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.