Algorithm-driven Health Recommendations – A Promising Prospect for Patient Empowerment, or a Means of Digital Paternalism?

The workshop aimed to stimulate the debate about the precarious balance between empowerment and paternalism in (future) health apps. One of its main objectives was to improve the mutual understanding between different research strands and disciplines working on questions related to digital health apps.

Within the scope of the workshop researchers from various scientific disciplines like medical informatics, ethics, sociology and law, but also experts from the fields of app design or clinical psychology presented the results of their research and activities. The talks were followed by vivid debates focusing empowerment and paternalism.

The topics discussed at the workshop included an overview on algorithms in medicine and possible effects of employing medical apps on users’ digital self-determination. Furthermore, the group addressed possible consequences of an increasingly quantified life which might result in a rational discrimination of various population groups.

Another issue picked up during our discussion were traditional regulatory techniques and the question, whether these are still suitable for regulating medical apps and other digital technologies in health care. In this context, we also discussed new innovative regulation systems drawing on data collection and redress systems.

Another relevant part of the debate dealt with the development, implementation and actual usage of medical apps. We discussed the opportunities and challenges of so called persuasive technologies, which aim at changing the users’ attitudes and health behavior as well as new models to evaluate health apps. Various promising examples as the development of a new lifestyle optimization app called ADAMILO (Automated Diet and Activity Monitoring for Intelligent Lifestyle Optimization) or the successful use of mobile health interventions in clinical psychology in the US were presented. Possible risks and downsides of excessive app use and challenges in the realm of funding and certification were identified.
As a main outcome of our workshop, we identified ten central questions concerning definitions, driving forces and dynamics, normative implications and possibilities for empowerment which need to be answered in the future and will be discussed in our planned publication.

The next step will be the collaborative writing of a paper elaborating on the main results of the workshop. It will be published in a scientific journal or an edited volume with an international academic publisher. In addition, a position paper will be published in an organ aiming at a wider audience for maximum outreach.

Furthermore, the workshop lead to further networking activities which e.g. resulted in the planning of new inter- or transdisciplinary research projects as well as a possible follow-up workshop.

Speakers

Prof. M. Sriram Iyengar, Ph.D. - Digital Algorithms: Definitions and Basic Considerations

Prof. Harri Oinas-Kukkonen, Ph.D. - Persuasive Technologies for Health – State of the Art

Prof. Dr. med. Christiane Woopen - Digital Self-Determination: Algorithm-driven Health Recommendations as a Means of Patient and Doctor Empowerment

Prof. Dr. phil. Stefan Selke - Rational Discrimination in Health Care by Algorithms - Lifelogging as ‘digital alchemy’

Dr. Thomas Kostera - Towards using the potential of digital health apps for public healthcare delivery – A view from Germany

Prof. Adrian Aguilera, Ph.D. - Digital Health Literacy in Mobile Health Interventions
Prof. Ela Klecun-Taylor, Ph.D. - The Role of Digital Literacy in Medical Apps Use  

Prof. Dr. iur. Ulrich M. Gassner - International Legal Framework

Henrik Vogt, M.D., Ph.D. - Participatory medicalization: How digital health changes medical paternalism

Prof. Christopher Hodges, Ph.D. - Regulatory Issues

Steven Chan, M.D., M.B.A. - Insights into the Evaluation of Medical Apps in Clinical Care in Psychiatry

Prof. Maged N. Kamel Boulos, Ph.D. - Algorithm-driven Health Recommendations in Medical Apps: Towards an Intelligent Lifestyle Optimisation App