Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care

Jun Bo Wu; Christina T. Yuan; Rachel Moyal-Smith; Elizabeth C. Wick; Michael A. Rosen

doi:10.1093/jamia/ocad237

Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care

Jun Bo Wu, Christina T. Yuan, Rachel Moyal-Smith, Elizabeth C. Wick, Michael A. Rosen

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: Enhanced recovery pathways (ERPs) are evidence-based approaches to improving perioperative surgical care. However, the role of electronic health records (EHRs) in their implementation is unclear. We examine how EHRs facilitate or hinder ERP implementation. Materials and Methods: We conducted interviews with informaticians and clinicians from US hospitals participating in an ERP implementation collaborative. We used inductive thematic analysis to analyze transcripts and categorized hospitals into 3 groups based on process measure adherence. High performers exhibited a minimum 80% adherence to 6 of 9 metrics, high improvers demonstrated significantly better adherence over 12 months, and strivers included all others. We mapped interrelationships between themes using causal loop diagrams. Results: We interviewed 168 participants from 8 hospitals and found 3 thematic clusters: (1) "EHR difficulties"with the technology itself and contextual factors related to (2) "EHR enablers,"and (3) "EHR barriers"in ERP implementation. Although all hospitals experienced issues, high performers and improvers successfully integrated ERPs into EHRs through a dedicated multidisciplinary team with informatics expertise. Strivers, while enacting some fixes, were unable to overcome individual resistance to EHR-supported ERPs. Discussion and Conclusion: We add to the literature describing the limitations of EHRs' technological capabilities to facilitate clinical workflows. We illustrate how organizational strategies around engaging motivated clinical teams with informatics training and resources, especially with dedicated technical support, moderate the extent of EHRs' support to ERP implementation, causing downstream effects for hospitals to transform technological challenges into care-improving opportunities. Early and consistent involvement of informatics expertise with frontline EHR clinician users benefited the efficiency and effectiveness of ERP implementation and sustainability.

Original language	English (US)
Pages (from-to)	591-599
Number of pages	9
Journal	Journal of the American Medical Informatics Association
Volume	31
Issue number	3
DOIs	https://doi.org/10.1093/jamia/ocad237
State	Published - Mar 1 2024

Keywords

clinical pathway
electronic health records
health plan implementation
patient safety
perioperative care

ASJC Scopus subject areas

Health Informatics

Access to Document

10.1093/jamia/ocad237

Cite this

@article{81394c84c00644a59577d5b29b492426,

title = "Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care",

abstract = "Objectives: Enhanced recovery pathways (ERPs) are evidence-based approaches to improving perioperative surgical care. However, the role of electronic health records (EHRs) in their implementation is unclear. We examine how EHRs facilitate or hinder ERP implementation. Materials and Methods: We conducted interviews with informaticians and clinicians from US hospitals participating in an ERP implementation collaborative. We used inductive thematic analysis to analyze transcripts and categorized hospitals into 3 groups based on process measure adherence. High performers exhibited a minimum 80% adherence to 6 of 9 metrics, high improvers demonstrated significantly better adherence over 12 months, and strivers included all others. We mapped interrelationships between themes using causal loop diagrams. Results: We interviewed 168 participants from 8 hospitals and found 3 thematic clusters: (1) {"}EHR difficulties{"}with the technology itself and contextual factors related to (2) {"}EHR enablers,{"}and (3) {"}EHR barriers{"}in ERP implementation. Although all hospitals experienced issues, high performers and improvers successfully integrated ERPs into EHRs through a dedicated multidisciplinary team with informatics expertise. Strivers, while enacting some fixes, were unable to overcome individual resistance to EHR-supported ERPs. Discussion and Conclusion: We add to the literature describing the limitations of EHRs' technological capabilities to facilitate clinical workflows. We illustrate how organizational strategies around engaging motivated clinical teams with informatics training and resources, especially with dedicated technical support, moderate the extent of EHRs' support to ERP implementation, causing downstream effects for hospitals to transform technological challenges into care-improving opportunities. Early and consistent involvement of informatics expertise with frontline EHR clinician users benefited the efficiency and effectiveness of ERP implementation and sustainability.",

keywords = "clinical pathway, electronic health records, health plan implementation, patient safety, perioperative care",

author = "Wu, {Jun Bo} and Yuan, {Christina T.} and Rachel Moyal-Smith and Wick, {Elizabeth C.} and Rosen, {Michael A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2024",

month = mar,

day = "1",

doi = "10.1093/jamia/ocad237",

language = "English (US)",

volume = "31",

pages = "591--599",

journal = "Journal of the American Medical Informatics Association",

issn = "1067-5027",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care

AU - Wu, Jun Bo

AU - Yuan, Christina T.

