Vous êtes sur la page 1sur 11

Design Principles for Health Wearables

John Jones Catherine Gouge Mariah Crilley


West Virginia University West Virginia University West Virginia University
john.jones@mail.wvu.edu cgouge@mail.wvu.edu mcrilley@mix.wvu.edu

ABSTRACT PRACTITIONER TAKE AWAYS


As wearables become increasingly prevalent, there is a concurrent ● Amplifies that wearable devices represent a unique
and growing expectation that we use these devices to track and opportunity, distinct from prior implementations of ehealth,
monitor our bodily states in order to be responsible “biocitizens.” for understanding the relation of bodies to technology and
To mitigate this, some health, design, and usability scholars have design
advocated for greater patient control over health data. To support
● Mobilizes theories of speculative usability (Rivers &
these efforts, this article offers a set of criteria for analyzing
Söderlund, 2016) and diffraction (Barad, 2007) to argue for
wearables, criteria that account for the handling of data and
a broader approach to usability in the design of wearable
user connections via wearables as they relate to three priorities:
interfaces
accessibility, adaptability, and iterability. These are meant to support
analyses that will clarify the ways wearables can more ethically ● Offers a heuristic for evaluating the design of health wearable
serve end-users’—that is, patients’ and wearers’—emerging needs, interfaces across the principles of accessibility, adaptability,
rather than primarily serving the intermediary goals of care delivery and iterability
personnel and systems to monitor and manage patient behavior.
To do this, this article addresses the usability of wearables as it
relates to other critical care issues, such as “information integrity”
INTRODUCTION
As the promises made on behalf of consumer-grade wearable health
and enabling patients to maintain their own health records and
devices become more expansive and their presence ubiquitous,
participate in shared decision making.
some bioethicists have argued that individuals are expected to take
Categories and Subject Descriptors more and more responsibility for managing their chronic conditions
H.0 Information Systems: General by monitoring and responding to fluctuations in the data generated
by their wearables (cf. Murray and Holmes, 2009; Walker, 2009).
General Terms One individual with diabetes describes it this way: “Diabetes is [
Human Factors, Design, Documentation . . . ] largely a data management game. If you can manage your
Keywords calories, and your macronutrient balance, and your fitness activity,
Wearable technologies, usability, accessibility, eHealth, elec- and your sleeping patterns, and your stress levels, etc., etc., etc.,
tronic medical records, information integrity, biocitizens, digital then you can manage your blood sugar effectively.… adjust your
medicine bio-markers and profit” (Long, 2015). As Meloncon and Frost
(2015) noted, technical communicators are uniquely positioned to
help address disparities in health and medicine that are impacted by
literacy. However, as wearable devices become more prominent—
Permission to make digital or hard copies of all or part of this work for and as they are increasingly seen as a route to improving healthcare
personal or classroom use is granted without fee provided that copies are outcomes for at-risk populations (Teston, 2016)—the question of
not made or distributed for profit or commercial advantage and that copies how we can improve these outcomes is not just one of literacy but
bear this notice and the full citation on the first page.
of communication design and usability: how people seeking care
Communication Design Quarterly. ACM SIGDOC, New York, USA.
(or improved health) and their caregivers will interact with devices,
Copyright 2017 by the author.
data, and each other.
Here we propose a set of design criteria for analyzing the interaction DIGITAL MEDICINE, USABILITY AND
of individuals with health and medical wearables and their
ecosystems, where wearables are defined as those technologies
DESIGN
that require connection to a body for their primary functionality Ehealth and Patient Participation
(Gouge & Jones, 2016). Though others have suggested criteria for At the turn of the twentieth century, the use of the internet for health
evaluating health websites (Grant et al., 2015) and health applications purposes, or what has more recently become known as “ehealth,”
(Boudreaux et al., 2014), the criteria we have developed go beyond was lauded as revolutionary. Anyone with access could search for
these to address the new opportunities and new challenges presented internet-based health information, join and participate in online
by wearables—and health wearables, in particular—for usability in support groups, and leverage this knowledge for the purposes of
relation to the body. In doing so, these criteria might help us directly self-advocacy at the doctor’s office and beyond. Many doctors
address emerging needs driven or impacted by wearables, such as feared or derided (and some continue to deride) such non-expert
patients having the capacity to maintain “their own health records” knowledge-gathering practices, prompting them to question these
and enabling “shared decision making” (Meloncon & Frost, 2015, practices: Was the information valid, reliable? Would patients
p. 11). To demonstrate their relevance, we apply these criteria to become belligerently (mis)informed? Would the information
the design of two wearable data platforms: 1) the Fitbit family of gathered from other non-experts make it harder for medical
activity monitors and 2) Philips’ DreamMapper software, which is professionals to treat their patients? However, others championed
designed for use with CPAP devices for sufferers of sleep apnea. the promise of ehealth to transform access to medical knowledge,
These platforms were chosen because they represent two distinct redress power imbalances between providers and patients, and
categories of health wearables: help to facilitate more productive conversations about treatment
and care practices. The idea that ehealth practices would empower
1. “Consumer wearables,” the category the Fitbit belongs to, patients and, in so doing, improve patient care and outcomes, was
need not be reviewed and certified as “medical devices” by described by Kopelson (2009) as initiating a tectonic shift in the
the FDA; whereas practice of medicine (p. 353). Echoing the on-going importance
2. Wearable “medical devices,” the category DreamMapper such technologies have been expected to confer on care practices,
belongs to, must be reviewed and certified as such by the Topol (2015) has been using the same phrase, tectonic shift, to
FDA because they aim to contribute to medical diagnoses. describe the impact of wearables on health practices (p. 5).

