Whenever I sit down to pay my monthly bills, I’m amazed at how much business I can take care of online. Yet every few months I moan: Why must I still stuff hand-written prescriptions into an envelope, so that my otherwise-efficient online drug provider can get permission to continue sending me my meds?

Rather than scrawling out a prescription — in that barely legible script they teach in medical school — my doctor should be able to simply open his laptop, or his hand-held e-mail device, tap out his orders and hit a button to send my prescriptions to my drug provider. Think of the time and money that would save me: I wouldn’t have to wait for the mail to deliver the prescription, which often causes me to pay extra for rush deliveries. Imagine how much easier it would be for my online pharmacy to read the order. And my doctor could be alerted if anything he is prescribing might adversely interact with some other medication on my list.

There is interest across the health care sector for exactly this kind of electronic prescription service, known as “e-Rx.” And the technology has been available for several years now. But unless some policy changes are made, we may never see it widely adopted. The reasons are many, but they boil down to this: Doctors have the most to lose from such a system — and the least to gain.

Indeed, the impediments to electronic prescriptions are the same as those blocking the creation of a broader “electronic medical records” (EMR) system: Neither will succeed without doctors. But for doctors to get interested, they’ll need inducements.

No longer paralyzed by privacy concerns and technophobic health care officials, most stakeholders are giddy about creating a national EMR network, including electronic prescription writing. Some analysts say that such a transition would shave $78 billion annually from medical costs after 10 years. Judging by the increase in local and regional medical records networks, public-private standards-setting groups and state and federal legislative and regulatory activity, tomorrow’s medical recordsphere is already well under way.

As is common in other industries that have shifted to Web-based supply-chain management, the vendors along that chain stand to benefit most: Hospitals are eager to cut costs and improve efficiency. Drug companies, medical device makers and insurance companies pine for better ways to manage records and assess risks. Patients like me hope for faster service, more access to our own information, fewer errors and better medical care. And I don’t need to tell you how the technology vendors feel about it. But where are the doctors — I mean, when they’re not busy actually practicing medicine?

Well, you’ll pardon them for not hosting the next healthcare IT seminar. Doctors will have to bear most of the costs of making the transition — an estimated $100,000 per physician over five years for hardware, software and training, according to John Glaser, president of the health care technology industry lobbying group, eHealth Initiative. And they face the biggest burden when it comes to potential liability issues and ensuring patient privacy and security.

And their payoff? Sure, the doctor’s office may (or may not) run more efficiently, but the real efficiency gains would go to those who process the paperwork, not those who create it.

Now toss in all the other usual fears (change, technology, patients’ protests) and it’s clear where the bottleneck is on this info highway.

New awareness of doctors’ reticence is leading to some innovative proposals, not to mention strange bedfellows. In the Senate, GOP leader Bill Frist of Tennessee and Democrat Hillary Rodham Clinton of New York have a bill that, along with proposals by the Bush administration and a handful of other measures, aims to give doctors the incentives they need. Foremost is a plan to reward docs with higher Medicare payouts if they meet certain benchmarks for upgrading their systems (read another way: lower payments for those who don’t). Some grants and low-interest loans are also being pondered. Standardized training and a national IT help desk are also under consideration.

But even if all those incentives were in place, another obstacle would remain: the “Stark rules” and “anti-kickback rules” that for years have sent physicians fleeing to their lawyers for advice and comfort. Those rules were intended to prevent Medicare providers (i.e., most doctors) from referring patients to medical facilities where they have a financial stake. The rules are routinely over-interpreted to mean facilities may not provide computer hardware or software to affiliated doctors. In fact, they can, so long as their aim is not to induce referrals.

The pending health care technology bills attempt to relax those rules, to make it clearer when such investments are allowed. But the sponsors better tread carefully: The large pharmaceutical companies and Health Maintenance Organizations would like nothing better than to provide doctors with free wireless prescription pads and computers.

And as much as I’d like to see my doctor packing such a device, I wouldn’t have much confidence in it if I knew one particular drug company had loaded the software.

Mike Mills is CQ’s executive editor for electronic publishing. Next week’s CQ Roundtable: Courts & the Law, by Kenneth Jost.