AU - Moyal-Smith, Rachel

AU - Wick, Elizabeth C.

AU - Rosen, Michael A.

N1 - Publisher Copyright: © The Author(s) 2023.

PY - 2024/3/1

Y1 - 2024/3/1

N2 - Objectives: Enhanced recovery pathways (ERPs) are evidence-based approaches to improving perioperative surgical care. However, the role of electronic health records (EHRs) in their implementation is unclear. We examine how EHRs facilitate or hinder ERP implementation. Materials and Methods: We conducted interviews with informaticians and clinicians from US hospitals participating in an ERP implementation collaborative. We used inductive thematic analysis to analyze transcripts and categorized hospitals into 3 groups based on process measure adherence. High performers exhibited a minimum 80% adherence to 6 of 9 metrics, high improvers demonstrated significantly better adherence over 12 months, and strivers included all others. We mapped interrelationships between themes using causal loop diagrams. Results: We interviewed 168 participants from 8 hospitals and found 3 thematic clusters: (1) "EHR difficulties"with the technology itself and contextual factors related to (2) "EHR enablers,"and (3) "EHR barriers"in ERP implementation. Although all hospitals experienced issues, high performers and improvers successfully integrated ERPs into EHRs through a dedicated multidisciplinary team with informatics expertise. Strivers, while enacting some fixes, were unable to overcome individual resistance to EHR-supported ERPs. Discussion and Conclusion: We add to the literature describing the limitations of EHRs' technological capabilities to facilitate clinical workflows. We illustrate how organizational strategies around engaging motivated clinical teams with informatics training and resources, especially with dedicated technical support, moderate the extent of EHRs' support to ERP implementation, causing downstream effects for hospitals to transform technological challenges into care-improving opportunities. Early and consistent involvement of informatics expertise with frontline EHR clinician users benefited the efficiency and effectiveness of ERP implementation and sustainability.

AB - Objectives: Enhanced recovery pathways (ERPs) are evidence-based approaches to improving perioperative surgical care. However, the role of electronic health records (EHRs) in their implementation is unclear. We examine how EHRs facilitate or hinder ERP implementation. Materials and Methods: We conducted interviews with informaticians and clinicians from US hospitals participating in an ERP implementation collaborative. We used inductive thematic analysis to analyze transcripts and categorized hospitals into 3 groups based on process measure adherence. High performers exhibited a minimum 80% adherence to 6 of 9 metrics, high improvers demonstrated significantly better adherence over 12 months, and strivers included all others. We mapped interrelationships between themes using causal loop diagrams. Results: We interviewed 168 participants from 8 hospitals and found 3 thematic clusters: (1) "EHR difficulties"with the technology itself and contextual factors related to (2) "EHR enablers,"and (3) "EHR barriers"in ERP implementation. Although all hospitals experienced issues, high performers and improvers successfully integrated ERPs into EHRs through a dedicated multidisciplinary team with informatics expertise. Strivers, while enacting some fixes, were unable to overcome individual resistance to EHR-supported ERPs. Discussion and Conclusion: We add to the literature describing the limitations of EHRs' technological capabilities to facilitate clinical workflows. We illustrate how organizational strategies around engaging motivated clinical teams with informatics training and resources, especially with dedicated technical support, moderate the extent of EHRs' support to ERP implementation, causing downstream effects for hospitals to transform technological challenges into care-improving opportunities. Early and consistent involvement of informatics expertise with frontline EHR clinician users benefited the efficiency and effectiveness of ERP implementation and sustainability.

KW - clinical pathway

KW - electronic health records

KW - health plan implementation

KW - patient safety

KW - perioperative care

UR - http://www.scopus.com/inward/record.url?scp=85185342548&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85185342548&partnerID=8YFLogxK

U2 - 10.1093/jamia/ocad237

DO - 10.1093/jamia/ocad237

M3 - Article

C2 - 38078843

AN - SCOPUS:85185342548

SN - 1067-5027

VL - 31

SP - 591

EP - 599

JO - Journal of the American Medical Informatics Association

JF - Journal of the American Medical Informatics Association

IS - 3

ER -

Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this