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Dr. Howell said that the idea of relaying sensitive health information through wireless networks might unnerve some people. "There's always early concerns about privacy," he said. "There's a feeling that something electronic is more vulnerable to invasions of privacy."

But it is not just individuals who are concerned about privacy. On Aug. 8, the Bush administration finished the first comprehensive federal rules covering medical privacy. Dr. Burke and other advocates of electronic records believe that their systems will meet the requirements. Dr. Howell argues that properly managed electronic records will be more secure than paper.

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"There is an experiment I don't recommend or hope you try," he said. "Put on a white coat, grab one on your way into a hospital, go up to a ward and start pulling charts. Then see if anyone asks who you are. With an electronic record, it's easy to track who is looking at it."

In addition, Dr. Howell noted, paper records are handled by clerical workers who can potentially copy information or even steal the cards. By contrast, an electronic system can track who examines every file and be protected by encryption and security devices, like biometric thumbprint readers, that can be defeated only by someone with sophisticated skills.

There have already been some unexpected privacy problems. Dr. Mankin at Temple said that Allscripts had warned his group that prescriptions were arriving on fax machines at one drugstore chain, which he declined to name, that were near cash registers and plainly visible to customers. The Temple group stopped faxing prescriptions to those stores. Despite the incident, Dr. Mankin is confident that digital records offer greater privacy.

That is a view shared by Jeneane Brian, president of VNA Home Health Systems, a nonprofit home nursing association in Southern California. The association transferred the record-keeping of its nurses and doctors from paper to Handspring Visors two years ago. "We've always had vulnerable data," Ms. Brian said, noting that nurses have been known to leave bags containing their records at airports or on the roofs of their cars.

"I do believe that with the hand-helds there is less vulnerability than there might have been in the past," she said. "Even without additional security on the hand-helds, it's no worse than it used to be."

The biggest hurdle facing advocates of the new systems, Dr. Shortliffe said, is the relationship between most doctors and hospitals. "In most hospitals, the doctors don't work for the hospital," he said, which can make it hard to work out who should pay for the new systems or to even reach agreement on what form they should take.

But Dr. Shortliffe added that there were several strong forces that might accelerate the movement. In addition to improving patient care, electronic systems should speed up and improve the accuracy of claims to health insurers. "This is an area where people know they are losing money, and money drives things," he said.

Dr. Burke's electronic system in Miami has produced an unexpected side effect. With a small camera attachment, the doctors and nurses can use their hand-helds to take digital photographs of their charges. The images have restored a little of the humanity that the factory-inspired paper records diminished. Now during the medical staff's weekly meetings, the patients are no longer just charts and words.

"With the photos, we're actually bringing the babies into the conference," Dr. Burke said. "There's an emotional element that used to be missed."