Health apps and online health care improve our lives and even save them, but like many new technology solutions, they also come with unique risks that aren’t necessarily obvious. This guide will help you get the most out of digital health products while keeping you and your personal information safe and secure.
Introduction
The accelerated progress of technology in the last few decades – specifically information and communication technology like phones, computers, and the internet – has advanced into the worlds of healthcare and sports. The last ten years have seen huge shifts in the medical device and life science sectors (as in all industries) with the introduction of smartphones, social media, and wearable technologies. And it’s a super innovative field, with new digital health and fitness products appearing all the time. Software solutions have completely changed the way people manage their health, as well as their interactions with healthcare professionals and the ways in which those professionals carry out their vital work. Today, nearly a fifth of people in countries like Germany and the US use one or more mobile apps to help manage their health. This is a huge market segment, considering the relatively short amount of time digital health products have been around. These technologies have experienced growth both in terms of the number of new applications and products being developed and in the number of new users for them. This growth is driven by people using digital health products and reaping their advantages. But, like with lots of new everyday technologies, we can always make digital health and fitness products work for us even more safely, productively, and sustainably. This guide is about using technology solutions as well as possible. Learning about the best practices for digital health and fitness products will help you use them with confidence because, like any new technology, they come with unique risks that aren’t always obvious. That way, we can get the most out of their advantages without any unwanted downsides. The tips in this guide can help you empower yourself to use digital health products safely, productively, and sustainably.
What is Digital Health?
There are a lot of technology products available today that help you manage and maintain great health and fitness. Fertility trackers can help people avoid pregnancy or start one. Digitized addiction therapy shows the progress people make back to them in hard data. Mental health apps can help you better understand your triggers and supports so that you can access support when needed. They have different uses for different audiences, but one thing links them all together: they are based on digital technology. This seems pretty obvious, but it’s an important point. The fact that these products use digital technology means two things. First, they are useful in ways that have never been possible before. Second, they come with a unique set of risks that we must be aware of. So, what are we talking about here? Well, all the freely available health information on sites like WebMD and Wikipedia is a part of digital health. So are the social media profiles of healthcare educators. The advice in this guide is just about the digital health products that you actively engage with; broadly speaking, those are telehealth services, health and fitness apps, and wearables.
Telehealth Services
Sometimes, you’ll be advised to use a digital health product by your caregiver. This might be a telehealth service. Telehealth is professional healthcare delivered remotely using phones, computers, and smart health devices. There are thousands of telehealth services with millions of active subscribers in the United States alone. Health insurance policies cover many, and health professionals often prescribe them alongside or after treatment in person. Since COVID-19, of course, the importance and use of telehealth have massively increased. Sometimes, treatment programs are linked to a digital product like an app or website. This is called telehealth. For care services, apps can be a great way to access target groups and deliver effective interventions. They’re also often better value for money than phone calls or clinic-based interventions. More and more providers are using apps to deliver care all the time.
Health and Fitness Apps
But digital health isn’t the sole reserve of healthcare providers. There are numerous digital health and fitness products available to everyday consumers now, too. The vast majority of digital healthcare products you can get are mobile apps, millions of which are available in Google Play or Apple’s App Store. Apps are particularly good at helping people with symptom management and self-care. For example, diabetes apps can help users to measure blood glucose levels easily, send data to medical professionals, and get appropriate feedback and care advice. And they’re popular. Just over half of mobile phone users in one survey had downloaded a mobile health app. The most common type was fitness and nutrition apps, and people who downloaded them tended to use them every day. Most users say these apps help them improve their health. There are apps to help you manage your sleep, look after your mental health, keep on top of fitness goals, stick to a diet, and monitor your menstrual cycle.
