I depend on paper-based processes. Manila folders containing customer files are piled high in my offices. For the most part, I resist new technology. Professionals who work for me are hidebound to traditional ways of working. What systems I do use generally can't communicate with anyone else's. Lest you think I'm some mom-and-pop operation, let me give you this clue: I'm a trillion-dollar industry. Who am I? If you guessed the nation's health-care system, you're right. One would be hard-pressed to find another industry even one-tenth as large that's so backward when it comes to the use of information technology. Despite the massive payoffs in efficiency and profits gained by other industries and the continuous improvements that make IT products and services more reliable and available, health-care professionals are still dragging their feet. I recently asked my dentist -- who personally is something of a technology fan -- if he was considering replacing his paper records with digital records. He said he was reluctant to do so because a computer crash could cause the loss of all his patient records in a heartbeat. Nor is the Internet likely to change things overnight. Many physicians are wary of communicating with patients via e-mail. There are perceived liability issues, not to mention the fact that docs understandably aren't excited about spending untold unpaid hours communicating online with patients. How about charging per consultative e-mail message? San Francisco-based Medem Inc., a joint venture of the American Medical Association and a number of medical societies, is testing a program that would enable physicians to advise patients online and charge their credit cards. The larger health-care institutions have embraced IT for many years. One of the leaders is Kaiser Permanente, the big Oakland, Calif.-based HMO with nearly 9 million members. A sophisticated user of technology, Kaiser recently teamed with IBM Corp. to offer Web-based help to patients with chronic illnesses. The health-care industry at large is well aware of the need to get with the digital program. Two years ago a much-publicized report issued by the Institute of Medicine, part of the National Academy of Sciences, revealed that almost 100,000 people die each year as a result of preventable medical errors. In a follow-up report issued earlier this year, the institute stated that the industry's problems had worsened, largely because of backward, fragmented delivery systems. In its latest report, the institute stated that rapid advances in treatment deriving from more than 10,000 annual clinical trials typically take 15 to 20 years to make their way into regular patient care. It recommended that a national effort be undertaken to eliminate the bulk of the handwritten clinical data within a decade. It won't be easy. The industry is extremely fragmented at the point of service. Nearly half of all physicians in the U.S. work in sole practitioner or two-physician shops. Moreover, much of what physicians do isn't likely to be translatable to some software package. In fact, it's been said that the practice of medicine is an art that defies quantification. The medical community has yet to be sold on the real benefits of converting from the old, tried and true ways of doing things. Many physicians just plain don't see the payback for investing in technology, except for billing systems. That's too bad. My guess is that there are plenty of inefficiencies in the health-care system that could be alleviated through the use of the Internet, better systems and automated record keeping. Remember, we are talking about a $1 trillion industry that the Health Care Financing Administration predicts will expand to $2.2 trillion by 2008. That leaves a lot of room for savings from improved processes, better communication and more informed decisions -- all benefits of smart application of IT. Assuming that one day we will develop all those revolutionary treatments that are expected to result from the Human Genome Project, wouldn't it be nice not to have to wait another 15 or 20 years for our health-care professionals to provide them? Doug Bartholomew is an IW senior technology editor. He is based in San Francisco.