Guest Commentary by Secretary Kathleen Sebelius
mHealth Summit Keynote Address
The Honorable Kathleen Sebelius is the 21st secretary of the Department of Health and Human Services, which includes NCI. Secretary Sebelius delivered the following remarks at the mHealth Summit on December 5 in Washington, DC. The goal of the summit is to bring together leaders in government, business, clinical research, academia, and other areas to advance collaboration in the use of wireless technology to improve health outcomes in the United States.
Since I was here in 2009, few fields have undergone such rapid change as mHealth. Virtually every American today has a cell phone. Some of us have to carry two. And every year, our phones have more features and computing power. This year, for the first time ever, smart phones accounted for more than half of all phone sales in the US.
As our phones get more powerful, they are becoming our primary tools for doing everything from getting directions to deciding where to eat. And increasingly, that includes using our phones to track, manage, and improve our health. In the iTunes store alone, there are nearly 12,000 different apps related to health — a number that will probably have gone up by the time I finish speaking.
As a technology story, this is hardly big news. Mobile phones have been playing a growing part of our lives for years. What is exciting about this change is that it's happening in an area where the rate of innovation has frankly been much slower.
Over the last few decades, we've seen information technology improve the consumer experience in almost every area of our lives. We've gone from waiting until a bank opened to make a deposit to 24-hour ATMs and paying bills online. But health care has stubbornly held onto its cabinets and hanging files.
When innovation is slow, so is improvement. As a result, in a country with the world's best doctors and nurses, its most advanced medical technology, its finest research institutions, and its highest health spending — Americans live sicker and die sooner than the people of many other nations around the world.
At the same time, doctors are frustrated by a health care system that has put increasing demands on them while making it harder to practice the way they want. And rapidly rising health care costs have put an enormous burden on the budgets of families and businesses while forcing increasingly difficult choices at the federal, state, and local levels.
Part of our health care problem is a lack of information. Patients have little access to their own health information, which is usually stored out of their sight on charts in doctor's offices and pharmacy computer systems. Even basic information about where to find a good specialist or the side effects of a medication can be hard to obtain. And doctors often have incomplete information about their patients too, whether it's the fact that they just came from an emergency room or whether they're sticking to their diabetes regimen.
It's with this information deficit in mind that the President launched a historic effort in the first month of his Presidency to speed up the adoption of electronic health records. And last week, I was pleased to announce that since then, the share of office-based doctors using electronic health records has risen from 17 percent to 34 percent, with 52 percent of doctors saying they intend to adopt them soon. In other words, electronic health record use has doubled and is on pace to triple, bringing huge benefits to patients across the country.
Mobile health is the natural extension of this trend, bringing health information from people's computers to their pockets and purses. The advantage of mobile phones is that they're always with us. That's especially true for many of the groups that can otherwise be hard to reach like African Americans, Latinos, and young people. This also makes cell phones an incredible tool for empowering consumers to take control of their own health.
Now, there are some parts of our health that most of us are happy to leave in the hands of the professionals. We don't want to be involved in performing our open heart surgery. We're happy to leave the scalpels and lasers in the hands of our surgeons.
But there are other aspects of health where we not only want to be involved — we have to be involved. Eating a healthy diet, managing our diabetes, choosing a doctor, quitting smoking — these are all areas that require us to take charge of our own health.
And it's been incredibly inspiring over the last few years to watch developers in this room and across the country come up with tools that are helping people do just that. From iTriage, which makes finding a local care facility as easy as finding a local lunch spot, to Pillbox, which helps people quickly identify unlabeled medications, you're making it easier for Americans get the right information at the right time to make the right health decisions.
It's not just patients. Today, technologies built for consumers like iPads are finding their way into lab coat pockets, and a smart phone loaded with Epocrates is almost as much of a requirement for new doctors as a stethoscope.
Perhaps most important of all, mobile technologies are opening up new lines of communication: between patients and their doctors, among health care providers trying to stay on the same page and even among communities of patients.
These innovations hold out the promise of a future with far more control for Americans and their doctors over their health. Still, I believe everyone here would acknowledge that we have a long way to go to fulfill that promise. So what we in the Obama Administration have asked is: what can we do to help accelerate the development of this transformative technology?
Let me be clear: there is no more powerful force for innovation than American entrepreneurs. Government couldn't replace the private sector as the primary force behind developing new products if it tried. And we don't want to try.
But government can play a limited but crucial role as a catalyst. And electronic health records are a perfect example.
