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A Challenge to Control Blood Pressure Using HIT

Screen Shot 2014-07-30 at 2.13.16 PMHeart disease and stroke are two of the leading causes of death in the United States. To combat these threats, the Department of Health and Human Services (co-led by Centers for Disease Control and Prevention [CDC] and the Centers for Medicare & Medicaid Services [CMS]) has joined with private and non-profit organizations such as the American Heart Association, American Pharmacists Association and the YMCA, to launch Million Hearts®, a national initiative to prevent one million heart attacks and strokes by 2017. The initiative is working to encourage clinicians nationwide to improve the quality of care through use of the ABCS strategies – Aspirin when appropriate,Blood pressure control, Cholesterol management and Smoking cessation.

On July 7th, as we marked the halfway point in this ambitious drive to improve America’s health, the Office of the National Coordinator for Health Information Technology (ONC), in collaboration with the CDC, launched the EHR Innovations for Improving Hypertension Challenge to accelerate improvement on the Million Hearts® “B” strategy – Blood Pressure Control. The goal is to show how professionals are using health IT to improve patients’ cardiovascular health. Evidence-based treatment protocols are an essential tool for providers to use in improving blood pressure control.

What makes this ONC challenge unique?  First, it taps the expertise of clinicians who care for patients with hypertension and are using health IT to improve their control. Second, the challenge is designed to promote the scalability of critical tools for maximum impact and reach.

The challenge will proceed in two phases, with up to five prizes worth a total of $50,000:

  • Phase 1 asks practices to document the clinical decision support (CDS) tools that they have successfully used to demonstrate blood pressure control improvements in clinical settings.  Submissions are due October 6, 2014, and four winners will be announced on October 27, 2014.
  • Phase 2 will reward organizations or consortia who spread the use of the Phase 1-winning CDS tools to the most practices. The submission period begins October 28, and a single winner will be announced in the fall of 2015.

To find out more or participate in this exciting challenge, visit Challenge.gov. In addition, ONC will be hosting an informational webinar on August 6 at 3:00 pm Eastern – you can learn more and register at  http://bit.ly/1jgNBEK External Links Disclaimer.

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22 replies »

  1. Even if low SES folks can access care, their living situations frequently preclude the ability to maintain good health. This is a problem that goes WAY beyond just having health insurance and access to doctors.

  2. Brad, as I said genetics plays a big part and I didn’t say they were the whole enchilada so be careful.

    Take note, I am not against care, but we are seeing a lot of foolishness due to the fact that healthcare is like a big tuna that all the sharks are feeding off of. They would like the taxpayer to feed the tuna more so the tuna becomes even bigger leaving more tuna to eat.

    Access to care plays a part, but not as big a part as many believe. But, if you are interested in improving lives the healthcare bill ought to shrink not expand because then that money could be used to put another policeman (many other things) on the street where he is needed or maybe the money could be returned to the taxpayer where it belongs.

  3. Granpappy, do you not realize that by sitting in front of a computer screen you will see less patients and help reduce healthcare costs?

    Who cares about outcomes? Since when did WHO or any of the other data reports consider outcomes? Instead of outcomes to determine quality they use those indirect metrics which mean sh– with regard to real quality medical care.

  4. Longevity and health have multiple inputs. Genetics not the whole enchilada, ethnic and geographic variation in outcomes abound.

    Access to care and modifiable risks play a role, especially when these folks have never received, or only get minimal care.

    Perhaps the above suggested intervention would flop amongst low SES individuals. Dont know. But much more juice for the squeeze in this population–those badly underserved–as there still remains low hanging fruit in be picked. By that I mean the A, B, C’s of care and not high tech, low touch adventures.

  5. Al, you should thank smokers and not tax their cigarettes so much because those taxes more than pay for their problems.

    Smokers, especially heavier smokers pay a tremendous tax on those cigarettes used by the rest of us and then they die early leaving an abundance of uncollected Medicare and social security payments. 😉

  6. Brad, when dealing with health disparities don’t forget that genetics plays a big part in who lives and who dies.

    Shorter lives can be due to counting a lot of people shot dead on the street before age 30.

    Hypertension is more difficult to treat and more malignant in one minority.

    Hispanics frequently associated with shorter lives actually have longer life spans than caucasians.

  7. “Similarly, 88% of heart disease deaths were after age 75”

    Vik, even old people want to live.

    “we don’t actually know a precise cause of death because no there is no post-mortem”

    But, the cause of death must be recorded. ASHD or a variant is frequently used so it becomes the default which increases the number of deaths from ASHD which…

    “stem the tide of these dastardly killers of mostly the elderly.”

    Not dying from heart disease or stroke is a leading cause of cancer mortality. 😉

    Take your statins if significantly indicated and probably take them if there is a lesser indication. Statins have a dual action.

  8. Was Szasz an objectivist? He always struck me as a common sense libertarian that was insightful enough to realize that the state safeguards property rights.

  9. I have Szasz’s books — he’s “The Myth of Mental Illness” dude. Some of his aphorisms are laugh-out-loud spot-on (I love the “humanectomy” px). He was cool before we went out of his depth and went all Randian. Though, maybe economics IS psychiatry.

    BTW, Vik, I just got back from my mandatory annual “wellness screening” at my wife’s company, which I have to do for the reduced insurance rate. What a waste of time. But, hey, it was “free,” as were the free post-exam chocolate chip granola bars.

  10. Some investments are sound. Others are unsound.

    Did you bother to read the document? I don’t think so.

    Cynicism – while certainly appropriate – offers us no way out.
    Is your position that no investment is allowable? Is your position that no technology can help.

