Did you know that the Veterans
Health Administration is the largest single medical system in the country?
It is also one of the most efficient, and, according to numerous independent surveys,
provides the highest quality of care.

A colleague frequently praises the VA for ease of use after
he takes his father, a World War II veteran, to the VA Medical Center in Long
Beach, California.

"We wait, just as one does at any doctor's appointment. But
when we see the doctor, he or she knows my dad's history, knows what the plan
is for this visit, and can instantly review and adjust his prescriptions.  By the time we walk down to the
pharmacy, everything's ready. We order refills online and they arrive at the
house without a hitch."

I've heard similar stories from others, and wondered what
measures and methods helped such a giant organization provide such excellent
service. The question is more intriguing because many people imagine VA
hospitals to be dirty, inefficient, uncaring places, as depicted in such films
as Born on the Fourth of July.

Much of the VA's success comes from clarity of mission: the
VA serves those who have served, and does so proudly. But the big secret of
their turnaround is something known as VistA, the Veterans Health Information
Systems and Technology Architecture. I don't understand technology all that
well, but this seems to be a clear case of problem-solving engineering - and everyone
can understand the results.

According to a 2005 article in Washington Monthly, "...the National
Committee for Quality Assurance today ranks health-care plans on 17 different
performance measures. These include how well the plans manage high blood
pressure or how precisely they adhere to standard protocols of evidence-based
medicine such as prescribing beta-blockers for patients recovering from a heart
attack. Winning NCQA's seal of approval is the gold standard in the health-care
industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo
Clinic? Massachusetts General? Nope. In every single category, the VHA system
outperforms the highest rated non-VHA hospitals."

In various incarnations, VistA has been in development since
the 1970s and in use since the 1980s, winning many prestigious awards along the
way. To say that VistA is an electronic medical record barely scrapes the tip
of the iceberg. The system includes advanced imaging and communications
capabilities, and offers an elegant interface accessible to every level of
healthcare worker in the VA system.

Internal communication has improved dramatically since the
adoption of VistA, raising the VA's pharmacy prescription accuracy rate to
99.997%.

The VistA software is in the public domain, available to
anyone who cares to download and implement it. Of course, "not-invented-here
syndrome" is so prevalent that most healthcare systems still rely on expensive
and less effective proprietary systems. Even the Department of Defense does not
use VistA, which resulted in congressional chiding after healthcare scandals
involving returning Iraq and Afghanistan veterans.

It takes more than a good information technology system to
produce a customer service hero, but the VA's VistA shows how such tools help a
motivated, mission-driven organization to provide excellent service on a truly
massive scale.