Sen. Hillary Rodham Clinton (D-N.Y.) said she will introduce legislation to increase federal funding of research into evidence-based medicine and head-to-head trials of prescription drugs and would boost federal spending on clinical information technology in a speech Monday at the Weill Cornell Medical Center in New York.
"Approximately 80% of the care delivered today is not backed by clinical research," according to a prepared text of her speech.
"It is physicians doing their best, often in the absence of solid data. That is why we need to do more research, and see if the care we provide today has sound justification in science."
That research would include comparative trials of drugs and other therapies, she said.
"Clinical decision tools, like hand-held computers, exist that would allow doctors to pull up the latest research information immediately, right at the bedside," according to Clinton. "We spend billions of dollars a year on medical research at NIH to produce that information, but it is worthless unless the doctor can retrieve it at the bedside. Information, in the hands of the right people, at the right time, drives quality and value."
Clinton noted that spending on technology averages $7,000 per worker for all U.S. industries and up to $15,000 per worker in banking, but just $3,000 per worker in healthcare.
She noted that 90% of primary-care physicians in Sweden in 2002 were using an electronic health record, and nearly 60% in the United Kingdom, but only 17% in the U.S.
She said the government could become directly involved in financing clinical IT for small, rural or safety-net providers through a revolving loan fund.
In a telephone interview following her speech, Clinton told Modern Physician that in addition to federal loans, she supports direct funding of healthcare IT.
"We've got to provide some capital investment," she said. "Some outright grants and demonstration projects that would set a system in process are called for. I think the federal government has to play a role, or we won't bring about the cost savings that are possible."
Clinton also called for adoption of standardized quality measurement yardsticks for hospitals, physicians and long-term-care facilities and said her legislation would continue to support and expand on work in that area already under way by the "Agency for Healthcare Research and Quality, Medicare, the hospital association and the National Quality Forum and others."
She proposed "federal leadership" in building an IT infrastructure to share medical information between all providers to improve patient care and halve the $23 billion spent each year on claims-processing costs.
Clinton also called for demonstrations and evaluations of payment methods to incentivize quality within Medicare and in private sector.
She said she will introduce the legislation Jan. 20.