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 jhall@msm.edu on

support promotion of ABP into the draft USCDI V4

Morehouse School of Medicine 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. Morehouse School of Medicine requests that ONC include the Average Blood Pressure Level 2 data element in the draft USCDI v4.

 

Submitted by nachcinformatics on

Average Blood Pressure for HTN Management in Primary Care

Over 120 million adults in the United States have high blood pressure. Average blood pressure readings can guide the diagnosis and treatment of hypertension.

The 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 and the AHA 2019 Scientific Statement on the Measurement of Blood Pressure in Humans provide guidance recommending that to properly estimate an individual’s blood pressure: 

  • Office-obtained blood pressure measurement should include the average of 2 or more BPs obtained on two or more occasions

For self-measured blood pressure (SMBP) monitoring, the average of all BP measurements obtained over >7 days of BP readings should be used.

NACHC has an 8 year participation in the nationwide Million Hearts Project sponsored by CDC and the lack of an EHR location to store and calculate average BP is a major impediment to the identification and management of hypertension. 

https://targetbp.org/patient-measured-bp/how-it-works/

https://www.ahajournals.org/doi/epub/10.1161/HYP.0000000000000087  

https://www.jacc.org/doi/pdf/10.1016/j.jacc.2017.11.006

Including average blood pressure in the USCDI would make it easier for physicians and other health care providers to diagnose high blood pressure and assess BP control more accurately. 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. The Centers for Disease Control and Prevention and the National Association of Community Health Centers agree with the AMA and support a standardized average blood pressure data element. Our organizations ask that the Interoperability Standards Workgroup include the Level 2 average blood pressure data element in its recommendations for inclusion in the USCDI version 3.

NACHC and FQHCs strongly support the use of the codes/value sets in the AMA submission and believe it is necessary to take home and in office BP management to the next level in primary care. 

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment

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.

Submitted by nedragarrett_CDC on

average blood pressure

The CDC Division for Heart Disease and Stroke Prevention and the Million Hearts® 2022 Hearts national initiative (co-led by and 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.This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC

USCDI_Version_2_Draft_Template for Comments_DHDSP_MENDS_04.15.2021_4.docx

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