Origins of the Veterans Health Administration Although health and social support for aged or disabled soldiers has existed in the United States since Colonial times, the spectrum of national programs for American veterans was consolidated with the establishment of the Veterans Administration in 1930. Resources for social services expanded rapidly following World War II with the Servicemen's Readjustment Act of 1944 (better known as the GI Bill of Rights), and a hospital system that specialized in meeting the rehabilitative needs of more than 1 million returning troops who had experienced physical and emotional trauma expanded and evolved. The Veterans Administration was elevated to Cabinet status and became the Department of Veterans Affairs in 1989, with financial support programs such as pensions administered under the aegis of the Veterans Benefits Administration and health services consolidated in the Veterans Health Administration (VHA). The Secretary of Veterans Affairs directs the activities of the department, and the Under Secretary for Health serves as the chief executive officer of VHA. Structural and Organizational Transformation Since 1995 Until the mid-1990s, the VA operated largely as a hospital system providing general medical and surgical services, specialized care in mental health and spinal cord

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ABSTRACT:The Veterans Health Administration (VHA) is a unique laboratory for using the electronic health record (EHR) to transform health care and accelerate discovery. This is particularly evident in the care of veterans with diabetes, who constitute a quarter of those served by the VHA. Although EHRs have enabled rapid learning, additional factors were necessary, including the lead participation of clinician-investigators, accountability through performance measurement, a delivery system focused on population health, and favorable economic externalities. "Off-the-shelf" technology is unlikely to generate similar benefits if these attributes are not in place. [Health Affairs 26, no. 2 (2007) A s t h e l a r ge s t i n t e g r at e d d e l i v e ry s ys t e m (IDS) in the United States, the Veterans Health Administration (VHA) serves 5.3 million patients annually across nearly 1,400 sites of care. Although its patients are older, sicker, and poorer than the general U.S. population, the VHA's performance now surpasses that of other health systems on standardized quality measures. 1These advances are related in part to the VHA's leadership in the development and use of electronic health records (EHRs). In this paper we describe the VHA's health information infrastructure and factors that made it possible, illustrating its impact on research in and care of diabetes, one of most prevalent conditions w 1 5 6 2 6 J a n u a r y 2 0 0 7

Background-Hypertension treatment and control remain low worldwide. Strategies to improve blood pressure control have been implemented in the United States and around the world for several years. This study was designed to assess improvement in blood pressure control over a 10-year period in a large cohort of patients in the Department of Veterans Affairs.