MOBILE
SOCIAL
AND FUN
GAMES FOR
HEALTH
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CONTENTS
I. WHY ARE MOBILE HEALTH GAMES EMERGING NOW?...........3
II. WHO CARES AND WHY?.................................................................8
III. WHAT IS A GAME?...........................................................................10
IV. NEW APPROACHES.........................................................................12
V. BUILDING THE EVIDENCE BASE..................................................18
VI. NOTABLE HEALTH GAMES..........................................................21
VII. CONCLUSION.................................................................................41
VIII. APPENDIX.......................................................................................44
Research and Interviews conducted by Bonnie Feldman
Edited by Brian Dolan, Editor MobiHealthNews
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ABOUT THE AUTHOR
Bonnie Feldman, DDS, MBA.
Feldman has built and owned two dental
practices, consulted at The Rand Corporation
and Prudential Insurance, and served as
a buy- and sell-side Wall Street analyst.
Feldman holds a BA in Economics, a Doctor
of Dental Surgery, and an MBA in Finance
from the University of California, Los Angeles.
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I.
I. Why are mobile health games emerging now?
G
ames, once dismissed as pastimes for wastrels,
have become an increasingly acceptable part
of society; so much so that, according to the
Entertainment Software Association, consumers spent
$25.1 billion on video games in 2010. Research firm DFC
Intelligence expects that number to top $70 billion by
2015.
“There may be silly applications out there, but we think
that this could be a multi-billion dollar business,” Dr.
Bill Crounse, Senior Director of Worldwide Health at
Microsoft, told MobiHealthNews in an interview. “Within
our gaming unit, as we look at intake from around the
world, we see more inquiries in health and health-related
industries than any other sector out there.”
Games jumped from the board to the television decades
ago, and console-based video gaming is still a massive
industry. Since then computer games, handheld gaming
devices, massive multiplayer online games, social
networking games, and games on mobile phones have
entered the fray. Suffice it to say, there are -- and will
continue to be -- games for every new platform.
Dr. Crounse is not alone in thinking that health gaming is
trending. Game designer Jane McGonigal argues in her
recent book, Reality is Broken, that “games are already
improving the quality of our daily lives, fighting social
problems such as depression and obesity, and addressing
vital twenty-first-century challenges.” McGonigal believes
that gamers “will be able to leverage the collaborative
and motivational power of games in their own lives,
communities, and businesses” to change the world.
Just as games have spread to various types of screens,
the types of games, their content and overall raison d’etre
has diversified, too.
Take Nintendo’s Wii and Microsoft’s Xbox – both consolebased video game systems that launched in recent
years. With the Wii, players interact with the console via
a wireless, accelerometer-enabled controller that tracks
the player’s motions. For some of its games, the Xbox
offers Kinect technology, which recognizes gestures
and movements that players make with their bodies
– no controller required. These innovations make the
platforms more accessible to non-traditional gamers
and have led to the development of a number of fitness
games, sport games, and ultimately healthcare games.
© Copyright October 2011 Chester Street Publishing, Inc. All Rights Reserved.
Leighton Read, a Venture Partner at Alloy Ventures and
Chairman of Seriosity, a startup that offers a playful
collaboration platform for businesses, believes that
games will “change the way we work and the way
businesses compete.” That’s actually the subtitle of the
book he wrote, called Total Engagement, which was coauthored by Read’s business partner, Byron Reeves. Read
is also the chair of the Health Games National Advisory
Committee. Read argues that leveraging games at work
can improve employee job satisfaction while increasing
productivity.
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I. Why are mobile health games emerging now? (continued...)
Games increase engagement. “When someone is
engaged, you have their attention,” Read wrote in a blog
post recently. “They are activated; they are in a better
position to make choices and take action consistent with
their own values and their own wishes.”
In a high profile journal article, entitled “Interactive
Games to promote Behavior Change in Prevention and
Treatment,” published in the Journal of the American
Medical Association (JAMA) in March 2011, Read and
Stephen Shortell noted that “games targeting healthy
behaviors are also proliferating.”
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Given the perceived proliferation of gaming and the
incessant buzz around “gamification” in health circles, we
undertook this report to develop a snapshot of gaming
in health – with a focus on mobile platforms. This report
pulls from interviews with dozens of academics, authors,
gamers, insurers, developers, investors, healthcare
providers and more.
