Digital Rx

Bouwman and the rest of the DMC's tech-savvy doctors are investigating dozens of other ways to use new devices, along with the clinical-information system, to streamline the practice of medicine. DMC neurosurgeons, for example, are testing some of the latest computer-guided surgical systems. And the emergency room at Huron Valley-Sinai Hospital is now installing a digital status board, which will let doctors, nurses, and administrators access up-to-the-minute information about patients in various treatment bays. Because it will be linked to the hospital's main information system, it won't require staffers to update it manually, as the current whiteboard-and-marker setup does.

"These days, we try to stimulate those kinds of projects rather than suppress them," says Ragan. He and other DMC leaders have sought to infuse the hospital's medical corps with a spirit of openness and exploration. That's why, when the turnaround got under way, one of Ragan's first moves was to crack open the hospital's network. Before last year, security fears had kept the DMC from allowing physicians to access the hospital's systems from outside its walls. Doctors couldn't even perform tasks as basic as using the DMC's email system from home. "We haven't opened up security totally," says Ragan. "But now, with appropriate authentication, any physician can get into the system from anywhere in the world."

Already, more than one-quarter of the DMC's 3,000 doctors are using the clinical-information system remotely, and a much larger number of doctors use the system every day within its various facilities. "We don't coerce people into using it -- at least not right now," says James Selwa with a slight smile. "We're rolling out wave after wave of enhancements to the system, along with enticements to physicians. A year from now, using it won't be optional. There will be no way to order a test or a prescription other than by doing it on the computer. But you need to get more than half of all users on board before you require it -- or else they'll rebel."

Bouwman doesn't worry much about rebellion among his colleagues. "My underlying supposition is that docs hate paper," he says. "It's the main weapon of bureaucracy. Technology can support the art and science of medicine, and it can help us support the business of medicine -- which we acknowledge we have to do."

Vital Signs Improving

Arthur Porter stands over his laptop, punches away at the keys, and calls up slides that illustrate the DMC's financial transformation. "August 2000 was our first profitable month, and September was profitable too," he says. "We will cross the end of the year at almost 2% profit, which is unheard of. This is the first time in DMC history when we've been on budget at this time of year." Thanks to new systems that allow the DMC to collect more-accurate insurance information from patients, the uncollectible portion of its gross revenue has gone from 8.3% in 1999 down to 6.8% in 2000. Losses have shrunk from more than $100 million in 1999 to just $8 million in 2000. And Porter predicts that the DMC will actually make $44 million in 2001.

Porter's office looks across the street to Orchestra Hall, home of the Detroit Symphony Orchestra -- another nonprofit organization that recently engineered a turnaround. Porter notes that both organizations have had to sharpen their marketing strategies in response to shifting demographics and increasing competitiveness. "You've got to spend money to make money," he says. "And we have long been drastically underspending on attracting new patients to the DMC."

And not just any new patients: The DMC's financial woes originated, in part, from its failure to serve a more lucrative clientele. "The problem," says Ragan, "was attracting the people who needed a bypass operation or who were going to deliver a baby" -- in other words, insured patients who were undergoing profitable procedures. While DMC leaders have no intention of abandoning uninsured patients, they hope to lure more middle- and upper-income residents of Detroit, many of whom still see the DMC as a health-care provider of last resort.

The Internet is playing a central role in helping the hospital reach those people. Already, for example, the DMC has rolled out a Web portal for patients that offers general health information, online appointment scheduling, online billing, and help with finding a general practitioner or specialist at the hospital (or anywhere in the world). Says Ragan: "The patient portal will help us accentuate the relationship between patients and doctors -- since, as we all know, patients invariably love their doctor but hate the hospital."