There is a growing obsession in the Department of Defense with wearable technology. Many leaders seem to believe that wearable technology data alone can address issues ranging from COVID-19 infection to fitness for duty. Wearables indeed provide biometric data—everything from heart-rate variability to sleep quality—and in theory could enhance operational effectiveness by minimizing stress and maximizing rest. Or they could create logistical and data-management challenges that limit actionable information.
If there is a good reason to collect physiological data, the military should consider the following challenges before implementing any wearables program. If the military manages each issue effectively prior to implementation, it will avoid the subsequent burden of managing petabytes of data with no actionable value.
Does the wearable measure what it claims to measure? For any device, the most important question is whether its technology functions as advertised. Too many products offer unsubstantiated claims and proprietary algorithms without empirical validation. Supporting testimonials, meanwhile, quickly wander into infomercial territory. Practitioners should ensure that any wearable device has undergone rigorous and independent scientific evaluation in the context in which it will be used.
For example, there are studies exploring how sleep-monitoring devices function in natural sleeping environments—but do the wearables effectively monitor unrestricted sleep outside of a laboratory? Individual sleep patterns could be misinterpreted if the device confuses periods of low motion and low heart rate (e.g., watching TV) as a person being asleep.
In addition, some environmental factors such as background motion—which can be expected on moving platforms such as planes and ships—may affect monitoring algorithms, especially if they are based primarily on accelerometry for classifying sleep and wake state. It is possible these devices could work on moving platforms if the algorithms are not primarily based on accelerometry or if the motion is filtered out. But such factors should be investigated before using these devices in these environments. Beware peddlers who promise the moon but deliver only moonrocks.
What protections does the information need? Data security is another major concern. For commercial applications, there are privacy issues when transmitting data over cloud-based servers. The military must also worry about hostile incursion, in which an adversary tries to steal physiological data or even locate U.S. personnel from their electronic emissions, both of which exacerbate operational security concerns.
Another potential issue involves individual attitudes about invasion of privacy. Sailors and Marines may be wary about how their data will be used—specifically, could punitive action be taken based on wearable data? Someone might reasonably be unable to fulfill duties such as flying an aircraft because of consistently poor sleep, and while it might be safer to ground them, what should happen to their service record when they regularly cannot fly? Physiological monitoring could make personnel more effective, but it also may make them wary of the negative affect the information could have on their careers and thus refuse to use a wearable as prescribed.
For military applications, the security issues are as much about personal privacy as protecting the system against foreign intrusion. The good news is, there are military researchers working to secure wearable data transfer by removing the need to connect to commercial cloud systems or pair with a personal smartphone.
How are you going to manage this data? Data analysis cannot always depend on off-the-shelf products for military purposes. A device might measure heart rate, but turning beats per minute into complicated heart-rate variability metrics might require subsequent analysis. Every byte of data collected becomes subject to management and analysis. In turn, data volume becomes a management problem that could quickly get out of hand. The solution is to ensure the data-management burden comes with a correspondingly valuable application—that is, make sure the juice is worth the squeeze. Having data is one thing. Knowing how to use it to optimize human performance and safety is another.
There are also policy considerations that still need to be worked out. In the United States, most commercial, fitness-type wearables are viewed not as medical devices, but wellness devices. This is not the case in other countries such as Australia that view them as medical devices and the data as protected health information that requires additional safeguards. Policy for how data will be treated and reported becomes an important consideration.
Can you get people to wear them? Commercial wearable technology must be worn to be effective. However, devices can be uncomfortable, particularly when people are not accustomed to wearing them or are asked to wear them 24/7. There are differences in form preference (e.g., ring versus watch) that should be considered, as well as allowing appropriate time for people to adjust to wearing the device. For example, wedding rings are worn by many, but some people adjust differently to them. Sleep-monitoring devices and other wearables introduce a similar problem.
In military environments, wearables could not only be uncomfortable but also risk injury that results in the wearer casting the devices aside. For example, there is a degloving risk for occupations that work primarily with heavy machinery, and, thus, a ring form may not be appropriate. In addition, depending on the application, the device might need to be worn only during specific periods such as sleep. If personnel are not wearing them, or wearing them has a negative affect on job performance, then the whole effort becomes self-defeating. The solution would be to ensure the human-factors integration step is completed prior to implementing any wearables program. If the military solves as many issues as possible before wearable devices are mandated, it would avoid many headaches down the line.
Use Wearables as a Check-Sailor Light
Wearable technology is evolving, and one day a core device may warn about everything from critical sleep deficiency to an impending heart attack. But it is not there yet. Most wearable technology has limited application in military settings simply because of operational security concerns. There are also the challenges of ensuring data is valid, safely managed, and does not create unnecessary logistical burdens, and that personnel are using the wearables properly.
Still, if there is one consistently valuable piece of advice, it would be to use wearables as a simple “check-human” light. Any company claiming a device has diagnostic capability or standalone potential is likely overselling the validity of its algorithms. However, these inflated claims do not mean that physiological monitoring cannot yield benefits. Managing expectations and avoiding overreach are the watchwords. Much as a car check-engine light warns of some problem, wearables can provide notification that a service member’s health is outside normal parameters. Addressing the challenges would help the military implement a wearables program in a safe, secure, and noninvasive way.