1. ETHICAL CONSIDERATIONS &
RELATION-CENTERED DESIGN FOR
MOBILE HEALTH APPLICATIONS
UNESCOTech4Dev
Lausanne, 2014
Kate Michi Ettinger, JD
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications

2. WHY ISTHE
ADOPTION OF
HEALTH CARE IT
SO CHALLENGING?
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Challenges
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
CC Wikimedia

3. 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
CLINICAL
BIOETHICS
Challenges
Flat Tire by Luis Prado & Pulse by TNS (The Noun Project)

4. 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 George
Impact Investor
New MediaVentures
PRODUCT
DESIGN
CLINICAL
BIOETHICS
Challenges

5. TECH
CHALLENGE #2
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
For technologists:
success = working product
SOCIAL
ENTREPRENEUR
Challenges
Mountain Climber by Juan Pablo Bravo from The Noun Project

6. FUNDER
CONSULTANT
CHALLENGE #2
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
For funders:
success = product & users
SOCIAL
ENTREPRENEUR
Challenges
Mountain Climber by Juan Pablo Bravo & Team by Jon Prepeluh

7. 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
CLINICAL
MEDICINE
Challenges
Mountain Climber by Juan Pablo Bravo & Patient by Wilson Joseph

8. TECH
CHALLENGE #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.
CLINICAL
MEDICINE
Challenges
Mountain Climber by Juan Pablo Bravo; Patient by Wilson Joseph & Team by Jon Prepeluh

9. 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
Challenges
PRODUCT
DESIGN
CLINICAL
BIOETHICS

10. Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaffold
HOW CAN MHEALTH APP DEVELOPERS NAVIGATETHESE CHALLENGES?

11. RELATION CENTERED DESIGN
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
RCD
Build products in service to our
relationships.
addresses the relational aspect of user interactions

12. 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
RCD
mHealth by Edward Boatman from The Noun Project

13. RELATION CENTERED DESIGN
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
RCD
mHealth by Edward Boatman from The Noun Project
Respect for Persons
Benefit/Harm (Beneficence/Non-maleficence)
Privacy
Quality | Reliability | Safety
Transparency

14. PRODUCT DEVELOPMENT
Stages
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaffold
Research &
Development
Deployment &
Maintenance
Prototype &
Usability

15. PRODUCT DEVELOPMENT
For Each Stage:
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaffold
Research &
Development
Deployment &
Maintenance
Prototype &
Usability
2 Parts to Inquiry:
Technical Development | Clinical Application

16. SCAFFOLD
Research &
Development
Research &
Development
Prototype &
Usability
Prototype &
Usability
Deployment &
Maintenance
Deployment &
Maintenance
Ethical considerations Technical Clinical Technical Clinical Technical Clinical
Respect for Persons
Beneficence
Non-Maleficence
Justice
Research Ethics
- Risk-Benefit
- Informed Consent
- Harm from research
Privacy
Quality | Reliability | Safety
Transparency
Relation-centered design
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Scaffold

17. Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Applied

18. 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.

19. 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

20. 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

21. Deployment &
Maintenance
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
D&M
SystemicPressures
Personal/Family
Pressures
mHealth by Edward Boatman from The Noun Project

22. 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 &
Development
Research &
Development
Prototype &
Usability
Prototype &
Usability
Deployment &
Maintenance
Deployment &
Maintenance
Technical Clinical Technical Clinical Technical Clinical
Respect for
Persons
Harm/Benefit
Privacy
Quality/
Reliability
Transparency
Relation-
centered
design
SCAFFOLDWHEN?
WHAT?
HOW?
WHY?
Conclusion

23. “THE DIFFERENCE BETWEEN
WHAT WE DO AND
WHAT WE ARE CAPABLE OF
DOING WOULD SUFFICETO
SOLVE MOST OFTHE WORLD’S
PROBLEMS.” - GANDHI
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Conclusion

24. SystemicPressures
WHAT IS ESSENTIAL FOR MHEALTH?
Research &
Development
Research &
Development
Prototype &
Usability
Prototype &
Usability
Deployment &
Maintenance
Deployment &
Maintenance
Technical Clinical Technical Clinical Technical Clinical
Respect for
Persons
Beneficence
Non-
Maleficence
Justice
Research Ethics
Privacy
Quality |
Reliability |
Safety
Transparency
Relation-
centered design
Kate Michi Ettinger
@k8ethics
integritybydesign.org
Ethical Considerations & Relation-Centered Design for Mobile Health Applications
Snapshot
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