The new paradigm of digital health care and confronting values
From the perspective of Value Sensitive Design
Preventive Digital Healthcare with wearables
Through the advancement of technology, continuous innovation is displayed by the preventive healthcare field. Digital transformations like Telemedicine, Artificial Intelligence, Augmented Reality, Wearables, and IoT ultimately extends our life and increase both our health and productivity (Daniel, 2019). Giant tech companies such as Facebook have recently launched personal digital healthcare tools on their social platforms. In addition, Google is reportedly attempting to buy the wearable smartwatch company Fitbit (Facebook, 2019). In this light, the growing trend of wearables with the advanced technology capable of collecting health data is expected to bring a new paradigm into the healthcare industry. To understand the potential of wearable technology and the future of preventive digital healthcare, let’s imagine the situation of Fitbit adopting an Artificial Intelligence system into their service. From the perspective of Value Sensitive Design (Friedman & Hendry, 2019), the concerns under the Fitbit’s virtual assistant’s goals and what to consider as a designer for the future of a healthy digital health care service are explored.
Virtual Assistant ‘BIT’ by Fitbit
Created by our team, the Fitbit’s virtual assistant (VA) named BIT provides customized health training for users and manages health-related areas of life. At the interaction design studio, we devised how a virtual assistant (VA) could be applied to their existing platform, how the backend system should be supported, and what visual communication and functions BIT should have for a consistent brand experience. In the early stages of research, we analyzed how Fitbit’s products were utilized in the user’s lifestyle zones. They were largely incorporated into the zones of exercise, food, sleep, health goals, and casual activity; and we wanted to test the capabilities of the VA in the first three. Here are three possible scenarios we devised:
1. Suggest proper diet: Ordering food through the app
We supposed a situation in which the user orders the food through a food delivery app. (Uber eats) When the user sees the menu on the screen, the VA will scan the menu with a text recognition tool (Third-party application like Google Lens) and then, the healthy option will be highlighted. Just by a few simple taps, the user can to order food and his or her choice will automatically be logged into Fitbit’s app.
2. Group Exercise: Making a quick reservation and inviting friends
When the user asks what kind of group activities are available through the Fitbit watch, Bit will show the user the curated classes through a screen. The user can see various group exercises and find the most suitable option. After choosing the class, Bit will set the exercise schedule and encourage the user to invite their friends.
3. Indoor Exercise: Offering personalized coaching with posture correction
This scenario supposes that Fitbit adopts a posture detection software into their applications. Through television with a camera, Bit will play indoor exercise instructions and record the user. During exercise, Bit will correct any posture issues displayed by the user. Also, it will provide motivation and encouragement to complete an entire exercise session.
According to a survey of 55 people (IxD Studio Fitbit team, 2019), BIT was in demand for facilitating personal training and interaction with the community as a health trainer. In addition, through service research, we were able to assume that verbal dialogue with VA and integration with third-party apps would ease the difficulty of tracking food consumption. In the future scenarios we devised, more stakeholders appeared, and the use of certain technologies also became a point of conflict between different values pursued by groups.
Stakeholders
Considering those scenarios, these are the direct and indirect stakeholders which are categorized based on their role in Fitbit’s product. Along with Fitbit’s users, the employers and employees of Fitbit, advertising and sales agencies, and digital health care services that utilize AI, IoT, VR/AR technologies are all directly related stakeholders. Indirect stakeholders could be the subcontractors and suppliers of the product, related industries such as food and sports, traditional types of health care service, and acquaintances of users.
Among them, the digital health care service and the user himself should be prioritized. The reason is that the data tracked from the user is reflected in VA’s algorithm, which is not very different from the private health covered by the digital health or medical industry. If a data-based nutritional diet, customized exercise, and sleep aids are what Fitbit can assist with in the future, Fitbit’s service would be more closely related to the preventive healthcare field, meaning that Fitbit’s ecosystem has the potential to change people’s future lifestyle regarding health care and forming healthy habits.
