{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:53:05Z","timestamp":1781707985184,"version":"3.54.5"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"Department of Health and Human Services","doi-asserted-by":"publisher","award":["HHSP2332015000201"],"award-info":[{"award-number":["HHSP2332015000201"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"Department of Health and Human Services","doi-asserted-by":"publisher","award":["HHSP23337004T"],"award-info":[{"award-number":["HHSP23337004T"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We interviewed 168 participants from 8 hospitals and found 3 thematic clusters: (1) \u201cEHR difficulties\u201d with the technology itself and contextual factors related to (2) \u201cEHR enablers,\u201d and (3) \u201cEHR barriers\u201d 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Conclusion<\/jats:title>\n                  <jats:p>We add to the literature describing the limitations of EHRs\u2019 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\u2019 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocad237","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T23:29:26Z","timestamp":1702337366000},"page":"591-599","source":"Crossref","is-referenced-by-count":2,"title":["Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care"],"prefix":"10.1093","volume":"31","author":[{"given":"JunBo","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, MD 21205, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina T","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, MD 21205, United States"},{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Moyal-Smith","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205, United States"},{"name":"Ariadne Labs: A Joint Center of the Harvard School of Public Health and Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health , Boston, MA 02215, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C","family":"Wick","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco , San Francisco, CA 94143, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, MD 21205, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"issue":"2","key":"2024021710211217200_ocad237-B1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1136\/jamia.2010.007229","article-title":"Early cost and safety benefits of an inpatient electronic health 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