Any evaluation of the communication and/or user-experience design Indexing a similar hopefulness in the transformative potential
of wearables ought to recognize both of these broad categories as of ehealth technologies and practices, the Patient Protection and
important test cases. As of the fourth quarter of 2016, Fitbit was the Affordable Care Act (2010) included several phases of designing
market leader for consumer wearable devices (IDC, 2017). Though and implementing electronic health records (EHRs) as a part of
Philips’ DreamMapper does not share the brand recognition of what it called “delivery system reform,” which was meant to “help
Fitbit, sleep apnea sufferers represent a vibrant, self-monitoring physicians, clinicians, and hospitals to deliver better care, smarter
community who interact with and troubleshoot their devices spending, and healthier people” (U.S. Department of Health &
through open-source software like SleepyHead (Watkins, 2011). Human Services, 2015). As a result of this initiative, between 2001
The analysis here is of a limited sample, but these choices have the and 2013, the percentage of U.S. physicians using EHRs increased
benefit of being representative of both categories of wearables. from 18% to 78%, and “94% of hospitals now report using certified
EHRs” (Burwell, 2015). By 2018, Patrick Conway, CMS deputy
The prominence of individualized medical technologies (many of administrator for innovation and quality and chief medical officer,
them wearable, like the Fitbit and CPAP machines) is transforming reports that the agency hopes these rules will “move us beyond the
expectations for the ethical role of individual “biocitizens.” There staged approach of ‘meaningful use’ and focus on broader delivery
are many uses of the term “biocitizen,” but here we refer to that system reform” (U.S. Department of Health & Human Services,
proposed by Swan (2012) to identify a person who dutifully gathers 2015). Most recently, the Office of the National Coordinator for
information about their body and then shares that data with others Health Information Technology (ONC) has been incentivizing
to engage in “proactive health self-management” (p. 108). As both those working on health-related apps to “connect and accelerate”
consumer wearables and wearable medical devices have become (ONC, 2016) a FHIR (Fast Healthcare Interoperability Resources,
more prevalent, expectations that we use these devices to track pronounced “fire”) App Ecosystem, which is the standard
and monitor our bodily states in order to be responsible, ethical for exchanging healthcare information electronically (FHIR
biocitizens have also intensified. This is just one part of what Gouge Infrastructure Work Group, 2015). The primary goals of the FHIR
(forthcoming) identifies as Compliance 2.0: the expectation that in standard are adaptability and connectivity: “to leverage existing
order to be ethical, productive healthcare participants and deserving logical and theoretical models to provide a consistent, easy to
of care and support, individuals in the patient role must proactively implement, and rigorous mechanism for exchanging data between
address both potential and existing disease issues, accepting their healthcare applications” in order to “simplify implementation
role as “at risk,” medicalized subjects. As with other forms of without sacrificing information integrity” (FHIR Infrastructure
medical compliance, this expectation sutures over other critical Work Group, 2015).
issues, obfuscating rather than illuminating how design processes
can participate in privileging and furthering ableist assumptions Some critics have challenged what they see as an uncritical emphasis
about issues of access, adaptability, and iterability. on “information integrity” as well as the rhetoric of empowerment
that often accompanies claims about the transformative potential
of EHRs. Kopelson (2009) has argued that even an “empowered
patient” armed with carefully-collated information risks reinforcing
medicine’s conventional power structure: “Self-reliance and
responsibilization function on behalf of the medical power structure
Communication Design Quarterly 5.2 2017 41
not only by constituting and then incorporating only the fittest of counts as valid and valuable design approaches. To date, ehealth
subjects into that structure, thereby keeping the unfit unseen, but by design has tended to emphasize traditional usability values, like
constituting the unfit as at fault for being so, thereby keeping the simplifying interaction and content (Lazard & Mackert, 2015, p. 26).
power structure itself un-interrogated” (Kopelson, 2009, p. 388). In their study of ehealth design, Lazard and Mackert (2015) argue
Segal (2009) has criticized an overemphasis on new sources of that design principles—including web aesthetics, visual complexity,
medical knowledge (e.g., websites that provide information about affordances, prototypicality, and persuasive imagery—can help
symptoms and treatments), an emphasis that too often comes at the reach audiences with low health literacies more effectively by
expense of more nuanced consideration of the knowledge seeker. strengthening attention, processing, and evaluation. Implementing
In particular, Segal argued that “empowerment,” in this context, best design practices can not only facilitate comprehension and
imagines an ehealth user who is calm, logical, and collected. retention, in other words, but improve access to some of the most
However, in practice, ehealth users are frequently anxious, nervous, vulnerable populations.
and uncertain about their health (Segal, 2009, p. 363). Rather
Universal Design (UD) works from a related premise: products should
than transforming and empowering conversations about care and
be designed for the widest possible audience from the beginning of
improving accessibility and adaptability of health data, ehealth may
a project rather than as an afterthought or retrofit. Although UD is
simply reify extant roles and scripts for both patients and healthcare
an outgrowth of the disability rights movement, some have been
professionals. These results may be exacerbated by the twin
critical of its ethical progressivism. These critics have argued that
developments of electronic health records and the copious amounts
it is a “problem-solving paradigm” that emphasizes “technological
of personal data produced by wearables (and the accompanying
fixes” at the expense of socio-political activism (Imrie, 2012).
expectations this data places on wearers).
Hamraie (2013) considers Karen Barad’s (2007) discussion of
There are studies of ehealth exchanges, however, that pay attention diffraction to argue that UD highlights the tangled, diffractive
to the ways that users develop and interact with knowledge nature of being, meaning, and ethics, noting that it highlights how
communities and the ways that knowledge is generated by these things make meaning and how bodies become included or excluded
communities. These studies do more than reinforce and locate users in that meaning. Following from this, we might consider the ways
along a simple continuum of empowerment and disempowerment. that diffraction—the visible effect of interference that matters (in
In her study of multimodal health texts, for example, Bellwoar both senses of the word)—might be understood as rejecting what
(2012) argues that usability studies have misunderstood how Bellwoar (2012) has called an “already-made world” and, instead,
people construct medical knowledge. Usability studies are meant recognizing that users inevitably interact with, transform, and
to improve specific technologies, but they frequently overlook how create their own worlds (Bellwoar, 2012, p. 343). For this reason,
users “chain” texts together—drawing knowledge not only from as we demonstrate in our analysis, the concept of diffraction might
official medical leaflets and conversations with doctors but also be a useful reminder to take seriously the complex ways that users,
from online forums, movies and television, friends and family (not designed objects, and environments are mutually transforming and
unlike Spinuzzi’s [2003] genre ecologies). Bellwoar writes, impactful.
this examination of already-made worlds is not enough In spite of growing recognition of the importance of UD principles
to understand how people are using products because in communication design scholarship, the design of health
it assumes that people intend to inhabit already-made technologies is typically a top-down affair—top down is a term
worlds, when in fact they intend to remake their own frequently used in discussions of grouping and classification,
worlds using the technologies along with the other official denoting categorization schemes established with little or no user
and nonofficial texts and professional and nonprofessional input or flexibility (cf. Bruns, 2008). Here, we use the term to evoke
people whom they tie with those technologies. (Bellwoar, this all-too-common and sometimes uncritical prioritizing of design
2012, p. 343) goals and processes and, returning to compliance-related concerns,
to recall the ways in which this approach can be used indirectly as
This “remaking” with ehealth technologies provides an opportunity
a mechanism of control—not just of designed processes but of the
for user-centered research and design to attend to—and ultimately
people who participate in them. Such top-down design approaches
learn from—the complex and complicated methods by which users
are incompatible with more progressive design principles.
make knowledge and apply what is learned to the design process.
Perhaps responding to this, Ito and Howe (building on Ito’s work
Such responses cannot be static, but are iterable, as developments
at MIT’s Media Lab) have proposed nine principles that, in the
in these communities feed into ever-changing innovation. In the
context of a discussion about wearable technologies in health and
case of medical wearables, such a focus is arguably more critical,
medicine, include some priorities that might sound a bit cavalier:
as it must consider how users access and control their own health
in particular, “risk over safety,” “systems over objects,” “resilience
data and how that data can be adapted to emerging situations and
over strength,” and “disobedience over compliance” (Ito & Howe,
to facilitate user-supported outcomes. It must not simply serve
2016). Indeed, the impulse towards conservatism in design and the
the self-reporting and compliance expectations of the biocitizen
desire to control processes often comes from the fact that in health
mandate that have intensified with the emergence of monitoring
and medicine, more so perhaps than many other design and use
technologies like health wearables.
contexts, the stakes can literally be life or death, and this can lead
those in positions of responsibility—or those who hope to sell new
UNIVERSAL DESIGN technologies to people with such responsibility—to favor strategies
The recent boom in wearable technologies has led to these devices that privilege control and predictability.
possessing increasingly broader (quantity of functions) and deeper
(quality and complexity of functions) capacities. These changes
offer communication design scholars opportunities to rethink what