One of the most memorable quotes from those
interviewed came from the Kaiser Innovation Center’s
Dr. Yan Chow who said that “game thinking gives people
permission to fail, and that is new and important in
healthcare.”
What else does gaming bring that might also be new
and important in healthcare? Gaming may make it a little
more fun.
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I. Why are mobile health games emerging now? (continued...)
Mobile trends and the gamer
KEY METRICS
According to mobile apps analytics company Flurry,
the combined revenues earned by gaming apps for
the Android and Apple iOS platforms surpassed the
combined revenues of Sony’s PSP and Nintendo’s DS
for the first time in November 2011. What does that
mean? The mobile phone, specifically the smartphone,
is now the biggest handheld platform for gaming.
Flurry’s research found that the combined revenues
for smartphone gaming apps totaled $500 million,
$800 million and $1.9 billion in 2009, 2010 and 2011,
respectively, while the incumbent handheld video game
makers made $2.2 billion, $1.6 billion and $1.4 billion for
2009, 2010 and 2011. The age of the smartphone and
tablet as primary gaming devices is now upon us.
š
Pyramid Research predicts that the 200
million mobile health applications in use
today will triple by 2012.
š
Pew Research Center’s Internet and
American Life Project estimates that close
to 20% of Americans with mobile phones
have used them to look up health or
medical information.
š
IDC predicts that in 2011, about 14% of adult
Americans will use a mobile health app to
manage their health, wellness and chronic
condition.
These location-aware devices are often equipped with
high-definition cameras and more computing power
than was offered by a standard PC just a few years ago.
š
Manhattan Research predicts that by 2012,
81% of physicians will own a smart phone.
š
More than 600,000 new devices running
the Google Android operating system and
Apple iOS (including iPhone and iPad) are
activated every day.
š
Asymco reports that worldwide more than
30 million apps are downloaded each day.
š
Smartphone global shipments have been
greater than PC shipments since q4:2010
š
A recent Pew report found that 85%
of adults in the United States have cell
phones, with 35% of Americans having
smart phones.
In early 2011 research firm Gartner predicted that sales
of smartphones in the US would hit 95 million units this
year since consumers were found to be more likely to
purchase a smartphone over any other electronic gadget.
While the majority of mobile phone users in the US are
still not using smartphones, some 35 percent of US adults
now have smartphones, according to a survey conducted
by Pew Research Center’s Pew Internet Project. CTIA, the
wireless industry association, announced this fall that
there are now 96 million active smartphones in the US
market. In March 2010 there were half as many.
Suffice it to say, soon enough smartphones will be
ubiquitous.
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I. Why are mobile health games emerging now? (continued...)
Mobile, social and fun
Mobile trends and the gamer (cont...)
Gaming is also becoming more common. During the
course of the past few decades video games have gone
from being an immersive diversion for the few to a casual
mass medium that not only entertains, but can also help
people learn quicker and work better. According to the
Entertainment Software Association (ESA), the average
gamer is 37 years old and has been playing for 12 years.
Some 40 percent of gamers are women and more than a
quarter are over the age of 50.
For any hangers on who still believe videos games are
just for kids, these numbers dispel that myth.
The steady adoption of smartphones and the rapid
uptake of tablets among US adults is putting cheap,
connected computing power into the hands of millions
of consumers and healthcare providers.
In tandem to the growth in adoption of mobile phones,
online social networks have seen adoption by hundreds
of millions of people the world over. The number
of Facebook users now tops 750 million worldwide.
Some 300 million of those users are playing games
on Facebook – primarily a wildly popular game called
Farmville, which was developed by Zynga. Farmville
players compete against friends and use their neighbors
as tools to grow their virtual farms and then post these
achievements to their Facebook profiles.
The power of social network games, of course, could be
used for more productive ends than impressive virtual
harvests.
In their book “Connected: The Surprising Power of Our
Social Networks and How They Shape Our Lives,” James
Fowler and Dr. Nicholas Christakis suggest that social
networks can help us achieve what we could not achieve
on our own. They tend to magnify whatever they are
seeded with – both positive and negative. Networks
can influence the spread of joy and the maintenance of
health as well as the spread of obesity and depression.
Seniors enjoying Humana’s Dancetown game.
Adam Bosworth, the CEO of Keas, tends to agree. In an
interview, Bosworth asserted that social games were
powerful tools for behavior change because “people are
social and fundamentally like positive reinforcement.”
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I. Why are mobile health games emerging now? (continued...)
Mobile, social and fun (continued...)
