ETHICAL CONSIDERATIONS & RELATION-CENTERED DESIGN FOR MOBILE HEALTH APPLICATIONS UNESCO Tech4Dev Lausanne, 2014 Kate Michi Ettinger, JD @k8ethics integritybydesign.org Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Ethical Considerations and Relation Centered Design for mHealth Applications
Aug 23, 2014
Ethical Considerations and Relation Centered Design for mHealth Applications presented in the Medical Devices Track: Strategies for Successful Implementation of mHealth in Low Resource Settings chaired by Walter Karlen, PhD, Grand Challenges Canada grantee and post-doc at University of British Columbia and Stellenbosch University.
Presented June 6, 2014, at UNESCO Technology for Development 2014, theme: What is Essential?, hosted by EPFL and CODEV in Lausanne, Switzerland. For more information: http://wiki.epfl.ch/opentech4dev
Presented June 6, 2014, at UNESCO Technology for Development 2014, theme: What is Essential?, hosted by EPFL and CODEV in Lausanne, Switzerland. For more information: http://wiki.epfl.ch/opentech4dev
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ETHICAL CONSIDERATIONS & RELATION-CENTERED DESIGN FOR
MOBILE HEALTH APPLICATIONS
UNESCO Tech4DevLausanne, 2014
Kate Michi Ettinger, JD@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
WHY IS THE ADOPTION OF
HEALTH CARE IT SO CHALLENGING?
Kate Michi Ettinger@k8ethics
integritybydesign.org
Cha
lleng
es
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
CC Wikimedia
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
CHALLENGE # 1
Failure culture of tech meets reality of health care delivery.
PRODUCT DESIGN
CLINICALBIOETHICS
Cha
lleng
es
Flat Tire by Luis Prado & Pulse by TNS (The Noun Project)
Flat Tire by Luis Prado; Pulse by TNS; Patient by Wilson Joseph
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
CHALLENGE # 1
“When we fail, we fail real people.”
- Christie GeorgeImpact Investor
New Media Ventures
PRODUCT DESIGN
CLINICALBIOETHICS
Cha
lleng
es
TECHCHALLENGE #2
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
For technologists:success = working product
SOCIAL ENTREPRENEUR
Cha
lleng
es
Mountain Climber by Juan Pablo Bravo from The Noun Project
FUNDERCONSULTANTCHALLENGE #2
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
For funders: success = product & users
SOCIAL ENTREPRENEUR
Cha
lleng
es
Mountain Climber by Juan Pablo Bravo & Team by Jon Prepeluh
CHALLENGE #2
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
For clinicians: success = data that shows improved clinical outcomes
SOCIAL ENTREPRENEUR
CLINICALMEDICINE
Cha
lleng
es
Mountain Climber by Juan Pablo Bravo & Patient by Wilson Joseph
TECHCHALLENGE #2
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Different metrics for success result in differing views on product value.
CLINICALMEDICINE
Cha
lleng
es
Mountain Climber by Juan Pablo Bravo; Patient by Wilson Joseph & Team by Jon Prepeluh
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
CHALLENGE #3
User-centered design:meets one set of needs at the expense of the clinical relationship
Cha
lleng
es
PRODUCT DESIGN
CLINICALBIOETHICS
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaf
fold
HOW CAN MHEALTH APP DEVELOPERS NAVIGATE THESE CHALLENGES?
RELATION CENTERED DESIGN
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
R C
D
Build products in service to our relationships.
addresses the relational aspect of user interactions
How does your mHealth app impact the clinical relationship?
RELATION CENTERED DESIGN
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
R C
D
mHealth by Edward Boatman from The Noun Project
RELATION CENTERED DESIGN
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
R C
D
mHealth by Edward Boatman from The Noun Project
Respect for Persons
Benefit/Harm (Beneficence/Non-maleficence)
Privacy
Quality | Reliability | Safety
Transparency
PRODUCT DEVELOPMENT
Stages
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaf
fold
Research &
Development
Deployment &
Maintenance
Prototype &
Usability
PRODUCT DEVELOPMENT
For Each Stage:
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaf
fold
Research &
Development
Deployment &
Maintenance
Prototype &
Usability
2 Parts to Inquiry:
Technical Development | Clinical Application
SCAFFOLD
Research & DevelopmentResearch &
DevelopmentPrototype &
UsabilityPrototype &
UsabilityDeployment & Maintenance
Deployment & Maintenance
Ethical considerations Technical Clinical Technical Clinical Technical Clinical
Respect for Persons BeneficenceNon-MaleficenceJusticeResearch Ethics - Risk-Benefit - Informed Consent - Harm from researchPrivacyQuality | Reliability | SafetyTransparency
Relation-centered design
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaf
fold
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
App
lied
Research & Development
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
R &
D
Tech developers build clinical decision support tools that enable people with lower levels of training to provide higher levels of care.
Research & Development
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
R &
D
Current regulatory approaches are mismatched to tech’s iterative development
Photo: Richard Holder
Prototype & Usability
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
P &
U
mHealth by Edward Boatman from The Noun Project
Deployment & Maintenance
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
D &
M
Syst
emic
Pre
ssur
es
Personal/Family Pressures
mHealth by Edward Boatman from The Noun Project
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
To respond to the challenges:
1. Address the clinical reality of technical failure from the outset of design
2. Include all metrics of success
3. Strengthen the clinical relationship
4. Build apps with integrity by design
Research & DevelopmentResearch &
DevelopmentPrototype &
UsabilityPrototype &
UsabilityDeployment & Maintenance
Deployment & Maintenance
Technical Clinical Technical Clinical Technical Clinical
Respect for PersonsHarm/Benefit PrivacyQuality/Reliability Transparency
Relation-centered design
SCAFFOLDWHEN?
WHAT?
HOW?
WHY?
Con
clusio
n
“THE DIFFERENCE BETWEEN WHAT WE DO AND
WHAT WE ARE CAPABLE OF DOING WOULD SUFFICE TO
SOLVE MOST OF THE WORLD’S PROBLEMS.” - GANDHI
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Con
clusio
n
Syst
emic
Pre
ssur
es
WHAT IS ESSENTIAL FOR MHEALTH?Research &
DevelopmentResearch &
DevelopmentPrototype &
UsabilityPrototype &
UsabilityDeployment & Maintenance
Deployment & Maintenance
Technical Clinical Technical Clinical Technical Clinical
Respect for Persons BeneficenceNon-MaleficenceJusticeResearch Ethics PrivacyQuality | Reliability | SafetyTransparency
Relation-centered design
Kate Michi Ettinger@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Snap
shot
Personal/Family Pressures
Apps that strengthen the clinical relationship
Build products with integrity by
design
Create technology in service to our relationships
mHealth by Edward Boatman from The Noun Project
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