Dr. Larry Cohan, a pediatrician who has always kept voluminous files on his patients from birth through college, is used to examining his young charges, questioning and quipping, while scribbling notes in the medical record. But a few years ago a third party came between him and his patients: a computer screen.

Prodded by the federal government, doctors are replacing their paper files with electronic records. There have been growing pains. As efficient as the technnology is, neither physicians nor patients want a computer screen separating them.