On Mobile Health, Empowerment, and the Limits of Task Shifting in Healthcare

Some public health authorities are calling on health systems to reevaluate the clinical division of labor, and where epistemically or normatively justified, to shift medical tasks onto less-experienced health care personnel. Mobile health technologies are often seen as the vehicle to achieve this aim. Two technology-driven task shifting approaches stand out. In Europe, <i>task-preserving</i> policies are the norm. These policies aim to integrate medical devices with regulatory approval into clinical care. In contrast, the U.S. is experimenting with <i>task-expanding</i> programs, which encourage unregulated <i>general wellness products</i> to be assimilated into medical practice and other informal healthcare delivering networks. Absent regulatory oversight of these products, some health systems are turning to digital navigators-entry-level health care personnel-and asking them to evaluate and recommend "empowering" devices to patients. This paper argues that these task expanding initiatives are weakly justified, self-defeating, or pose unacceptable risks to patients and consumers.