to communicate uncertainties to the average consumer, it is also not clear how to communicate uncertainties to doctors. Effective communication of uncertainties may take different forms between these two groups. For example, doctors may be more comfortable interpreting raw data or graphs or need data in a certain form to be compatible and comparable with their existing patient records. It may take new training to be able to interpret results from commercial wearables within the standard assessment frameworks (these practices may need to evolve), as well as further training for dealing with patients who may have drawn their own (possibly false or irrelevant11) conclusions from their personal devices.

Entering the consumer health-wearables market also raises potential ethical questions, including whether patients want their doctors to know everything they do. If not, research is needed to determine how to strike the appropriate balance in data that supports serious medical decision making while preserving plausible deniability for the patient.

Conclusion

Future research is needed to address these questions and the trade-offs they imply:

How to provide access to confirmatory evidence of reliability. An inherent problem of many pervasive sensor technologies is the data recipient (whether doctor or patient) has little or no way to verify the data’s accuracy. 13 In the case of health wearables, users might have some general sense of whether they are, say, dehydrated or have low blood sugar but are unlikely to be able to put an exact number on the measurements. So how might future health wearables provide access to confirmatory evidence of their precision? Doing so would be especially useful for enabling users to help with device calibration, as discussed by Mackinley, 18 to help mitigate at least some potential input uncertainties.

How to preserve provenance of un-
certainties. Due to the trend toward
greater interdependence between
data systems, with outputs from one
system being churned through the al-
gorithms of others, 13 it is conceivable
Uncertainty”) and for capturing infor-
mation regarding subsequent actions
taken by users in order to improve un-
certainty feedback visualizations and
interfaces, as in Morris and Klentz11
and Kay et al. 12

Patient compliance monitoring. It has been argued by some technology experts that the commercial appeal of activity trackers for relatively affluent and active individuals has obscured the true potential of the devices for helping manage chronic illnesses— given that those with a true health need are significantly less likely to abandon their gadgets when the novelty has worn off. 10 If the degree of certainty in the reliability of activity-track-ing data were to be better understood, such devices might be more readily accepted in the doctor’s office as a way of inferring compliance with exercise plans and dietary advice, as discussed by Swan. 24 With this end in mind, we anticipate commercial wearables will advance to the point of being able to determine whether and when a patient is taking prescribed medication and at what dosage; the effects of such medication on their physiologies; and what other behavioral factors might be affecting symptoms.

Doctors could thus disambiguate factors that are affecting a patient’s health. This is important information for determining the accuracy of patient self-reports, which can be flawed for any number of reasons, ranging from innocuous memory failings to subjective interpretation of one’s experiences to intentional misrepresentation or deception. To the extent that patients understand noncompliance is detectable by their doctors, this may indeed promote greater compliance. On the other hand, the use of wearables as an objective (certain) measure may result in greater emphasis being placed on quantitative data than on the patient’s own anecdotal reports. Inconsistencies between the two accounts that arise as a result of uncertainties surrounding the wearable data or input uncertainties relating to sensor-error rates and the device having been used incorrectly by the patient could have negative implications for the dynamic of patient-doctor trust if the uncertainties are not clarified by both parties.

Just as it is not always clear how

Seemingly
innocuous
uncertainties
emerging in
the present use
of wearables
need attending to,
as they are likely to
produce important
consequences
in the future.