    The fact that bad investments have been made in the past is irrelevant, this is the way investors operate and you know that – or at least you should

    The problem is that if “we” don’t make smart investments, we eventually end up making dumb ones. Those cost a lot more.

  11. “Tell me there are not useful applications to this research, that will benefit medicine in the years to come.” —

    There is no better expression of the vacuity and deception of the modern American medical establishment than that sentence. It is medicine’s siren song and has been for 50 years….”just give us another 10 years and another $100BN and we’ll have it all figured out.” Whatever “it” is.

  12. I know of Szasz, but not in any great depth. I will make it a point to learn more about him since you’ve raised his name.

    I knew nothing of Skrabanek until your comment. Last night I downloaded and read the first 20 pages of Death of Humane Medicine. Terrific work.

    I am a devotee of Ival Illich and his thesis Medical Nemesis.

    Thanks, Saurabh.

  13. Don’t know where to begin, but I’ll give it a try:

    “Have you ever had a non-compliant patient suffer a heart attack or stroke?”

    Yes.

    Have you ever had a compliant patient suffer a heart attack or stroke?

    Yes. Many more than the non-compliant patients, as there are fewer of the later category.

    “Did that bother you at all?”

    Yes.

    “Did you wish you’d bugged them?”

    No, because it wouldn’t have changed the outcomes.

    The idea that by spending more time sitting in front of a computer screen, I will develop the magical power to alter the basic behavior, personalities and medical destinies of responsible, educated adults who have the right to manage their own health decisions is . . . words fail me.

  14. So Southern Doc, I’m curious

    Beyond garbage, what’s your specialty?

    How many of your patients are on hypertension meds? What if those numbers could be reduced? Would that be a bad thing? A good thing?

    Have you ever had a non-compliant patient suffer a heart attack or stroke?
    Did that bother you at all? Did you wish you’d bugged them?

    Please go read the description of the challenge, included in my response to Vik. (And included below as well) Tell me there are not useful applications to this research, that will benefit medicine in the years to come. If we can mine EHR data in this way, there are many other things we can learn ..

    http://challenge.sites.usa.gov/challenge/ehr-innovations-for-improving-hypertension-challenge/

  15. Vik
    A question. If the offer had a slightly different slant:

    Health disparities lead to premature deaths. Minority and less economically privileged individuals live shorter lives, and die at much higher rates of vascular disease due to under or lack of treatment. Tell us the HIT tools you use to assist and successfully treat these folks, etc.

    Would you find an offer like the one above more agreeable? And assume the interventions clinicians offer back have a (+) effect, ie, they really do something.

    Brad

  16. Vik,

    You probably don’t need that help, but a lot of people do. I’m not sure that incentivizing simple tools to get at that data is the end of the world.

    http://challenge.sites.usa.gov/challenge/ehr-innovations-for-improving-hypertension-challenge/

    There are a lot of things that are a waste of taxpayer money, but I’m thinking this is not one of them.

    I think your real problem is with the perhaps audacious language of the program, which I think you may be treating a little too seriously. It’s a goal. And it’s marketing.

  17. Vik, are you a disciple of Thomas Szasz?

    Or have you been reading Death of Humane Medicine by Petr Skrabanek? (that’s an unsubtle book recommendation, btw)

  18. Your smart phone shocks you every time you smoke, eat fast food, or go two days without exercizing. How do I collect my prize?

  19. Why not just increase the tax on cigarettes? Of everything you’ve listed there, cigarettes are the easiest to control and the most dangerous.

    And, yes, to prevent a million heart attacks you’ll have to go back and look at the actual heart attack rate itself, which according to HCUP data has been falling singificantly for more than a decade. You can’t take credit for the pre-existing trendline. You’d be double-counting

  20. I may not be as bright as some THCB readers, so let me see if I understand this new initiative fully. Stroke and heart disease are the nation’s two leading killers and, thusly, must be tamed. Except, here’s the thing that puzzles me: 91% of stroke deaths in 2010 were in people age 75 or older. Similarly, 88% of heart disease deaths were after age 75 and a full 95% were after age 65. The age-adjusted death rate from heart disease has dropped 25% since 1999 and the stroke death rate by 30% during the same period, so it is unclear to me how this new strategy adds value. We appeared to be doing pretty well.

    People are living longer, but they do eventually have to die of something, and, given that average age of death in the US is now about 78 (76 for men and 81 for women), whose deaths are we actually trying to prevent here? Then, there is the issue that in many older adults we don’t actually know a precise cause of death because no there is no post-mortem (nor should there be). It’s easy to attribute the death to heart disease (or stroke). I wager that if we had “s/he just got old” as a cause of death, this duo might rapidly decline in prominence. But, then that would upset the cash gravy train wouldn’t it?

    It is a bold (some would say arrogant) presumption that prompting non-elderly Americans to engage with the healthcare industry will somehow stem the tide of these dastardly killers of mostly the elderly. Having an impact of the kind described here (1 million events prevented) presumes that the strategy is sustainable for decades, which is, of course, great if you are in government or the healthcare industry because nothing produces revenues like a person who’s been duped into believing they “need” you to prevent something that is very unlikely to happen before its time and can be averted to the extent possible by a broad range of lifestyle strategies that require no medical intervention.

    Speaking as a middle-aged American adult, I agree with Nortin Hadler: I don’t get my blood lipids checked. I occasionally take my blood pressure when I am in a pharmacy. The notion that I need a health IT initiative to tell me anything about it is ridiculous.

    A partnership between the government and the American Heart Association, they of “take more statins” and the worst workplace wellness guidelines ever devised? What could possibly go wrong?

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