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Though most American medical centers are information technology backwaters, one Washington hospital has spent millions wiring its chaotic emergency room. It has saved a lot of money -- and, more important, lives.

If this were a busy day at an ordinary trauma unit, here's what would likely happen next: nothing. For 20 minutes or more, staffers would move on to other patients as they waited for the scan to be retrieved from the CT suite. Eventually someone would ask, "Where's Fred's scan?" If no one had retrieved it, an attendant would scurry to the CT suite, look through a pile of films, find Fred's, rush back to trauma, tack the film to a lighted board, and shout, "Fred's scan in." If no one happened to hear that announcement over the trauma room din, Fred would have to wait until someone remembered again.

All these delays and unknowns are not a good thing. In the "golden hour" after a major trauma, a patient's chances for survival grow slimmer with each tick of the clock. A Washington Hospital Center researcher says 40 to 60 percent of a typical ER physician's day is spent hunting for data.

But Fred has already caught one break. He's in a trauma room that is outfitted with state-of-the-art computer systems. Fred's CT scans appeared on PCs in the trauma unit before he even returned from the CT suite. Because the scans are digital, the crew can adjust the contrast and zoom in or out with simple key commands, keeping the need for additional scans to a minimum. Should Fred have a subdural hematoma -- a blood clot in the brain that needs surgery fast -- neurosurgeons won't have to wait for Fred to arrive with the scans at the foot of his gurney to review his records. They will have seen them on their PCs before Fred even leaves the trauma unit. "It took us 20 minutes to get CT scans before. Now it's two to five," says chief ER resident Chris Kowalski. The doctor has studied Fred's scans on an emergency room PC. He glances at the groaning patient. Time to get to work.

With 907 beds and annual operating expenses of $600 million, Washington Hospital Center (WHC) is the largest medical facility in Washington, D.C. Until recently, it was about as sophisticated in information technology as most hospitals, which is to say, it was an IT backwater. A recent survey conducted by polling company Harris Interactive found that only 28 percent of physicians use a computer to access patient information. Similarly, a study done last December by PricewaterhouseCoopers found that hospitals dedicate only 2.5 percent of their budgets to IT, while other industries spend three to four times as much; the consulting firm also claims that hospitals lose $11 billion a year by not buying supplies online.

But many doctors say the biggest consequence of being unwired is that 40 percent of critical patient information is missing when doctors need it. And certainly, before WHC got its computers in place, its ER's condition was critical: Through the early 1990s, respondents to Gallup polls voted the ER the worst in the region. Its patients waited six to eight hours on average for treatment. Some 4 percent of charts were lost, or were missing critical pages, before they reached the billing department.

Today, the ER at WHC is one of the most technologically advanced in the country. Not coincidentally, its patient load rose from 37,000 in 1995 to about 59,000 in 2000 -- with no increase in staff or space. On most days, 70 percent of its ER patients are sent home within two hours. Only 0.001 percent of chart info is missing before billing.{previously 4%} In a 1998 Gallup poll, the WHC emergency room was ranked number one in the D.C. area. {previously voted the worst in the region}

Much of this transformation can be credited to Craig Feied. A small, bearded man in bow tie and suspenders, the 46-year-old Feied is a medical rarity: both a gifted physician (president of the American College of Phlebology) and a first-rate technologist. He created his first device in "my little inventor's shed in the backyard" at age 7: a water heater made from a radio coil dropped into a cup of water and plugged into a wall. "I guess that was kind of dangerous, now that I think of it," he says. He got the computer bug at an early age, and paid his way through college by creating a company whose software helped proprietary computer systems or different databases communicate with each other. Feied had launched the company at age 18.

He found his professional calling, however, not in computers but in medicine, and ended up in the ER, where, he says, "not a day goes by when you haven't saved someone's life." {Skyaid will save 3,000 lives daily} But the software writer in him was horrified by the chaos and inefficiency of the ER. As an emergency physician at George Washington University Medical Center, also in Washington, he saw huge time delays occurring for ridiculous reasons: For instance, when electrocardiograms were done, they were tossed in the back of a rack, not handed to doctors. Feied made a name for himself at George Washington by pushing for a number of simple procedural changes that made the ER run more smoothly.

He also drew lessons from a side business he started that provided medical services for movie production teams on films like The Abyss and Total Recall. Unconstrained by tradition-bound hospital culture, he could build medical systems from scratch for almost any contingency. On a shoot, say, in the desert, free to improvise, "you can efficiently save lives, money, and time. If we can create a process de novo in the middle of the desert, why can't we do it effectively in an ER?"

After a Gallup poll found that George Washington's ER had become the most respected in the area, administrators at WHC, ranked lowest in the same poll, begged Feied and George Washington ER chief Mark Smith to switch to WHC, offering a two-word mandate: "Fix it." Feied demanded the freedom to create his own system and work outside the bureaucracy. {similar to General Electric "Black Belts"} He got it. He and Smith arrived at WHC in November 1995.

WHC was then what many hospitals still are: a lumbering bureaucracy with a virulently anti-IT culture, a place filled with "free-roaming doctors used to doing things their own way," in Feied's words. "Local-area networks were only just being installed, and if you wanted to buy a computer, [the purchasing department] chose the vendor," he says. "There was a policy against computers in the clinical emergency department. If a PC came with Windows, by policy it was taken off and DOS put on. No graphical user interfaces were permitted."

