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Col. Jill Phillips has a stone plaque on her desk at the Walter Reed Army Medical Center in Washington. It reads: 'Failure cannot cope with persistence.'Persistence is a critical aspect of leadership for Phillips, director of Walter Reed's HealtheForces program.'We find a vision, and once we know that the vision is right, we stay focused on that vision,' Phillips said. 'We don't get pulled to the left or the right. That's very important'the focus, the persistence, the passion.'Phillips, an Army nurse practitioner for nearly three decades, demonstrated those qualities in spearheading HealtheForces, an outcomes-management program that supports patients with chronic conditions such as diabetes, asthma or heart disease.The heart of the program is a Web information system that lets patients and physicians provide input and feedback online, creating a comprehensive electronic medical record.The system, built on the Air Force's Integrated Clinical Database platform, provides links for doctors to standards of care known as clinical-practice guidelines and incorporates quality-of-life surveys that patients fill out online.Patient feedback is a unique and important part of the program. Using the online survey, for example, patients can convey the impact of their health-care needs on their daily lives, giving primary-care and specialty physicians an understanding of how their patients' quality of life is affected by the disease and treatments.The ability to organize outcomes data into an easily accessible electronic record is key to the program's success. The old, paper-based process would have been too slow and cumbersome, Phillips said.'We'd have to comb through hundreds of paper clinical records to get at the information we get at easily [via the electronic-record system],' she said.Phillips used'that word again'persistence to overcome some cultural resistance to the shift to an electronic system.'Standing up an electronic health-care record with surveys is 10 percent technology and 90 percent an education process,' Phillips said. 'It's not without its risk when people are very comfortable with paper. You have to be persistent. You have to be a friendly burr under their saddle.'Since deployment at Walter Reed, the program has expanded to other military medical centers around the country.HealtheForces has also attracted the attention of health officials high in the government'David Brailer, national health IT coordinator at the Health and Human Services Department, for one.Brailer is the point person for President Bush's plan for a nationwide health IT infrastructure that would help improve quality and lower costs in health care and reduce medical errors.Phillips has visited Brailer's office several times to talk about HealtheForces.'They're trying to build criteria to determine what's a good electronic health-care record,' Phillips said. 'There has been very-high-level interest in [HealtheForces] be- cause it is government-owned code.'Phillips began proselytizing in the late 1990s for an outcomes-based program for patients with chronic conditions. For her, care is more than tests and measures.'Blood tests are a nice process measure, but it doesn't mean you've improved the patient's ability to cope with their disease,' she said. 'We can't cure those diseases, but we can help the patient work with the disease.'Once she got the support of Walter Reed's top brass, the program got on track and it has stayed there. In 2002, Phillips' IT team integrated the electronic-record system into the program.'We started out capturing health-care outcomes, and then we added the electronic patient record,' she said. 'We moved it to very current technology.'Communicating the vision for a program like HealtheForces is a fundamental part of Phillips' approach to leadership.'When people know that they're moving in the right direction, they are really vested in the work,' Phillips said. 'They don't see themselves as programmers just doing programming; they see themselves as part of a team improving patient care. Therein lies the difference. They want to stay with the project because they understand the vision.'Phillips, born and raised in San Francisco, joined the Army in 1976 because she wanted to see the world. She also wanted to become a nurse practitioner and knew she could get that training in the Army.Her IT knowledge, she said, came from 'OJT''on the job training. She doesn't consider herself a technical expert, but she knows how to develop a vision using IT.'I know enough about it to go with the right decisions,' she said. 'But my strength is developing the vision, getting people to buy into it and assembling the right team to push the vision forward. I'm the thought leader and I have very strong technical people.'