Center for Digital Health, Department of Medicine Stanford University Stanford CA USA.
Division of Nephrology, Department of Medicine Stanford University School of Medicine Stanford CA USA.
J Am Heart Assoc. 2024 Jan 16;13(2):e030884. doi: 10.1161/JAHA.123.030884.
High blood pressure affects approximately 116 million adults in the United States. It is the leading risk factor for death and disability across the world. Unfortunately, over the past decade, hypertension control rates have decreased across the United States. Prediction models and clinical studies have shown that reducing clinician inertia alone is sufficient to reach the target of ≥80% blood pressure control. Digital health tools containing evidence-based algorithms that are able to reduce clinician inertia are a good fit for turning the tide in blood pressure control, but careful consideration should be taken in the design process to integrate digital health interventions into the clinical workflow.
We describe the development of a provider-facing hypertension management platform. We enumerate key steps of the development process, including needs finding, clinical workflow analysis, treatment algorithm creation, platform design and electronic health record integration. We interviewed and surveyed 5 Stanford clinicians from primary care, cardiology, and their clinical care team members (including nurses, advanced practice providers, medical assistants) to identify needs and break down the steps of clinician workflow analysis. The application design and development stage were aided by a team of approximately 15 specialists in the fields of primary care, hypertension, bioinformatics, and software development.
Digital monitoring holds immense potential for revolutionizing chronic disease management. Our team developed a hypertension management platform at an academic medical center to address some of the top barriers to adoption and achieving clinical outcomes. The frameworks and processes described in this article may be used for the development of a diverse range of digital health tools in the cardiovascular space.
高血压影响了美国约 1.16 亿成年人。它是全世界导致死亡和残疾的主要风险因素。不幸的是，在过去十年中，美国的高血压控制率一直在下降。预测模型和临床研究表明，仅减少临床医生的惯性就足以达到≥80%的血压控制目标。包含能够减少临床医生惯性的循证算法的数字健康工具非常适合扭转血压控制的局面，但在设计过程中应仔细考虑将数字健康干预措施整合到临床工作流程中。
我们描述了一个面向提供者的高血压管理平台的开发。我们列举了开发过程中的关键步骤，包括需求发现、临床工作流程分析、治疗算法创建、平台设计和电子健康记录集成。我们采访和调查了斯坦福大学的 5 名初级保健、心脏病学的临床医生及其临床护理团队成员（包括护士、高级实践提供者、医疗助理），以确定需求并分解临床医生工作流程分析的步骤。应用程序设计和开发阶段得到了大约 15 名初级保健、高血压、生物信息学和软件开发领域专家团队的帮助。
数字监测在改变慢性病管理方面具有巨大的潜力。我们的团队在一所学术医疗中心开发了一个高血压管理平台，以解决采用和实现临床结果的一些最大障碍。本文描述的框架和流程可用于开发心血管领域的各种数字健康工具。