42 Communication Design Quarterly 5.2 2017


SPECULATIVE USABILITY in technical communication, rhetoric and disability studies, and
If a design approach for wearables in health and medicine were to related communication design and UX scholarship (cf. Howard and
prioritize “risk over safety,” “systems over objects,” “resilience over Greer, 2011) have been working on how to approach the challenge
strength,” and “disobedience over compliance” (Ito & Howe, 2016) of user design that pays attention to our changing understanding of
and also to take seriously the mutually transforming influences access. Dolmage (2014), for example, has argued that an approach
of wearables, users, and environments, it might look a little like based on incorporating both the “primary design-goal of serving
what Rivers and Söderlund call “speculative usability” (2016). a diversity of users” that universal design approaches emphasize
Speculative usability complements traditional usability studies in and the “iterative design-feedback-design process of user-centered
that it recognizes the ways that the actual uses of designed objects design” can lead to modifications that incorporate the best of
often exceed their intended uses and, further, acknowledges that each, producing outcomes that benefit users. Where an approach
such unintended uses of objects can produce something new, what that emphasizes the user’s role as a compliant biocitizen might
Barad (2007) argues ought to be thought of as “differences that narrowly constrain how these products produce and manage data,
matter” (p. 146). Traditional user testing does not conventionally a more open design would seek such an iterative process focused
assess user-defined goals and adaptations that exceed the intended on user needs.
uses of a design; rather, traditional usability studies are designed Such an approach for the application interfaces of wearable devices
to test to what extent users are able to perform prescribed uses. might consider the following three design goals, which are versions
Speculative usability, on the other hand, expands usability studies of Dolmage’s (2014) design “vectors” for improving instructional
to “focus as much on discovering the multiple relations that an methods (his object of study) and grow from the particular concerns
object has as it does on elaborating the specific dysfunctions that a of design related to wearables:
user experiences in his or her encounters with an object” (Rivers &
Söderlund, 2016, p. 3). 1. Accessibility: Examine the methods of delivery of data and
other content to identify the ways that they include and
Building on this, an approach to wearables that considers such exclude differently-oriented and identified users (i.e., how
“excessive uses” potentially noteworthy and valuable would need they serve or priorities some users—those who are affluent or
to let go of the presumption that people only interact with health sighted, for example—and exclude others—those who have
wearables in order to be informed, served, and/or persuaded by access issues and abilities that are underprivileged) (Lazard
them as (perhaps) their designers intend. In other words, it would & Mackert, 2015; Meloncon & Frost, 2015).
need to let go of the idea that people only wear activity monitors to
lose weight or use a CPAP machine for better sleep. An approach 2. Adaptability: Consider how users are invited to respond
that recognized that people use wearables for uses that exceed those to and interact with their data and other users and what
for which they were designed would need to incorporate a way of possibilities these invitations enable and disable (Bellwoar,
paying attention to the open-ended nature of such technologies. 2012; Rivers & Söderlund, 2016).
For example, web-based tools like IFTTT (ifttt.com) allow Fitbit 3. Iterability: Investigate the flexibility and portability of
users to automate actions—such as turning on a smart lightbulb data—are there ways (or multiple ways?) that users can take
when the wearer wakes up—using their data, and projects like Unfit the data they generate with their use of the wearable away
Bits (unfitbits.com) teach wearers how to produce false data—for from the specific environment of the app (to refer to or use
example, logging steps while sitting at a desk. Similarly, Mark in another context, for example)? And how can innovations
Watkins’s SleepyHead software (Watkins, 2011) allows CPAP from this process be fed back into the design of the platform?
users to access and analyze their data independent of software (Hamraie, 2013; Potts, 2014)
provided by the machine’s manufacturer. This access allows users
This adaptation of Dolmage’s vectors can help communication
to troubleshoot problems with their CPAP device beyond the scope
design scholars see more clearly what health wearable applications
of manufacturer settings, which aim for compliance rather than
can and cannot do for users and how they enable and disable their
improved sleep.
interaction. It can, further, lead to modifications that might help
Coupling speculative usability principles with the universal design us design wearables that serve a diversity of users and take into
goals of designing objects to work for a wider range of users would, as account both the limitations of the more conservative process
Potts has proposed future work should, “push us beyond the current outlined by Boudreaux et al. (2014) as well as the more progressive
user-centered design paradigms” in valuable ways (Potts, 2014, p. design principles that privilege risk-taking, disobedience, systems,
3). Gouge (2016) addresses the ways that design approaches that and resilience over safety, objects, strength, and compliance (Ito &
draw on speculative usability and the universal design adaptations Howe, 2016).
to traditional usability studies proposed by Dolmage (2014) can
help facilitate and account for the improvisation of medical forms DESIGNING PATIENT-CENTERED
(like patient discharge instructional documents) once they are in
use. WEARABLE EXPERIENCES
Others have tried to establish rubrics for designing ehealth
Speculative approaches to thinking about wearable phenomena technologies. In their 2014 article, Boudreaux et al. (2014)
that keep in mind the diffractive potential to reveal “differences provided a seven-step process for healthcare providers to use in
that matter” cannot only provide users with top-down systems of evaluating health apps that could be recommended to patients:
data entry and management; rather, they must be adaptable, taking “(1) Review the scientific literature, (2) Search app clearinghouse
advantage of user experimentation and tinkering to explore what websites, (3) Search app stores, (4) Review app descriptions, user
new information patients and caregivers can learn about bodies and ratings, and reviews, (5) Conduct a social media query within
health and what wearables can and should do. And, indeed, scholars professional and, if available, patient networks, (6) Pilot the apps,

