Wearable Device Technology on the Human and Social Relationships in Healthcare

A Research Paper submitted to the Department of Engineering and Society

Presented to the Faculty of the School of Engineering and Applied Science

University of Virginia • Charlottesville, Virginia

In Partial Fulfillment of the Requirements for the Degree

Bachelor of Science, School of Engineering

Michelle Wu
Spring 2022

On my honor as a University Student, I have neither given nor received unauthorized aid on this
assignment as defined by the Honor Guidelines for Thesis-Related Assignments

Advisor
Rider W. Foley, Department of Engineering and Society
 STS Research Paper

Introduction to Wearable Device Technology

Over the past decade, there has been a rise in wearable device technology, especially in the

healthcare industry. These devices combine health and technology attributes to provide a unique

advantage on increasing the availability of users’ health information in real-time (Mahajan et al.,

2020). Through this intersection of combining health and technology, the users have the advantage

of also managing their physical conditions to improve their health level (Zhang et al., 2017). With

the motivation to know more about one’s physical health on a more personal level, the market has

been growing rapidly. In the global healthcare wearable device market, there was a growth rate of

46.6% in a span of 5 years between 2015 and 2020 (Zhang et al., 2017). This growth rate is only

expected to increase with each passing year. By the year 2024, shipments for wearable devices

(wristwear) is projected to reach almost 230 million units to the U.S., which highlights the amount

of demand and usage there is for wearable devices (Vailshery, 2021). With continual growth and

increased demand for a personal health monitor, it could potentially change the way healthcare is

perceived.

Along with the increased growth of the devices and technology itself, the accuracy of the

devices at providing correct health information has also increased (Li et al., 2016). These devices

do not only inform the user about their health status, it is also predicted to influence different

aspects of healthcare including prevention, diagnosis, and disease management (Liao et al., 2019).

There are currently two types of wearable devices: fitness wearable devices that are targeted for

the young and healthy users and medical wearable devices that are likely adopted by the elderly

and unhealthy patients (Gao et al., 2015). While these two devices serve different purposes, there

have been advancements for medical functionalities to be added onto the fitness wearable devices,
such as the Apple Watch Series 4’s built in electrocardiogram (ECG) option (Liao et al., 2019).

Another example would be the Fitbit Alta being used as a tracker for sleep apnea disorders

(Moreno et al., 2019). These two wearable device functionalities will be explained more in depth

later in the paper. These enable personal health data to be continuously collected and transformed,

allowing more streamlined reporting about physiology and kinesiology (Gao et al., 2015; Liao et

al., 2019; Metcalf et al., 2016). As the medical functionalities of the wearable devices get more

accurate, researchers believe that it will transform the way patients are evaluated, treated, and

managed (Loncar-Turukalo et al., 2019). One way being that instead of a human physician

observing the patient, there may instead be a health monitoring device system in place. In the same

way, the wearable devices may also transform the way patients view healthcare (Zhang et al.,

2017). For instance, patients may choose to use a medical wearable device for diagnosis instead

of traveling to see a medical professional (Mahajan et al., 2020). However, for wearable

technology to be used in this way in healthcare as a whole, the outcomes would not only need to

continue to be consistently accurate, but also need to be widely accepted by society (Jin, 2019).

Thus, this paper will explore the impact of wearable devices on diagnosing and monitoring both

young and elderly patients through their relationships to healthcare providers.

ISTA

The Interactive Sociotechnical Analysis (ISTA) framework was used for discussing

wearable devices. This framework draws on previous studies of unintended consequences, along

with research in sociotechnical systems and social informatics (Harrison et al., 2007). The ISTA

framework was developed by the researchers Harrison et al. in order to overcome the unintended

consequences that occurred when implementing healthcare information technology. The

consequences resulted in undermining patient safety practices, which occasionally harmed the
patients (Harrison et al., 2007). Additionally, when unintended consequences arise due to an

introduction of new technology, one tends to put the blame on the technology itself. However, the

failure point may not only be at that one reason, and so the framework provides an opportunity to

decompose the surrounding situations for further analysis. The ISTA framework describes five

different interaction types, which will be explained in detail below. Ultimately, the ISTA types are

a way to break down all of these interactions between social groups and evaluate how it impacts

each other (Harrison et al., 2007).