Mental health apps are the largest subcategory of health and fitness apps. One study found that over half of Americans may have used a mental health app at some point. And the significant mental health impact of the COVID-19 pandemic is making them even more popular. Fitness apps generally record a lot of sports performance data (often with a connected “wearable”) and process that data to give the user detailed performance feedback or even structured progression plans. Diet apps are another really popular healthcare app category. They generally get users to input their caloric intake data (what they’ve eaten) alongside data on their physical activities, sometimes combining with wearables or fitness apps. The most feature-packed dieting apps automatically calculate nutritional information like calories, macros, and vitamins from users’ meals; create summary plots and graphs; compare data with users’ dieting goals, and offer useful and timely nutrition information. Some even have barcode scanners, heart rate monitors, and step counters. Fitness apps collect and process sports performance data to help improve training, both for recreational purposes and in high-performance elite sports. Common metrics to track include heart rate, pace and distance, power transfer (for example, with a connected power meter on a bicycle), and route information like location, terrain, and profile. Period-tracking apps help women and trans and non-binary people with pregnancies, fertility, and period tracking. There are tens of millions of users signed up to the most popular period-tracking app today. These apps allow people to record when periods start and stop, helping them to track their cycles effectively. Your phone might also come with a general health app. You can use this to keep track of your daily step count, make a record of any medications you need, and even monitor vital signs like your blood pressure or glucose levels. Apple’s Health app, for example, collects data from iPhones’ accelerometers, location trackers, and gyroscopes to automatically create health reports for their users. Many manufacturers for Android include a similar app in presets, and there are a number of general health-tracking apps available on Google Play.
Wearables
To help these apps get the most useful data possible, there are also many “wearables” on the market today. Wearables are smart devices that you wear. They have their own built-in computer processing power, and they often communicate with other devices like your phone or computer via Bluetooth or WiFi connections. The most popular wearables today are smartwatches and fitness bands or trackers. But modern smartphones are also wearables in their own right, able to monitor loads of health information from your step count to your sex life and your sleeping patterns. During COVID-19, smartwatches that could measure blood oxygen saturation became widely available. These alerted users to low blood oxygen saturation, a life-threatening virus symptom that is often unnoticeable, and over 10% of American smartwatch owners were using them. The latest Apple watch also uses this technology, and it’s giving millions of users access to data that only trained professionals could measure just a few years ago. Wearables are a major trend in consumer electronics, and emerging technologies promise to make digital interactions increasingly immediate and passive. These include glasses, smart clothing and jewelry, and a new generation of medical devices like hearing aids, contact lenses, and asthma inhalers. As the technological reach of wearables is expanding, so is the size of the global market. Analysts predict that there will be 440 million health and wellness wearables on shelves and in people’s homes by 2024.
This guide is about how to use all of these new things – telehealth services, health and fitness apps, and wearables – as safely and effectively as possible.
The Safest Way to Use Digital Health and Fitness Products
When it comes to our health, of course, we want to make sure anything we use or do is going to have a positive effect. There are lots of ways to do this. For example, it’s super important to discuss any changes in your health care with others, especially healthcare professionals. This doesn’t just help ensure you’re looking after your body safely. Talking to people you can trust can also help you get the most benefit possible from your efforts and stick to the positive changes you make for the long term. With digital technology, we also want to make sure that any product we use won’t expose us to unacceptable digital and online risks. Digital health and fitness products can be especially risky for our privacy because of the rich, personal dataset we create with them. The tips below are about this second group of risks related to digital and online technology.