Communication Design Quarterly 5.2 2017 43


Table 1. Questions regarding design criteria for health wearables apps
Data Connectivity
Accessibility ● Do data access methods meet the needs ● Can users determine who contacts them
of multiple users? through the system and the nature of
those contacts?
● Do users control how (and if) data is
collected? ● Are communications secure?
● Is data—at all levels, from device to
external storage, if used—secure from
unauthorized access?
Adaptability ● Can users add and edit data if they ● Can the app integrate with EHRs to
choose? upload data?
● Can data be entered manually?
Automatically? Or both, depending on
user needs?
Iterability ● Can users store personal copies of their ● Do user feedback and needs influence
data? design processes?
● Are users able to move their data
between systems?

and (7) Elicit feedback from patients” (p. 1). Although these steps extend to underserved populations (Teston, 2016). We cannot hope
might be helpful for providers who wish to thoughtfully introduce to address all issues of access and compliance addressed by the role
medical apps into their practices, collectively, the parts of this of wearables in healthcare and the changing relationships between
metric rely on a traditional usability model that works within caregivers and those receiving care. However, we will focus on
closed-systems and predetermined uses. Such an approach, as those factors of communication design that affect accessibility,
Rivers and Söderlund (2016) argued, can limit innovation because adaptability, and iterability.
it fails to capture the unintended uses and relations among objects,
users, and environments. That is, any app designed following a Recognizing the value of the design modifications proposed
process such as that outlined by Boudreaux et al. (2014) would be by Dolmage (2014) and the diffractive potential afforded by a
focused on current trends in medical research regarding diagnosis speculative usability add-on to traditional usability approaches
and treatment. It would be modeled on existing apps and those proposed by Rivers and Söderlund (2016), we suggest these
features identified as beneficial (or not) in reviews and ratings, as criteria for evaluating (and ultimately designing) the interfaces
well as those that are popular among professionals, providing little of wearable health applications. Based on versions of Dolmage’s
room for integrating—or even recognizing—the diffractive and (2014) vectors, we propose that accessibility, adaptability, and
speculative uses we have drawn attention to here. iterability be the focus of and priorities for evaluation: The design
of wearables and their software interfaces should be fully accessible
Though no single part of this process is negative in and of itself, to patients; data produced by wearables and other interface features
as a whole, such a design process would privilege and reinforce should be adaptable for user needs and innovation; and this data, in
existing ideas of what wearables in health and medicine can (and both use and access, should be portable and sustainably supported
should) do, emphasizing the users’ role as ethical biocitizens and for a range of patients. We see these criteria not as being linear
minimizing the exploration of uses that exceed their original design (to be attended to in sequence), but as an interconnected matrix of
and, subsequently, the new opportunities for care made possible concerns. In contrast to evaluative criteria like Boudreaux et al.’s
by these emerging technologies. Our concern is that perpetuating (2014), we argue that health apps should include some mechanisms
current ehealth paradigms with wearables has the potential to that allow users to create bottom-up data and health monitoring
exacerbate, justify, or reinforce existing errors or inequalities in experiences.
care (cf. O’Neil, 2016) because an app designed according to this
process would likely be one that uncritically adhered to conventional Although different use cases—or different wearables—might
ideas of patient compliance (for example, that the ethical role of the respond to these priorities differently, because wearables are
patient is to follow agreed upon or accepted guidelines for care, to designed primarily to produce data about bodies and connect that
either treat or prevent illness) and closed, top-down understandings data with other individuals and systems, our proposed criteria
of the categories that are used in these apps to define both patients’ account for the handling of data and connectivity of wearables
bodies and care. across these three principles. Table 1 contains a series of questions
designed to explore these criteria. This two-dimensional approach
Such a concern is made more pressing by the fact that the volume to the analysis of health wearable ecosystems allows us to take into
of data collected by wearables on individuals and their health account both the usability of these ecosystems and their openness
(“Health Wearables,” 2014) is growing exponentially, and this to speculative, diffractively-productive uses.
growth ought to make us concerned about how that data will be
used (Wilbanks & Topol, 2016), how benefits from this data can be These criteria address those ways in which wearable devices offer
best achieved (Patel, Asch, & Volpp, 2015), and how these benefits new opportunities for engaging in usability-related questions