The first type is discussing how new technology changes an existing social system, which

analyzes the process through which the new technology alters prior patterns of work,

communication, or relationships (Harrison et al., 2007). In this type, the before and after, the cause

and effect are being considered in order to evaluate the new technology’s outcome and whether

those line up with the anticipated ones.

The second type is discussing how technical and physical infrastructures mediate the new

technology’s use because a poor fit or an inappropriate fit would likely lead to problems with

interfaces and technical failure (Harrison et al., 2007). In addition, in order for the new technology

to be integrated into society, it would have to be properly embedded into the existing infrastructure

(Star, 1999).

The third type evaluates how the social system mediates the new technology’s use by

analyzing how the technology changes based on the social groups that use it (Harrison et al., 2007).

This type discusses that the technology’s intended use changes after putting it into practice and it

is because the original design fails to reflect the current features of the infrastructure or the social

relations. Thus, it is important to design technology that would not only have the flexibility to

change, but also be specific in their roles in the society.

 The fourth type assesses how the technology’s use changes the social system because as in

the third type, the technology can be impacted by the social group, but then the technology can

lead to additional changes in the social system (Harrison et al., 2007). This type highlights the

recursiveness of how technology can impact and be impacted by the social system. Finally, the

fifth type illustrates whether the social systems engender the technology’s redesign, which

demonstrates the recursiveness even further when there are more dramatic adaptations in the

technology because of social systems and vice versa (Harrison et al., 2007).

Therefore, ISTA framework portrays that there is a codependent relationship between the

social system and the new technology, and both systems are constantly impacting each other to

change. The technology that will be focused on will be wearable device technology and how the

rise in usage will impact the social system in healthcare. To discuss this relationship, the ISTA

framework will be applied and the differing perspectives of how healthcare will impact wearable

devices as well as the other way around.

Research Question

The overarching research question that was analyzed was: how will wearable device

technology impact the human and social relationships in healthcare? Specifically, the question

tackled how wearable devices would affect relationships between healthcare workers and patients,

both young and elderly. With the rise of wearable devices on the market, more and more people

have access to medical devices that can potentially alert the user to any maladies in their body as

a diagnostic or a health monitoring tool (Zhang et al., 2017). Thus, if the wearable device is able

to self-diagnose, it is effectively taking the role of a medical professional (Metcalf et al., 2016). If

a device is making decisions relating to physical health, it may positively or negatively affect the
patient physician relationship. Positive impacts include increasing communication between

physician and patients or prompting more to seek out healthcare assistance. Negative impacts

would include decreases in trust to the physician or ceasing to see a doctor (Gao et al., 2015).

Methods

To collect evidence for researching how wearable device technology impacts the physician

patient relationship for young and elderly patients, interviews and two specific case studies were

utilized.

Interviews were conducted with medical and research professionals in the wearable device

technology field in order to gain insight into what their perspective is regarding the rise of medical

device technology. The interviews were with five qualified professional participants in the

wearable device technology area of focus: two directly in the medical field, and three in the

research field. When interviewing, three specific questions were asked: “How have you noticed

wearable device technology change in the past decade?”, “How do you predict that the wearable

devices would change healthcare? How about in relationships?”, and “What barriers do you

foresee preventing wearable devices to be fully integrated?”. These questions were chosen because

they encompass the range of how wearables devices have changed from the past and what they

can achieve in the future, all within the context of the healthcare system. Each interviewees’

response was parsed through to quantify certain words or phrases corresponding to the current

state, future state, potential barriers, and how wearable devices affect the patient physician

relationship (Fakis et al., 2014). Words such as “currently” or “ubiquitous” corresponded to the

current state, “revolutionary” or “potential” corresponded to the future state, “accuracy”

corresponded to barriers, and “conversation”, “trust”, or “overwhelm” corresponded to the ways

wearable devices would impact the relationship between patients and physicians. The coded

analysis provides a quantitative perspective for analysis on relating the integrating of wearable

device technology in the healthcare system.

