WASHINGTON – President Bush is readying a major push to computerize the nation’s medical records, including what is expected to be between $100 million and $200 million in funding for the program in the federal budget he will propose next month.

Two likely 2008 presidential contenders and leaders of their respective political parties, Senator Frist, a Republican of Tennessee, and Senator Clinton, a Democrat of New York, teamed up last year on legislation to try to encourage doctors to replace pen-and-ink scribbles with a sophisticated network of electronic medical records. Yet despite the high-profile bipartisan backing, Congress has failed to agree on standards for the technology or how to fund it.

Advocates say electronic medical records could save $140 billion a year in health care expenses on things like file clerks and space for file cabinets, while also saving tens of thousands of lives each year by reducing medical errors.

“We’re really ready to step up in 2006 for a pretty aggressive agenda,” the Bush administration’s national coordinator for health information technology, David Brailer, told The New York Sun on Wednesday. “The president loves this topic,” added Dr. Brailer, who was appointed to his post at the Department of Health and Human Services in 2004 under an executive order to achieve “widespread deployment” of electronic medical records within 10 years.

Dr. Brailer told the Sun that later this month the administration will start by unveiling “breakthrough” health information technology initiatives that may be completed by year’s end, increasing the issue’s visibility among the American public. The initiatives include nationwide computerized personal medication histories, so that a doctor anywhere in the country can know what medications a patient is taking before treating him; providing “secure messaging” to allow for private e-mail and other electronic correspondence directly between doctors and patients, and “bio surveillance,” which uses computerized records to monitor disease outbreaks and provide earlier detection and better treatment of pandemics or bioterrorism attacks.

A Washington-based health care administrator who advises the White House on health information technology, Barth Doroshuk, said the administration is expected to seek between $100 million and $200 million for the technology initiative in this year’s budget, to be announced in February.

At least some doctors’ offices, however, are moving ahead on their own.

One example is a practice founded and partly owned by Mr. Doroshuk, Washington ENT, one of a variety of “paperless” practices around the country. The downtown office of the six-year-old ear, nose, and throat practice has no filing cabinets. There are no rooms full of shelves lined with manila folders stuffed with charts. Instead, patients’ insurance, medication, examination, and treatment records are maintained on eight Dell servers stacked in a large closet.

Washington ENT’s doctors use software provided by A4 Health Systems of Cary, N.C. – one of around 1,200 companies nationwide currently specializing in electronic health records – that organizes and updates their schedules, patients’ medical histories, patient correspondence, examination notes, and lab results. Washington ENT’s records are backed up at a separate location, protecting the data. The system also allows doctors to view the information from home, and when their pagers buzz in the middle of the night with a medical emergency, each physician has the patient’s entire medical record instantly accessible.

“I would never go back to the old system,” one of Washington ENT’s head and neck surgeons, Dr. Catherine Picken, said.

Doctors’ computers are also connected to Washington ENT’s laboratory, and every half hour the computers check automatically for updates and alert the doctors when new test results are in. Mr. Doroshuk said the technology dramatically reduces the time between a patient’s initial consultation with a physician and his receiving treatment, allowing each of Washington ENT’s four physicians to see between 30 to 35 patients a day.

The practice’s technology also improves the quality of doctors’ service, Mr. Doroshuk said. When a patient’s symptoms are entered into the computer, for example, the practice’s software maps out all the possible ailments those symptoms might indicate. When a patient comes in with a runny nose and headache during allergy season, Mr. Doroshuk said, many doctors might automatically identify as an allergy what may in fact be a sinus infection. The software, Mr. Doroshuk said, helps doctors “think outside the box,” increasing the likelihood that a patient will get an accurate diagnosis sooner.

Analysts say the use of electronic records significantly reduces redundant and improper treatments, and cuts back on potentially fatal medical errors resulting from incomplete or erroneous information in a patient’s medical file. According to the Institute of Medicine, between 44,000 and 98,000 Americans die each year from medical errors.

Another significant motivation for going “paperless,” Mr. Doroshuk said, is money. The federal government estimates that nationwide electronic health records would save the health care industry $140 billion a year. At a forum in Cleveland early last year, President Bush put the estimated savings at around 20% of the health care industry’s total expenses.

Because of Washington ENT’s sophisticated computer system, Mr. Doroshuk said, “there are functions that don’t exist in this office” that represent significant costs for traditional medical practices.

“There are some offices that have chart rooms with chart staff, and that’s all they do is assemble charts. We don’t have anything like that,” Mr. Doroshuk said. “When you’re talking about 1,000 square feet on K Street that you wouldn’t have to rent a year, and $50,000 a year on transcription that you wouldn’t have to spend, and you start adding those chunks of money up, you’re literally coming up with millions of dollars in savings.”

One of the most significant savings, Mr. Doroshuk said, is in staff salaries. According to the Medical Group Management Association, the average support staff to physician ratio for a multispecialty physician practice is almost 5 to 1. At Washington ENT, Mr. Doroshuk said, the ratio is less than 2 to 1.

