A new study from the June issue of the American Journal of Managed Care concludes that EHRs can dramatically reduce costs and save resources compared to managed care programs for high-risk cardiac patients. The study shows that even minimal use of an EHR can help prevent costly medical procedures and increase quality of life in millions of patients at risk for chronic diseases, the number one global killer according to the World Health Organization.

The two-year study at Kaiser Permanente Colorado (KPCO) began September 1, 2005, when 400 patients with Cardiac Artery Disease (CAD) were randomized into two groups, with 214 receiving care through Kaiser’s Clinical Pharmacy Cardiac Risk Service (CPCRS) and 207 receiving only notifications generated by Kaiser’s Web-based, electronic database HealthTrac.

Patients enrolled in the CPCRS program were closely monitored by primary care providers, cardiologists, and nurses who made sure treatment strategies were adhered to, and follow-up lab tests were completed. Enrollees were in contact with care providers primarily over the telephone.

In contrast, the EHR group received only laboratory reminder letters generated electronically by Kaiser’s HealthTrac database, which is integrated with Kaiser's administrative, laboratory, pharmacy, and demographic data systems.

Results showed that 93.1 percent of patients in the EHR group maintained an LDL-C goal of <100 mg/dL compared to 91 percent in the CPCRS program. Overall, 75.7 percent of patients maintained their blood pressure goal by study end. In fact, a higher proportion of EHR patients maintained a blood pressure goal of  <140/90 mm Hg compared with those in the CPCRS care group (75 percent CPCRS care vs 84.2 percent EHR).

The study shows that deploying EHR-generated notifications was on par with high cost, resource intensive managed care programs in maintaining adherence to care strategies over a two-year period.

Could this signal the beginning of the end of fee-for-service care? The argument goes that fee-for-service medicine is lucrative for providers and offers an incentive to order more tests and expensive medical procedures. As the Kaiser study shows, EHR-based preventive care can reduce the need for such procedures by keeping patients healthy with minimal time and resources on the provider side.

However, the Kaiser study was not without limitations. Only patients with a proven track record in maintaining healthy lifestyles were chosen. Patients had to have at least two consecutive LDL-C and non–high-density lipoprotein cholesterol (non–HDL-C) values at goal prior to the study. The most recent value had to have been recorded within 6 months prior to study enrollment. The report did not show how much effort was required to get high-risk patients to goal prior to undergoing the study.

Regardless, this study proves that in similar patient populations EHR-based, long-term care is on par, if not superior, to resource intensive care programs. This is the data the EHR believers have been pointing to -- data that shows EHRs can reduce costs and save resources long term.

Along with the Cleveland Clinic, Kaiser is undoubtedly on the forefront of EHR technology. Many hospitals and providers are no where near the level of integration of these two health giants. But the data is welcome by EHR advocates, and is reassuring that we are moving in the right direction.