Automated EMR alert helps clinicians pay attention to elevated BP

Investigators demonstrated a new use for electronic medical records (EMRs): to notify providers when an intake blood pressure (BP) is elevated by incorporating a real-time electronic alert into the EMR. The alert was generated by BPs that were ≥90th percentile for age/sex/height percentile or ≥120/80 mm Hg. The alert disappeared only when the clinician obtained another BP and entered it into the EMR.

Researchers tested this intervention in 5919 encounters with 3285 patients aged 3 to 21 years with no prior diagnosis of hypertension. They compared documented recognition of elevated intake BP and its relationship with documented cardiovascular disease (CVD) risk factors during the intervention period and an historical control period.

During the 6-month intervention period, clinicians documented recognition of 42% of 1305 elevated intake BPs compared with 12.5% recognized during the control period. Elevated BP was more likely to be recognized in children who indeed had CVD risk factors, but this was true in both the intervention and the historical period. However, several factors not associated with elevated BP recognition in the control period triggered recognition more often during the intervention: older age, male sex, and non-African American race. Providers were less likely to recognize an elevated BP during an acute care visit than during a scheduled appointment. Finally, the EMR alert remained effective throughout the intervention period, with no signs of so-called alert fatigue (Brady TM, et al. Clin Pediatr. 2015;54[7]:667-675).

Commentary: With norms that vary by gender, age, and height, recognition of elevated BP has never been a simple task in pediatrics. In addition to previous studies cited by the authors, Beacher et al recently reported results for 29,000 pediatric patients seen by a variety of pediatric specialties at a tertiary care center outpatient facility. Even when the authors limited their observations to patients with 3 or more abnormal BPs (meeting diagnostic criteria for hypertension), only 21% of patients were labeled with the diagnosis. (Beacher DR, et al. J Pediatr. 2015;166[5]:1233.e1-1239.e1.) Identification of this finding is a perfect application for increasingly ubiquitous EMR systems. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.