Everyday across the U.S., tens of thousands of patients in the Veterans Administration health system start their day by answering questions about how they feel. But they aren't meeting with a doctor or a nurse — or even talking to them on the phone. Instead they are pressing buttons on an alarm clock-size device called a Health Buddy. Some of the patients will connect a weight scale or a blood pressure cuff to the device, which transmits the information to a VA database where it is analyzed for warning signs of impending health problems. The VA's 49,000-patient network is part of a quiet revolution in health care dubbed "telemedicine," aimed at improving care and lowering costs by keeping patients out of hospitals and nursing homes. The cost of monitoring a VA patient at home is $1,900 per year, compared with $77,000 for nursing home care, according to the government agency. Most of the patients in the VA program have chronic diseases like diabetes, heart disease and depression. With health care costs consuming nearly a fifth of the economy, devices like the Health Buddy offer one way to manage the wave of baby boomers that will require more and more medical care as they age. Telemedicine has been endorsed by doctors and care takers who believe seniors fare better at home, amid familiar routines and surroundings. Even doctors at tech savvy medical practices point out the technological and economic hurdles.