When this Administration came into office in 2009, less than one in five doctors used even a basic electronic health record. The benefits of health information technology for improving care coordination, minimizing errors, and reducing paperwork were well known. Nearly every other industry had embraced information technology. But adoption rates for electronic health records were barely budging.
We thought we could help change that. So as part of the Recovery Act, we made a series of investments targeted at the obstacles that were slowing the technology's spread. We created regional extension centers to help small doctor's offices that had no IT departments. We invested in health information exchange to address compatibility concerns. And we provided incentive payments to help offset the significant upfront costs of switching over.
And the results speak for themselves. As I mentioned earlier, not only has electronic health record use among doctors doubled. It's on pace to triple. And we've also created 50,000 new jobs in the field since we started.
When government targets its resources effectively, it can play a critical role in creating the conditions for innovation to thrive. And that's what we want to do with mobile health too.
That starts with taking the vast amounts of public health, medical, and other data our department collects and making it available to innovators. This data can be an incredible resource. But until recently, most of it was hidden from the public — scattered across hundreds of websites or publications, stored in unusable formats, and often locked behind pay walls.
So what we did is, unlock the data, put it in a central clearinghouse called healthdata.gov, and then told developers: have at it. And the response so far has been incredible. Today, our data is being used in dozens of apps for consumers and providers. And we're just getting started.
We're also shining a spotlight on health problems that mobile developers can help solve. Earlier this year, for example, the Vice President and I challenged developers to come up with innovative apps that could help young adults protect themselves against dating violence and abuse. And today, I want to congratulate the two winners of our Apps Against Abuse challenge — Circle of 6 and On Watch — both of which are powerful new tools to help young people stay safe.
In addition, we're working directly on mobile health projects, from text4baby, which has provided over 250,000 moms with free health text messages, to a program we're announcing today called SmokeFreeTXT that's using text messaging to help teens quit smoking. And I've created a task force that is exploring additional opportunities to use mobile health technologies in areas like diabetes education, asthma management, and emergency preparedness.
But perhaps the biggest way we can make a difference is by continuing our work to improve our health care system. As you know, today's health care system often penalizes doctors who spend more time with their patients or take extra time to coordinate care with specialists. It often discourages investing in prevention or engaging patients in their own care.
That's bad for patients and doctors. And under the health care law, we're making some changes. Today, providers have a new menu of options they can choose from that allow them to focus more of their energy on keeping their patients healthy. There are shared savings programs that allow doctors and nurses to benefit when they help patients manage their chronic conditions and stay out of the emergency room. Another new program will help them improve coordination during care transitions so that patients who leave the hospital don't have to come back.
All these efforts can benefit from mobile health technologies. But the mobile health industry will also benefit from improving the health care system. Any change that empowers patients and encourages providers to work more closely together also creates more demand for your products.
So today, my first challenge to you is to be supporters of all the innovations underway in our health care system, not just those that directly involve mobile tools. If you want mobile health technologies to succeed, the best thing you can do is help move us towards the kind of patient-centered health care system that allows those technologies to make the biggest impact.
But there's a second part to my challenge too. We all know these technologies will only be embraced if consumers know they are safe and that their health information will be secure. So today, I'm asking you to work with us to deliver on these promises. We're working hard at the FDA today to practice smart regulation that promotes safety and innovation.
And we're also working to ensure that mobile devices come with full protections on patient privacy — a valid concern given that a large share of reported data breaches happen because health information on mobile devices was unencrypted. For mobile devices to flourish, we'll need your help, guidance, and support in both of these areas.
This is an incredible time to be having this conversation. When we talk about mobile health, we are talking about taking the biggest technology breakthrough of our time and using it to take on one of the greatest national challenges of our time. And while we have a way to go, we can already imagine a remarkable future in which control over your health is always within hand's reach.
We can imagine a future where you take a video of a rash on your foot and get a diagnosis later that afternoon without needing to schedule a doctor's appointment. A future where you keep a healthy weight with a phone that uses a motion sensor to calculate how many calories you've burned and estimates how many calories are on your plate by snapping a picture. A future where you get an automatic reminder that it's time for your next mammogram, text back to confirm your appointment, and schedule the test without any doctor or office staff lifting a finger. A future where taking care of your health is something you do with the help of your doctor every day, not just once a year at an appointment.
And I'd add to that a future in which these products are developed right here in the US and exported to countries around the world. As countries like China and India get richer, their health care spending will rise rapidly and so will their demand for technologies that can improve health and care. The question is not whether they'll buy mobile health technologies. It's who they'll buy them from. And there's no reason the answer shouldn't be the United States.
This future is not here yet, but it is within sight. And I look forward to working with you to achieve it.
Secretary of Health and Human Services