A Novel Customizable Datamart and Tableau Dashboard to Monitor Multiple Enhanced Recovery After Surgery Programs: Development and Validation Study.

Background: Enhanced recovery after surgery (ERAS) programs bundle evidence-based interventions to standardize care, expedite recovery, and improve outcomes. As ERAS programs have expanded, it has become clear that a major challenge is monitoring the compliance of bundle elements and outcomes to feedback performance to stakeholders and guide changes. Manual data abstraction is onerous and not feasible. Reliance on receiving new reports from busy health system IT groups is challenging. Therefore, we sought to address this unmet need at our hospital by developing a novel ERAS Datamart system. Objective: Our objectives were to develop a novel Datamart and Tableau dashboard to (1) enable continuous analysis of data, harvested directly from the electronic medical record (EMR), measure compliance and outcomes, and (2) enable end users (e.g., an ERAS coordinator) to create reports customized based on surgical procedure types, requested data variables, and custom date ranges. Methods: After "buy-in" from hospital leadership and other stakeholders, data metrics were identified and categorized according to phase of care, that is, preoperative, intraoperative, and postoperative. A multidisciplinary team reviewed International Classification of Diseases, Tenth Revision procedure codes to capture EMR data for patients undergoing ERAS procedures. IT was given a master list with metric names, definitions, and screenshots of the discrete field in the EMR to assist with building the metrics. Validations of the novel Datamart were done against known ERAS patient populations maintained by the surgery clinic. Results: The Datamart and Tableau dashboard has been built, is functional, and contains over 17,000 patients across 5 ERAS service lines: colorectal (n=1742), joint replacement (n=4235), surgical oncology (n=941), bariatric (n=1130), and cesarean section (n=9390). Currently, 56 metrics spanning the perioperative period have been validated across these populations. Reports can be tailored according to patients, time frames, and metrics. If desired, patient-level raw data can be exported for statistical analyses. Two use cases (total joint replacement and surgical oncology ERAS programs) are presented showing how the Datamart can be used. Conclusions: Discrete fields within an EMR can be successfully captured into a novel Datamart and visualized using a custom Tableau dashboard for providing stakeholder feedback, facilitating quality improvement analyses, and auditing pathways.