ROHNERT PARK, Calif. -- Electronic record keeping "has made my practice possible," says Dr. Leo Kanev of Evanston, Illinois. "Without it I couldn't do my work in a way that suits me and my patients."

The special feature of the practice, which he started in 2001, is that it includes about a hundred patients whom he sees at their homes and who, for the most part, are very sick and medically complicated. "I have colleagues who make home visits whose car trunks are filled with paper charts," he says. "I use my laptop, and it contains all the information I need."

When he goes into a house all he carries is the laptop and necessary medical supplies that fit in the same bag. "I've never had a negative response from a patient. In fact, many of them talk about it as though it's a piece of magic. 'You seem to know so much about me,' they say."

Their surprise is understandable, he adds, because the system is a highly effective way of ensuring that he has all the data at his fingertips. "I can tell at a glance what we did last time, what medications they're on, what we've tried before. I can see both old and recent blood work and other test results."

Sometimes the need for those details is urgent. "When I get called about patients in the middle of the night, I can look up their history there and then. Obviously, if they've been taken to the emergency room, that could be a matter of life and death. But even if all the family wants is the phone number of the pharmacy the patient uses, it can be a big comfort at a time of stress."

Dr. Kanev says that computerized record keeping isn't an expensive method for improving health care. "I started my practice the day my residency ended. I was already deeper in debt than I ever wanted to be. But for a few thousand dollars I was able to acquire the system I wanted -- ChartWare -- and it has worked well ever since. I have a completely paperless office. I don't need storage space for charts or transcription services."

The system also gives him peace of mind. "The reminders in it make it difficult to overlook anything important. It reassures me that I haven't missed any test results and that I have reviewed consultations notes that I arranged for. When you're going from house to house, those things are easy to forget and, with patients like these, potentially very serious."