Although Smith says that their 6000-plus health care workers participated in the system's development and implementation, I have found no details on just how this came about. Baker describes the need for the staff to have an ID and password before they could treat hospital patients. Improvement in services, especially pharmacy, is also mentioned, as well as a faster time to get test results in other departments such as X-ray. What isn't mentioned are the obstacles met and resolved during implementation of the new technology. Baker does say that, according to Smith, other systems, not referred to by name, were studied and found to be lacking, and the reason for one failure was because staff usage was voluntary, and not enough people signed up to use it. This is the only reference to an obstacle. Baker says that Smith attributes the success of Epic at ENH to the commitment of management to make it a priority. In fact, most of the credit is given to management, even though cooperation of staff appeared to be very much a contributing factor. Although Baker did describe the system set up with staff to make the system work, none of the pros or cons faced by them was covered.
In past years, especially before the year 2000, patient record keeping in health institutions focused far more on the financial records of the institution, with computer usage mostly in accounting. Patient tracking did not always exist as a complete package, combining physician, laboratory, hospital, and information records. Because of layoffs in the health field, in clerical as well as medical areas, filing was not always up to date, and records were sometimes missing. This led to medical errors. The computer as an interconnected unit collecting all information on a single patient was not being utilized. As the millennium drew near, the need for updated systems of communication through information technology became evident, and a concerted effort was made to prevent data loss with the advent of Y2K. Even though the anticipated problems never really materialized, the use of electronics became the system of choice for record keeping and intercommunication. The institution of new programs and increased computer usage meant setting up training programs for workers who often had no previous computer knowledge.
One factor not addressed in Baker's article is whether management explored assistive technology to aid disabled people in an age in which the emphasis is on equal access and function. According to a recent article on access for the disabled, "at the systems (or public technology) level, technology provides access that enhances community integration and equal opportunity. ("Technology for Access and Function," par. 3). In looking to the future of information technology in health care, the events that followed Hurricane Katrina and Rita in Louisiana were unprecedented, and that state finds itself rebuilding its health care system. The Rand Corporation set up an institute for a