Editor's note: In Montana and the nation, the cost and availability of health care has become a burning issue. Nearly one-fifth of the state's citizens are without health insurance and health care costs continue to climb faster than inflation.

In 2006, the Lee Newspapers State Bureau began examining factors behind these costs, as well as looking at alternatives to our current health care system.

The series' fifth installment continues today, with a look at the medical-records technology used by the VA nationwide and the care returning soldiers receive.

Walk into any Veterans Administration health care facility in the nation as a patient, and the physician or pharmacist won't have to ask about your medical history - because they'll already know it.

If you're diabetic, they'll know when you had your last eye exam. If you need a prescription, they'll know what other drugs you're taking and any drug allergies you have. If you had an X-ray last week in Florida, the VA doctor you're seeing anywhere in the country can look at it.

It's all courtesy of the VA's Computer Patient Record System, a 12-year-old electronic system of medical records that serves all 1,400 clinics and hospitals in the VA health care system.

"It's a fabulous computer system," said Mike Evans, a surgeon on staff at the VA hospital in Fort Harrison, west of Helena. "It has led to better quality of care and more preventive medicine."

Public-health systems in other countries are using CPRS, such as Germany and Finland. The system's software, developed by the U.S. government, is in the public domain and can be purchased for a few dollars.

But in the United States, the private sector does not have a comparable integrated medical-records system. Private hospitals, clinics and other providers have their own computerized systems, but they usually can't talk electronically to each other.

A coalition of health care businesses in Montana has been hoping to begin work on an electronic medical-records system for the state, but has yet to secure funding.

"In the private sector, you won't get buy-in from a private doctor's office in town to integrate with some other hospital," said Alex Brown, medical coordinator for CPRS at Fort Harrison. "We have an advantage in that we're the VA; we're a closed health care system."

Brown, who's also a dentist, said he believes if a similar system served all medical providers in a single Montana community, like Helena or Billings or Missoula, it would save millions of dollars and greatly reduce medical error.

The VA health care system, which serves 5.3 million veterans in Montana and the nation, is a publicly funded, government-owned system that has seen a remarkable turnaround in quality and focus the past 15 years.

A good deal of credit for the change goes to the VA's computerized records system, which has become a powerful clinical tool that helps physicians, nurses and other staffers do a better job, VA officials and staffers say.

For example, before a VA hospital patient takes a prescribed drug, the attending nurse scans a bar-coded wristband worn by the patient. The drug, which has been entered into the system by the prescribing physician, must match the bar code on the wristband.

"We have cut our medication errors almost to nothing, as a result," Brown said.

Another example is a patient with diabetes, who will have a series of "clinical reminders" in his or her electronic file. Diabetics are supposed to have periodic eye exams, foot-sensation exams, urinalyses and other tests.

When a physician sees the patient, a check of the records system will show when the diabetic patient last had those tests and when a new test is due.

VA pharmacists also have access to the system. Lori FitzGerald, director of pharmacy for the VA in Montana, said prescriptions are ordered via the computerized system, so there's no problem reading anyone's handwriting and pharmacists can see the patient's drug and medical history.

"As we're finishing prescriptions, we have access to the doctor's notes, the lab (results), so we can do a better job of assessing whether this drug is appropriate for the patient and whether the dose is right," she said.

The system is accessible at every VA hospital, clinic or other site in the country.

Diana Corzine, a physician at Fort Harrison, said that fact alone can be a great time and money saver. Veterans who are traveling and get injured or sick, or forget a prescription, can stop into any VA facility and the doctor or pharmacist can call up their medical records in seconds.

"You go into (the VA pharmacy) and say, 'I forgot my blood-pressure pills, can you get me a two-week supply?' " Corzine said. "They look it up and the say, 'OK, I see that you're on that medication, let me get it for you.' "

Desktop computers are ubiquitous at the VA; every physician has one and nurses carry laptop computers as they dispense drugs to hospital patients. Physicians are required to use the system, making an entry each time they meet with a patient.

Brown said there was resistance when the VA began switching to its computer-records world in the mid-1990s. Some physicians actually left the VA because they didn't want to do everything on computers.

"If we would have asked (physicians) about this when we first brought it up 11 years ago, they would have said, 'Get rid of this thing; I want to do it the way I've been doing it,' " he said. "You go around and ask them today: 'What if we got rid of this thing and went back to paper?' They'd say, 'Oh, no, I don't want to do that.' "

In Montana's private health care sector, a group known as HealthShare Montana has been trying since 2007 to secure $1.5 million in funding to begin work on an electronic medical-records system that could serve the state.

Mike Foster, regional director of advocacy for St. Vincent Healthcare in Billings, said the group wants to work toward a system that would allow any participating health care provider to access medical information on any patient.

"We want to make sure that (electronic) systems can talk to each other, for the benefit of health care consumers in Montana," he said. "We believe that it will cut costs and increase efficiency."

Foster is hoping the 2009 Legislature will appropriate $1.5 million for a pilot project or will at least give out half the money, with the other half coming from the federal government.

Yet for now, the VA's electronic-records system remains the gold standard in Montana and the nation.

"The advantage is that you have a total picture of a patient wherever they show up, for whatever treatment, at any time," said Brown. "We can pull patient medical data from anywhere, at any time."