Development and Pilot Testing of Hypertension Management Support with EHR-Integrated Telemonitoring and Proactive Patient Messaging

Background Automated patient messages based on home blood pressure (BP) may help overcome clinician and patient inertia in hypertension treatment. Methods We designed and piloted an automated messaging system based on remote patient monitoring (RPM) results delivered through patients’ electronic health record portal. Messages included reminders to monitor, what to do if BP is above or below goal, and positive feedback when goal BP is achieved; these were triggered via a deterministic algorithm based on reported home BPs. Seven clinicians agreed to participate in this pilot study. Patients with most recent two office BPs ≥140/90 mmHg were eligible. Outcomes assessed after 9 months included change in home SBP, net change in antihypertensive medication, and number of automated messages. Subgroup analysis was conducted by baseline home BP. Results Of 285 eligible patients, 70 (25%) enrolled. Baseline mean (SD) office systolic/diastolic BP was 148(18)/81(12) mmHg. By 9 months, participants had received a mean (range) of 13 (5-44) messages and viewed 85%. Among 64 patients completing the 9-month study visit, the baseline home BP was 142(17)/84(15) mmHg, 9-month change in home SBP was -9.4 mmHg (95% CI: -1.3, -14.7). Among 13 patients with controlled baseline home BP (<130/80 mmHg), SBP change was +2.7 mmHg (-4.8, +12.3). Among 51 patients with uncontrolled baseline home BP, SBP change was -12.5 mmHg (-5.2, -16.8); 51% had antihypertensive pharmacotherapy increased. Conclusions Delivering automated feedback based on RPM BP results through a commercial EHR was feasible. Participants with sustained hypertension had large BP declines.