In addition to primary sourced interviews, the evidence collected will be supplemented by

secondary sourced interviews from a published research paper where the researchers collected

health professionals’ attitudes towards patient use of wearable device technology (Watt et al.,

2019). The supplemental research paper will be mainly used for corroboration purposes.

Case Context

Two specific case studies of wearable devices were also utilized in order to give a context

for the use of wearable device technology (Kitchenham et al., 1995). The two specific watches and

functionalities that were researched were the Fitbit Alta HR for sleep monitoring and the Apple

Watch Series 4 for ECG functionality. The Fitbit Alta HR has been validated in previous research

to be used in patients with obstructive sleep apnea, a sleep disorder where there is intermittent

airflow blockage during sleep (Moreno et al., 2019). The watch keeps track of the patient’s sleep

cycle through heart rate, oxygen level, and movement, and with the combination of these the watch

can monitor patients with sleep apnea (Moreno et al., 2019). The Apple Watch Series 4 includes

an ECG functionality, which records the heart’s electrical activity (Avila, 2019). An ECG can

identify different heart related disorders, so through the Apple Watch, users can be notified of a

potential heart ailment, and take the necessary actions to get it checked out. Both of these devices

have specific health monitoring functionalities in addition to keeping track of physical health and

exercise, and as such provide a perfect situation for the context of determining how wearable

devices would impact healthcare.

Results

All of the interview responses were in agreement that wearable device technology has

transformed a great amount from what it was a decade ago, giving examples on how the devices

have changed, such as becoming much more common, increasing functionalities, and being more

accurate. However, from the research it was found that even though the technology has

transformed greatly from what it was, there still needs to be more technological development

before the devices can be fully integrated into the healthcare system. The wearable devices have a

lot of potential to improve healthcare, such as lowering medical costs or increasing disease

prevention, in the case of the Fitbit or the Apple Watch, but many barriers were identified that

would need to be overcome before the device impacts can reach their full capability (Zheng et al.,

2013). Additionally, the wearable devices would impact physician patient relationships both

positively and negatively. Positive impacts from the devices include prompting patients to seek

medical care or induce more meaningful conversations between patient and physicians. Negative

impacts stem from the accuracy of the device. False positives could lead to a decline of trust along

with increases of unnecessary anxiety.

The current views of wearable device technology are rooted in transitioning towards being

more integrated into the medical system, focusing on whether the wearable device’s functionalities

are up to par with the clinical systems. Currently, the only wearable devices that are being used in

the healthcare setting is through clinical trials and for research purposes only. A valuable finding

through Participant 1’s research with wearable devices and elderly patients is that the devices hold

the potential to “remotely send alarms to the patient and data to doctors” (Participant 1). The ability

for the wearables to remotely send and verbally announce, medication or exercise reminders was
valuable since the patients could not see the small screen of the watch. This functionality broadens

the usage of wearable devices in the healthcare industry, without it being just for diagnostics or

monitoring. Additionally, the watch tracked data throughout the patient’s days, transmitting it

remotely to the doctors, giving them more insight into what the patient’s health is like more

intimately. This research highlights the trend that there is a lot of potential and a space for wearable

devices in the practice of medicine.