Value confliction
Then what are the implicit values and the confrontations surrounding this system design considering Friedman and Hendry’s thesis (Friedman & Hendry, 2019, p. 28)? First of all, in Fitbit’s smartwatch-based, the user seeks Human welfare (healthy eating habits, regular exercise, and managing biological rhythms), and they want to ensure that the information being collected has at least the same level of security due to it being Private information. Meanwhile, this makes tension with the Autonomy that VA should pursue. This is because service providers want to gain the value of universal usability by personalizing their services for the benefit and sustainable growth of the company. Then, employees attempt to draw Informed consent through VA’s sound, visual image, and experience and build a social community among users from the credibility. Secondly, the value of Trust can simultaneously exclude non-users. We designed Fitbit’s new features grounded on social aspects which aim to engage people with group excise. But unintentionally, it could put a dichotomous logic into the value of an individual’s Identity between having the product and pursuing a healthy life. The identity of the product represents the pursuit of the value of the user population, and the larger the population, the stronger the mental model. The last is the value tension that designers are well aware of. That is the skepticism that comes from designing this VA without precisely predicting how this new feature of technology will affect the user and society. It can be assumed that many of the conductors, including designers, are people who realize the Accountability of the services defined by the higher-level decision-makers though the form of User Experience.
Value sensitive design methods
In terms of rearranging the values, the tools proposed by Friedman and Hendry are applicable. (Friedman & Hendry, 2019, p. 61–64) The value scenario will be helpful to set the direction of the VA that is currently being designed. This is because thinking of the whole story starting from one available feature is a good way to imagine how implicit stakeholders relate and affect society over time. For example, we came up with a scenario in which the function of automatically recognizing the text of the menu board, recommending a diet based on calories and nutrients, and logging in at the same time works in a real restaurant environment. This allows us to think about sustainable food order environments such as dedicated menu boards being created in collaboration with a restaurant union and Fitbit and standardizing word selections used on a menu board since the text that the Fitbit can recognize would be limited in real situations.
Our team did something similar to a Value-oriented semi-constructed interview (IxD Studio Fitbit team, 2019). Through this process, we could better understand the user’s perception, views, and values toward this virtual assistant system that were previously hard to estimate properly. The survey showed that 50% of respondents do not mind customized nudges according to their statistics and daily activity from VA. 40% of the respondents replied they would be motivated by VA’s exercise suggestion. Users are highly interested in accomplishing a fitness goal, but 75% of them feel severely violated or uneasy if their health stats are sent to their employer for general health stats of the company employees, and they have high concerns about securing personal data.
What is the role of a designer in an era in which technology and people coexist?
From the perspective of Value Sensitive Design (Friedman & Hendry, 2019), designers believed that they should adjust value tensions between different groups. As mediators, we must consider the ways of achieving strong security policies for the product and the transparency of the utilization of information collection and further communicate with the user. Furthermore, we must be aware of the impact that our planned services may have on the groups that are not included in the current stakeholders and should reflect their voices in the planning phase. Finally, conflicting values must all be taken into consideration. If designers can cross the border between themselves and the user, they will realize what they have overlooked during the production phase.
The end of the Fitbit VA project led to the realization that high technology can introduce new features to the service. But in addition, it has become necessary to establish a social and cultural foundation on which subsequent changes can be accepted and to consider different values that each group holds. Under the virtual assistant’s voice, there are several technical systems that have not been mentioned. Thus, a few questions were necessary in order to avoid treating the users as mere consumers and excluding them from the information cycle. This will be in line with the expected attitude those who plan, design, and technically implement the product should hold. We need to answer more direct questions about what the speech-recognition feature of the product entails. For example, we must consider that the virtual assistant technology detects ambient noise as well as voices and resolve the potential of resultant hacking. As sharing information becomes more common, it is important to provide users with transparent communication with other software and stakeholders or enable complementary platforms. Understanding the impact of the accumulated information under the name of personalization is crucial, and healthcare wearables services like Fitbit must help users recognize that their food intake, physical activity, and location tracking is personal information and must be protected. Moreover, individuals must question what their rights and responsibilities are as potential users of the service. The accumulation of information, respect of privacy and the establishment of transparency goals are only possible when the producers’ and facilitators’ opinions, market norms and appropriate user awareness come together.
References
Daniel, N. (2019). Forbes: Top 6 Digital Transformation Trends in Healthcare For 2019
Anonymous. (2019) Facebook Newsroom: Connecting People with Health Resources
https://newsroom.fb.com/news/2019/10/connecting-people-with-health-resources/
Jon, P. (2019) The Verge: Google is reportedly trying to buy Fitbit
https://www.theverge.com/2019/10/28/20936415/google-fitbit-acquisition-alphabet
Friedman, B.& Hendry, D. G. (2019). In Value sensitive design: shaping technology with moral imagination. Cambridge, MA: MIT Press.
IxD Studio Fitbit team (2019) Survey result:https://drive.google.com/file/d/1tfrdz0XwqG4XcrRrUIz5QUY9DEhGy5gD/view?usp=sharing
