Physicians share success in managing hypertension with HIT

“Use your powers for good” is the mantra of Sarah Woolsey, MD, medical director of HealthInsight Utah, who has successfully deployed health IT to control hypertension in her patients. Woosley and Christopher Tashjian--a medical director who has made significant inroads in managing hypertension in rural Wisconsin clinics--shared their successes in combatting hypertension through health IT practices during a Feb. 22 webinar presented by the Human Resources and Services Administration.

The discussion coincided with National Heart Month, which spotlights cardiovascular disease prevention. Its main contributor, hypertension, affects 72 million American per year, which is one reason why EHR regulations defined hypertension control as a core clinical quality measure in its Meaningful Use incentive program.

Woolsey outlined specific EHR approaches that enabled Utah Beacon Community providers to achieve a 10 percent improvement in hypertension levels for 2,000 patients, of whom 99 percent is at or below 200 percent of the federal poverty line.

“We were surprised with that result,” she said, noting that the efforts showed providers the benefits of implementing better IT practices in managing population health.

Practices included the development of registries, patient lists and reminders; the creation of templates that capture data accurately and alert staff on all requirements; and smart clinical support tools inclusive of reminders, alerts and flow sheets.

“Turn on a few meaningful alerts to remind your team of missing care, and teach them to respond and satisfy these,” Woolsey said, but cautioned not to overload staff with alerts or lest they be ignored.

Woosley also encouraged providers to put medication adherence assessment into their EHR templates, so providers can review e-prescribing lists and see whether patients are filling their medications. Also, she said visit summaries are an opportunity to “teach back,” which means that patients are asked to communicate their post-appointment plans and review their medications.

“Make the visit summary speak to the patient in their language at their health literacy level,” Woosley added.

Other tips she stressed included patient assessment of depression, appointment follow-ups through phone calls, emails or text, use of charts so patients can report blood pressure levels at subsequent visits, and uploading education tools directly into the EHR. An ability to capture team or provider specific report cards also is critical, she said.

For Christopher Tashjian, MD, medical director of the Wisconsin health information technology extension center for the Ellworth, Wisc., medical clinic, improving hypertension management requires greater patient involvement and engagement.  Four years ago he put into place new practices and achieved the following results: hypertension control increased from 73 percent to 97 percent for patients with diabetes, BP control increased by 68 percent to 97 percent among patients with cardiovascular disease, and as of December 2012, all patients with hypertension controlled at 90 percent.

Getting these results required that all staff, from the front desk clerk to the physician, were on the same page, he said.

“It’s not a physician problem, but a team challenge. We had to include everybody,” Tashjian said. “In retrospect, it’s the best thing we did.”

If a patient comes in for any reason, staff would recheck blood pressure and intervene when it surpasses the 130/90 threshold. “Every visit is a hypertension visit,” he said.   

Both low-tech and high-tech solutions helped ensure hypertension management remains on the radar, he said. For instance, nursing staff would put a small “Recheck BP” magnet on the front door of a patient room in case of a high reading, so doctors were alerted to the need for further investigation.  

On the high-tech side, Tashjian said EHR data is put into Microsoft Excel and then exported into a Microsoft Access database to generate lists to assess who needs treatment.  Care Coordinators and providers review the list, and reach out to patients who are at risk or need treatment.

“Patients like when providers call them, they understand that we don’t want them getting a stroke and heart attack,” he said.

He also developed patient scorecards that look at four controls of ultimate vascular care, including aspirin, tobacco cessation, LDL levels and blood pressure. “It allows you to be more efficient to manage the population.”

“To be honest, we’re not treating numbers, but treating people,” Tashjian said.