You did good work on the Discussions this week.  Thanks for sharing your background in D1 and for using your personal experiences in D2 and D3. 

I would like to highlight the comments made in several areas.

Change Management : Brian made comments about use of computers in his family business. Large businesses may also be very resistant to change. It is important to plan and manage change as part of any systems effort. Traning and coaching can be an important part of bringing a new system into a business.

Electronic Medical Records: Insurance companies have been digitally storing claims information including photographs for many years so we know the storing Medical Records electronically is technically feasible. I now see very little paper in my doctor's office. Health Level 7 (HL7) is a developing standard for exchanging Electronic Medical Records. See http://en.wikipedia.org/wiki/Health_Level_7 to get an idea of how complex the the process of exchanging medical records will be. Personal opinions: The psychological, social and technical challenges to implementing effective Electronic Medical Records are immense (in my opinion). You are right to be concerned about privacy and security. Paper backup of EMRs will not be feasible just considering the cubic feet of storage that would be required.

System up time: Dominican ran on backup generators for three weeks this summer. As a customer of Dominican Information technology, I was very happy that Dominican had good disaster recovery planning.

Technology Change: You gave Groupon as an example. I use the Groupon App on my iPhone and as a result have eliminated the need to print and carry paper coupons. Groupon has required all their partners to accept electronic input. That is the key to eliminating parallel paper based systems.

My opinion is that many businesses will need to deliver their content and applications to mobile devices in order to remain competitive. Also, as a techie, I need to totally replace my technical knowledge every 5 years. My current learning projects are Objective C (iPhone) and HTML5/CSS (technology for building interactive web sites).

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Computer specialists: I have been both a compute specialist and a manager at various times in my career. If a computer system is being designed or implemented for your department, DO NOT decide you "don't have time" to work on it. As you saw in the Discussion, computer specialits will probably not understand your business or your department and therefore will implement something that could be painful to use. Become actively involved with the design decisions, training plans, and implementation schedules.

Staffing: Kathleen commented that some managers do not have good knowledge of the systems they use in their departments. I agree with the comment that it is important for computer specialists to interact with the people doing the work as well as management. In fact, on my development projects, I knew I had the right person on my project when their manager would claim that they "were too valueable to be working on a systems project".

Web Sites and specialists:

You gave examples of problems building web sites in small companies. Here is my analysis: