TeenBP: Development and Piloting of an EHR-Linked Clinical Decision Support System to Improve Recognition of Hypertension in Adolescents.
BACKGROUND
Blood pressure (BP) is routinely measured in children and adolescents during primary care visits. However, elevated BP or hypertension is frequently not diagnosed or evaluated further by primary care providers. Barriers to recognition include lack of clinician buy-in, competing priorities, and complexity of the standard BP tables.


METHODS
We have developed and piloted TeenBP- a web-based, electronic health record (EHR) linked system designed to improve recognition of prehypertension and hypertension in adolescents during primary care visits.
Important steps in developing TeenBP included the following: review of national BP guidelines, consideration of clinic workflow, engagement of clinical leaders, and evaluation of the impact on clinical sites. Use of a web-based platform has facilitated updates to the TeenBP algorithm and to the message content. In addition, the web-based platform has allowed for development of a sophisticated display of patient-specific information at the point of care. In the TeenBP pilot, conducted at a single pediatric and family practice site with six clinicians, over a five-month period, more than half of BPs in the hypertensive range were clinically recognized. Furthermore, in this small pilot the TeenBP clinical decision support (CDS) was accepted by providers and clinical staff. Effectiveness of the TeenBP CDS will be determined in a two-year cluster-randomized clinical trial, currently underway at 20 primary care sites.


CONCLUSIONS
Use of technology to extract and display clinically relevant data stored within the EHR may be a useful tool for improving recognition of adolescent hypertension during busy primary care visits. In the future, the methods developed specifically for TeenBP are likely to be translatable to a wide range of acute and chronic issues affecting children and adolescents.
HealthPartners Institute for Education and Research.
Elyse O
EO
Kharbanda
HealthPartners Institute for Education and Research.
James D
JD
Nordin
University of Minnesota, Department of Pediatrics.
Alan R
AR
Sinaiko
HealthPartners Institute for Education and Research.
Heidi L
HL
Ekstrom
HealthPartners Medical Group.
Jerry M
JM
Stultz
HealthPartners Institute for Education and Research.
Nancy E
NE
Sherwood
HealthPartners Institute for Education and Research.
Patricia L
PL
Fontaine
HealthPartners Institute for Education and Research.
Steve E
SE
Asche
HealthPartners Institute for Education and Research.
Steven P
SP
Dehmer
HealthPartners Institute for Education and Research.
Jerry H
JH
Amundson
HealthPartners Institute for Education and Research.
Deepika X
DX
Appana
HealthPartners Institute for Education and Research.
Anna R
AR
Bergdall
HealthPartners Institute for Education and Research.
Marcia G
MG
Hayes
HealthPartners Institute for Education and Research.
Patrick J
PJ
O'Connor
Evidence Based Medicine; Health Information Technology; Research Translation