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.