"Secret knowledge" was required to obtain what electronic data existed, Feied says. He relates the tale as if telling a grandchild what life was like in the era of the gas lamp -- yet it reflects real conditions only five years ago in the largest hospital in the nation's capital. "Say you wanted a lab result. You had a green screen, 80 characters by 24. You'd go to that screen, type in your user name and password, and hit PF4. If you hit Enter, it locked -- you had to know to hit PF4. Then you had to choose among cryptic messages -- OIG or AOD. Then you had to know to hit Enter to jump over four or five zeros, and to type a zero. Then you typed in a number that was either the patient's medical record or billing number, but nobody could ever remember which, so you'd try one ..." And on and on.

With three tech-savvy employees and $500,000 to buy hardware, Feied and Smith set about fixing things. They figured they knew what ER physicians really craved: a computer system that would knit together scattered islets of information and allow doctors to organize data however they wanted, on the fly. Scrapping WHC's entire existing system would have been expensive. So Feied built "bridges," 36 interfaces to 50 data sources. Among them: written lab and radiology reports, in 1996; visual X-rays -- rare for a hospital -- in 1998; and visual CT scans -- even rarer -- in April 2000. (At the core of the system is some heavy-duty hardware -- about 80 servers, linked to 120 PCs. The hardware drives what is in essence a series of relational databases fronted by a browser that enables easily personalized user views.)

The system's promise of enabling physicians to organize information any way they want is crucial, says Alton Brantley, CIO of Medstar Health, which owns the hospital: ER doctors "have no idea what information they're going to need on any given patient." The WHC network is "much freer than most," Brantley says. Doctors at other hospitals are also impressed. "What Craig and Mark have accomplished is remarkable," says Steven J. Davidson, ER chief at Maimonides Medical Center in Brooklyn.

The payoff is easy to see on a visit to WHC's emergency room. Patients sail this way and that on bargelike gurneys. Two physicians stand in the middle of the room before a row of computer screens, talking on cell phones and fiddling with mice. One doctor is using an online textbook to look up a drug to counteract the effects of another medication, a task that's taking him critical seconds, not critical minutes. On another computer screen, a physician is reading the results of old lab tests -- helpful, since his debilitated patient can't tell him what tests have previously been performed. Within seconds after a patient rolls through the front door, the system can access records of his prior WHC visits. It used to take hours to retrieve paper copies of such records.

Meanwhile, the network is playing classical guitar music selected from one of the touch-screens by a staff member. By flagging patient records whenever a glucose level over 200 is punched into a computer, the system is quietly catching patients who forgot to mention -- or didn't know -- that they have diabetes.

In the ER, the changes are considered powerful medicine. "When a patient comes in, we can automatically retrieve all his prior ER visits instantly, and see what was done," says physician David Rosenberg. "We can sort the database to come up with the name of a patient who we knew came in with a particular symptom on a certain day by filtering the database accordingly." Another doctor declined an outside job offer, noting he'd be "going back to the Stone Age" in any other ER.

Still, Feied says, the system must reach its tentacles into far more than 50 data sources for him to be satisfied. To demonstrate this point, he walks over to a black box at the side of the ER and peers in tentatively, like a kid looking through a keyhole. When an eye -- his eye -- as big as his head appears on a nearby monitor and flashes the words recognition and Craig Feied, he smiles with visible relief. Yesterday the iris scanner wasn't working. A staffer was in until 4 a.m. trying to fix the problem. But the machine works now, and when an ER addition is finished next year, the plan is for patients' eyes to be scanned and filed as data. Feied hopes it will end another common ER problem: patient mix-ups.

WHC recently installed the largest wireless telemetry unit in the region, allowing any patient's blood oxygen level, blood pressure, and temperature to be monitored constantly. Feied also has experimented with equipping machines, patients, and staff members with radio transmitters so his system can track their movements. People wear the transmitters on strings around their necks. One possible use: instantly notifying doctors if a patient on suicide watch tries to leave the ward. When the tags were in trial, "it was weird, like Big Brother was watching," Rosenberg says, grinning. "But if it works ..."

Then there's the voice recognition software. It's live, but little used so far. Feied hopes that one of his technologically savvy doctors will experiment with it -- say, dictating patient summaries and chart information into the database -- and draw a jealous crowd. That's how he sold his doctors on the whole system in the first place. He plopped the terminals in the middle of the room, and waited for crowds to form -- waited for doctors to launch their own silent, natural evolution in behavior.

It's a key part of his philosophy. To make systems like this work, you can't "overplan," Feied says. "Landscape architects who built big campuses in the old days built all walkways on paper before ground was even turned. But often they found they hadn't built where people wanted to walk. Nowadays they put turf in everywhere, then wait to see where people walk. Wherever people have worn a path in the turf, that's where they pave. That's what we did. We put in turf, allowed people to walk where they wanted, then paved in the parts people were using."

Overall, Feied says, he is pleased with the progress at WHC. "We had a personal goal," he says, "to become the most technologically advanced ER in the world." Although he expects to reach that point soon -- and some people think he already has -- he is less optimistic about his chances for accomplishing all his objectives. For if an all-knowing ER system is doing its job, it is constantly changing, like the ER itself. When does Feied think his mission will be complete? "Never," he says.

If his head wasn't split open, Fred, wheeled into the trauma room earlier on a gurney, might tell Feied not to be too hard on himself. Chief resident Kowalski has reviewed the digitally transmitted CT scan of Fred's skull. Fred has a concussion, a nasal septal fracture, brain stem contusions -- but nothing that requires emergency surgery. He's hurting, but Kowalski stitches up his head, and within hours Fred is resting in a ward. He'll be observed, and then released in two days. Before Feied began transforming the ER, Fred's treatment could have taken hours longer. Hours that critically injured patients don't have. Hours that Kowalski is able to spend on patients who need him more.