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A great little book that covers some of the history involved is Best Care Anywhere: Why VA Healthcare Is Better Than Yours by Phillip Longman.

The VistA system used by the VA was developed in bottom-up fashion by doctors and interns, who snuck minicomputers into the hospitals in defiance of the mainframe-based IT staff, which went around removing them. One year IT removed more computers than it installed.

But VistA ended up so well-suited to doctors' needs that it ultimately won. Now it's open source and is the basis for several national healthcare systems.

It's a complete medical records system, makes it easy to get instant lab reports, prevents medication errors, etc. About the only thing it doesn't cover well, for obvious reasons, is dealing with insurance companies.

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