The “anytime, anywhere” connectivity promised by
mobile devices, which is fulfilled save for network
coverage gaps or heavy data traffic areas, helps us stay
connected to our online social networks as we go about
our day.
In April 2011 the Deloitte Center for Health Solutions
found that a small but increasing group of US healthcare
consumers use social networks:
t
to find or share healthcare information (11 percent)
t
to comment on experiences using the health care
system (6 percent)
t
to learn about prescription drugs (5 percent)
t
to communicate with an insurance company (2
percent)
t
to communicate with a physician (2 percent)
It’s also likely that many of these users are accessing
social networks via their mobiles: Overall mobile social
networking has grown substantially in the past year. A
report published by ComScore in October 2011 found
that Facebook’s mobile users doubled to top 57 million
users this year, while Twitter’s mobile audience grew
by 75 percent to top 13.4 million people. Interestingly,
mobile Twitter users are likely to share three times as
much as mobile Facebook users, an October 2011 study
by Lolatycs found. ComScore estimates that about 40
million people check their social networks via their
mobile every single day.
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For this report, we focus on the use of social tools as
a means to gather motivation and support for healthrelated activities. Online support networks are taking on
new roles.
Facebook and other networks allow individuals to share
fitness and wellness activities and receive motivation and
encouragement from friends and followers. For employee
wellness programs, social games can encourage
teamwork, friendly competition, and accountability. For
chronic disease management, condition- or diseasespecific communities help people share information,
life-coping skills and other support.
Given the metrics noted above, it’s no surprise that the
financial world often groups mobile and social gaming
into one bucket: Piper Jaffray estimates that the market
for mobile/social gaming will grow from $4.4 billion in
2010 to $17 billion in 2014.
Much of that growth could come from the gamification
of apps: “Gamification of apps is the ultimate way to
engage a new generation of audiences,” Kleiner Perkins’
Bing Gordon said during a recent presentation.
As the sections to follow illustrate, healthcare
incumbents and developers new to the field are
beginning to agree that gamification has quickly become
a popular strategy for many health offerings.
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II.
II. Who cares and why?
P
ut simply, the potential users of mobile health
games include nearly everyone from the
worried well to fitness fanatics and patients
living with chronic conditions to healthcare
providers themselves.
Still, the expected stakeholders in the
healthcare industry each have
particular needs that mobile
Designers
health games could help
address.
The provider
Psychologists
community is in
need of better
educational
tools to improve
efficiency and
lower costs.
Gaming
Care providers
Entertainment
of all stripes
are interested
in employing new
ways to help patients
understand their diseases
and regimens to help them
better take care of themselves.
offerings, in order to stay competitive in a new and
rapidly evolving ecosystem.
Pharmaceutical companies must reinvent themselves
to secure a strong position in a rapidly changing
ecosystem. They cannot rely on their old
model of success that was based on
Providers
the number of drug units sold.
Instead, they need to focus
on improving health
Payors
outcomes. Although
usually slow to adapt
to new technology,
they see a pressing
need to identify
Users
Medical
and market a
(Providers, Patients,
Device
new suite of
Fitness, Wellness)
offerings that will
function together
to improve health
outcomes.
Pharma
Hardware
Software
The payor community is seeing their business
models changing from managing risk to providing
new services. They are developing innovation
centers and experimenting with gaming elements to
enhance both the depth and breadth of their service
© Copyright November 2011 Chester Street Publishing, Inc. All Rights Reserved.
Medical device
developers are looking at
Health
gaming elements to bring
Marketers
deeper customer engagement
with their products to increase sales,
improve compliance and make managing
chronic conditions or complicated regimens easier.
Device manufactures are especially beginning
to understand the need for more “user friendly”
approaches, and are beginning to think more about
design and consumer engagement principles at the
early engineering design stages.
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II. Who cares and why? (continued...)
Outside the traditional healthcare arena, a variety of
stakeholders seek to lend their expertise and contribute
to solving healthcare problems. These include people
from the gaming and entertainment communities,
hardware and software engineers, behavioral
psychologists, cognitive psychologists, behavioral
economists, designers, and communication experts
thinking about creating lasting behavior change.
Why now?
Given the widespread adoption of mobile phones and
social networks in addition to the popularity of casual
gaming, those focused on improving health outcomes
see an opportunity to leverage these technologies to
drive health behavior change.
