Dark Metrics: Illuminating the Negative Impact of Digital Health Design
Summary
Traditional design metrics and KPIs are often geared towards measuring product success. Dark metrics challenge this paradigm by proactively measuring the unintended yet harmful psychological, social, and physical effects of our technologies. The examples within digital health are plentiful. From accelerating burnout among clinicians to widening racial disparities in quality of care, we can only reach the height of our most courageous solutions when we expose our deepest failures.
Key Insights
-
•
Traditional product metrics, like the Google HEART framework, often miss broader impacts on users, focusing narrowly on product success rather than holistic well-being.
-
•
Dark Metrics is a framework designed to measure negative unintended effects in digital health across four dimensions: disempowerment, exclusion, addiction, and distraction.
-
•
Disempowerment occurs when technology removes users’ autonomy, such as opaque black-box AI systems that undermine clinician or patient decision-making.
-
•
Exclusion can be subtle, as algorithms that proxy biased variables like healthcare cost can reproduce racial disparities without explicit intent.
-
•
Racial equity in design can be assessed using heuristics or rubrics co-created by diverse teams, as demonstrated by Raven’s IBM colleagues Dre Barbara, Sherees Cooper, and Morgan Foreman.
-
•
Addiction to technology is an overused concept in consumer health, but distinguishing healthy from excessive use requires linking engagement data to well-being measures.
-
•
Distraction from core tasks is common in clinical environments when new tech disrupts workflows, evidenced by studies with ER staff and clinical trial recruitment tools.
-
•
Ethics frameworks like the Institute for the Future’s Ethical OS help anticipate risks like surveillance, bias, and data control, which inform Dark Metrics design principles.
-
•
Engaging diverse stakeholders and including co-creation early in research helps uncover biases and unintended consequences before launch.
-
•
Addressing negative impacts requires transparency with clients and a strong ethical posture, even when business priorities may conflict with user protection.
Notable Quotes
"The traditional product metrics focus narrowly on the product or near-term impact but fail to capture what success means for the whole person."
"Within IBM Watson, we prefer the term augmented intelligence rather than artificial intelligence to emphasize support, not takeover."
"An AI algorithm that didn’t explicitly consider race still produced racial disparities by using healthcare costs as a proxy."
"I am a Black person, but I do not have every Black experience. Not having experienced something is not proof that it doesn’t exist."
"The difference between technology and slavery is that slaves are fully aware they are not free."
"Doctors want to help people, not be on a machine all day; many health technologies are more distracting than helpful."
"We can assess distraction by observing time spent on screens versus with patients, and self-reported mental effort and stress."
"It’s important to ask, before any new release, what are all the things that could possibly go wrong?"
"Our jobs are to protect users from harm. If clients don’t care about side effects, it may be necessary to draw a line and walk away."
"Storytelling is highly effective in helping stakeholders understand the complete performance of products, including the darker sides."
Or choose a question:
More Videos
"Our agile project process lets us look six months ahead to prevent overload and support human dignity."
Chelsea MauldinLet's Talk About Money
November 17, 2022
"Measuring impact is not just nice to have, it’s critical to hold ourselves accountable and to catalyze change at scale."
Stephanie WadeBuilding and Sustaining Design in Government
December 8, 2021
"The state of IT is a daily reflection of what the company thinks and feels about its employees."
Kristin WisnewskiMeasuring What Matters
October 23, 2019
"We need to speak the language of the stakeholders, whether tech-focused or human-centered."
Tala Tayebi Kelly Goto Jared SpoolVoice and influence in an age of noise
March 10, 2026
"Once you have momentum, you need to enable others to broadcast your wins, or your efforts just become ‘one of the other things people have stopped caring about.’"
Eniola OluwoleLessons From the DesignOps Journey of the World's Largest Travel Site
October 24, 2019
"Small micro changes every week add up — ask your team what tiny improvements they’ve made recently."
Mark InterranteCollaboration Flows in Product Development
June 9, 2017
"The wrong place is to not start with accessibility; where you start doesn’t matter as long as you do."
Nicole Bergstrom Anna Cook Kate Kalcevich Saara Kamppari-MillerAccessibilityOps: Moving beyond “nice to have”
September 19, 2024
"White people are not the problem. White supremacy culture is the problem."
Spencer L. A. StultzWhy Social Justice Frameworks are Necessary for Successful DEI/JEDI Initiatives
October 4, 2023
"Complexity is not a barrier to accessibility; even complicated games like The Last of Us are accessible."
Samuel ProulxInvisible barriers: Why accessible service design can’t be an afterthought
December 3, 2024