Be Mindful of Your Digital Footprint
Being mindful of the value of the digital record or dataset you are creating with a wearable, app, or telehealth service can help you ensure you look after it. The dataset you make with a health or fitness product contains lots of personal, sensitive information about you. Your personal information is really valuable because of how it can be used in today’s world of “big data.” Machine learning software can automatically scan millions of lines of data in seconds, gleaning useful and otherwise unfindable information from it and giving instructions to other programs and systems based on it without any human intervention. As digital information, it’s also easily searchable, storable, and shareable. With a health and fitness dataset, advertisers could show you targeted and possibly even intrusive ads related to private health conditions or the fact you’re trying for a baby. Running apps record your physical location and routines; this is pretty useful information for a would-be home invader. Life insurance providers and mortgage brokers alike would love to see your health app’s history before deciding on a policy or interest rate. This is related to your digital footprint, something that everyone needs to be mindful of today. A digital footprint is the unique dataset of somebody’s activities, actions, communications, and contributions on the internet and in digital devices. If you’re reading this, you’ve got one. When you’re using a digital health or fitness product, you’re increasing the size of your digital footprint. The first step in using these products safely and effectively is simply being mindful of the dataset that you’re creating. This may not seem obvious at first; what could someone actually do with your step count after all? But it’s not just about your step count. We need to remind ourselves that these frictionless, everyday technologies work by processing massive amounts of data beneath the user interface. This data is what we want to protect.
Reduce Digital Clutter
It’s so easy to search for an app that you think you might use at some point, download it, and forget about it. It’s not like a physical object taking up space in your home (although lots of people will probably admit to storing barely used exercise equipment out of sight and out of mind!) and it doesn’t seem to be doing any damage. Apps you aren’t using create unnecessary risks. If the app has permission to interact with other parts of your phone, it may still be doing this to gather data on you in the background. The app you’ve forgotten about is still adding to your digital footprint. The simple solution? Delete apps that you don’t use. Besides, a health or fitness product that you use regularly is always going to be more effective than one that you hardly ever touch. Think about sufficiency: Do I need this? Am I using it? Is it helping me? If the answer is no, just delete it.
Practice Safe Sharing
A lot of digital health products encourage us to connect with friends and share our progress. Whether they connect us with a community of people who share our health and fitness interests or enable us to celebrate achieving our goals with friends and family — sharing features are a significant part of what makes digital health and fitness so popular. But, again because of the sensitive and valuable nature of the dataset you make with digital health and fitness products, we may want to take extra precautions to make sure this dataset doesn’t put us at risk. Think carefully about who will see the content you’re sharing. If it’s health-related, sensitive, or personally identifying, you may want to restrict who’s going to see it in the first place. You can do this on most social media platforms by either limiting who can see all of your posts or restricting individual posts. But any time you put some digital content out there in public – even if you limit who can see it – you lose control of it. It’s impossible for you to know if, for example, your friend’s social media profile has been hacked. Your content could also be intercepted by hackers, or the company you’re trusting it with might hand it over to anybody who asks for it. But if the content you share can’t be used to identify you in the first place, you’re a lot safer. If you want to share screenshots from your telehealth service on social media, make sure you remove all personal information from them first. You can do this with your phone’s photo editor, by cropping out information or covering it up with shapes and stickers. Oversharing is a uniquely dangerous risk with health and fitness wearables. That’s because of the kind of information you’re sharing: location data can show people where you’re likely to be given your regular running routes, and sleep monitors create a dataset that tells people when you’re likely to be in bed. Going through the privacy settings on a wearable and any app it connects to will help you understand when and how it shares your information.
