Take an average medical practice. It has four doctors who each see 25 patients a day. About 20 staff take 200-300 phone calls every day. To assist the doctors, the staff have to find and pull from the files about 300 charts.

They are busy, too busy to tidy up every night. So a backlog of some 1,500 unfiled charts accumulates. A missing file could be in that pile when a doctor needs it. It delays the practice of medicine.

Meanwhile, at the nearest pharmacy, patients are arriving with prescriptions. The pharmacists have no idea in advance who is coming or what they want.

They might not have the drug in stock. The drugs prescribed might not be covered by the patient's health insurance plan.

And there is real danger too. Every year, bad handwriting kills people. The pharmacist squints at an illegible scrawl from the physician and accidentally hands out the wrong medicine or the wrong dosage.

Now for some costs: by some health insurance estimates it might cost $10 to process an insurance claim. If all was completed electronically, that cost could come down to 30 cents.

And the pharmaceutical manufacturers have huge costs too. They spend millions of dollars sending thousands of sales representatives round doctors' surgeries pitching medicines.

If there was a way to market drugs effectively and save on physician visits, the doctors and the drug companies would appreciate it. But how do you entice doctors to find out about your medicines without "face-time"?

Plenty of companies are exploring ideas to sort out various parts of this mess. It would save time, lives and millions of dollars. But doctors and hospitals have proven intractably stubborn at adopting new technology.

WebMD, founded in 1996 by Jeff Arnold, a young medical equipment salesman in Atlanta, sought to create an online healthcare community. By using the internet to process prescriptions, connect doctors to patient files, file medical claims and disseminate information, WebMD aimed to slash costs and improve efficiency in the highly-fragmented healthcare industry.

To consumers, that means having more control over their healthcare needs. For doctors, insurance companies and hospitals, WebMD claims it could wipe out more than $280bn in costs simply by putting the whole industry online.

But WebMD has had to modify its initial goal of being the America Online of healthcare. A plunge in its stock price has forced it to rethink its strategy.

Its grand vision of being the global hub for healthcare was curtailed after running into several obstacles, such as the reluctance of insurance companies to share proprietary information.

Meanwhile several insurance companies have formed their own online health community called MedUnite. It is busy planning, but has yet to make an impact.

Patient privacy issues were at the centre of a lawsuit between WebMD and Quintiles Transnational, a data and clinical trialling company. But a federal court in North Carolina ordered the patient data be given in a modified form.

At the drug marketing end, all large companies have been studying electronic methods for about five years. Sales representatives - whose visits to doctors are known as "details" - are positioned at the other end of an internet link and doctors enticed to contact them.

Even though e-detailing can hardly be said to have taken off, companies are hopeful, like WebMD and MedUnite elsewhere, that it will happen. Newt Crenshaw, vice-president of e.Lilly at Eli Lilly, is optimistic: "Traditional detailing is still important but will need augmenting."

Mr Crenshaw says Lilly has been running a number of pilot schemes, some for over a year. One for remote e-detailing involves thousands of doctors in the US and Scandinavia.

A doctor is asked to dial in on a secure connection via the internet to a rep at at Eli Lilly's headquarters in Indianapolis. The interaction is triggered by the physician.

Lilly says, without giving details, that the doctors are given incentives to make the call. That could be anything from free computer equipment on condition they dial in regularly, to more traditional gifts such as stationery for the practice.

But Mr Crenshaw concedes that e-details will not replace traditional sales reps. To augment marketing, it and its peers have all set up web sites related to their specific products.

And Lilly is also trialling schemes for doctors involving wireless handheld devices. A free Palm might be accompanied by prescribing information.

But incentives are a problem. First, US regulators are worried about the extent of gift-giving. And a doctor would be reluctant to have 20 PCs in his office, one from each large comany.

Without incentives, busy doctors are unlikely to take the trouble to call up drug companies remotely. And there is also very little standardisation. Mr Crenshaw says the large pharmaceutical companies have barely started talking about common computer platforms.

This is why initiatives such as MedUnite, involving all the largest health insurers, could have some success. And now another venture has grabbed headlines. In March Pfizer said it would collaborate with Microsoft and IBM to develop software and services for physician practices.

The focus of the company will be to reduce the administrative workload for physicians, linking them to pharmacies, health insurers and specialists.

Pfizer's Peter Brandt says doctors have not embraced technology so far because they have not been offered multi-application programmes. "Now they are to be offered an integrated, comprehensive package," he says. Maybe the revolution can begin.