An avuncular man with a gravelly voice, Dr. Michael Simberkoff, 69, fires up his computer. With a keystroke, he’s on a page that lists a patient’s complete health record, including office visits, drug prescriptions, and lab tests.

“Absolutely everything is available,” says the chief of staff at the Manhattan campus of the VA New York Harbor Health Care System. Up pops a reminder telling him the patient - a 44-year-old diabetic - is due to have an eye exam. Simberkoff dispatches the man to the eye clinic on the second floor, where an ophthalmologist administers the test. An alert soon flashes on Simberkoff’s screen saying the exam has been completed.

On the 11th floor, nurse Lumara Romero is using the same computer network to make sure she’s giving the right medication to a 60-year-old patient with high blood pressure. With a handheld device, she scans a bar-coded bracelet on her patient’s wrist and then a bar code on the drug’s bottle. A nearby computer linked to the hospital pharmacy confirms that she’s giving the right drug to the right patient. In the Tele-Health unit on the sixth floor, nurse Maggie Kong-Lopez is reading the vital statistics of a 57-year-old patient in Queens, sent to her computer via a Telebuddy that the VA has rigged at his home.
Today the news is worrisome: The patient, who is suffering from heart disease, has gained three pounds overnight, indicating that he’s retaining fluids. After a few quick phone calls to the patient and his doctor, she tells him to double his diuretic medication today. “We caught him before his condition got worse,” she says with satisfaction.

The dream of modern health care achieved
The seamless integration of science, information, and compassion is the dream of modern health care. Scenes like these are not fantasies, however, but daily realities at the Veterans Health Administration, the federal agency that is the most wired and cost-effective health system in the land.

By making medical information both more centralized and easier to access, wiring health facilities can reduce the errors that the Institute of Medicine, a nonprofit research group that is part of the National Academy of Sciences, says cause at least 44,000 deaths a year. A national health-information network could also save $140 billion a year, estimates the U.S. Department of Health and Human Services.

Just don’t expect that to happen anytime soon. For a $1.9 trillion industry (16 percent of GDP), medicine remains stubbornly backward. Some 90 percent of the estimated 30 billion health-care transactions done each year in the U.S. still occur by phone, fax, or mail. In part this is because the nation’s 700,000 doctors and 5,700 hospitals each collect data in their own way; that makes it difficult to share information. And at $20 million a pop, the price to implement a state-of-the-art IT system is out of range for most U.S. hospitals, a third of which operate in the red. But the promise of a paperless information system is being realized in some corners of health care. There’s the Indiana Heart Hospital in Indianapolis, PeaceHealth in Bellevue, Wash. - and the VA.

The veterans’ health system is the one that stands out because for much of its history it was considered a treacherous backwater offering below-par care in substandard facilities. A low point came in 1992 when the decomposed bodies of three missing patients were found near a military hospital in Salem, Va., a discovery that triggered a federal probe that uncovered lax oversight at several facilities. The VA’s poor reputation even seeped into pop culture. In the 1989 film “Born on the Fourth of July,” Tom Cruise, who plays a wounded Vietnam vet languishing in a wretched facility in the Bronx, shouts, “This place is a fuckin’ slum!”
Today the VA health system - which provides lifetime medical care to veterans with service-related disabilities, as well as to low-income and other qualifying vets and their families - has turned that reputation around. The nation’s largest health network, with 1,300 hospitals, community clinics, and other facilities, the VA beats most other medical providers on dozens of “quality indicators,” such as administering regular cancer screenings or prescribing beta-blockers to heart-attack survivors.

The VA’s transformation
Tech is at the heart of the transformation. A networked software program - dubbed Vista - runs a powerful electronic medical record-keeping system that acts as the VA’s brain. Through Vista, doctors submit prescriptions electronically, minimizing errors that stem from illegible handwriting. They are notified when their patient needs a flu shot, a chest X-ray, or other follow-up care. (In a pilot program, many vets also get reminders over home computers.)

The improved care at the VA hasn’t been lost on veterans. This year the agency expects to treat 5.4 million patients, up sharply from the 2.9 million people it treated a decade ago. Customer satisfaction with the veterans’ health system, as measured by the University of Michigan, has exceeded that for private health care in each of the past six years. “The care is second to none,” says Tom Bock, national commander of the American Legion, the nation’s largest veterans’ organization.

What’s more, the VA has achieved all this while containing costs. As more vets have come in the door, the agency’s overall budget has nearly doubled since 1996, to $30 billion. But the cost per patient has held steady at roughly $5,000. Over the same period, total health spending for the average American shot up more than 60 percent, to $6,300.

“We are providing veterans with more effective, more efficient, and more compassionate care,” concludes Jonathan Perlin, undersecretary for health at the VA since April 2005.

The agency’s new capabilities proved vital after Hurricane Katrina, which destroyed the paper records of untold thousands. But Vista’s electronic health records meant that VA physicians could treat the vets who showed up at their doors as if they had known them all along: Every patient’s health record was there at the touch of a few keystrokes.

“It showed in a vivid way the value of having an electronic medical record wherever you are,” says Jim Nicholson, secretary of the Department of Veterans Affairs.

The VA isn’t perfect. While the agency now outranks other providers on most quality measures, it generally scores in the 70th to 80th percentiles, so there’s room for improvement. And some vets complain that the increased demand is causing unreasonable delays for appointments. Still, the VA’s experience shatters one of the great myths of medicine - that improving care always requires spending more money.

By using tech to practice preventive medicine and reduce unnecessary doctor visits, the VA has proved that quality can actually save money. “The VA turns the paradigm on its head,” says Margaret O’Kane, president of the National Committee for Quality Assurance, a private nonprofit that accredits health organizations based on various performance measures. “It shows that better quality pays.”