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Appl Clin Inform 2025; 16(04): 1298-1309
DOI: 10.1055/a-2697-2107
Research Article

Development of a Patient-Facing Clinical Decision Support Application for Hypertension

Authors

  • Michelle Bobo

    1   Division of Informatics, Clinical Epidemiology and Translational Data Science, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States

  • Shannon M. Canfield

    2   Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States

  • Victoria Shaffer

    2   Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States

  • Matt Storer

    1   Division of Informatics, Clinical Epidemiology and Translational Data Science, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States

  • LeAnn Michaels

    1   Division of Informatics, Clinical Epidemiology and Translational Data Science, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States

  • Amy Yates

    1   Division of Informatics, Clinical Epidemiology and Translational Data Science, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States

  • Abigail J. Rolbiecki

    3   Department of Family Medicine, Division of Geriatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States

  • Richelle Koopman

    2   Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States

  • David Dorr

    1   Division of Informatics, Clinical Epidemiology and Translational Data Science, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States

Funding This work was funded by the following grants: 1. AHRQ 5-U18-HS026849-02 Translating Hypertension Guidelines into Practice: Development of Interoperable Clinical Decision Support. 2. AHRQ R18HS028579 Collaboration-Oriented Approach to Controlling High Blood Pressure (COACH).
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Abstract

Background

Hypertension is a chronic condition defined by persistent high blood pressure (BP) that contribute to significant morbidity and mortality. Evidence-based clinical guidelines provide recommendations for the diagnosis and management of hypertension. These recommendations are frequently incorporated into clinical decision support (CDS) tools used by clinicians. CDS tools can also be oriented toward patients but careful attention to the development process is required to make a useful, usable, and engaging digital health intervention.

Objectives

We sought to design, develop, and optimize a patient-facing CDS application for hypertension, which emphasizes home-based monitoring and collaboration with the health care team around treatment goals.

Methods

We conducted an iterative, user-centered design process to develop the application. First, we identified user needs, key components, and the technological platform. Then, we developed the integrated application and performed extensive testing to validate and optimize performance and usefulness. After identifying issues in the testing processes, we performed an additional round of optimization development.

Results

We have completed development of the COACH (Collaborative Approach to Controlling High Blood Pressure) web application using JAVA and SMART on FHIR technologies with a focus on interoperability. The COACH application supports home-based BP monitoring and provides evidence-based, patient-centered CDS incorporating education, counseling, and treatment recommendations. Early results showed that we were able to increase usability, address data quality concerns, and demonstrate improved BP control in a pilot study.

Conclusion

Extensive preparatory research and user-centered design processes enabled the successful development of a novel tool for enabling management of high BP. The tool uses data from the patient's medical record and ambulatory BP monitoring to provide patient-centered CDS recommendations. We are now evaluating the tool through a multisite clinical trial.

Keywords

blood pressure - clinical practice guideline - patient self-care - home care - and e-health - requirements analysis and design - patient - consumer health

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the University of Missouri Institutional Review Board, which served as a single Institutional Review Board. Oregon Health and Science University Institutional Review Board relied on the University of Missouri.




Publication History

Received: 13 February 2025

Accepted: 05 September 2025

Accepted Manuscript online:
08 September 2025

Article published online:
08 October 2025

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