According to the MGMA, support staff salaries represent the largest operating cost for multispecialty physician practices, at a median level of about $176,000 annually a physician, followed by building and occupancy costs, at about $40,000 a physician. Both expenses, Mr. Doroshuk said, are significantly reduced by going “paperless.” According to government estimates, these savings could translate into around $700 shaved off every American family’s annual health insurance bill.

Despite the benefits, physicians represent one of the largest obstacles to full implementation of electronic records, analysts said. The up-front costs of purchasing and implementing the technology dissuade many doctors from computerizing their records. According to an HHS-funded MGMA survey published in September, medical practices that implemented electronic records last year spent about $33,000 for each physician on the technology, with maintenance costs of about $1,500 a month for each physician. The initial costs for the computer system at Washington ENT, Mr. Doroshuk said, were around $300,000. Starting up the practice cost about $750,000, he said, compared to the $500,000 price tag he estimated for a paper-based office.

On a national scale, “We’re more than $100 billion from here to where we need to end up,” Dr. Brailer said. Another likely 2008 presidential contender and a former speaker of the House, Newt Gingrich, has advocated spending $7 billion a year on computerized medical records.

Physician behavior and pay incentives, too, are halting the further spread of health information technology. One observer noted that since most physicians are paid based on the number of procedures they perform, computerized records’ reduction of unnecessary procedures could slash doctors’ revenue. Doctors could also lose some revenue by spending time learning the new technology instead of seeing patients. Analysts expect that larger health care providers, which have greater access to capital and can guarantee doctors’ salaries during transition phases, will lead nationwide private sector conversion to electronic records. One government official cited as an example one of America’s largest health care providers, Kaiser Permanente, which will complete the switch to electronic records for its 8 million patients later this year.

In Washington, the biggest dispute over the health care industry’s switch to electronic records is whether the government should finance or merely regulate it.If Washington bankrolls the upgrade, further disagreement arises over what form financial assistance to doctors should take.

There is bipartisan agreement that the federal government needs to set standards for the technology. When it comes to funding, however, Democrats typically advocate the use of direct grants and Republicans an incentive based approach, said a spokesman for the Senate Health Committee, Craig Orfield. Among the senators most active on the issue, Senators Frist and Clinton have advocated direct government grants. The two leading members of the Senate’s Health Committee, Senator Enzi, a Republican of Wyoming, and Senator Kennedy, a Democrat of Massachusetts, have pushed for loans, according to Senate staff. Senator Grassley, a Republican of Iowa, and Senator Baucus, a Democrat of Mon tana, joined Messrs. Enzi and Kennedy to press for incentives for computerized medical records as part of Medicare payments.

Dr. Brailer cautioned that ultimately the American public would be paying for the technology, either as taxpayers or consumers. The main question, Dr. Brailer said, was through whose hands the money would be funneled – the government’s, doctors’, employers’, or health insurance plans’. “Therein lie all the political questions,” he said.

Congressional staff said two other key political questions must be answered before Congress officially embraces electronic health records. One is vocal concern from “privacy advocates,” including the American Civil Liberties Union and the AARP, about the security of the electronic records and the rules governing access to them. While most state laws prohibit the health care industry from sharing patient information for commercial purposes, it is less clear whether the technology companies managing the electronic records would be covered by the same laws.

Federalism, too, is a nettlesome issue, staff said. The privacy and other regulations that govern health records are set state by state, and the creation of a national electronic health records network might require the federal government to override states’ own regulations, spurring concerns among some representatives that the computerized records initiative may spur Congress to exceed its authority over the states.

After Senate passage of health information technology legislation in November, these “political questions” now belong to the House of Representatives. Late last year, the approach backed by Messrs. Grassley, Baucus, Enzi, and Kennedy was rejected by the House. Meanwhile, a House version of the Frist-Clinton-Kennedy-Enzi bill – the Wired for Health Care Quality Act, which directs the Department of Health and Human Services to spend $125 million on electronic medical records – rests with the House Energy and Commerce Committee after introduction in December by Rep. Darrell Issa, a Republican of California.

Another House bill pushing electronic medical records is being sponsored by Rep. Nancy Johnson, a Republican of Connecticut, who is chairwoman of the Health Subcommittee of the House Ways and Means Committee, which has oversight of Medicare. Ms. Johnson, one of the House members most active on electronic health records, told the Sun Wednesday that she was optimistic the House will soon finalize the push for electronic records, before recessing for the congressional elections later this year. She cautioned that the House was less inclined to finance the initiative with taxpayer dollars than the Senate, but said implementing health information technology enjoys enthusiastic support from the Speaker of the House, Dennis Hastert, a Republican of Illinois, who she said is “very determined” to pass computerized-records legislation.

“For those of us who understand the need for the health sector to adopt modern technology, we certainly feel an urgency,” Ms. Johnson said. “This is a time where we can all have a little window of opportunity, in early 2006.