Tracking Gestational Hypertension Using Home Monitoring

When Epic staff member Beth Morgan’s care team noted an unusually high blood pressure reading during her pregnancy in 2019, she found herself being carefully monitored for the rest of her pregnancy and postpartum. This gave her the opportunity to provide a real-live perspective to an Epic tool that was already being planned to guide patients in similar situations through specific escalation path using MyChart Care Companion.

“When my blood pressure was higher the next week, we decided that I needed to go to the hospital that day and have the baby at the end of August rather than September,” Beth said. “I was induced and had a small but healthy baby. I needed to stay in the hospital for five days to keep my blood pressure under control.”

Gestational hypertension can cause problems for both the expecting parent and the fetus. It can also lead to further complications such as heart disease, kidney disease, and stroke. To help Beth continue monitoring her blood pressure after her delivery, she was sent home with a Bluetooth scale, blood pressure cuff, and tablet for home monitoring.

“Part of getting my blood pressure stabilized was managing and tweaking different medications and doses. Without regular data going to my nurse team, I almost definitely would have needed to be readmitted,” Beth said. “But with the program they enrolled me in, I was able to stay home with my new baby and converse over text and phone with my care team, who could adjust my medications when needed.”

For several months over her maternity leave, Beth used the devices provided to track her blood pressure, and she manually recorded her readings in a spreadsheet twice a week because there wasn’t a way for her track in MyChart.

This experience led her to think about how Epic could help. She texted her officemate, Kimberly Bell, who worked on the MyChart Care Companion team. With MyChart Care Companion, she would be able to link up the devices she was using with MyChart, communicate easily with her care team, and follow a clear escalation path when monitoring her risk.

“That was the first time I knew someone who had high blood pressure during pregnancy and learned how scary it could be to have to deliver several weeks early in order to reduce risk,” Kimberly said. “I felt strongly that we needed to get something into the Foundation System so that multiple organizations could easily implement it.”

That following November, Kimberly worked with the Society for Maternal-Fetal Medicine, as well as Epic’s Maternal Safety initiative and Obstetrics Steering Board to create a MyChart Care Companion program for monitoring gestational hypertension and preeclampsia risk.

Within the care plan, patients are prompted to check their blood pressure every day in MyChart. If a patient records an abnormal reading, that automatically triggers an escalation path that includes re-checking their blood pressure after 15 minutes and answering questions about their symptoms. Then, based on that second reading and symptom screen, the patient is instructed to contact the doctor and a warning is sent automatically to the patient’s care team.

Because of the risks with her first, Beth was closely monitored throughout her recent second pregnancy. She regularly measured her blood pressure at home and updates were sent automatically to her OB in Epic. When it spiked at 37 weeks, Beth’s OB called her and told her to go straight to triage. To mitigate risk of severe preeclampsia, she was induced, and her son–Jamie Michael–made his way into this world in August 2021. 

“Catching the escalation point during pregnancy is key,” Beth explained. “The sooner that you catch it, the more likely you are to prevent a bad outcome. Having that alert to a care team is really impactful.”