCDI v4

As the founder director of the University of Miami AHA certified Comprehensive Hypertension Center 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. University of Miami AHA certified Comprehensive Hypertension Center requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Submitted by Peter.Basch on

Support Average Blood Pressure for USCDI v4

I fully support the inclusion of average blood pressure into USCDI v4.  I am a primary care internist with MedStar Health in Washington, DC, as well as their Senior Director for Quality and Safety.  MedStar Health was the first large system partner with the CDC and HHS, for the original Million Hearts effort.  One of the difficulties we found then... the inability to capture within our EHRs what clinicians found most meaning in viewing / managing hypertension - average blood pressure.  Incorporation of this data element will also support meaningful capture of home digital blood pressures - helping to create clearer pictures of control, rather than data overload.

Submitted by Atul Bali on

Adding Average BP Data Element

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 treatment efficacy. 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 separately, in addition to individual BP 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.

Therefore, I request that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

Log in or register to post comments