It has taken between 30 and 40 years. About 30 years ago, we put into place the core systems of laboratory, pharmacy, and radiology, so that you could look up the results. About ten years ago, it migrated to the electronic health records system, which put a graphical user interface on top of the existing systems and their provider tools. At about the same time, the Institute of Medicine published information about errors caused by illegibility. It was a move to get rid of the problems we had with paper records.
Not all of our VA sites perform heart surgery, so we have a lot of referrals from the smaller clinics to the larger ones. A lot of it was born out of the inability to transfer paper records efficiently enough to keep up with patient care. In the beginning, it didn't have anything to do with being a luxury or being cutting-edge. It had to do with the logistics of not being able to move this paper quickly enough for patient care.