All of the participants had a lot of views and perspectives with how wearable devices would

impact healthcare in the future, but these views were also coupled with responses about the barriers

that prevented the devices from reaching its potential (Figure 1). For example, the interviewees

described the future of wearable devices to “revolutionize medicine and lower medical costs”

(Participant 1). However, they would also mention that the devices would have to be “equally

accurate to the medical level quality” (All Participants). Revolutionizing medicine would include

changing up the entire system with how medicine is being practiced today. This change would

radically shift the social system in healthcare as well as evaluate how data should being transferred

from device to patient health records. This insight on accuracy reveals that those in the wearable

device and healthcare field are wary of introducing change that isn’t going to be working 100%

perfectly at all times. However, having all of the participants discuss the future potential of

wearable devices at length reveals that they are all excited at the prospect of having “more readily

available and individualized way of looking at health” (Participant 2). The wearable devices as a

diagnostic tool in the future would be much more readily available for many more social groups

because it is more affordable and easier to come by, as opposed to, traditional medicine which is

very expensive and would usually need insurance. Furthermore, wearable devices also give a more

individualized way of looking at health for both the physician and patient. It will also give an
opportunity for more remote doctor visits while still looking at personalized patient data. Overall,

the excitement for wearable devices in the future is promising, but is mainly overshadowed by a

lack of confidence in the accuracy.

There were similar perspectives and number of responses for both the positive and negative

impacts, illustrating a mixed review of how wearable devices would affect physician-patient

relationship (Figure 1). Some participants felt that the devices would “have a more informed

conversation by providing the physician a better picture of what the patient experiences outside

the hospital” (Participant 5), which would be a positive effect. At each appointment, the doctor

only sees the patient for a very small portion of the day about their illness, but with data from

wearable devices, the doctor would have much more information to be able to provide a more

holistic view of what’s going on with the patient. Additionally, some interviewees predict that if

users have more access and knowledge about their personal health, there may be “increases of

anxiety”, which would prompt patients to see a doctor (Participant 4). Having more people

concerned about their health and seeking medical care is a positive impact, but having this outcome

happen in an unregulated increased fashion would likely “overwhelm medical systems”

(Participant 4), which would be a negative impact. There is a delicate balance between the potential

positive and negative impacts that wearable devices may have on the physician patient

relationship, which is to be expected since there are still barriers that need to be overcome before
the devices can be substantially integrated into the health system.

In the secondary sourced interviews with medical professionals, the researchers discussed

similar themes of positive or negative impacts due to the wearable device (Watt et al., 2019). The

participants identified many more negative impacts than positive ones compared the five primary

sourced interviews. Many of the participants described usability issues as a barrier, such as being

“too technical for older adults” or “too complicated even for those who are used to a smartphone”.

These responses were not found to be true in the primary sourced interviews. Additionally, there

were also concerns of how a constant monitoring of one’s health may “make people more unwell”,

which corroborates with the interviewees of the primary sourced interview (Watt et al., 2019). A
positive impact that the researchers found was that the participants agreed that the wearable devices

would be instrumental in the long-term cost savings to the healthcare system.

In the two case studies of the Fitbit Alta HR and the Apple Watch Series 4, the researchers

compared their sleep and ECG functionalities, respectively, to medically approved equipment

(Avila, 2019; Moreno et al., 2019). In the Fitbit Alta HR case, it was found that the sleep tracking

functionality for sleep apnea had an acceptable sensitivity towards the user, but lacked specificity,

meaning that it was not sufficiently accurate to track sleep apnea (Moreno et al., 2019). The lack

of confidence in accurate results for this study confirms that the devices currently still need

improvements before integration into the practice of medicine.

In the Apple Watch Series 4 case, the researchers found that the ECG functionality had

similar results to the traditional ECG measurements, leading to a conclusion that the watch could

detect early diagnoses relating to the heart (Avila, 2019). In this study, it reveals that wearable

device technology as a diagnostic or preventative tool is not too far off.

Knowing that these wearable devices have the capability of tracking and monitoring

pertinent health problems, even if it isn’t at 100% accuracy yet, is a significant step using these

devices with a medical functionality, since it brings promise of lowering healthcare costs and more

access to healthcare on a day-to-day basis (Pentland, 2004).