The medical community is clearly interested in the
topic, as demonstrated by the increasing number of
conferences focused on the topic and the advent of a
new medical journal, for example.
t
Games for Health
t
Serious Games Summit
t
The Power of Play: Innovations in Getting Active
Summit 2011 (A Science Panel Proceedings Report
from the American Heart Association-sponsored by
Nintendo)
t
t
A number of interviewees were enthusiastic about
mobile games moving into healthcare:
“Healthcare, in and of itself, is boring, while gaming is
exciting, fun, and addicting,” Don Jones, Vice President
of Wireless Health Global Strategy and Market
Development, Qualcomm Labs said. “Applying game
theory [gamification] to health apps, you can capture the
consumer’s imagination and engage them in their own
health.”
Sutha Kamal, CEO of Massive Health, agrees. Kamal said
that “it is time to measure success by how many times
people smile.”
Chuck Parker, who is the executive director of the
Continua Health Alliance, noted that he has heard about
a number of health and medical sensor companies are
beginning to discuss partnerships with entertainment
companies.
Admittedly, this sector is still in its early days, but given
the trends towards anytime, anywhere and personalized
information with group influence, we expect that use of
games, game mechanics and gamification will increase in
healthcare services.
In recent months, talk of gaming and gamification during
onstage pitches by mobile health startups at industry
events has become increasingly commonplace.
The first annual Games for Health in Europe 2011
A new medical journal: “Games for Health: Research,
Development, and Clinical Applications.”
Before digging deeper into specific mobile health games,
let’s take a step back to define what games are and how
they engage players.
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III.
III. What is a game?
S
torytellers have been influencing people for
millennia. Telling and listening to stories is one of
the oldest forms of human entertainment, at least
since our ancestors developed language, and forms a
deep foundation upon which games can be developed.
Health games pioneer Debra Lieberman, PhD, who is
director of the Health Games Research national program
and a researcher at the University of California, Santa
Barbara said that storytelling is very important to
behavior change:
“We learn from observation,” she said. “Storytelling
engages us and gives us a vicarious experience, lets us
learn what is likely to be rewarding and punishing. Some
people think about games only in terms of commercial
games -- the look and feel of a video game, [but] I
define it broadly as… a rule-based activity that involves
challenge to reach a goal and [it] provides feedback on
your progress to reach that goal.”
In this sense, people have always enjoyed playing
games, which fulfill fundamental desires for exploration
and mastery. For today’s games, the underlying human
motivations are the same, but the new media have given
game developers a broader array of tools to surprise and
delight us with new experiences.
Will storytelling be used in health games? While the
opportunity is not universally agreed upon, some of
those interviewed saw it:
“I believe narrative is critical to immersive…video
games,” Richard Buday of Playnormous said. “Humans
are hardwired to expect important information to be
communicated through story.”
You should “take a chore and make it a game with story,”
according to Academy Award-winning producer Ed
Saxon, who is working alongside his sister, Dr. Leslie
Saxon, at the USC Center for Body Computing.
Storytelling can “do good and do well in the world,
marrying tech and entertainment,” according to Tim
Jones, formerly of Disney and now at HealthNuts Media.
GAMES
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GAME
MECHANICS
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III. What is a game? (continued...)
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The use of game mechanics to influence customer
behavior is not entirely new online or offline. Airline and
hotel reward programs have an element of competition
and reward about them. Online services have long
leaned on gaming precepts: eBay auctions feed
competitive instincts and social media sites have made
a game of accumulating friends and followers. Nike, the
world’s largest manufacturer of footwear and apparel,
has gamified exercise with the launch of Nike+ in 2008
along with an iPod application that rewards users when
they reach fitness milestones.
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Why do game mechanics work? Games satisfy some of
our fundamental desires: reward, competition, status,
achievement, and altruism.
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IV.
IV. New Approaches
G
ame developers without experienced healthcare
partners, advisors, or team members won’t
make an impact. Healthcare service providers
with an eye on gamification but no experience creating
beautifully designed and engaging apps, won’t either.
Health games are under development or have launched
by teams going about these types of partnerships in
various ways.
Anne DeGheest, a managing partner at MedStars
Ventures Partners, agreed that it is “hard to find a team
with the right mix of skills [because] you need people
from the healthcare, technology, and consumer sectors.”
Rock Health, an incubator for mobile health and Health
2.0 startups, leverages multidisciplinary teams for its
screening process of startup applicants, according to
managing director Halle Tecco. “Applications are vetted
with expert teams that include multiple disciplines,”
she said. “It takes a village, so we need deep level of
engagement with the medical community, as well as
with the consumer health and wellness community.”