44 Communication Design Quarterly 5.2 2017


regarding bodies and their interactions with the environment, ones is uploaded to Fitbit’s servers, it can be accessed via the wearer’s
that go beyond the biocitizen mandate. Accessibility, adaptability, login credentials. At the time of this writing, Fitbit’s platform does
and iterability of data and connectivity, we propose, are critical not offer multi-factor authentication natively, but users can make
vectors for exploring and supporting these interactions. However, use of this stronger security feature by logging into their Fitbit
while the criteria we offer for this purpose are designed to account accounts via Google (Fitbit, 2016b).
for the potential value of these vectors in the evaluation of health
Connectivity. Users can control who sees their data and who they
wearables, we do not mean to advance that any one vector, criterion,
or question should necessarily be prioritized over others, or that message in the system. The Fitbit software allows users to share their
each should be a priority for every wearable. Whether the UX data with other Fitbit users. As with social network sites (boyd &
design of a health wearable ought to prioritize user access to the Ellison, 2007), users can make their profiles public, send messages
means of data collection should depend on the purpose and context to their friends, as well as compete and compare metrics with those
for use of that wearable for the wearer, not just as a biocitizen, friends. Such sharing can consist of basic metrics for comparing who
but as an active participant in their own data-production and health has taken the most steps, for example, or sharing “badges,” awards
decisions. These criteria are meant to be tools that provide a means assigned to a user’s account by Fitbit for achieving particular goals.
for evaluating such engagements for existing applications and, by In the latter case, a user can earn the “Japan” badge when they have
so, doing planning for such engagements (as those between user walked the equivalent of the length of Japan. Users can also send
and data) in particular contexts for use. a “cheer” or “taunt” to other users, small emoticons representing
those actions, and send each other messages. Fitbit claims that they
do not “sell data that could identify” users (Fitbit, 2016c), a claim
ANALYSIS that leaves open the possibility of selling anonymized or other
To test the utility of these criteria, we apply them to the interfaces data. The privacy statement also states that the company uses user-
through which users store, access, and manage their wearable data. generated data internally for product improvements. In short, it
This analysis addresses data collection and management for two
seems likely that user data is accessed by non-users, in some cases
sets of wearables, the monitoring software for the Fitbit family of
without the user’s knowledge. It is not clear how Fitbit handles
activity monitors and the Philips DreamMapper app. In so doing,
other data they are given access to, such as information about a
we hope to illustrate the potential value of this criteria to the
user’s contacts on a mobile device (Fitbit, 2016b).
communication designers of health wearables.
Adaptability
FITBIT PLATFORM Data. Data from Fitbit devices can be deleted or re-categorized but
As of September 2016, Fitbit offered nine wearable devices, from not otherwise edited. Users cannot add their own data categories
step-trackers that can be worn on the belt to smartwatches capable to the Fitbit system. Earlier incarnations of the system allowed for
of tracking user movement with built-in GPS. These devices can what the company called “custom trackers” to input data manually,
variously be worn on the wrist or waist where they record data but this functionality has been removed. Manual data entry only
about movement and, for some devices, the wearer’s heart rate. exists for categories that cannot be tracked automatically, such as
Additionally, the company offers a Wi-Fi-enabled bathroom scale food consumed or to log specific exercises. Users also have a limited
that records weight and calculates the user’s BMI (body mass ability to edit data and, in many cases, cannot delete existing data,
index). Fitbit devices automatically record data about movement, such as steps taken or floors climbed, from the system. In some
heart rate, and (from the scale) weight and BMI. This data can be instances, such as when an activity like driving is inaccurately
synced with a computer or mobile device using Fitbit’s website or logged as walking, users can “negate” it by re-categorizing it:
mobile apps (for IOS, Android, and Windows Mobile). This data selecting the data range and then identifying the input as a different
is stored on Fitbit’s servers and can be accessed via the mobile or activity (Fitbit, 2016a).
web-based apps, although a single wearable can only be paired
with (and thus sync data with) one mobile device at a time. Connectivity. The patients of some health systems can share their
Fitbit data with their doctors via EHRs (Pennic, 2015), although
Accessibility this idea has received mixed support from HC providers (cf. Lynn,
Data. Fitbit users can access wearable data via their computers 2015; Sullivan, 2014).
or through applications on a range of mobile operating systems.
The interface across these platforms consists of a dashboard Iterability
that uses tiles to track a range of metrics such as steps walked Data. Data exports from the Fitbit system are restricted to 31 days
or hours slept. Users can choose which tiles to display and their of activity at a time. This is an improvement over past company
arrangement, allowing for a personalized data access experience. practices—previously data downloads were limited to users of the
Tiles for activities or metrics the user does not wish to monitor can Fitbit Premium ($49.99/yr) service. However, the 31-day limitation
be removed from the dashboard. Some devices can be shut down can make it difficult for users to export large amounts of data to
to preserve battery life, thus ending tracking. Otherwise, users other trackers or health/fitness apps. Fitbit does allow users to
can only reliably stop automatic data collection by not wearing sync their data with their various partners (https://www.fitbit.com/
the device. Fitbit does not detail their security protocols (Fitbit, partnership), although if the partnership were to end or one of the
2016b)—the company’s security recommendations focus primarily partners were to close their service, it is not clear how users could
on preventing phishing attempts or other forms of hacking. As it access data or analysis located on the partner site.
moves to the cloud, user data is stored on the wearable, mobile
Connectivity. Third party sites like IFTT (ifttt.com) allow Fitbit users
devices and computers, and Fitbit’s servers. The restriction that
to customize how their devices interact with other internet enabled-
prevents a single wearable from pairing with more than one mobile
services, and Fitbit maintains a list of partners that can import or
device or computer helps secure data on the wearable, but once data
Communication Design Quarterly 5.2 2017 45
Table 2. Summary of Fitbit analysis
Data Connectivity
Accessibility ● Users can edit the Fitbit interface to ● Users can control their connections
prioritize metrics and categories. with other users and what data those
other users see.
● Users can power off some trackers or
choose to not wear them to limit data ● Users cannot send information to HC
collection. providers unless they are part of the
system.
● Security protocols aren’t clear, but data
is unlikely to be secured for user-only
access.

Adaptability ● Users cannot add their own data ● Users have limited ability to integrate
categories, edit existing data, or delete data with EHRs.
some data categories; erroneous data
can be re-categorized.
● Users can input data manually for those
categories that aren’t automatically
tracked or log exercise when tracker
wasn’t worn.

Iterability ● Users can store their own copies of ● Users can connect with other online
their data, but can only export 31 days systems, but the extent to which user
of activity at a time. feedback informs the design process is
not clear.

export data with the system. It is not clear how user adaptations Accessibility
with these outside entities affect Fitbit’s design practices. Table 2 Data. Users can access the data, either through the app itself or
summarizes this analysis. the connected web interface, by selecting the category (mask fit,
hours used, AHI) and the date, but they do not have the ability
DREAMMAPPER to adjust the interface in any way. For example, users cannot
Sleep apnea is characterized by an individual’s breathing being turn off data collection because, according to DreamMapper’s
interrupted during sleep. This condition can be serious, leading to privacy policy, turning off data collection undermines the ability
an oxygen deficiency in the afflicted person and contributing to a of the app to perform as intended: “The DreamMapper application
number of secondary problems such as high blood pressure, heart may collect information automatically, and it will not function
problems, and depression (NHLBI, 2012). Some cases of sleep correctly if it cannot receive the information requested” (Philips
apnea are treated with devices that help to regulate oxygen intake. Respironics, 2015). Securing data relies on physically securing the
These devices, CPAP (continuous positive airway pressure) and machine or the related SD or SmartCard, and users cannot create
BiPAP (bi-level positive airway pressure) machines, connect with a DreamMapper account without identifying their device’s serial
users using nose plugs or masks that cover either just the nose or number. Though the security of the data on the user’s SmartCard
or SD card is not clarified by supporting documentation, there is
both the nose and mouth (Virk & Kotecha, 2016).
reason to think that this data is not encrypted. For example, the
The DreamMapper app works with both CPAP and BiPAP open source apnea analysis software SleepyHead claims to be
machines, harvesting data from the machines in order to track compatible with some Philips devices (Watkins, 2011). Logging in
mask fit, the number of hours the device was used, and the apnea- to DreamMapper is managed with a username/password and does
hypopnea index (AHI). The AHI represents the incidences of no not support two-step authentication. DreamMapper’s software
breathing (apneas) or shallow breathing (hypopneas) that occur works with a system commonly used by providers, EncorePro 2,
during sleep. Users of DreamMapper can set goals (including and the associated documentation does not address data security
consecutive days of use and mask fit percentages), complete for the app. EncorePro2 is, however, described as being compliant
questionnaires on motivation and feelings, set reminders to clean with HIPAA standards (Philips Respironics, n.d.-a), and providers
their machine’s tubing or replace filters, and watch informational can access data by downloading it from the user’s device via an
and instructional videos on sleep apnea (Koninklijke Philips N.V., SD card or SmartCard to the provider system or syncing with the
2016). The DreamMapper platform is designed to be paired with user’s device via an optional wireless modem (Philips Respironics,
other members of the “Dream Family,” including “DreamWear” n.d.-b). The DreamMapper data does not sync with the provider’s
masks and the “DreamStation” CPAP machine. The promotional system wirelessly.
materials for the family emphasize that the machines and devices Connectivity. DreamMapper does not have messaging or friending
are “patient-driven,” “user-friendly,” comfortable, and customizable capabilities. The software comes with links to videos and other
(Philips Respironics, n.d.). information about apnea and CPAP and BiPAP devices and is
46 Communication Design Quarterly 5.2 2017
Table 3. Summary of DreamMapper analysis
Data Connectivity
Accessibility ● Users can toggle between three main ● Users cannot contact others in the app.
categories of data collection but cannot
● Providers can upload information
customize the interface.
from machine manually via SD card or
● Users cannot turn off data collection. SmartCard or wirelessly via a modem.
Data from a CPAP device can either be Many interactions are handled through
uploaded to the software by transferring a smart-card that is programmed by
it to a computer via an SD card or to a the provider and uploaded to users’
mobile device via an attached Bluetooth devices.
module.
● Data gathered from users’ devices is
● The DreamMapper documentation does synced via the Web.
not address data security. Logging in to
the system is managed with a username/
password.
Adaptability ● Users cannot add or edit data or ● Users can only pair one CPAP machine
categories. to one mobile device via Bluetooth.
● Data cannot be added manually.
Iterability ● There is no official support for exporting ● No official support for connecting with
data from DreamMapper. outside services.
● Users can access data from SD cards.

