Kentucky ranks fifth in the U.S. for adults with hypertension, many of whose condition is not controlled. Untreated high blood pressure increases the risk of heart attack, stroke and other serious health problems.

THE PROBLEM

The traditional approach of seeing a patient in the office, prescribing medication, advising them on lifestyle changes to make, having them check their blood pressure at home and report back, has fallen short, said Dr. Brett A. Oliver, chief medical information officer at Baptist Health, which serves Kentucky and Indiana.

"We were looking at an alternative method to improving our patients' lives that was scalable," Oliver explained. "The No. 1 reason for uncontrolled hypertension is lack of medication adherence."

There can be a number of causes for this, he added, such as cost, side effects, not recognizing the seriousness of the disease, etc. "But our theory was reminders outside of the office and simple, short educational pieces would drive improved adherence and ultimately better blood pressure control and outcomes."

Healthy lifestyle habits, such as not smoking, exercising and eating well, can help prevent and improve hypertension.

"High blood pressure is sneaky," Oliver said. "The vast majority of people with high blood pressure have no symptoms even when blood pressure readings are dangerously high. While hypertension can cause headaches, nosebleeds or shortness of breath, these are nonspecific and generally do not occur until high blood pressure has reached a severe stage."

Baptist Health needed ways to encourage patients to regularly check their blood pressure even when feeling fine.

In addition, the Centers for Medicare & Medicaid Services has selected hypertension as one of three quality measures to be submitted electronically in the future. That only solidified the need for a strategy moving forward.

PROPOSAL

Oliver and his team theorized they needed more touchpoints with patients outside of office visits. Such a large percentage of the population has a cell phone, so the team elected to start with a technology that was readily available for most. With these additional touchpoints and reminders, Baptist Health hoped to empower patients to take charge of their blood pressure problem and become more engaged in the management.

"So many people will have trouble with medication, but will not notify their physician for changes or adjustments," Oliver noted. "They wait until their next appointment, which could easily be six months later. Meanwhile, their BP remains out of control causing silent damage.

"Although other medical specialties care for patients with hypertension, we elected to begin with primary care, where a majority of patients turn for care of their hypertension," he continued.

Epic’s MyChart Care Companion is an interactive app designed to be an extension of a patient’s support system. It is highly individualized and user friendly. Many Baptist Health patients already were using MyChart; adding this functionality was a simple extension to what patients already were doing.

"The interactive plan of care allows a patient to upload their blood pressure values (either manually or via Bluetooth integration with their BP cuff) and data provided by questionnaires/symptom checkers," he said. "If symptoms or BP numbers warranted, messages were sent to members of the patient’s care team to address so patients were not waiting until their next visit to address important issues."

RESULTS

Baptist Health has been live with this program only for a little more than 90 days, so much of the follow-up is still to come.

"We can report we have enrolled 143 patients to date," Oliver said. "For those who have completed the program, our initial data shows a 10-11 mmHg drop in systolic pressure and 3-4 mmHg drop in diastolic pressure. That would be on par with adding a new medication to a patient’s regimen.

"Our team knows that without this technology, along with the ability to provide a BP cuff for some, we would not see this improvement," he continued. "We have years of data to back up the challenge of uncontrolled hypertension."

USING GRANT FUNDS

Baptist Health received a grant for this program from the American Heart Association.

"The grant opportunity was a specific opportunity to improve the health of McCracken County in Kentucky," said Jordan Ellis, director of operations for value-based care at Baptist Health. "$87,200 in grant funding was received by the Baptist Health Foundation to support this project.

"85% of the grant funding was used to complete the build of the Epic MyChart Care Companion application (specific for hypertension) to allow patients to upload their self-reported blood pressure readings to their electronic health record," he continued. "The remaining 15% of grant funding was used to provide blood pressure devices for patients."

Initial findings are the grant-funded blood pressure devices are very important to support the IT build that was necessary. The ability to provide a patient with a blood pressure device has accelerated the project because the provider knows that a blood pressure device is available, Ellis concluded.

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