{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:59:16Z","timestamp":1790611156929,"version":"4.1.0"},"reference-count":50,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Systematic strategies to harness electronic health record (EHR) workflows, reduce redundancy, and support decision-making remain limited in acute care surgery (ACS). Understanding how EHR systems and workflows intersect with time-sensitive settings is critical to improving decision-making and outcomes in ACS.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate how ACS clinicians leverage the EHR for decision-making and to identify opportunities and challenges for EHR-enabled decision support.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a qualitative ethnographic study over a 6-month period, combining in-depth interviews with 15 ACS surgeons and providers and 100 hours of \u201cpaired fieldwork\u201d observations spanning the entire perioperative arc by a surgical provider and an organizational sociologist. Using constructivist grounded theory, we identified the enablers, challenges, and opportunities for EHR-enabled decision-making in ACS.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Surgeons fell into two groups: (1) those who accepted information overload as inherent to the EHR, relying on generic templates and standard attestations, and (2) others who viewed it as a problem to fix, actively correcting errors and composing individualized summaries. Ambiguity in billing requirements drove overdocumentation, resulting in \u201cnote bloat\u201d that obscured high-yield information. EHR use during decision-making focused primarily on risk assessment, though navigation challenges hindered access to critical data. Forecasting key outcomes that alter management or facilitate shared decision-making was seen as valuable. Automated risk stratification, generated from live EHR data while minimizing alert fatigue, was seen as a potential solution.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n ACS clinicians use various tactics to navigate EHR challenges and focus on high-value tasks. Streamlined risk assessment using EHR data may strengthen decision-making in critical moments, but solutions must integrate seamlessly within existing workflows to provide rapid and accurate outputs that prioritize meaningful outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/89846","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:41:21Z","timestamp":1790610081000},"page":"e89846-e89846","source":"Crossref","is-referenced-by-count":0,"title":["Electronic Health Record Workflows in Acute Care Surgery: Ethnographic Study"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3842-1225","authenticated-orcid":false,"given":"Alex H","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4201-1421","authenticated-orcid":false,"given":"Devesh","family":"Narayanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5336-376X","authenticated-orcid":false,"given":"Kristan","family":"Staudenmayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6347-2601","authenticated-orcid":false,"given":"Aussama K","family":"Nassar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-3512","authenticated-orcid":false,"given":"Syed Morad","family":"Hameed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1097\/TA.0000000000001312","article-title":"Surgical rescue: the next pillar of acute care surgery","volume":"82","author":"Kutcher","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/TA.0000000000002910","article-title":"Modifiable factors to improve work-life balance for trauma surgeons","volume":"90","author":"Brown","journal-title":"J Trauma Acute Care Surg"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.1097\/TA.0000000000000226","article-title":"Update on the status and future of acute care surgery: 10 years later","volume":"76","author":"Lissauer","journal-title":"J Trauma Acute Care Surg"},{"issue":"5","key":"R4","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1097\/TA.0000000000000986","article-title":"The painful truth: the documentation burden of a trauma surgeon","volume":"80","author":"Golob","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1177\/000313481808400137","article-title":"Trauma surgeons save lives-scribes save trauma surgeons!","volume":"84","author":"Golob","journal-title":"Am Surg"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1177\/00031348211061102","article-title":"Acute care surgeons spend more time than general surgeons on the electronic health record (EHR)","volume":"89","author":"Loszko","journal-title":"Am Surg"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.amjsurg.2018.02.017","article-title":"The influence of stress responses on surgical performance and outcomes: literature review and the development of the surgical stress effects (SSE) framework","volume":"216","author":"Chrouser","journal-title":"Am J Surg"},{"issue":"10","key":"R8","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1056\/NEJMp1703370","article-title":"The HITECH era and the path forward","volume":"377","author":"Washington","journal-title":"N Engl J Med"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1145\/3531146.3533223","article-title":"What is the bureaucratic counterfactual? 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