Electronic health records have become an integral part of healthcare. The electronic health records (EHR) is a system that provides medical records in electronic form while allowing for information interchange with other facilities such as laboratories. The system guides physicians to make the correct decision, such as prescribe right medicines to the patient. A successful EHR implementation increases the operational efficiency and improves the quality of patient care provision ( Jha et al., 2009) . However, while the benefits of an EHR system are clear, application and adaptation of the system can be challenging due to complexities. A good implementation plan delivers on schedule, increases adoption among stakeholders, and increases its adoption success.
This paper discusses the implementation of EHR in acute care general medical and surgical hospitals in the United States. In healthcare, a medical and surgical hospital is a facility that is established to provide medical and diagnostic treatment to inpatients. The facility engages in providing medical care services to inpatients while maintaining beds to meet their medical needs ( Hirshon et al., 2013) . The acute hospitals offer a wide variety of services to inpatients including clinical laboratory, x-ray, pharmacy services, anatomical pathology, and outpatient services. The hospitals deal with all types of common diseases including critically ill patients.
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The acute medical and surgical health facilities are categorized as profit, non-profit, and state establishments. The acute hospitals are structured around an administrative staff overseeing all nursing and managerial functions. Its benefits arise from providing quality patient care to patients and improving customer experience. In this regard, the hospital has to look for measures to facilitate customer satisfaction through technological changes and innovation ( Hirshon et al., 2013) .. Implementing electronic health records in the general medical and surgical acute hospital is a long process that requires a plan that delivers on schedule. The implementation is a comprehensive set of steps and strategies that starts with assessing organizational readiness in terms of infrastructure, staffing and skills
The crucial first stage is to select an EHR and determine the approach for transferring data from the old system to the new EHR system. This is the point where the implementation team deals with setting up the EHR database, converting paper records to electronic, data cleansing, and verification. Data transfer to the new system is the first phase of implementing the EHR program and move away from the paper records ( Lorenzi et al., 2009) . This step of EHR implementation happens after the health facility has the necessary hardware and software tools to facilitate the process. The technology should be in place to facilitate functioning of the EHR system.
As a result, the implementation process starts by transferring data from the former record system to the new program. Most experts recommend starting with crucial information such as major illnesses, medications, immunization, and laboratory results for active patients ( Lorenzi et al., 2009) . Once the critical information has been keyed into the EHR system, the rest of the data can then be transferred. There are several ways of migrating data into the new EHR system, depending on the implementation plan. For example, an organization can assign the responsibilities to exist staff or hire additional staff to upload information into the new system. The process of migrating data can be made smooth by preparing a checklist of items to be entered in the electronic health records and doing the migration. Having a list is crucial to ensure no information is left out during the transfer.
The second stage is to decide on the launch approach, whether it is an incremental or big bang. This step comes once the EHR implementation plan is ready to go. Gradual implementation of EHR entails step-by-step changing of the hospital functions, starting in one department and gradually introducing into the other departments as it assesses its success ( Lorenzi et al., 2009) . It is a slower approach to implementing the EHR program by introducing it one at a time. This approach is easier to manage while making the physicians ready for the change. It also ensures a smooth transition for patients and staff. Another method is use of big bang approach that entails converting all functions to EHR on the same day. Organizations can use this approach when seeking to reduce the implementation time and ensure the one-time transition ( Lorenzi et al., 2009) . However, this approach can be accompanied by risks of poor implementation that can disrupt operations. Once the implementation team has decided on the launch approach, they can accustom to the new system in practice.
The third step of EHR implementation is to create a training plan that is essential for the success of the implementation process. It ensures all stakeholders are well equipped with necessary knowledge and skills in operating the EHR system when launching it. Training should be provided just before starting the program after identifying members of the practice who require training in necessary computer skills ( Lorenzi et al., 2009) . The organization needs to create a training plan to ensure all physicians gain the knowledge and skills before launching the program. They need to be trained on technical aspects of the system as well as workflows and appropriate procedures.
Successful implementation of EHR needs adequate, role-specific, and appropriately timed training off the entire practice. A better training program has to start slow by touching on the necessary skills before getting into complex issues to avoid confusion. Additional training to increase skills are introduced once the team is comfortable with using the system. Successful training program for EHR implementation includes role-based training to ensure relevancy, clear communication channels, and feedback loops ( Lorenzi et al., 2009) . It can also be carried through peer-to-peer training, such as nurses teaching nurses. The value of training can never be overstated since lack of knowledge on how to use the EHR effectively affects its implementation. The success rate of the program is tied to the quality of training to avoid any mistakes.
References
Hirshon, J. M., Risko, N., Calvello, E. J., Ramirez, S. S. D., Narayan, M., Theodosis, C., & O'Neill, J. (2013). Health systems and services: the role of acute care. Bulletin of the World Health Organization , 91 , 386-388.
Jha, A. K., DesRoches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G., ... & Blumenthal, D. (2009). Use of electronic health records in US hospitals. New England Journal of Medicine , 360 (16), 1628-1638.
Lorenzi, N. M., Kouroubali, A., Detmer, D. E., & Bloomrosen, M. (2009). How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC medical informatics and decision making , 9 (1), 15.
