Facilitators and Barriers to Integrating Patient-Generated Blood Pressure Data into Primary Care EHR Workflows.

Abstract

Background:  Evidence supports using patient-generated blood pressure data for better outcomes in hypertension management. However, obstacles like dealing with home-generated paper data sets and questions of validity slowed the meaningful incorporation of home blood pressure into clinical care. As clinicians value patient data more, reliance on digital health solutions for data collection and shared decision-making grows.

Objectives:  The purpose of this study is to evaluate the design and early implementation of an electronic health record (EHR)-based data visualization tool and explore the barriers or facilitators to integrating) patients' home blood pressure data into the electronic workflow in the clinical setting. Findings can inform potential next steps for implementation and provide recommendations for leveraging patient-generated health data (PGHD) in hypertension management.

Methods:  We qualitatively explored pre- and early-implementation factors for integrating PGHD into clinicians' EHR interfaces intended to support shared decision-making using the Consolidated Framework for Implementation Research (CFIR). We collected data in the form of notes and transcripts from clinician focus groups, administrative leadership feedback sessions, research team observations, and recurring team meetings. This study took place at a midwestern academic health center.

Results:  We identify implementation facilitating factors, adoption considerations, and next steps across CFIR domains focusing on large-scale implementation. Key recommendations include aligning internal and external priorities, empowering champions to facilitate uptake, using intuitive design, and anticipating and planning for unintended consequences.

Conclusion:  These findings can guide future efforts to include PGHD in workflows, thus enhancing shared decision-making and laying the groundwork for larger implementations. Understanding the implementation barriers and facilitators to connect PGHD to clinician apps in the EHR workspace can promote their adoption and maintenance.