The Effect of an Electronic Health Record–based Tool on Abnormal Pediatric Blood Pressure Recognition

Evaluation of whether provider recognition of abnormal BP (greater than 90th percentile) differed before versus after the introduction of an app that extracts age, sex, height and BP data from the EHR to calculate and track a patient’s BP percentile longitudinally. The app was based on the Substitutable Medical Applications & Reusable Technology (SMART) platform and is available In the SMARTApp Gallery. Examining ~79,000 records of outpatients (primary care, endocrinology, cardiology, nephrology clinics), of which ~3500 had elevated blood pressure, showed that abnormal BP was recognized in 4.9% of visits before the app was available and 7.1% of visits afterwards. The app was used in 13% of encounters where an elevated BP was present; significantly, when the app was used, recognition of elevated BP was much higher (OR 3.17, CI 2.29-4.41).

Twichell 2017 (Link) | PubMed 28493451 | Author Search

Automated Identification of Implausible Values in Growth Data from Pediatric Electronic Health Records

Reports the development of an automated method for identifying implausible values in pediatric EHR growth (weight and height) data, tested via data points collected in the primary care environment on over 280,000 patiets. The method compares each measurement’s z-score to a weighted moving average of prior measurements. The method had a sensitivity of 97% and a specificity of 90% for identifying implausible values compared to physician judgment, and identified almost all simulated errors.

Daymont 2017 (JAMIA) | PubMed 28453637 | Author Search

Recognition of Elevated Blood Pressure in an Outpatient Pediatric Tertiary Care Setting

Another study suggesting we are not very good at officially diagnosing elevated blood pressure in children when the record shows BP readings that are repeatedly elevated. Of 29,000 records retrospectively reviewed, only about 1 in 6 of those with repeatedly high blood pressure values were diagnosed in the encounter diagnoses or problem list.

Beacher 2015 (J. Pediatrics) | PubMed 25919733 | Author Search