Integrated Health Model Initiative IHMI Selfmeasured Blood Pressure

Integrated Health Model Initiative (IHMI): Self-measured Blood Pressure Using A Remote Monitoring Device (SMBP) Corey Smith Director, Global Terminology and Data Operations August 15, 2019

Objectives 1. 2. 3. 4. 5. 2 IHMI background Why hypertension? SMBP use case and data elements Data standardization goals, assumptions, and predicate work How do we work with the HL 7 community? © 2019 American Medical Association. All rights reserved.

The Problem with Health Care Data Liquidity INACCESSIBLE Data are largely inaccessible. However, accessibility is only half the solution to the interoperability problem. 3 © 2019 American Medical Association. All rights reserved. Data Portability LACK OF INCOMPLETE & CLINICAL ACCESSIBILITY INCOMPATIBLE RELEVANCY Once shareable, data are often incomplete and cannot be interpreted by other parties. (Semantic Interoperability) A lack of relevant clinical data elements can diminish the value of patient data transmitted to or made available for clinicians.

IHMI Mission Improve patient health outcomes by empowering physicians with the clinically valid health care data needed to make informed decisions. SMBP: - Proliferation of remote monitoring devices – Wild West - Clinical value in using this data to make care decisions 4 © 2019 American Medical Association. All rights reserved.

Why Hypertension? Uncontrolled Blood Pressure • About 85 million adults (approximately 1 in 3) in the United States have high blood pressure, a contributing factor to major health conditions including heart attack, heart failure, stroke, and kidney failure. Research also shows that in 45. 9% of those with high blood pressure the condition is not controlled — 36. 7 million people! Costs Beyond Patient Health 5 • It is estimated that high blood pressure costs the country $48. 6 billion each year, including health care services, medications, and missed days of work. • There are new opportunities to use remote monitoring outside the clinic. © 2019 American Medical Association. All rights reserved.

Improving Health Outcomes: Target BP Program • Helps health care organizations, at no cost, improve BP control rates through an evidence-based quality improvement program and recognizes organizations committed to improving BP control ACCESSIBILITY • MEASURE blood pressure accurately, every time • Enable Patient Self‑Measurement • Patients can take an active role in their treatment by monitoring their own BP readings outside of the clinical setting. • SMBP can also help providers better diagnose high BP and effectively manage patients. • www. targetbp. com 6 © 2019 American Medical Association. All rights reserved.

SMBP Use Case Overview (Clinician Guided) ACCESSIBILITY 7 © 2019 American Medical Association. All rights reserved.

SMBP Clinically Validated Data Elements • Exertional status – at rest • Body position – seated ACCESSIBILITY • Body site – left or right brachial artery • Device and cuff size – automated BP monitor with adult small, medium, large, extra large • Device ID – in anticipation of more clinical validation of remote monitoring devices • Body height, weight, average BP, heart rate 8 © 2019 American Medical Association. All rights reserved.

Data standardization goals • Meet clinical criteria and gain widespread adoption in support of AMA IHMI mission • Reduce variability in the expression of meaning ACCESSIBILITY • Ability to compute logical subsumption and equivalence across terminology and information models (experimental) • Leverage existing tools, team strengths, and work within internally established AMA timelines 9 © 2019 American Medical Association. All rights reserved.

Data standardization assumptions and predicate work considerations • Data standardization assumptions • Built draft SMBP IG (15 profiles, 4 SNOMED CT value sets) with intention of bringing something concrete to HL 7 community for consideration ACCESSIBILITY • IHMI profiles may be adopted or IHMI data elements may be incorporated into other profiles – either option achieves our objectives • Predicate work considerations: • IHM SMBP 1 and SMBP 2 (SNOMED CT extension) • US Core STU 3 vital signs profiles – BP, Systolic BP, Diastolic BP, body height, etc. • Some review of HSPC BP profile 10 © 2019 American Medical Association. All rights reserved.

Next steps • Is this work that OO would like to consider for collaboration? • We look forward to working more closely with the HL 7 community. 11 © 2019 American Medical Association. All rights reserved.

12

History Developed Self Measured Blood Pressure (SMBP 1) in IHM to test our assumptions and provide concrete examples to industry for feedback 2017 Launch Q 4 - goal of developing a common data model for the industry. Composition at launch 1. Engagement – online platform and collaborators 2. Clinical Review Group – volunteer physicians 3. Development – terminology and information modeling 13 © 2019 American Medical Association. All rights reserved. 2018 Dr. Tom Giannulli joins IHMI as CMIO and lead Released SMBP 2 incorporating feedback from industry Pivot from the IHM to FHIR March 2019 Current Composition 1. Engagement – online platform, collaborators, business development focus 2. Clinical Review Group – staff led, volunteer physicians, Health Equities Group 3. Development – terminology and information modeling, product management 4. Engineering – software and services