1.

Abstract

This Davies Report concerns the organization, Cleveland Clinic, which implemented the
Hypertension Improvement Program. This organization functions in the world of Adult
Primary Care, with the specific imperative of improving hypertension control, and the goal
of improving blood pressure outcomes in its population of 400,000 patients. This report
focuses on the role of primary care physician, whose primary goals are to minimize
uncontrolled blood pressure among patients. I focus on the primary functions of the
primary care physician’s role in blood pressure management and describe its success. I
describe its workflow, and provide an example of the user’s interaction with the system,
including the cognitive processes involved (“blood pressure monitoring and intervention”).
I describe the information system put into place, and how it works to support that workflow
and the functions. I also describe the modules comprising the system (EHR and patient
outreach), and how they are “systems” in their own right. I describe the data, information,
and knowledge employed by the modules and the system to support those functions.
Finally, I describe the technology underlying the information system.

I consider the standards in the system from each level of the stack, in the context of
interoperability. I also describe the privacy, confidentiality, and security concerns
addressed, and any ethical issues either explicit or implicit in their report.

I close with an assessment of the completeness of this report itself, an assessment of the
Stack for describing the project, and my thoughts on what I gained from the exercise.

2. World

The Cleveland Clinic implemented the Hypertension Improvement Program in the world of
Adult Primary Care. The imperative driving this project was to improve patient outcomes by
addressing hypertension and ensuring proper blood pressure control in the population.
National Academy of Medicine Initiative Goals such as improving health care quality and
patient outcomes played a role in this imperative. The world of Adult Primary Care also
impacted the requirements and design of the system by necessitating ease of use for both
in-office visits and remote patient management.
3. Organization

• Name: Cleveland Clinic

• Type of Organization: Healthcare provider (multi-specialty academic medical

center)

• Mission Statement: Cleveland Clinic’s mission is to provide better care of the

sick, investigation into their problems, and further education of those who serve.

• Organization-Level Goal: Minimizing uncontrolled blood pressure across

their patient population.

• New Policies or Models: Yes, policies including rechecking all high blood
pressure numbers, ensuring proper measurement, and reaching out to patients who were
not coming in were implemented.

• Evidence of Goal Achievement: Blood pressure control among patients

improved significantly due to continuous follow-up and proactive patient management
strategies.

4. Role

The role in this report is the primary care physician. This role is mission-critical for the
success of the Hypertension Improvement Program, as the primary care physician is
responsible for the diagnosis, follow-up, and ongoing treatment of patients with
hypertension.

5. Functions

• Primary Function: Supporting hypertension management and blood pressure

control.

• Goal for the Function: Minimizing uncontrolled blood pressure by ensuring

accurate measurements, patient engagement, and medication adjustment.
 • Evidence of Achievement: The report demonstrated improvement in blood
pressure control among patients. The workflow also emphasizes close follow-up and
appropriate medication interventions based on real-time data.

6. Workflow

The report describes the BP control workflow as follows:

• Office Visits: During an office visit, blood pressure is detected on intake and
entered into the electronic health record. The primary care physician then visually
manages the patient during the visit and makes necessary interventions.

• Non-Office Visits: For patients who do not come into the office, the primary
care physician identifies those with high blood pressure through remote monitoring or
medical record review and reaches out to manage their blood pressure, offering follow-up
or medication adjustments.

The patient receives ongoing interventions, either in-office or remotely, depending on their
condition.

7. Information System

• System Name: The Electronic Health Record (EHR) system.

• Needs: The need to accurately track and monitor blood pressure data both
during in-office and remote patient visits.

• Requirements: A reliable system that integrates patient data from various

touchpoints (office visits, remote monitoring) and supports decision-making for timely
intervention.

• Specifications: The EHR needed to be equipped to handle both data entry

from office visits and incorporate remote self-reported data from patients.
 • Development Process: The system followed traditional healthcare software
development practices, with an emphasis on user-friendly interfaces for clinical staff.

• Architecture: Closest to the “Enterprise architecture” model, which supports

multiple users across departments.

• Dependencies: Previous departmental systems that tracked patient visits

and medication histories, along with newer models of patient outreach for those missing
appointments.

8. Module

• Relevant Modules: The key modules include the EHR system for blood
pressure data entry and tracking, and the patient outreach module for managing remote
patient care.

• Information System as Module: The patient outreach module could be

considered an information system in its own right, as it functions to manage
communication, scheduling, and follow-up for patients based on data-driven insights from
the EHR.

9. DIKW

• Data Types: The primary data include blood pressure readings (numeric
data), patient demographics, and visit history.

• Information: Blood pressure trends over time, flagged high readings requiring
follow-up, and missed visit reports.

• Knowledge: The explicit knowledge used includes clinical guidelines for

hypertension management, which guide the physician in medication changes and
treatment decisions.

10. Technology
 • Supporting Technologies: EHR system, remote patient monitoring devices,
and integrated communication tools.

• Hype Cycle: The most important technology—remote patient monitoring—is

in the “slope of enlightenment” phase, as it’s being increasingly adopted in clinical
settings.

• Interoperability Standards: HL7 and FHIR standards are used to ensure data
can be shared between different systems.

11. Policies

• Inter-organizational agreements: Agreements with technology vendors to

ensure data compatibility and smooth interoperability.

• Use Cases: Blood pressure tracking, remote monitoring, and patient follow-
up.

• Functional Standards: Compliance with blood pressure management

protocols.

• Identifiers/Privacy: Strict adherence to HIPAA for protecting patient

information.

• Information Exchange: Utilization of HL7 standards for health information

exchange.

• Data Content: Data concerning patient health records and remote

monitoring data.

• Transport: Secure data transport protocols to safeguard patient information

during transmission.

12. Privacy, Confidentiality, Security

• Privacy Concerns: Addressed by ensuring that all patient data is encrypted

and stored in secure systems.
 • Confidentiality Concerns: The system ensures that only authorized
healthcare providers can access patient information.

• Security Concerns: Data is protected using advanced encryption and multi-

factor authentication to prevent unauthorized access.

13. Ethical Concerns

• Ethical Concerns Raised: The report highlights the need to ensure that
patient data is not misused or accessed without proper consent.

• Additional Ethical Concerns: There may be concerns around the accuracy of

self-reported data, as well as equity in care for patients who may not have access to
remote monitoring tools.

14. Reflection

The report provided a comprehensive overview of the system’s implementation and its
impact on hypertension management. However, the Stack analysis could have benefited
from further details on patient outcomes over a longer period and more granular data on
the challenges in patient engagement.

A key learning outcome from this exercise is the realization that data accuracy is
paramount, and it heavily depends on both in-office and at-home users. Additionally, the
project faces challenges with finding and tracking all patients with high blood pressure and
ensuring they come for follow-up visits. This aspect requires continuous improvement to
maintain patient compliance and ensure effective intervention.

This completes the entire outline with your edits. Let me know if you need any further
adjustments!