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"It's in your face for safety," said Charles Cooperberg, a Durham, N.C., nephrologist who uses a program called Allscripts Professional and whose 12-person practice netted $18,000 per doctor in federal incentives in 2011. "Multiple people can have the chart up at the same time. It doesn't really matter. Everything's everywhere."

Some health systems have been using a patchwork of electronic records for years, adding so many systems over time that they now have several hundred separate programs that have to be cobbled together with patches and interfaces.

Raleigh-based WakeMed Health & Hospitals, with a network of 250 doctors, uses 130 systems of bedeviling complexity. When the WakeMed system made an internal change, reclassifying NICU from Neurological Intensive Care to Neo-Natal Intensive Care, the new classification required a month and a half of reprogramming, debugging and testing.

"If something that simple takes six weeks, we came to a conclusion that we had to make a change to a single system," said Denton Arledge, WakeMed's chief information officer.

The health system expects to spend more than $100 million over five years on new software and implementation. For its trouble, the health care company is also counting on federal incentives of $15 million to $18 million.

Talbert is dreading the change he'll have to make. He said his practice had to cut its workload in half to learn how to use the MyWay system sold by Allscripts.

When Allscripts said Oct. 5 that it would discontinue MyWay, competitor Aprima announced that Allscripts was "abandoning" its customers. Texas-based Aprima has since retracted that characterization but says in its statements that it is "rescuing" MyWay users. Aprima has offered to give MyWay doctors an $8,500 software license for free for switching to Aprima's electronic medical records system.

Allscripts is offering to upgrade Talbert and other doctors from MyWay to a different Allscripts software program, called Professional, at no extra cost. "Ease of use was really critical to our decision here," Allscripts President Lee Shapiro said of the MyWay phase-out.

The company says 180,000 doctors use its electronic records software, about a third of the nation's practicing physicians, according to Shapiro.

Cooperberg, the kidney specialist, said computerized patient records are essential in his specialty, where patients sometimes use a dozen drugs and have multiple illnesses that must be monitored carefully.

"No one could read my writing - I couldn't read my own writing," Cooperberg said of his scrawled prescriptions, a common complaint in the medical profession. "I could never go back to paper."

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WHAT'S BEHIND THE PUSH FOR ELECTRONIC MEDICAL RECORDS

Electronic medical records, a major part of the Obama administration's strategy to cut medical costs, are driving a massive technology shift in the health care field.

The American Recovery and Reinvestment Act of 2009, commonly known as the federal stimulus bill, includes bonuses for doctors and hospitals that achieve "meaningful use" of electronic records with Medicare and Medicaid patients. Failure to meet the federal goals with Medicare patients triggers penalties.

For doctors, the maximum federal incentive for electronic records is $44,000 under Medicare and $63,750 under Medicaid. Failure to use achieve "meaningful use" targets triggers penalties in 2015. The penalties start with a 1 percent reimbursement reduction in the first year, and increase to 5 percent over time.

The Medicare incentive is available to dentists, podiatrists, osteopaths, optometrists and chiropractors. The Medicaid incentive is available to nurse practitioners, nurse midwives, physician assistants and other types of medical providers.

Under the "meaningful use" standard, the majority of prescriptions, diagnoses and other procedures must be processed and stored electronically.

Hospitals could receive incentives worth several million dollars. The hospital incentives are based on complex formulas, starting with a base minimum payment of $2 million a year that is adjusted on a range of factors.