Automated health databases can help physicians monitor chronic diseases like hypertension

Aug 2 2004

Blood pressure readings recorded in a computerized database provide as much valid information on care as doctor’s notes, suggesting that automated health databases can help physicians monitor chronic diseases like hypertension, according to new research.

Extra information contained in doctors’ notes changed the assessment of whether or not high blood pressure was controlled for a given patient in fewer than 2 percent of the cases examined by Ann Borzecki, M.D., M.P.H., of the Bedford Veterans Affairs Medical Center and colleagues. Their study was published in the American Journal of Managed Care.

“If valid blood pressure data were available in automated form, this would make evaluations of blood pressure control and quality of hypertension care more useful by encompassing more cases and allowing more timely feedback of information to providers, so that corrective actions would be more likely,” Borzecki explains.

More than 50 million Americans have high blood pressure. Despite readily available therapies to treat the condition, most hypertension patients don’t have their blood pressure under control.

Borzecki and colleagues compared the information on blood pressure in databases and doctors’ notes at 10 VA hospital sites around the country. The researchers examined blood pressure readings in records from 981 patients, representing 6,097 medical visits.

Blood pressure measurements were recorded in either a computerized database or doctors’ notes for 71 percent of the visits. Nurses probably took most of the database measurements as part of a regular “intake” procedure, the researchers say. In 11 percent of the visits, the blood pressure measurement was recorded only in the doctor’s notes.

Blood pressure readings differed about half the time when separate readings were recorded in the database and doctor’s notes. Doctors were more apt to take their own reading for their notes if the intake measurement indicated high blood pressure.

Despite this, the database readings alone give an accurate picture of a patient’s blood pressure control, Borzecki and colleagues note. Patients would have been incorrectly diagnosed as having uncontrolled blood pressure in only 48 of the visits.

The researchers say the VA’s clinical computerized data system that captures blood pressure readings “could be easily adopted by other settings.”

The study was supported by the Department of Veterans Affairs Health Services Research and Development Service.