title: Real-time electronic medical record alerts increase high blood pressure recognition in children.
abstract: OBJECTIVE
  Pediatric hypertension remains largely unrecognized. We hypothesized that an electronic medical record (EMR) alert would increase elevated blood pressure (BP) recognition in a pediatric primary care setting.
  
  
  METHODS
  Pre-post evaluation of a real-time EMR alert and one-time provider educational session. A total of 1305 encounters of children 3 to 21 years with elevated intake BP and no prior hypertension diagnosis were included. Elevated BP recognition and relationship of recognition with cardiovascular disease (CVD) risk factors during the intervention was compared with an historical control.
  
  
  RESULTS
  Recognition increased from 12.5% to 42% (P < .001). Recognition increased soon after alert implementation and was sustained without evidence of "alert fatigue." During both periods, presence of CVD risk factors was associated with recognition. However, the magnitude was lesser in the intervention period.
  
  
  CONCLUSIONS
  Real-time EMR alerts substantially increase elevated BP recognition in children. However, underrecognition of elevated BP persisted, highlighting the need for additional strategies to improve provider recognition.
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA tbrady8@jhmi.edu.
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Brady
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Neu
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA Eunice Kennedy Shriver National Institutes of Child Health and Human Development, Bethesda, MD, USA.
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Solomon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D011320:Primary Health Care; D055815:Young Adult
keywords: automated; cardiovascular health; computer alert; electronic health record; hypertension; pediatrics; primary care; quality improvement; screening; triage