JMIR Publications

ABSTRACT

Background:

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.

Objective:

This study aimed to evaluate how ACS providers leverage the EHR for decision-making and identify opportunities and challenges for EHR-enabled decision support.

Methods:

We conducted a qualitative ethnographic study over a six-month period, combining in-depth interviews with 15 ACS providers and 100 hours of “pair fieldwork” observations spanning the entire perioperative arc by a surgical provider and an organizational sociologist. Using inductive grounded theory, we identified the enablers, challenges, and opportunities for EHR-enabled decision-making in ACS.

Results:

Surgeons fell into two groups: those who accepted information overload as inherent to the EHR, relying on generic templates and standard attestations, and others who viewed it as a problem to fix, actively correcting errors and composing individualized summaries. Ambiguity in billing requirements drove over-documentation, resulting in “note bloat” 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.

Conclusions:

ACS providers employ 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.