GABE S. ARRINGTON and CHRISTOPHER P. MULDER
The 2022 National Defense Authorization Act directs the Department of Defense to develop a digital health strategy to incorporate new and emerging technologies — including wearable devices that could utilize big data and predictive analytics to bring a value-added capability to personnel across the DoD. While initial efforts will focus on improving the delivery of clinical care, health services, and the patient experience, wearable devices should quickly transition to other operational settings as well.
Using data from humanity’s eight billion people creates the opportunity to enable new medical technologies, healthier living conditions, and optimally engineered work environments. Even a slice of that greater population, such as the two million US servicemembers, would provide valuable insights and be a game changer in operationalizing wearable technology. Clearly, expanding the use of wearable technology in the DoD could have positive implications for both military capability and general health research.
Wearables first became a serious defense topic in 2018 when it was discovered that a running app was tracking service member data and location on military installations, setting off a firestorm of concern that led to new regulations. Those regulations have evolved to the point that allows wearables on military locations after meeting certain criteria. Now, if approved and in compliance, service members routinely include wearable technology as part of their daily attire in classified areas at military installations around the globe.
While other challenges will arise, such as who owns the data and how it will be used, the operational impacts for the joint force make this maturing technology worth incorporating into the DoD. Given Congress’ intent on this technology, department leaders should seek to embrace its potential and empower each service.
The good news is there is a clear test case: The DoD realized the potential of wearables early in the COVID-19 pandemic. The Defense Innovation Unit built a system with Philips Healthcare called Rapid Analysis of Threat Exposure, or RATE, in 2020. Designed to take advantage of commercial technology, the user wears a Garmin watch and Oura Ring to provide data from 165 different biomarkers into an algorithm that takes advantage of predictive analytics, allowing those potentially sick to know up to 48 hours ahead of being symptomatic. The Oura ring application displays three scores (sleep, activity, and readiness) that can be used to help one’s ability to perform and recover at any particular time.
After RATE proved successful with a sample size of 8,500 personnel, the Director of DIU, Mike Brown, referred to it as a critical capability and the DoD moved to quickly adopt it. The program has expanded across the services and the wearables are now common among senior leadership in the Pentagon and around the DoD to include West Point [PDF]. This success offers an opportunity for the DoD to expand the operational use of wearables.
How many of us wear Apple Watches now that tell us to breath every so often or stand up? What if a military leader, at any rank, could program their wearable to assist them with their leadership style and application? Imagine if, say, Will Smith had been alerted to his increased emotional state before he slapped Chris Rock on public television, allowing an opportunity to consider his actions before lashing out. When a wearable senses an increased heart rate or aggressive body language, a person in a similar scenario could receive an audible tone, buzz on their skin, or a number of other reminders that indicate that now is the time to disengage or alter their behavior. A built in coach could assist a leader in how best to lead through the challenging scenario for a number of susceptible behaviors.
Healthy Living to Maximize Performance
There is increased emphasis on burn pits, toxins in the workplace, and on preventative training for physically active career fields such as flight operations. In the future, wearables will include sensors that can actively monitor and track service member’s exposure to toxins, mental health conditions, or demanding physical conditions like soldiers carrying heavy loads over an extended period of time. With both individual and aggregated data, leaders can make better decisions on how to optimally train and fight, while proactively preventing excess exposure to harmful conditions.
The DoD must provide guidance for holistic health that each Military Department can use to build upon their own programs. It could be used to launch wearable and other holistic health initiatives by using the formal budget process to methodically sustain and mature wearable technology and additional holistic health support. Guidance concerning data security must be addressed.
Optional Training Regimens
The services are now expanding upon the success of the RATE system in novel ways. One use case will be to enhance, or maybe even eliminate, portions of physical fitness testing. The Space Force is considering using monitored health data to replace PT Tests, and former Navy leadership has proposed the same for replacing semi-annual testing. The Air Force has also begun testing wearable technology for flight operations. The 12th Flying Training Wing at Randolph Air Force Base has become a technology innovation hub after incorporating the Air Force’s Pilot Training Next into its daily operations. Now, pilots are testing the Garmin Fenix 6, a Hidrate Spark Smart Water Bottle, and Oura Ring to better understand the conditions of its pilots before they fly on a mission. The Army is also exploring the technology, partnering with the University of Queensland to outfit Army paratroopers in Alaska with the technology to elevate their performance in demanding environments. At a time when the military is looking for alternative PT methods to bring in more technically-minded individuals, the possibilities could be notable.
As with any new technology, there are going to be challenges. The obvious downside to overly scaling wearables is the question of who has access to the data and for what purpose.
While the DoD has an opportunity to partner with the commercial sector to operationalize wearables, it must also establish processes and infrastructure to protect this data from breaches in security, particularly from potential adversaries, as well as preventing use outside of official DoD purposes. Culturally, commanders must learn to use data for operational decision-making for the benefit of a unit’s mission and be deliberate in building a culture of trust in which medical data will not impact a commander’s opinion of someone’s performance. Yes, these are serious questions which need to be well thought out, but they won’t be vitally important until these technologies are at scale — and can be addressed as the department begins to integrate wearable tech into the military.
A well implemented plan that respects servicemember’s privacy and includes their buy-in can mitigate most risks, and the technology has the potential to maximize the combat capability of the joint force for years to come. Wearables are not a panacea to all current service member challenges, but they are a good place to start exploring what is in the realm of possible.
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