advertised as reducing the time patients and providers must interact integrating it with third party software like SleepyHead (Watkins,
troubleshooting the machines (Philips Respironics, n.d.-a). Many 2011). Further, there is no specific support for accessing data via
interactions are handled through a smart-card that is programmed third party software.
by the provider and uploaded to users’ devices (Philips Respironics,
n.d.-b). Data gathered from users’ devices is synced via the
Web. Philips claims in its privacy policy that any data from the DISCUSSION
DreamMapper application may be shared “if and only to the extent Because software and hardware platforms like that of the Fitbit
necessary” with employees, including external vendors, “in the and DreamMapper are in constant flux, as software updates and
context of providing the application to you” (Philips Respironics, new hardware become available, analyses must also be flexible
2015). Though the language of this policy is vague, Philips seems and, ultimately, provisional. In other words, rather than delivering
to be suggesting that any data collected and/or shared will be used a once-and-for-all assessment, this analysis might be thought of as
to tailor the application to individual needs. descriptive of users’ experience at specific points in time. Accounting
for this, we can productively speculate about the openness of a system
Adaptability to diffractive influences and, in so doing, draw attention to the as-yet-
Data. A user’s CPAP data is uploaded to DreamMapper either by unexplored potential in the UX design of specific wearable devices.
transferring it via an SD card, the Bluetooth module, or attached We can, in other words, pay attention to the data in a way that might
modem (Philips Respironics, n.d.-c). Although users can toggle enhance the speculative usability and universal design capabilities of
between three main categories—mask fit, hours used, and AHI— wearables and avoid the biocitizen mandate.
they cannot add data categories, edit data, or manually enter data.
According to the DreamMapper privacy policy, users who want to It might not be surprising to find that the results of our analyses point
delete or change data should contact their healthcare provider or to closed-system tendencies for medically-oriented wearables—
Philips directly (Philips Respironics, 2015). since, for example, DreamMapper’s context of use is one with some
serious concerns about well-being and privacy were the device
Connectivity. Users can only pair one CPAP machine to one mobile ecosystem compromised in any way. However, given Fitbit’s much
device via Bluetooth. If the user is using the DreamStation CPAP broader user base, customization of its software is quite constrained
machine, however, the user can use its SD card to share data with regarding what categories of data can be tracked, what data can be
others, including healthcare professionals. Users can only use the edited or deleted, and how data can be exported from the system.
DreamMapper platform with six Philips CPAP devices and three This is despite the fact that it allows for a wide range of connectivity
Philips BiPAP devices. Devices from other manufacturers are not options for users relative to DreamMapper, providing them with
compatible with it. While DreamMapper does not integrate with flexibility in how they access data from third party applications and
EHRs, such connection could be facilitated via the application for interact with other users. That is, while both systems seem primed to
healthcare providers. address the push for electronic health records embodied by FHIR,
they also fall short of embracing the user-based innovation Bellwoar
Iterability (2012) has identified. In short, both platforms could provide users
Data and Connectivity. There is no advertised method for exporting
with a greater range of options for adjusting their access to data to
data from the DreamMapper application. Users can store personal
make that data open to new relations.
copies of their data by accessing the SD card of some devices and
Communication Design Quarterly 5.2 2017 47
This analysis reveals that future innovation on the Fitbit platform mask fit and this was attributable to some identifiable or correctable
may come from its social and messaging functions. The inclusion cause such as a broken strap, this information could be added to the
of social networking features may allow for new, innovative data. Although this example is quite mundane, providing users with
approaches to motivating users and for engagement with fellow agency in interpreting their data could be a means of increasing
users and healthcare providers. Although the potential for negative their involvement and “buy in” with regard to their treatment and,
uses of wearable data on the part of employers and other authority perhaps as a consequence of that, the benefit they experience from
figures is clear (cf. Carman, 2016; Chen & Pettypiece, 2015)—and that treatment.
the importance of data privacy with wearables underscores the need
for significant data security measures—there is also potential for
CONCLUSION
improved health outcomes. For example, there is some research
The analytical framework we describe here provides a means
that suggests that the use of activity monitors can lead to improved
for users, designers, and other scholars to think past the current
health (Evenson, Wen, & Herring, 2016).
ehealth focus on compliance and data monitoring. By evaluating
As we have suggested, designers can play a role in this process, the accessibility, adaptability, and iterability of data collection by
either through a focus on making systems more accessible to wearable devices and the connectivity of that information, these
individuals with low health literacies (Lazard & Mackert, 2015) or stakeholders can make informed decisions about wearable use
by designing systems for openness (Ito & Howe, 2016). We argue and, where possible, improve designs related to these criteria. The
that patient-centered design of this type that also embraces both ease analytic framework also aims to be a useful tool for evaluating
of use and speculative innovation is crucial to a changing healthcare and altering existing designs to address the ableist assumptions of
landscape. The DreamMapper application is less open to user- those designs (where they exist) and potentially make the health
based interventions when compared to the Fitbit. As compliance benefits of wearables available to more individuals. We offer it here
and precise attunement to patient needs is a primary purpose of the as a means for designers to engage with the unique affordances
system, there is little opportunity for users to add their own data, and situations presented by health wearables, building on previous
edit existing data, or turn off data collection. Accessibility of the work in disability studies and ehealth and design (Boudreaux et al.,
product to user data management is limited. Although the sleep data 2014; Dolmage, 2014; Ito & Howe, 2016; Kopelson, 2009; Rivers
from a user’s machine is gathered automatically, accessing that data and Söderlund, 2016).
requires extra technical steps and equipment. To wirelessly connect
Certainly, decisions for care and/or those otherwise designed
with the data, users must have additional wireless modules attached
to improve our health must be made thoughtfully, but if health
to their CPAP or BIPAP machines or manually remove the device’s
wearables are to be transformative to care in positive and
SD card to sync with their own and their provider’s computers. Such
empowering ways and if such transformations are going to be
diversity allows for tailoring the device and access to a range of use
ethical and productive, we must consider the interplay of and
cases, but extra devices in each step—modules, mobile devices,
among the factors we identify: different wearables, specific use-
a home computer—are all an additional expense and (potentially)
cases, and contexts for wearing. For wearables to be empowering
new technological barriers for users to master. Additionally, each is
and not simply reproduce existing power relations or intensify
a new way to collect data and share it with the app or providers but
new expectations of users, they must be open, and our design
does not necessarily allow for user ownership of that data.
approaches ought to recognize the diffractive relationship between
If a user were to switch providers or machines, he or she could and among users, wearables, and environments for use. These are
lose access to their data, either the ability to share it with the the ways that such technologies can facilitate uses and ends beyond
provider or to sync it with data from another, incompatible system, and sometimes heedless of those intended. To meet the needs of
respectively. Although the hardware and software issues above multiple users, wearables must at some level allow users to control
have various justifications and may be difficult to adjust, a concrete how their data is produced and disseminated as well as be mindful
improvement for users that would seem to pose little health risk of feedback from users who explore speculative relations within
would be the capability to export data from DreamMapper in an their particular use cases.
openly accessible format, one that would more directly support
Our design processes, in other words, must not be so focused
third party applications (Watkins, 2011). Similarly, data security
on enabling certain choices that designers fail to question the
for the device itself and the app could be improved; although data
investment in and limitations of circumscribed data collection, even
transmitted via wireless connections is encrypted, there is additional
as we are hopeful about the choices we imagine might be enabled
room to encrypt data on the SD and SmartCards and provide more
by it. Empowered decision-making might be an effect of wearable
secure login protocols for the app and web interfaces.
technologies in health and medicine, but it is critical that we not
Since long-term adherence to treatment plans for sleep apnea can simply enact design processes that uncritically reproduce abstract
be as low as 40% (cf. Donovan, Boeder, Malhotra, & Patel, 2015; ideas of the ethical and productive role of healthcare participants
Virk & Kotecha, 2016), and since compliance in apnea treatment is as those who make the “right” choices. It is important that we not
so important to its success, perhaps DreamMapper could be more simply reinvest in a new medicalized subjectivity for healthcare
open to user input as a way of enabling those with sleep apnea participation, a biocitizen who dutifully collects and shares their
to make adjustments that retrofit aspects of the user experience data via these developing technologies.
to work better with their particular needs and uses, feeding such
data back into the design process (Hamraie, 2013). Seeing as it is REFERENCES
designed to provide data to both users and providers, this system Barad, K. M. (2007). Meeting the universe halfway: quantum
could provide multiple opportunities for users to annotate their data, physics and the entanglement of matter and meaning.
both to better track long-term trends and provide providers with Durham: Duke University Press.
additional information. For example, if the data identified a poor