Use Tools to Hide from Prying Eyes
You might not want anybody to see your health information, fitness goals, or prescription schedule unless you’ve given them your express permission. If you’re using digital health and fitness products, this may be harder to achieve. But it’s not impossible. First, there are some great developers out there who don’t even save your personal information on their servers. For example, some period-tracking apps recently put privacy features in their products that mean the developer can’t see or hand over information that could be linked to an abortion. Often when you download an app, it requests access to wearable data, for example, from a connected smartwatch. This means that another service or organization will have access to these hugely informative datasets, therefore increasing the risk that that data will be exposed. It’s a good idea to be extra vigilant with all the health and fitness apps you download, to make sure they aren’t going to share your data in ways you aren’t comfortable with. Check the privacy policy if they have one. If they have a privacy policy and it seems vague, it’s probably not a very safe app. If there’s no privacy policy, it’s even less likely to be safe to use. If you access a telehealth service through an internet browser, you may want to strip cookie data from your browsing history to make sure that sites you visit afterward won’t know where you’ve just been. Privacy-focused browsers like Firefox come with this functionality already built-in, and you can get extensions for other browsers like Google Chrome. Look for email and chat platforms with end-to-end encryption. This way, any health info you send to friends, family, or your doctor couldn’t be seen by the company that owns the platform even if they wanted to. Most good providers will tell you if their encryption is independently verified, too. Direct or private messages on social media aren’t really private without end-to-end encryption, as the platforms themselves can always view them. You can also use tools to protect your anonymity by hiding your IP address and data that identifies you with your phone. This includes some VPNs (virtual private networks), provided they have strong encryption and an independently verified no-logs policy. The Onion Browser, which uses Tor’s “onion-lake” layered encryption technology, is another privacy tool that stops anybody from being able to look at your internet traffic (although it does slow traffic down quite a bit). As well as preventing digital health and fitness products from identifying you through your IP address, internet traffic, or phone, you can also hide your identity in low-tech ways. If you have to make a profile, consider using a fake name, profile picture, and location. If you have a public profile on an app or website, make sure you check that it’s not displaying an automatically generated profile name based on your personal information.
Defend Yourself from Cybercriminals by Keeping Apps and Devices Updated
If you’re using your phone or laptop to connect with digital healthcare, telehealth, fitness apps, or wearables, you might be a target for cybercriminals. This is because hackers are motivated to acquire and sell your unique, rich, and valuable health data for a good profit. One of the most important ways to protect yourself from hackers is to keep on top of updates. Make sure you update your phone, laptop, and any apps you put on them as soon as possible when new versions are released. You’ll usually get a notification to update and it won’t go away until you’ve done it. Bugs and vulnerabilities get discovered all the time, so it’s important to make sure you’re using the most current versions of apps and the most current release of your device’s OS. Updates are important because they include security patches that protect you and your devices from recently discovered exploits. It’s important to keep an eye on the devices that you’re connecting with, too. Lots of fitness wearables give you the option to lock the wearable to your device so that other people can’t randomly connect to them via Bluetooth. Turning this on could block hackers who are trying to access your health data or even all the data and passwords stored on your phone.
Make Sure Developers and Manufacturers Are Legit
A bogus digital health or fitness product could be used to extract your valuable health data, gain access to your routine, or even infiltrate other parts of your phone or device and cause more harm. You can usually avoid this risk by taking a moment to check out the developer or manufacturer’s credentials before you download or buy. You’d expect your gym to check out the credentials of any trainer they let use their space, you need to act like the gym and check out the credentials of app developers or wearables manufacturers if you’re going to let them into your health and fitness routine.
Be Prepared for Loss or Theft
If your phone, laptop, or wearable is picked up by the wrong person they could access your health and fitness data and potentially cause you harm. So it’s a really good idea to be prepared for this! Anybody can have their pockets picked, leave a bag on a train, or otherwise misplace a device. Set remote wiping up on any device that handles your personal information. Most device manufacturers (like Apple and Samsung) now include this feature in their mobile ecosystems, but you usually need to turn it on and create an account that you can access from another computer or device. Use multi-factor authentication wherever you can, and prioritize digital health and fitness products that offer it. Using biometrics like fingerprint and facial recognition can also really boost the security of your device, and good, strong, and unique passwords are still one of your best lines of defense. Make sure that your health and fitness apps can’t push notifications through to your lock screen, too. You can usually do this in your phone’s general settings, and it will stop the app from displaying your personal information to people who can’t get into your phone. Notifications displayed on the lock screen can present a security risk for multi-factor authentication systems as well, as they will show the temporary passcode sent to you by SMS. The best security practice is to turn off all lock screen notifications on your phone.
