Self-Measured Blood Pressure Telemonitoring Programs: A Pragmatic How-to Guide.

Self-measured blood pressure (SMBP) telemonitoring is the process of securely storing and tele-transmitting reliably measured, patient self-performed blood pressure (BP) measurements to healthcare teams, while ensuring that these data are viewable and clinically actionable for the purposes of improving hypertension diagnosis and management. SMBP telemonitoring is a vital component of an overall hypertension control strategy. Herein, we present a pragmatic guide for implementing SMBP in clinical practice and provide a comprehensive list of resources to assist with implementation. Initial steps include defining program goals and scope, selecting the target population, staffing, choosing appropriate (clinically validated) BP devices with proper cuff sizes, and selecting a telemonitoring platform. Adherence to recommended data transmission, security, and data privacy requirements is essential. Clinical workflow implementation involves patient enrollment and training, review of telemonitored data, and initiating or titrating medications in a protocolized fashion based upon this information. Utilizing a team-based care structure is preferred and calculation of average BP for hypertension diagnosis and management is important to align with clinical best practice recommendations. Many stakeholders in the United States are engaged in overcoming challenges to SMBP program adoption. Major barriers include affordability, clinician and program reimbursement, availability of technological elements, challenges with interoperability, and time/workload constraints. Nevertheless, it is anticipated that uptake of SMBP telemonitoring, still at a nascent stage in many parts of the world, will continue to grow, propagated by increased clinician familiarity, broader platform availability, improvements in interoperability, and reductions in costs that occur with scale, competition, and technological innovation.

The sociology of change.

Sociology is defined as the study of the origin, development, organization, and functioning of human society. Implementing a new electronic medical record is a change management project with a technology component and requires an understanding and appreciation of the history, organizational structure, and culture of the practice as well as an understanding and appreciation of how people function within a given organization. Practices that embrace this philosophy and approach to implementation are successful and see their practices positively transform as a result of using health information technology. This article describes an approach to technology projects that improves success.

Using computers in the exam room.

Purchasing an electronic health records system is the first step to assimilation of the new system into the fabric of a practice. The next hurdle is use of the electronic health record as close to the point of patient care as possible, which requires the clinician to use a computer. This article presents some of the unique challenges of using computers to document patient encounters and some practical advice and considerations for improving the use of computers at the bedside.

Using a phased-in incremental approach to EMR implementation.

Electronic medical record assimilation will affect every aspect of a medical practice, and when complete will transform how healthcare is delivered. Many practices underestimate the impact on the practice and amount of planning that is necessary. The result is abandoned or failed implementation and assimilation. This article presents an implementation methodology that is effective and can improve successful use of an electronic medical record system.

Ten steps to EMR assimilation into a practice.

War stories abound about the assimilation of computerized patient records. Physicians are asking about how to prepare for implementation. This article provides physicians with practical tools to prepare them for implementation by knowing what to expect and how to get ready for the transition from paper to electronic.

E-prescribing.

Electronic prescribing was included in the Medicare Prescription Drug Improvement and Modernization Act of 2003, yet provider adoption rates are estimated to be as low as 5%. E-prescribing brings many benefits to the practice, namely time savings, increased safety, error prevention, efficiency, and improved patient and provider experiences. Rather than focusing on what is gained, providers hesitate to adopt e-prescribing due to its cost, lack of incentives, and fear of being slowed down. Perhaps the key to broader adoption lies in hearing the stories of successful implementations.

Preparing your practice for EMR: are you ready?

Practices considering an EMR system purchase and implementation must first consider if the practice is ready to undertake a project of this size and magnitude, with such far-reaching implications for the organization. Before considering EMR, an evaluation of the existing PM system is in order. Incorporating an EMR system when the PM system is inadequate decreases ROI, minimizes the efficiencies gained through EMR and ultimately may not support the long-term goals of the practice. The first step for any group or solo medical practice is to understand itself: what are the practice's goals; where will the practice be in terms of maturity, market share, and community presence in five or 10 years; what are the requirements for a system to support the needs and goals of the practice? Understanding each of these aspects improves the negotiating strength of the practice, ensures a successful implementation plan, and decreases the time to return on objective and subsequent ROI.

How to motivate physicians and develop a physician champion.

Physician champions and leaders are essential to the success ofa CCIS implementation. Physician champions or leaders can be developed by recognizing the qualities of a leader and cultivating them. Finally, sustainable second-order change is facilitated bv a transformational leader--a leader who is charismatic, considers individual characteristics and needs of the constituency, and stimulates the constituency intellectually. A transformational leader does not accept the status quo but rather is continually questioning and offering constructive problem solutions. Transformational leadership may require more patience, time, tolerance, and resources, but it is worth the effort.

Teaching on the front lines: using the Internet and problem-based learning to enhance classroom teaching.

Working on the front lines in health care at the bedsides, in the primary and specialty care offices and in the community with patients; and in health care education, teaching graduate and undergraduate students, is more challenging today than ever before. Shifts in reimbursement from fee for service to a managed care model, increasingly informed consumers, and increasingly complex health problems create a tension that often leaves the advanced practice nurse (APN) managing conflicting human and business interests. Nurse educators must prepare providers to function in that world. Using Problem-Based Learning (PBL) to provide APN students with experiences that will supply them with rehearsal will better prepare them to function in today's primary care environment. Providing PBL using the Internet is the next logical step and may insure that this type of experience is more widely available to students.