Discussion

Integration of wearable devices into the healthcare system is dependent on both the

technology itself, but also the interaction of it with the social system in the system. The wearable

devices need to be accurate enough for any diagnostic or monitoring functionalities to even be

considered as the main device used for patient use. The devices would also need to work well with
the existing social system in the healthcare system, meaning that the data collected from the

devices would be easy to incorporate into patient information systems and that the physicians

would easily be able to interpret them. The longer the wearable devices are intertwined with the

healthcare system, the more fluid the dynamics will become, since there would be mutual

adjustments on either end.

This research presents some limitations. Primarily, the sample size of interviewees of five

was small. A small sample size only gives a small glimpse into what the professional opinion on

the impact of wearable device technology would be (Alsaawi, 2014). Secondarily, the participants

were all from the same region with many of them working on similar projects together. Having a

lack of diversity in a physical area prevents different perspectives and generally tends to produce

similarly like-minded people, which may have contributed to the uniform responses (Grumbach &

Mendoza, 2008). With both of these limitations, the responses of the participants are not enough

to be representative of the whole wearable device academia nor the health professionals working

with wearable devices. Finally, the current research focused on wearable devices in a very general

and broad sense, which only gives a very loose viewpoint into the potential impact of wearable

devices. Thus, the conclusions of this research have to be further explored in order to fully take

them under consideration.

There can be a few extensions of future research that would be valuable: (1) conducting

interviews with participants in diverse populations, (2) conducting surveys with the general

population to categorize their perceptions of how wearable devices can change healthcare, and (3)

investigating the impact of a specific wearable device. The interviews that would be conducted

will be with a larger pool of more diverse participants, with different upbringings and backgrounds,

so that their responses would be able to embody many different perspectives in this topic. The
responses from each city or population can be compared against each other in order to investigate

whether there is a difference in perspective or opinion. These potential differences can then be

traced back to whether they are influenced by the corresponding healthcare system and whether

the healthcare systems are organizationally different. Additionally, responses from surveys to the

general population can also further expand the research on how the U.S. perceives wearable

devices and what their opinions are on how it would change their relationship to physicians.

Finally, conducting an exploration on a specific wearable device would allow researchers to

concretely understand the process of how that device would change healthcare relationships.

Through the process of this research paper, there were many opportunities to discuss this

research topic with other people, either officially or unofficially. Interviews were officially

conducted with those that have been in the wearable device technology field for many years, but

also informal conversations with colleagues. Through these, many different perspectives were

evaluated and considered as conclusions about the research questions was being formulated. Being

able to be exposed to differing perspectives helps enhance understanding of the world in which we

live in. Additionally, as engineers continue to design, develop, and create technologies for the

world, it is important to know how the technology would affect those around it, which is where

different perspectives are critical.

Conclusion

Wearable devices have recently increased medical functionalities to include features that

could potentially detect abnormalities in the body, effectively creating a diagnostic tool. Through

the research, it was found that wearable devices have an extraordinary potential to change the way

healthcare can be performed. These ways include diagnosing, monitoring, and preventing diseases
and illnesses in patients. When the devices are integrated into the healthcare systems, it will not

only transform the technicalities of medicine, but also the social interactions between patients and

physicians. The impacts on the social interactions may be either positive or negative. For a positive

impact, the devices will allow a deeper and more meaningful conversation to take place between

the physician and patient as the physician will have more knowledge on what the patient has been

going through regarding the disease. For a negative impact, the devices could decrease the trust

between the physician and patient by reporting, say, a false positive result. Decrease of trust for

physicians is not ideal as it would lead to a decline of returning patients to see a doctor. Thus, it is

important for the devices to be accurate enough to the traditional medicine devices. Wearable

device technology has the capability to revolutionize healthcare systems and improve patient

physician relationships in the near future.

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