One reading, one automated loop.
A patient measures their blood pressure. The app runs the same protocol a Kaiser hypertension clinic would run — every time, in under a second — and only surfaces the patients who need a human.
The loop
Step 1
Signed reading arrives
An FDA-cleared cuff (Omron VitalSight cellular hub or a paired Bluetooth device) POSTs the reading to a signed public endpoint. The signature is verified before anything else runs. Manual entry works too, for patients without a device yet.
Step 2
Protocol triage
The reading is classified into a band (normal / stage 1 / stage 2 / severe) using AHA thresholds. Severe asymptomatic readings trigger a mandatory 5-minute recheck; severe with symptoms routes straight to 911/urgent care. Program hours are not 24/7 by design — this is chronic management, not urgencies.
Step 3
Patient nudge
The patient sees a plain-language message tied to their own numbers and, when BP is elevated, a motivational-interviewing lever picker: one small, chosen change beats one prescribed change. All screens are bilingual (English/Spanish).
Step 4
Clinician queue
Only patients meeting the escalation rule surface in the clinician's triaged alerts queue. Every alert ships with a Kaiser-style suggested next step and a copy-ready SOAP draft.
Step 5
Titration when the cycle is ready
After the 14-day cycle, if the average is above target, the engine recommends the next rung of the Kaiser 2019 ladder (start → lisinopril → +HCTZ → +amlodipine → +spironolactone). Clinician approves in one click; a SOAP note writes itself.
Step 6
KDIGO safety carve-outs
Recent labs (K⁺, Cr, eGFR, UACR) block or steer the recommendation: high potassium blocks ACEi/ARB additions, low eGFR forces the CKD monotherapy track, and lab draws are scheduled from the KDIGO heat map.
Why this shape
Cheap
Target patient pays $10–17/month. No RPM billing overhead. FDA-cleared devices at consumer price points.
Safe
Every recommendation is anchored in a published protocol (Kaiser 2019, KDIGO). The engine won't advance past a lab contraindication.
Portable
Same architecture works standalone or embedded as a companion layer to a hospital's Epic instance via FHIR Observations.