Often times these multidisciplinary teams are brought
together by design innovation firms like Frog Design and
Continuum.
Frog Design is an active member of the Innovation
Learning Network, an international non-profit network
of noncompeting healthcare innovators who come
together to share best practices. Describing the Frog
Design San Francisco’s team approach, Aimee Jungman,
a Vice President of Strategy, said that she “believes
multidisciplinary collaboration is essential in developing
mobile healthcare games that are engaging and drive
lasting health outcomes.”
“Frog brings together designers with deep expertise in
motivating behavior change, strategists experienced in
the healthcare industry, and technologists with skills in
developing medical communication platforms to build
mHealth connectivity and then translate the game data
into meaningful health information,” Jungman said.
Michael Bidu, the Founder and CEO of Canada’s Centre
for Wireless and Digital Health Innovation, has a front
row seat for the types of partnerships that could lead
to future health games: “Seasoned executives from
Electronic Arts Canada, Microsoft Interactive Games,
as well as young video game designers [are] coming
together with healthcare and wellness professionals to
partner on consumer engagement [to] deliver fun and
meaningful consumer or patient experiences.”
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IV. New approaches (continued...)
Continuum, a global design and innovation consultancy,
says it uses a human-centered approach. As part of its
methodology, Continuum commonly incorporates a
behavior change framework — designing to “support
people’s actual goals, not the goals we might wish
they had,” Continuum Principal Devorah Klein said. The
hoped for outcome: products, services and experiences
designed for how people actually live, not how
companies think they should live.
Multidisciplinary teams? “It’s how we work every day,”
says Continuum Director Stuart Perry. A typical team
includes a cognitive psychologist, graphic designer,
interaction designer, industrial designer, and an engineer.
When asked about interdisciplinary collaboration, Dr.
Leslie Saxon, the Chief of Cardiovascular Medicine at
the University of Southern California’s Keck School
of Medicine and founder of the USC Center for Body
Computing said: “We love other disciplines, we are
not afraid of them. USC, from the president down, is
dedicated to interdisciplinary work.”
In her gaming work, Saxon collaborates with the USC
School of Cinematic Arts, the Institute for Creative
Technologies, the Viterbi School of Engineering and the
Marshall School of Business. That approach gives the CBC
a “360 approach to mobile gaming,” according to Saxon.
One of the games in development at the CBC is “Beating
Heart,” which “introduces heart health to young adults by
letting them get their heart rate when they touch their
iPhone and also allowing them to share this information
with friends.”
The Center for Body Computing is also developing a
pulmonary rehabilitation game called “The Magic Carpet”
game where the harder the user blows into their phone,
the more an interactive magic carpet pictured on the
user’s phone moves.
Majid Sarrafzadeh, a Professor of Computer Science and
Director of the UCLA Wireless Health Institute, said his
institute’s community also includes an interdisciplinary
group of experts and innovators from many UCLA
Schools including Engineering, Law, Management,
Medicine, Nursing, Public Health, and Theater, Film &
Television.
“We think the only way to make progress in this field
to ensure we are solving the right problem is to work
with other disciplines,” Sarrafzadeh said. “In fact the
collaboration has to be a tight collaboration, where you
meet and discuss on a regular basis – truly as partners.”
Kevin Patrick, M.D. M.S., a Professor of Family and
Preventive Medicine at University of California, San
Diego, is doing research using social media and mobile
technologies to promote improved health behaviors.
Mobile technology has created a new field that is “very
multidisciplinary, with teams composed of psychologists,
cognitive science experts, computer design, electrical
and computer engineers, software engineers, nutritional
scientists, exercise scientists and physicians working
together,” Patrick said. “No one discipline owns more than
a minority share.”
Patrick directs the Center for Wireless and Population
Health Systems at Calit2 where collaborators come from
the UCSD School of Medicine, UCSD Division of Social
Science, the Jacob School of Engineering, the San Diego
Supercomputer Center and San Diego State University.
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IV. New approaches (continued...)
It’s not just academics and researchers who are
beginning to look at mobile health gaming. Perhaps
unsurprisingly, pharma companies are, too. About a
year ago Janssen Healthcare Innovation was formed to
accelerate the transformation of Johnson & Johnson from
a healthcare product company to a broader health care
company.
