Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Abstract

OBJECTIVE: Pediatric hypertension remains largely unrecognized. We hypothesized that an electronic medical record (EMR) alert would increase elevated blood pressure (BP) recognition in a pediatric primary care setting. STUDY DESIGN: Pre-post evaluation of a real-time EMR alert and one-time provider educational session. A total of 1305 encounters of children 3 to 21 years with elevated intake BP and no prior hypertension diagnosis were included. Elevated BP recognition and relationship of recognition with cardiovascular disease (CVD) risk factors during the intervention was compared with an historical control. RESULTS: Recognition increased from 12.5% to 42% (P < .001). Recognition increased soon after alert implementation and was sustained without evidence of "alert fatigue." During both periods, presence of CVD risk factors was associated with recognition. However, the magnitude was lesser in the intervention period. CONCLUSIONS: Real-time EMR alerts substantially increase elevated BP recognition in children. However, underrecognition of elevated BP persisted, highlighting the need for additional strategies to improve provider recognition.

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