Be Aware of Your Surroundings
Finally, think about the physical space you’re in when you’re using digital health and fitness products. If you’re in the gym, don’t leave lots of space behind you for people to look over your shoulder and check what you’re putting into the app. If you’re accessing telehealth at the library or community center, try to sit so that the screen is facing a wall behind you and not an open space.
Conclusion: Digital Health for Digitized Bodies
In the last few decades, more and more aspects of our lives have moved online. In health, this has brought about tangible benefits. For example, multiple studies of telehealth services in various disciplines have found them to be as effective as usual in-person care at least, and often even more effective. Mobile app users tend to have better health outcomes than people who don’t use apps. And wearables are already having an impact on medicine, both in terms of helping to improve people’s health and in providing data for medical research. Digital products that help us record and monitor information that’s important to our health empower us to understand our bodies better. Our bodies are being digitized. Smartphones alone are packed full of tiny sensors that are capable of collecting huge datasets of your various biological markers over time. Wearables like smartwatches and fitness trackers may be collecting data from you 24/7. Accelerometers, cameras, location tracking with GPS and WiFi, wearable heart rate monitors, even breathalyzers and pulse readers: if you have the means, today, you can fit the better part of an intensive care unit’s monitoring system in your pocket, on your wrist, or strapped across your chest. And the direction of travel for development in computers and information technology is toward more data extraction with automated, superfast computer processing (which is called artificial intelligence). Any biometric or health information we generate, whether collected automatically with advanced sensor tech or submitted manually through an app or website, combines to make an extremely valuable dataset.
It’s valuable because it’s so rich and so immediate in terms of directly recording our bodies’ physical states. This has been terrific for medical research. The emergence of smartphones, apps, and wearables in the late 2000s – and the datasets these helped researchers generate – has directly contributed to our growing knowledge of the human body and how it works. With the help of a good digital health product, we can put this data to fantastic use for our personal health and fitness as well. There are great apps, websites, and online groups out there to help folks manage chronic illnesses, get more regular activity in their lives, tackle their mental health, train for peak performance, or stick to a diet. The most personalized digital healthcare products collect the most sensitive data about you. That’s how they work, by manipulating an extremely valuable dataset that you have provided. But the extreme value of this dataset also introduces new risks.
Because the information your apps and wearables are collecting is often collected passively, it’s pretty easy to be complacent with your privacy. After all, you get a pop-up that asks for access, you accept because the app won’t work otherwise, and then (most of us) never think about it again. However, in a worst-case scenario, the dataset you make can be used against you or get you into serious trouble. Any app that has access to your location can potentially expose that information. But it’s not just location data that puts you at risk. In too many parts of the world, women and people who can get pregnant are denied access to basic healthcare like birth control and abortions. Apps like period trackers may be creating evidence that exposes their users to serious harm. Even if your biometric data won’t get you into trouble, it’s still hugely sensitive information that everyone would do well to protect. We’d be rightly angry if we found out that our doctor was unethically (and probably illegally) sharing our personal health information with a third party without asking us first. We should expect app developers and wearable manufacturers to treat our privacy with the same amount of diligence and respect. Privacy underlies many of the rights that enfranchised people around the world rely on. Creating a rich biometric dataset – effectively my body’s digital twin – potentially undermines my privacy. The immediate consequences of that (not to mention more abstract outcomes of increasing surveillance from all directions) are the topic of another article. But essentially, privacy keeps us safe from harm, abuse, exploitation, and social and professional embarrassment. Online, where our information can spread around the world and reappear infinitely without ever degrading, privacy is even more important. Of course, there’s a conflict here. If we only cared about safeguarding our privacy to the maximum extent possible, then we simply wouldn’t use any digital or online products. But we do use them because of their clear benefits: we can share information instantly over any distance, we can access information in a way that we understand, and we can get insights from that information that enriches our lives (and our health) without having to train as a data scientist first. But it’s definitely possible to walk this tightrope, use digital health and fitness products, and stay safe! Following the simple and effective tips in this guide will keep your digitized body safe and secure.
Sources
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