48 Communication Design Quarterly 5.2 2017


Bellwoar, H. (2012). Everyday matters: Reception and use Gouge, C. C. (2016). Improving patient discharge communication.
as productive design of health-related texts. Technical Journal of Technical Writing and Communication, 1–21.
Communication Quarterly, 21(4), 325–345. doi:10.1080/105 doi:10.1177/0047281616646749
72252.2012.702533
Grant, L., Hausman, B. L., Cashion, M., Lucchesi, N., Patel,
Boudreaux, E. D., Waring M. E., Hayes, R. B., Sadasivam, R. S., K., & Roberts, J. (2015). Vaccination persuasion online:
Mullen, S., & Pagoto, S. (2014). Evaluating and selecting A qualitative study of two provaccine and two vaccine-
mobile health apps: strategies for healthcare providers skeptical websites. Journal of Medical Internet Research,
and healthcare organizations. Translational Behavioral 17(5), e133. doi:10.2196/jmir.4153
Medicine, 4(4), 363–371. doi:10.1007/s13142-014-0293-9
Hamraie, A. (2013). Designing collective access: A feminist
Boyd, d. & Ellison, N. B. (2007). Social network sites: disability theory of universal design. Disability Studies
Definition, history, and scholarship. Journal of Computer- Quarterly, 33(4), n.p.
mediated Communication, 13(1). doi:10.1111/j.1083-
Health wearables: Early days. (2014, Oct. 2014). PwC. Retrieved
6101.2007.00393.x
from https://www.pwc.com/us/en/ health-industries/top-
Bruns, A. (2008). Blogs, Wikipedia, second life, and beyond: health-industry-issues/assets/pwc-hri-wearable-devices.pdf
From production to produsage. New York: Peter Lang.
Howard, T., & Greer, M. (2011). Innovation and collaboration
Burwell, S. M. (2015). Setting value-based payment goals—HHS in product development: Creating a new role for usability
efforts to improve US health care. New England journal of studies in educational publishing. In M. J. Albers & B. Still
Medicine, 372(10), 897–899. doi:10.1056/NEJMp1500445 (Eds.), Usability of complex information systems: Evaluation
of user interaction (pp. 67-88), Oxford, UK: CRC Press.
Carman, A. (2016, Feb. 2). An Oklahoma university now requires
new students to wear Fitbits. The Verge. Retrieved from Imrie, R. (2012). Universalism, universal design and
https://www.theverge.com/2016/2/2/10893630/oral-roberts- equitable access to the built environment. Disability and
university-fitbits-Requirement rehabilitation, 34(10), 873–882. doi:10.3109/09638288.201
1.624250
Chen, C., & Pettypiece, S. (2015, Sept. 16, 2016). Target to
offer Fitbits to 335,000 employees. Bloomberg Business. Ito, J., & Howe, J. (2016). Whiplash: How to survive our faster
Retrieved from http://www.bloomberg.com/news/ future. New York: Grand Central Publishing.
articles/2015-09-15/target-to- offer-health-tracking-fitbits-to-
Koninklijke Philips N.V. (2016). DreamMapper 2.4: Mobile app
335-000-employees
user guide. Murrysville, Pa.
Dolmage, J. T. (2014). Disability rhetoric. Syracuse, NY:
Kopelson, K. (2009). Writing patients’ wrongs: The rhetoric and
Syracuse University Press.
reality of information age medicine. JAC, 29(1/2), 353–404.
Donovan, L. M., Boeder, S., Malhotra, A., & Patel, S. R. (2015).
Lazard, A. J., & Mackert, M. S. (2015). E-health first impressions
New developments in the use of positive airway pressure for
and visual evaluations: Key design principles for attention
obstructive sleep apnea. Journal of Thoracic Cisease, 7(8),
and appeal. Communication Design Quarterly, 3(4), 25–34.
1323. doi:10.3978/j.issn.2072-1439.2015.07.30
doi:10.1145/2826972.2826975
Evenson, K. R., Wen, F., & Herring, A. H. (2016). Associations of
Long, R. (2015, Jan. 25). Garmin Connect and Google Fit.
accelerometry-assessed and self- reported physical activity
Retrieved from www.stationarywaves.com/ 2015/01/garmin-
and sedentary behavior with all-cause and cardiovascular
connect-and-google-fit.html
mortality among US adults. American Journal of
Epidemiology, 184(9), 621–632. doi:10.1093/aje/kww070 Lynn, J. (2015, Nov. 3). Fitbit data in the EMR? Retrieved from
http://www.emrandehr.com/2015/11/03/fitbit-data-in-the-
FHIR Infrastructure Work Group. (2015). 1.8.0 FHIR Overview.
emr/
Retrieved from https://www.hl7.org/fhir/overview.html
Meloncon, L., & Frost, E. A. (2015). Special issue introduction:
Fitbit. (2016a, Oct. 28). How do I delete data? Retrieved from
Charting an emerging field: The rhetorics of health
https://help.fitbit.com/articles/en_US/ Help_article/1306
and medicine and its importance in communication
Fitbit. (2016b, May 16). Is my Fitbit data secure? Retrieved design. Communication design quarterly, 3(4), 7–14.
from https://help.fitbit.com/articles/en_US/ Help_ doi:10.1145/2826972.2826973
article/1758/?l=en_US&c=Topics%3AAccount_
Murray, S., & Holmes, D. (Eds.). (2009). Critical interventions
Settings&fs=Search&pn=1
in the ethics of healthcare: Challenging the principle of
Fitbit. (2016c). Let’s talk about privacy, publicly. Retrieved from autonomy in bioethics. London: Ashgate.
https://www.fitbit.com/legal/privacy
NHLBI. (2012, July 10). What is sleep apnea? Retrieved from
Gouge, C. C. (forthcoming). ‘The inconvenience of meeting you’: https://www.nhlbi.nih.gov/health/health-topics/topics/
Rereading non/compliance, enabling care. In A. K. Booher sleepapnea
& J. Jung (Eds.), Feminist rhetorical science studies: Human
O’Neil, C. (2016). Weapons of math destruction: How big data
bodies, posthuman worlds. Southern Illinois University
increases inequality and threatens democracy. New York:
Press.
Crown.

