The VA Hospital system is a worthwhile model to ponder as we look at the possibility of national healthcare. Those who have actually investigated the VA operation are uniformly impressed. Here’s the latest story, which begins:

Divya Shroff, a staff physician at the Veterans Affairs Medical Center in Northwest Washington, stops what she’s doing to answer her phone: It’s a doctor down the hall who needs help with a man struggling to breathe.

She calls up the patient’s medical record on the computer at her desk and scrolls through lab reports, doctors’ notes, X-rays and EKGs, thinking out loud with the medical resident, who is at the man’s bedside.

Strep pneumo in the blood. Chest film looks like he’s accumulating fluid. Supposed to get a chest tube. Hard to wake up. No new meds that would be sedating him. Looks like he needs the ICU.

Over the next 10 minutes, Shroff visits the patient’s room and the ICU, and in both places summons his medical record on other computers while she talks with a half-dozen people about what needs to be done. She spends no time looking for the patient’s chart, riffling through paper or decoding handwriting. Nor does she ask anyone to take her word for things. She just lets the evidence — all of it right there for everyone to see — make the case that the patient needs to be moved as soon as possible.

It turns out to be the right decision. Soon after he gets to the ICU, he stops breathing. Doctors resuscitate him and put him on a ventilator.

Did the electronic medical record save this 71-year-old man? It’s impossible to say.

But this much is clear: Never again will a VA patient’s chart be an excuse for things not happening efficiently. Never again will information that is lost, hard to read or impossible to move from one place to another be a factor in the complicated calculus of what makes good medical care — and, on occasion, saves lives.

The electronic medical record is the most important single development helping to usher in the Era of No Excuses in modern medicine. It is an age in which clinical decision-making, physician performance and patient outcomes are increasingly transparent; patient safety is mechanized; and the once-secret medical chart is sometimes open to contributions from the patients themselves.

Electronic medical records make confusing and physically unwieldy masses of data instantly available, portable and searchable — altogether more useful than when the information was stored on paper. Computer-accessible records have the potential to save the cost-strangled American medical system billions of dollars in waste, repetition and error. They may also prove to be essential tools of research, allowing scientists to examine patterns of medical practice, drug use, complication rates and health outcomes.

Since 1999, the VA’s 155 hospitals, 881 clinics, 135 nursing homes and 45 rehabilitation centers have been linked by a universal medical records network. It allows any authorized person to look at 5.3 million patients’ records — everything from a nurse’s note written during a hospital stay, to the result of a blood test drawn at a clinic visit, to the moving-picture film of a coronary angiogram done in a cardiology lab.

Even though President Bush has set a goal of 2014 for when most Americans should have their medical information stored electronically, the Department of Veterans Affairs is today one of the few health systems — and by far the largest — that is virtually paperless.