BANGOR – Terri-Lee Brown, a registered nurse in Eastern Maine Medical Center’s rehabilitation unit, is looking up a critical piece of information about her patient.

Instead of leafing through the bulky loose-leaf chart most people are familiar with, Brown clicks to the data she needs on a backlit computer screen.

The small wireless computer is mounted on a wheeled pedestal. Brown affectionately calls the mobile rig a “computer-on-a-stick” or “my buddy” and trundles it with her as she moves from room to room taking vital signs, dispensing medications, assessing progress and managing the problems of her patients.

Brown uses the computer to find lab results, X-ray reports, doctors’ orders and myriad other information. Throughout her busy shift, she electronically documents her treatments, observations and other information, and the computer files the data in the appropriate location.

While the bedside technology is relatively new at EMMC, computers are edging out the cumbersome paper chart, the clipboarded bedside flow sheet and the ever-changing medication administration records in hospitals across the country.

Health officials at many levels intend the electronic medical record, or EMR, to become the standard of care in all settings, as familiar and indispensable as a tongue depressor.

A challenging proposition – expensive and technologically complex – it demands a new way of thinking about information.

Though EMR has been in development at EMMC for about 10 years – and has cost about $35 million so far – Brown and her colleagues on the rehab unit have been using the technology at the bedside since May, the first nurses at the 400-bed teaching hospital to pilot the new system.

On this busy morning, Brown brings up her patient’s medication administration record and carefully confirms the order for the painkiller she’s about to give to 72-year-old Albion Stillman.

She watches him swallow the pill, and with a single tap of a pointy-ended stylus, she “signs” the computer record, legally documenting the process.

Sharp-eyed and laconic, Stillman, a Carmel resident recovering from a broken hip, watches skeptically as Brown demonstrates the bedside technology for a curious onlooker.

“It doesn’t mean much to me, but I guess it’s faster than using a pencil,” he said with good-natured gruffness. “But I tell her,” – inclining his head toward Brown – “I tell her a computer’s only as smart as the person using it.”

Of course – no offense intended to nurse Brown – computers aren’t smart at all. They’re just faster, more organized and have better memories than the rest of us put together.

Learning to use the new system has been a challenge, Brown readily admitted, but now she has come to rely on its quick access to information, the built-in reminders to stay on schedule with treatments and medications, and the speedy check-off system of documentation.

For example, the EMR will remind her to check on Stillman’s comfort level in about an hour to determine if the medication has been effective, and it will pester her to record his response.

“A lot of times I might ask … but then I get too busy to write it down,” Brown said. “It’s not a question of whether I do the assessment; it’s a question of documenting that I did it.”

The EMR is good for doctors, too, allowing them to gain access to information and to write orders quickly from any online computer in the hospital, at home or elsewhere. Doctors and others authorized to use the program are issued an electronic device that generates a constantly changing numeric password, guaranteeing the security of the information.

The computerized system is programmed to question problematic physician orders such as a treatment that’s incompatible with a patient’s diagnosis, a drug combination that spells trouble, or a dosage that isn’t in keeping with the manufacturer’s recommendations.

“The implications for patient safety and quality of care are enormous,” said cancer specialist Dr. Eric Hartz, who is also EMMC’s chief medical information officer.

Hartz is one of dozens of doctors, nurses, pharmacists, administrators, physical therapists, social workers and other professionals who have helped to design the hospital’s EMR system, customizing an off-the-shelf software product called Powerchart.

Hartz said in a recent interview that EMR already has brought EMMC into the top 2 percent of hospitals in the country in terms of patient safety, as measured by the avoidance of “potential adverse effects” such as medication or surgical errors.

In addition to guarding against errors, computer technology can improve health care by reminding doctors to use “best practices” in treating their chronically ill patients. This means that physicians who treat diabetes or chronic lung disease, for example, use current research to arrive at an agreement on the best way to manage these conditions.

Then the EMR reminds physicians of the orders they should write and asks them to justify deviations. With the treatment of chronic conditions eating up at least 75 percent of all health care spending, such standardization of care promises lower costs and better outcomes, according to Hartz.

It’s also more convenient for patients: no more redundant questioning during the stress of an acute illness or injury, no need to be weighed three or four times while being admitted.

“Sometimes patients assume we repeat things to be safe,” said Pat Patry, director of clinical information systems at EMMC, “but most often it’s just a failure of communication.”

Patry said training nurses to use the new system has met with mixed results, with younger RNs generally picking it up more quickly. Between the challenge of learning to navigate the complex program and some unexplained quirks in the technology’s operation, frustrations have sometimes run high, she admitted.

The day after Brown demonstrated the technology, the EMR nursing pilot temporarily was put on hold. Persistent slowdowns in the system’s ability to process information were interfering with patient care and wreaking havoc with nurses’ tempers, Patry said.

After a period of troubleshooting, the system was put back in use last Wednesday, making life easier for rehab nurses such as Brown who have come to appreciate its positive impact on their work.

“This is why we have pilot programs,” Patry said, downplaying the glitch, “instead of rolling it out to the whole institution at once.” But she stressed the inevitability of the technology, despite its predictable growing pains.

“This is where life is,” Patry said. “The ultimate value outweighs the difficulty of the paradigm shift.”

Patry said the bedside technology will be in use throughout the hospital by the end of this year.

A new initiative from the U.S. Department of Health and Human Services identifies the development of a nationwide system of electronic medical records as a 10-year goal – the most significant way to reduce medical errors, improve patient care and save more than $140 billion a year in health care spending.

An electronic health care infrastructure is also a high priority in Augusta, as planners work out the reforms mandated by Gov. John Baldacci’s Dirigo Health plan.

“We look at electronic medical records as the first priority for improving health care in Maine,” said retired Bangor surgeon Dr. Dennis Shubert.

Shubert is chairman of the Maine Quality Forum, the Dirigo work group charged with coordinating quality issues, promoting best practices in medical treatment and assessing medical technology needs throughout the state.

In a recent interview, Shubert said the goal is to have EMR – “the holy grail of patient safety” – in every hospital, clinic and doctor’s office, considered “as important as a stethoscope.”

By ensuring patient safety, reducing errors and steering physicians to manage chronic conditions according to established guidelines, Shubert said the Maine health care system can save big.

“Just by avoiding unnecessary hospitalization, we can save $157 million a year in the state of Maine,” he said.

Although the technology is expensive – $5 million to $20 million per site – Shubert said most Maine hospitals are in a position to make the change. The quality forum is looking at ways to help smaller facilities afford the upgrade, he said.

In time, the comprehensive technology that’s being fine-tuned in Bangor will be extended throughout the Eastern Maine Healthcare System. Similar initiatives are under way in other parts of the state.

Together, the institutions will become part of a spreading network that can quickly access and exchange detailed, accurate patient information with the click of a mouse button.