Communication Design Quarterly 5.2 2017 49


ONC. (2016). Connecting and accelerating a FHIR app Spinuzzi, C. (2003). Tracing genres through organizations: A
ecosystem. Retrieved from www.healthit.gov/techlab/ sociocultural approach to information design. Cambridge,
innovation/connecting-accelerating-fhir-app-ecosystem MA: MIT Press.
Patel, M. S., Asch, D. A., & Volpp, K. G. (2015). Wearable Sullivan, M. (2014, Aug. 15). Guess what? Doctors don’t care
devices as facilitators, not drivers, of health behavior about your Fitbit data. Retrieved from http://venturebeat.
change. JAMA, 313(5), 459–460. doi:10.1001/ com/2014/08/15/guess-what-doctors-dont-care-about-your-
jama.2014.14781 fitbit-data/
Patient protection and affordable care act, 42 C.F.R. § 18001 et Swan, M. (2012). Health 2050: The realization of personalized
seq. (2010). medicine through crowdsourcing, the quantified self, and the
participatory biocitizen. Journal of Personalized Medicine,
Pennic, F. (2015). Novant health to integrate pic MyChart with
2(3), 93–118. doi:10.3390/jpm2030093
Fitbit & HealthKit. Retrieved from http://hitconsultant.
net/2015/08/21/novant-health-to-integrate-epic-mychart- Teston, C. (2016). Rhetoric, precarity, and mHealth technologies.
with-fitbit-healthkit/ Rhetoric Society Quarterly, 46(3), 251– 268. doi:10.1080/02
773945.2016.1171694
Philips Respironics. (2015, Aug. 6). Privacy notice: DreamMapper
application. Retrieved from https://www.mydreammapper. Topol, E. (2015). The patient will see you now: The future of
com/Legal/PrivacyPolicy medicine is in your hands. New York: Basic Books.
Philips Respironics. (n.d.-a). DreamMapper: Saving you time, U.S. Department of Health & Human Services. (2015). HHS
helping your bottom line. Retrieved from http://www. issues rules to advance electronic health records with added
usa.philips.com/healthcare/product/HCNOCTN196/ simplicity and flexibility. Retrieved from http://www.hhs.
dreammapper gov/ about/ news/2015/10/06/hhs-issues-rules-advance-
electronic-health-records-added-simplicity-and-flexibility.
Philips Respironics. (n.d.-b). EncorePro 2: Patient data
html
management software. Retrieved from http://www.usa.
philips.com/healthcare/product/HC1054785/encorepro-2- Virk, J. S., & Kotecha, B. (2016). When continuous positive
patient-data-management-software airway pressure (CPAP) fails. Journal of Thoracic Disease,
8(10), E1112. doi:10.21037/jtd.2016.09.67
Philips Respironics. (n.d.-c). FAQ: Common questions and
answers about DreamMapper. Retrieved from https://www. Walker, K. (2009). My life? My choice? Ethics, autonomy, and
sleepapnea.com/products/dreammapper/faq evidence-based practice in contemporary clinical care. In S.
Murray and D. Holmes (Eds.). Critical interventions in the
Philips Respironics. (n.d.-d). Introducing the dream family.
ethics of healthcare: Challenging the principle of autonomy
Retrieved from https://www.sleepapnea.com/products/dream-
in bioethics (pp. 15-32). London: Ashgate.
family
Watkins, M. (2011). SleepyHead. Retrieved from http://
Potts, L. (2014). Social media in disaster response: How
sleepyhead.jedimark.net/
experience architects can build for participation. New York:
Routledge. Wilbanks, J. T., & Topol, E. J. (2016). Stop the privatization of
health data. Nature, 535, 345–348. doi:10.1038/535345a
Rivers, N., & Söderlund, L. (2016). Speculative usability. Journal
of Technical Writing and Communication, 46(1), 125–146.
doi:10.1177/0047281615600635
Segal, J. Z. (2009). Internet health and the 21st-century patient:
A rhetorical view. Written Communication, 26(4), 351-369.
doi:10.1177/0741088309342362

50 Communication Design Quarterly 5.2 2017

Vous aimerez peut-être aussi