Delivering results with ERAS® requires both structured implementation and ongoing compliance monitoring. Without these two components, hospitals risk incomplete adoption, inconsistencies in adherence, and missed opportunities for improvement — all of which lead to poor ROI for the investments made in attempts to implement ERAS without the appropriate and proven tools. Many hospitals attempt to develop their own ERAS compliance tracking solutions, often using existing Electronic Health Records (EHRs), spreadsheets, or business intelligence tools. While this approach may seem viable, it presents significant challenges.