HEN nurses make rounds at the cardiovascular surgery unit of Miami Children's Hospital, there is one piece of medical equipment that is missing: the clipboard. Instead of writing information about the patients on pocket-size cards, nurses tap away on hand-held organizers.

As soon as the patient information is gathered, it moves by wireless modem through a network to a server elsewhere in the hospital, making it available through a password-protected Web site to doctors and other health care providers.

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In many workplaces, the process would hardly seem exceptional. But by the standards of the medical community, the Miami system verges on revolutionary. While medicine has long utilized sophisticated technologies to diagnose and treat health problems, the methods doctors and nurses use to record and track those diagnoses and treatments have remained remarkably unchanged for almost a century.

But the hand-held computer may someday be as ubiquitous as the stethoscope, as the medical industry adapts to new federal regulations on the privacy of medical records, released earlier this month, and works to overcome the problem of records and drug prescriptions based on the infamously illegible handwriting of doctors, which studies have shown are error prone.

For now, the cardiac unit in Miami has one of the most extensive hand-held systems in the medical industry. A small but growing number of hospitals are using palmtops for writing prescriptions, consulting reference manuals and, in a few cases, keeping records, although generally in a more limited way than Miami's system.

Dr. Edward H. Shortliffe, chairman of the department of medical informatics at Columbia University, said that earlier initiatives to expand computing in medicine bred mostly suspicion. "Why is medicine behind other segments of society?" he said. "There's no simple answer. But there is something about the ability of computers to disrupt rather than improve the work flow of people who are very busy."

But, Dr. Shortliffe, said, the increased scrutiny of medical record-keeping along with the general improvements in and awareness of computers, may wash away the bad taste. "There's a climate for change right now," he said.

When Dr. Redmond Burke became the chief of cardiac surgery at Miami Children's Hospital seven years ago, it was apparent to him that the records system was out of date.

"I was frustrated that Federal Express could keep better track of a package than we could track patients," he recalled. "We were walking around with 5-by-7-inch index cards as the hospital database. They got lost. You couldn't access them. I wanted to have one hand on a sick baby and in the other hand, I wanted to hold that baby's information. That's where the hand-helds came in."

It was an earlier era of technological change that introduced the record-keeping system that so frustrated Dr. Burke.

Dr. Joel D. Howell, who is a professor of history and internal medicine at the University of Michigan, said, "In the early part of the 20th century, people are explicitly saying that hospitals need to be more like factories and if that happens, people's lives will be saved."

Until then medical records had been nothing more than pieces of paper that were not always properly filed. One of the industrial practices that hospital administrators adopted was the use of standardized forms. At the same time, the expansion of specialists and the growing use of laboratory testing and technologies like X-rays increased the paperwork. "Suddenly you've got this burgeoning of forms," said Dr. Howell, the author of "Technology in the Hospital" (Johns Hopkins University Press, 1995).

A century later, Dr. Howell relies on many forms of the same kind when treating patients and making diagnoses. He does, however, use a Palm organizer to consult electronic drug reference manuals before writing prescriptions.

Such electronic checking has become common among doctors who use hand-held organizers. ( Harris Interactive, a research firm, estimates that about 17 percent of doctors use a hand-held in some way.) "The P.D.A. is much easier than the P.D.R.," Dr. Howell said, referring to the Physicians' Desk Reference, the bulky print volume containing much the same information.

In Miami, however, Dr. Burke wanted to go beyond using hand-helds as reference books. To that end, he lured Jeffrey White, a former aerospace engineer, away from his doctoral studies in biomedical engineering at the University of Miami.

With Mr. White's help, Dr. Burke's department introduced its first system using Palms in April 2001. It required doctors and nurses to put their organizers into cradles regularly to download and receive patient information. Unfortunately, harried doctors sometimes forgot to do that, creating delays in updating information and potential privacy problems because patient data stayed on their devices.

"They were literally walking out of the hospital with people's medical records in their pockets," Mr. White said.

The system was soon abandoned. One key to the second system, he said, is a series of Web servers, which take data from all the hospital's computer systems, handling tasks like billing and test results, and convert the information into standard Web pages. The servers also store the digital patient files as Web documents, allowing them to be read by any computer, hand-held or otherwise. Those digital files can include photos and videos of procedures. The bedside information is entered on organizers using a combination of on-screen forms and either a small add-on keyboard or a shorthand handwriting program that works with the Palm and Microsoft PocketPC operating systems.

Using wireless organizers to link with servers also reduced the potential for confidentiality problems. Now the hand-helds act as dumb terminals; patient information is immediately sent to the servers for storage and the hand-helds' memories are cleared. Similarly, records viewed by doctors on their palmtops are never stored on the units.

When it comes to prescriptions, many systems go beyond providing a simple drug reference. Dr. Eric Mankin, the chief medical officer of Temple Physicians, a group affiliated with the Temple University Health System in Philadelphia, said handwritten prescriptions do not inspire confidence in patients.

"Imagine if they got their bank statement every month and found that it was in handwriting," Dr. Mankin said. "How confident would they feel about its accuracy?" He estimates that in the past, about half of the calls to doctors in the Temple group were from pharmacists who could not decipher the prescription.

Now the doctors in the group have replaced their prescription pads with a system using iPaq hand-helds and software from Allscripts Healthcare Solutions, a company in Chicago. The doctor enters a patient's name and birth date, finds the appropriate diagnosis from a list that includes the most common ones and, from menus, enters a prescription. A red frowning face flashes on the screen if there is a potentially dangerous drug interaction or if a misplaced decimal point or other mistake has created an overdose.

From there, the information goes through the wireless network to a printer or to a telephone line for faxing to a pharmacy.