Exploring a Digital Health Solution to Collect and Manage Health-Related Needs for Patients Who Undergo Complex Surgery: Mixed Methods Study

Abstract

Background: Patients who undergo complex surgery (eg, esophagectomy and liver resection) often experience a substantial burden of health-related needs (medical, social, and behavioral health). A digital solution could facilitate the collection and resolution of health-related needs by care team members for these patients. A digital solution may facilitate adherence to a clear treatment plan and concomitantly reduce surgical complications and readmissions. Objective: The aim of the study is to establish gaps in the collection and management of health-related needs and identify a set of user specifications for a digital solution to collect and resolve health-related needs for patients who undergo complex surgery. Methods: We applied the double diamond framework and organized the study into two sequential phases: (1) qualitative methods to discover the perspectives of patients and care team members on health-related needs and (2) participatory design sessions to gain feedback and sentiment about ideal features of a digital solution. Both phases were conducted between December 2023 and March 2025. We supplemented both phases with analysis of electronic health record (EHR) data for patients who underwent complex surgery at our academic medical center. Results: Extensive themes emerged from interviews with patients (n=20) and care team members (n=24), capturing their health-related and surgical experiences as well as desired features for a digital solution. Our swimlane diagram demonstrated four critical gaps in workflow: (1) heterogeneity in the approach to screening, monitoring, and managing health-related needs; (2) patients felt uncomfortable reporting health-related needs, particularly behavioral and social needs, to their care team; (3) lack of access to referral resources to resolve needs; and (4) the need for a closed-loop intervention for patients and care team members. A subset of participants from phase 1 (n=5 patients and n=9 care team members) provided feedback on preferred features, drawing from digital tools currently available in the EHR at our academic medical center. Among the 3 existing EHR tools tested, there were variations in how patients and care team members felt about their potential use. Participants also provided extensive feedback for preferred components (eg, goals and active plans) that should be available in an existing or custom digital solution to manage health-related needs. Findings from the qualitative interviews and design sessions were corroborated with documentation in the EHR. Conclusions: Digital solutions could provide a streamlined approach for the collection and management of health-related needs in surgery, with the goal of addressing unmet needs and improving patient activation. This approach is critical to ensure that patients, especially patients who undergo complex surgery, have positive health outcomes. We identified preferences for specific features in a proposed digital solution based on our systematic assessment that will inform future work.