1. Director, Global Terminology and Data Operations
Integrated Health Model Initiative (IHMI): Self-measured Blood Pressure Using A Remote Monitoring Device (SMBP)
Corey Smith
Director, Global Terminology and Data Operations
August 15, 2019

2. Objectives IHMI background Why hypertension?
SMBP use case and data elements
Data standardization goals, assumptions, and predicate work
How do we work with the HL7 community?

3. The Problem with Health Care Data
Data Liquidity
Data Portability
INACCESSIBLE
Data are largely inaccessible. However, accessibility is only half the solution to the interoperability problem.
INCOMPLETE &
INCOMPATIBLE
Once shareable, data are often incomplete and cannot be interpreted by other parties.
(Semantic Interoperability)
LACK OF
RELEVANCY
CLINICAL
A lack of relevant clinical data elements can diminish the value of patient data transmitted to or made available for clinicians.
ACCESSIBILITY

4. IHMI Mission
Improve patient health outcomes by empowering physicians with the clinically valid health care data needed to make informed decisions.
SMBP:
Proliferation of remote monitoring devices – Wild West
Clinical value in using this data to make care decisions
- SMBP because there special considerations about devices and systems that are disparate; segmant

5. Why Hypertension? Uncontrolled Blood Pressure
About 85 million adults (approximately 1 in 3) in the United States have high blood pressure, a contributing factor to major health conditions including heart attack, heart failure, stroke, and kidney failure. Research also shows that in 45.9% of those with high blood pressure the condition is not controlled—36.7 million people!
Costs Beyond Patient Health
It is estimated that high blood pressure costs the country $48.6 billion each year, including health care services, medications, and missed days of work.
There are new opportunities to use remote monitoring outside the clinic.

6. Improving Health Outcomes: Target BP Program
Helps health care organizations, at no cost, improve BP control rates through an evidence-based quality improvement program and recognizes organizations committed to improving BP control
MEASURE blood pressure accurately, every time
Enable Patient Self‑Measurement
Patients can take an active role in their treatment by monitoring their own BP readings outside of the clinical setting.
SMBP can also help providers better diagnose high BP and effectively manage patients.
ACCESSIBILITY

7. SMBP Use Case Overview (Clinician Guided)
ACCESSIBILITY

8. SMBP Clinically Validated Data Elements
Exertional status – at rest
Body position – seated
Body site – left or right brachial artery
Device and cuff size – automated BP monitor with adult small, medium, large, extra large
Device ID – in anticipation of more clinical validation of remote monitoring devices
Body height, weight, average BP, heart rate
ACCESSIBILITY

9. Data standardization goals
Meet clinical criteria and gain widespread adoption in support of AMA IHMI mission
Reduce variability in the expression of meaning
Ability to compute logical subsumption and equivalence across terminology and information models (experimental)
Leverage existing tools, team strengths, and work within internally established AMA timelines
ACCESSIBILITY

10. Data standardization assumptions and predicate work considerations
Built draft SMBP IG (15 profiles, 4 SNOMED CT value sets) with intention of bringing something concrete to HL7 community for consideration
IHMI profiles may be adopted or IHMI data elements may be incorporated into other profiles – either option achieves our objectives
Predicate work considerations:
IHM SMBP1 and SMBP2 (SNOMED CT extension)
US Core STU3 vital signs profiles – BP, Systolic BP, Diastolic BP, body height, etc.
Some review of HSPC BP profile
ACCESSIBILITY

11. Next steps
Is this work that OO would like to consider for collaboration?
We look forward to working more closely with the HL7 community.

13. History
Developed Self Measured Blood Pressure (SMBP1) in IHM to test our assumptions and provide concrete examples to industry for feedback
Pivot from the IHM to FHIR March 2019
2017
2018
2019
Launch Q4 - goal of developing a common data model for the industry. Composition at launch
Engagement – online platform and collaborators
Clinical Review Group – volunteer physicians
Development – terminology and information modeling
Current Composition
Engagement – online platform, collaborators, business development focus
Clinical Review Group – staff led, volunteer physicians, Health Equities Group
Development – terminology and information modeling, product management
Engineering – software and services
Dr. Tom Giannulli joins IHMI as CMIO and lead
Released SMBP2 incorporating feedback from industry
Self