Abstract—Telemedicine interventions are being increasingly used in the care of adults with hypertension however application of these technologies in children with high BP has not been systematically studied. The goal of this project was to develop a mobile BP telemanagement system for children with hypertension and to evaluate its feasibility. The prototype system consisted of a home unit, decision support server, and care management site. The home unit was based on a wireless netbook and automated BP monitor. The home unit was designed to complete a symptom diary, assess medication side effects, obtain BP, undergo hypertension education, and communicate with the decision support server. Feasibility of the BP telemanagement system was assessed in 8 children ≤21 years of age with essential hypertension. The study participants were asked to review the system functionality and provide their feedback by completing attitudinal survey and semi-structured qualitative interview. Attitudinal survey results were as follows: 88% reported that working with the computer was not difficult; 100% reported that self-testing procedures were not complicated; 75% felt the self-testing procedure took little time and did not interfere with their usual activities; 63% felt safer while being monitored by the BP telemanagement system; 63% felt it was important to know that the self-testing results can be immediately reviewed in the medical center; 88% would like to use the home telemonitoring system in the future. Qualitative interview results showed consistently positive comments for content, interface and process components and provided suggestions for improvements. We concluded that BP telemanagement in children may be feasible means for hypertension care delivery, and that further development and evaluation of the system is warranted. I. INTRODUCTION With elevated blood pressure identified as the number one attributable risk for death worldwide, there is significant focus on identification and treatment of high blood Manuscript received September15, 2012. This work was supported in part by the Pearl M. Stetler Research Fund, the National Kidney Foundation of Maryland, and the Secunda Family Foundation. Cozumel Pruette, MD, MHS is with the Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA (e-mail: csouthe1@jhmi.edu). Jeffrey J. Fadrowski MD, MHS is with the Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA (e-mail: fadrowsj@jhmi.edu). McKenzie Bedra, MPH is with Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA (mbedra1@jhmi.edu). Joseph Finkelstein, MD, PhD is with Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA (phone: 410-558-0480; fax: 410-558-0470; e-mail: jfinkel9@jhmi.edu). pressure [1]. The growing prevalence of hypertension in children is alarming, as it is currently estimated to be between 3-5% among all children and adolescents [2]. Additionally, there is significant concern that hypertension in childhood may be associated with an increase in hypertension-related morbidity and mortality in adults. Major barriers to successful treatment of hypertension are patient non-adherence with medication and the ability to maintain necessary clinic follow-up appointments. The development of a successful monitoring and treatment program for hypertension in children is vitally important given the rising prevalence of pediatric hypertension and concern for hypertension-related morbidity and mortality in adulthood. Several studies involving adult patients have explored the possibilities of home telecare programs for patients with hypertension [3-5]. However, none of these programs included pediatric patients [6-8]. To date, there are limited studies that evaluate the validity of blood pressure self-monitoring and anti-hypertensive medication adherence in a pediatric population using a home blood pressure monitoring system. This is a critical population in which to do such a study, given increase in prevalence of pediatric hypertension and potential consequences of high BP in children on future health during adulthood. We therefore conducted a study to evaluate the feasibility of a new and innovative multi-component telemanagement system as a method of improving medication adherence and blood pressure monitoring in children with hypertension. Specifically, with this feasibility study, we sought out to evaluate patient/caretaker acceptance of a telemanagement system for blood pressure care in children, which involves self-monitoring and allows prompt reciprocal exchange of medication adherence and blood pressure measurement information between patients and health care providers. This system has not previously been implemented in a pediatric population with hypertension and therefore is a novel approach to improving monitoring and treatment of hypertension in children. II. SYSTEM DESIGN Home Automated Telemanagement (HAT) is a telemedicine system designed to assist health care practitioners treat patients according to current clinical guidelines, to assist patients in following individualized self-care plans, to assist providers in monitoring patient self-management, and to assist care management teams in empowering and engaging patients in their self-care [9-12]. The HAT system is based on Wagner’s model of chronic disease care [13] and supports patient self-management, comprehensive patient-provider communication, and multidisciplinary care coordination [14]. Feasibility of a Mobile Blood Pressure Telemanagement System in Children with Hypertension Cozumel S. Pruette, Jeffrey J. Fadrowski, McKenzie Bedra, Joseph Finkelstein, Member, IEEE 188 2013 IEEE Point-of-Care Healthcare Technologies (PHT) Bangalore, India, 16 - 18 January, 2013 978-1-4673-2767-1/13/$31.00 ©2013 IEEE