Previously submitted to: JMIR AI (no longer under consideration since Oct 14, 2025)
Date Submitted: Mar 24, 2025
Open Peer Review Period: Apr 9, 2025 - Jun 4, 2025
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Addressing ethical issues in multimodal integration of digital biomarkers: A rapid review
ABSTRACT
Background:
In recent years, digital biomarkers have become increasingly popular in research and clinical investigations for therapeutic interventions. Traditionally, biomarkers are classified as physiological, pathological, and anatomical agents with specific features or characteristics for biological processes, including monitoring mechanisms and assays. As new generation of biomarkers, wearable technologies, or mobile health (mHealth) are rapidly expanding as outpatient tools for early disease screening and diagnosis. Digital biomarkers are non-imaging (non-invasive) sensors that are used to collect real-time data, perform measurements and/or enter metrics value in portable devices such as smartphones, and immersive technologies for alternatives to conventional biomarkers. When pairing with other advanced technologies including machine learning, and algorithm, multimodal biomarkers are proven efficient for biological monitoring including cognitive and behavioural changes. However, the socio-technological aspects are not well studied, and no specific policy exists for data collection, management and governance. Recent research raised several concerns relating to digital biomarkers including ethical issues, data privacy and security and data governance. This paper presents a short review highlighting the critical issues with digital biomarkers, considering their proliferation in healthcare.
Objective:
This research presents an in-depth analysis with critical issues surrounding non-imaging biomarkers. Drawing from empirical data, the literature is scoped systematically to present an in-depth analysis where the issues surrounded non-digital biomarkers are highlighted and examined
Methods:
Comprehensive electronic searches were conducted in the literature as a first steps, following a five-stages approach for scoping method in social science described by Arksey and O’Malley, (2005). Data from six public databases were analysed searched. Key words: “non imaging biomarker” “safety”, “privacy”, “security” narrow the search to focus relevant issues addressing the problem questions that retrieve and synthesise existing data; in addition to “ethics”, and “social” concerns. Our selection purpose was meant to explore the literature and summarise findings and identifying gaps.
Results:
Emerging App-based devices exploit behaviour patterns to predict or response to the user’s cognitive states or cognitive manipulation. Data collected can potentially be used to trigger mental health interventions. Table 2 highlighted the four types of risks identified (1) ethical concerns, (2) privacy, (3) security/cyber breach, (4) data safeguarding/data governance, and (5) policy/regulation/governance (Table 1). The risk of data hacking through data storage sites increased significantly with open platforms available to users, including those who are inexperienced and vulnerable users.
Conclusions:
Digital biomarkers enable individuals to remotely personalized and self-assessed their condition for better health management. Between 2014 and 2023, the digital market has seen a boom in digital health devices ranging Portable smartphone App connected wearable devices to neuromodulating devices. However, the socio-technological aspects are not well studied, and no specific policy exists for data collection, management and governance. Recent research raised several concerns relating to digital biomarkers including ethical issues, data privacy and security and data governance. Clinical Trial: N/A
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.