Digital Rx

"What's wonderful about this system is that I can track my own data over the course of years," says Bouwman, 55, a surgeon affiliated with the DMC. "Am I being aggressive enough when it comes to saving breasts? Am I doing too many mastectomies versus lumpectomies? I can also compare my profile with the profiles of other doctors in my peer group."

The move to digital records makes it easier for more than one doctor to treat the same patient: Physicians no longer need to copy paper records and then pass them back and forth between each other. That improves patient care, since it reduces the chance that one doctor won't know how another doctor is treating a patient. And it gives the hospital's bottom line a boost as well. "In the paper world, one patient's medical record may have to be signed by 10 physicians," says Dr. James Selwa, 44, a practicing neurologist who is the DMC's medical director for information services. "And you can't bill the patient until that's been done." The hospital's accounts-receivable picture has already brightened, with the average bill-collection period dropping from more than 100 days to a low of 80 days.

The clinical-information system also helps doctors overcome the constraints of time and space. They now have much faster access to test results, especially over the weekend. (In a paper-based system, test results that arrive late on a Friday often don't get distributed until the following Monday.) And theoretically, at least, doctors can give their counterparts in a foreign country instant access to the medical records of a DMC patient who is there on vacation.

Another element of the Cerner system allows the hospital to archive digitized MRIs and CT scans. "It's much easier to run a radiology department where images never get put on sheets of film," Ragan explains. Digital imaging saves money -- film and film processing are both hugely expensive -- and it saves time. "We're shaving half a day to a full day off the time that it used to take before a physician could see the result of a scan," says Ragan.

The Cerner system is not limited to the simple exchange of data. Doctors can use it to write prescriptions -- thereby avoiding the age-old medical problem of indecipherable handwriting -- or to order and track tests. Here again, savings go hand in hand with innovation. In the predigital days, whenever paper results from a test failed to show up quickly enough, doctors would often simply reorder the test: They had no way of knowing, in a timely fashion, whether the results had been lost or whether the test had never been done in the first place. "That makes costs go up, and it causes the patient to stay in the hospital longer," Ragan says. "Everything that we do with technology has an element of driving out unnecessary costs."

Ragan is something of a demon when it comes to using information technology to gain efficiencies. Before taking on his current assignment, he had been CIO at the Karmanos Cancer Institute, and he had also started a medical-software company while simultaneously heading up the DMC's radiation-oncology department. "I spent 20 years at the DMC casting stones, being a thorn in the side of the IS [information-services] department," Ragan laughs. "So Dr. Porter said, 'Why don't you see if you can do any better?' It's fun. I like a challenge."

New (Digital) Therapies

Other physicians at the DMC are welcoming the challenge of launching their own experiments with technology. In one test that Bouwman is helping to conduct, surgical residents at the hospital are using Palm IIIxe handheld computers to keep track of the patients they're responsible for. "It's not unusual to have a team of 5 or 6 residents who are responsible for the patients of 25 different doctors," Bouwman says. "For each resident, that could mean seeing 40 patients spread across 10 floors and five buildings."

Previously, residents would typically print out lists of their patients and then manually copy, in shorthand, each patient's test results onto the printout. "Now you export the list of your patients to your Palm, with the room number for each patient and with lab results from the last 24 or 72 hours," Bouwman says.

Bouwman hopes that within the next year, residents and doctors alike will be using the Palm devices to access patient histories, to order tests and procedures, and to receive notice of potential problems. "I imagine these things saying, 'Hey, turkey, this patient is allergic to penicillin,' or, 'This patient's blood pressure is 10% higher today, and you've ordered an additional antihypertensive,' " he says.