While the U.S. health care bureaucracy frets and fumbles over what to do, one Anchorage doctor says he has found a way to care for people in a more satisfying, yet cost-effective way. A newspaper advertisement for Dr. Daniel Steward's office off Dimond Boulevard describes his "Ideal Medical Practice."

It promises 30- to 60-minute doctor visits, and the ability to make your own appointments online and to communicate via e-mail with the doctor.

"If they wake up in the middle of the night and the kid has a 102 fever, they can make an appointment first thing," on their own, Dr. Steward says.

His type of family practice is part of a national movement to focus on excellent patient care. Its value is limited in the larger scheme of health care reform: Steward can't afford to bill Medicare for older patients, Medicaid for poor patients, or Tricare for the military, for example. But Steward's practice does demonstrate how you can effectively use computers to drastically cut costs and simplify.

There's no receptionist or biller in his office. It's just two people, the doctor and a staffer who is both medical assistant and phlebotomist.

He uses an Internet-based appointment program that doesn't tie in with any medical records. He creates electronic medical records based on his computers, using a program that cost $1,000 plus $750 per year for tech support.

Patient reminders go out automatically.

At the end of the day, he takes 10 minutes to get together the billing information and to upload insurance information to a clearinghouse that sorts it all out.

If after the insurance check arrives there's a balance, he e-mails a statement to the patient, or if necessary faxes or mails it. Patients generally call in with a Visa card, he says.

By taking a hatchet to overhead, Steward has found a way to create a more personal family practice that lets him see fewer patients -- his goal is 10 patients a day -- spend more time with them and get to know them better than a doc running 20 clients through.

The direction of medicine overall is headed toward a more collaborative system than one doctor going it alone, and it should be. We can't hope to ever cover the uninsured and people on government programs with limited-access practices.

But the industry can take a lesson from the way Dr. Steward has marshaled computers and the Internet. He's ahead of the game. The good news is other Alaska hospitals and other doctors are racing to catch up.