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

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Ethical Considerations and Relation Centered Design for mHealth Applications

  • 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