The patient decision tree
Every branch a patient can reach — what triggers each screen, what it says, and where it leads. Nothing in this path changes a medication on its own; every dose change is a clinician decision.
Stage 1
Onboarding
Everything that happens once, before the first reading. Staff enroll the patient; the patient finishes setup on their own phone.
Welcome & consent
Program scope, what data is shared, and that this is not a 24/7 service.
Language choice
English or Spanish. Every downstream screen follows this setting.
Goal set at enrollment
<130/80 standard
Frail-elderly checkbox relaxes the goal to <140/90.
Device pairing
Bluetooth, Wi-Fi, or cellular cuff — or manual entry while a device ships.
How to measure
Cuff placement, 5 minutes of rest, feet flat, no talking, same arm.
Open the screen
Lifestyle intake
Short questionnaire that ranks which lifestyle lever to offer first.
Stage 2
Taking a reading
The repeating core loop. Cadence follows the patient's lane — twice daily during a measurement week, lighter at maintenance.
Reminder to measure
Push/SMS prompt on the schedule for the patient's lane.
Reading captured
Sent automatically by the cuff, or entered by hand. Both land in the same timeline.
Automatic quality screen
Looks off — retake
Implausible value, or a >20 mmHg systolic swing inside one sitting.
Patient is asked to rest 5 minutes and measure again; nothing is deleted.
Reading accepted
Stored, plotted on the trend, and counted toward the measurement week.
Stage 3
Immediate triage on the reading
What the patient sees the second the number lands. Bands follow AHA thresholds; the goal line follows the patient's own target.
≥180/120 confirmed
5-minute recheck first. Still severe →
The reading goes to the clinic's urgent queue with a 60-minute callback deadline; staff call the patient. The patient sees one fixed notice: the app is not monitored around the clock, and emergency symptoms mean call 911 now.
≥160/100 with symptoms
Stroke-like symptoms at this level route to the ED even below the crisis threshold.
Stage 2 · ≥140/90
Plain-language explanation, MI lever offer, care team notified via the queue.
Stage 1 · 130–139/80–89
Lifestyle-first message; high-risk patients already on medicine keep their cycle.
Elevated / at goal
Reassurance, trend context, and the next measurement time.
Unusually low / lightheaded
Hold-and-call guidance: sit down, do not take the next dose, call the clinic.
Blood pressure categories follow the American Heart Association, Understanding Blood Pressure Readings.
Stage 4
Symptom and side-effect screen
Asked with every check-in and any time the patient taps 'I don't feel right'. This branch overrides everything else on the page.
Stop the medicine and call 911
Face/tongue/throat swelling, trouble breathing, fainting, chest pain, one-sided weakness, trouble speaking, sudden severe headache.
Hold and call the clinic today
Persistent dizziness on standing, very low pulse, new severe swelling, muscle cramps or weakness on a diuretic.
Keep taking it — tell us
Dry cough, ankle puffiness, mild fatigue, more frequent urination.
Open the screen
Stage 5
Motivational interviewing branch
Offered after an elevated reading, or opened any time from the education tab. The patient picks the lever and the step — the app never assigns one.
Lever picker
Ranked from the lifestyle intake: weight, DASH, sodium, potassium, activity, alcohol.
Open the screen
First time with this lever vs. coming back
Full MI guide
Why it works · change-talk prompts · importance and confidence rulers
Common barriers · the full target for context
One small step the patient commits to
Open the screen
Short check-in
Going well → keep the step
Hit a bump → shrink the step
Not the right fit → switch levers
Open the screen
What the care team sees
The chosen lever and an engagement count only — no ruler scores, no transcripts.
Stage 6
Between readings
The quiet parts of the program: scheduled check-ins, progress toward a usable average, and what happens when a patient goes silent.
Scheduled check-in
Symptoms, side effects, and whether the medicine is being taken as prescribed.
Measurement-week progress
Target for a high-confidence average:
≥12 readings across ≥3 days in 14 days
Falling short slows the decision — it never blocks the cycle.
Missed readings — outreach ladder
7d · 14d · 21d · 35d
App nudge → text → staff phone call → care-team review. Any reading or contact resets the clock.
Stage 7
End of the 14-day cycle
The cycle closes on the calendar, not on a threshold. What the patient sees depends on their average and how much data is behind it.
Above goal, enough data
Clinician reviews the suggested next rung and decides. If the dose changes, the patient gets a plain-language "your medicine is changing" message and a new cycle starts.
Above goal, thin data
Coaching to build the measurement week; the clinician still sees the case, flagged low-confidence.
At goal
Congratulations screen, maintenance cadence, and a longer reassessment interval.
Always-on overrides
- Red-flag symptoms and a confirmed severe reading override every branch above, at any stage of the program.
- The program is not a 24/7 service. Severe readings are routed to the clinic's urgent queue — staff make the call, the app never does. Every patient screen says so and points to 911 for emergency symptoms.
- No medication is started, stopped, or titrated by the app. The patient path gathers information and surfaces a recommendation; a clinician makes the call.