Since 1995, the Veterans Health Administration (VHA) has had an ongoing process of systems improvement that has led to dramatic improvement in the quality of care delivered. A major component of the redesign of the VHA has been the creation of a fully developed enterprise-wide Electronic Health Record (EHR). VHA's Health Information Technology was developed in a collaborative fashion between local clinical champions and central software engineers. Successful national EHR implementation was achieved by 1999, since when the VHA has been able to increase its productivity by nearly 6 per cent per year.