The “purpose of the group is twofold; one is to help
optimize our existing businesses, and the other is
to build additional businesses in the new spaces in
healthcare” said Dr. Diego Miralles, who heads the
team. With significant support from the company
leadership, Miralles said he has built a dedicated
multidisciplinary team with diverse sector experience
from pharmaceuticals, devices, telecommunications, IT,
consumer and financial/consulting.
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“We want to understand the new ecosystem and
participate in its growth and development. We see
an opportunity to collaborate with non-traditional
partners, to co-develop and to scale up many exciting
new solutions that facilitate consumer empowerment
for optimal health management. We also see the need
for integration of systems throughout the healthcare
continuum and believe we can be a leader in driving
these types of advancements.”
Janssen Healthcare Innovation is actively looking for
strategic partnerships, from both inside and outside
of healthcare, including mobile behavior modification
solutions.
Dr. Miralles said he had a sense of “wonderment and
excitement” when he first began to explore this new
ecosystem. “This is a time of rapid change, some of
which we can’t even imagine… but we know we need to
be a part of it.”
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IV. New approaches (continued...)
Insurance companies are also rising to the challenge and
opportunity by forming innovation centers. Humana’s
Innovation Center was founded in 2000 to create services
based upon their understanding of the rise of consumer
empowerment in healthcare. In 2007 the center
recognized “the prevalence of gaming across all ages,”
Nate Bellinger, Director of Consumer Innovation, said. By
then “gaming was done by kids, seniors and parents and
we wanted to work with all age groups around health.
This initiated Humana Games for Health.”
Humana has a dedicated website for its health games,
called HumanaGames.com. The health insurer’s current
offerings include Colorfall and Goldwalker (pictured
right).
“We expect to use what we have learned in developing
these games as we expand our gamification approaches
to health and wellness,” Tony Tomazic, Consumer
Innovation Director, said.
Colorfall: A puzzle game based on the color spectrum
where you arrange cascading colored tokens in the order
of the colors of the rainbow.
Goldwalker: An adventure strategy game you can play
while going about many of the activities in your daily life
including walking and exercising.
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IV. New approaches (continued...)
In 2003, Kaiser’s Innovation Consultancy began working
with design firm IDEO to better understand which design
methodology would work in a healthcare setting.
According to Chris McCarthy, an innovation consultant
for the Innovation Center, “it was challenging to try to
use a product design methodology in a service design
company.”
Now, in 2011, the team is made up of an industrial
designer, a communication designer, a design strategist
and several generalists. McCarthy explains that “our
design thinking is becoming more sophisticated,
blending the best thinking from product design, service
design and now behavioral design thinking.”
Games from the consultancy now include “The Amazing
Food Detective” (pictured right) and “Dr. Hero”.
Another pilot is addressing pediatric obesity using FitBit,
BodyMedia, and Nintendo’s Wii Fit to encourage exercise.
The Kaiser team is also very enthusiastic about clinical
gaming. Dr. Yan Chow, Director, Innovation and
Advanced Technology, believes that gaming “gives us the
freedom to fail in a safe environment, and could expand
our abilities to observe and analyze user behavior in a
richer way.”
The Amazing Food Detective: Based on a
skit developed internally at Kaiser and then
produced by an outside game designer, the
game utilizes eight short mysteries and 24
fun arcade mind-games. Kids play the role of
detectives fighting childhood obesity.
According to Chow, the hospital patient of the future
may be playing games for personal entertainment or
learning about aftercare on a large screen, while an
attached Kinect-type motion sensor could assist with
physical therapy rehabilitation or monitor physical
activity to track recovery.
Dr. Hero (no image available): A training game
that simulates an emergency in labor and
delivery. Innovation Labs manager Richard
Chennault describes the game as an “immersive
learning environment that adds the stress of
a simulation yet gives the freedom to make
mistakes and recover from the mistake.” The
first version of “Dr. Hero” was done on a
noncommercial budget and is designed as a
platform that could be applied to other medical
scenarios or even to giving a patient a simulated
experience ahead of a procedure.
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IV. New approaches (continued...)
NEED SOME
ADDITIONAL PERSPECTIVE?
Are doctors likely to benefit?
Doctors at Kaiser Permanente may soon benefit from
new approaches to gaming: “With electronic medical
records [already] implemented at Kaiser, we can now
think about layering gaming technologies like scenario
modeling, real-time analytics, and decision support on
top to increase productivity and engage clinicians more
effectively,” Chow said.
Importantly, he sees uses for gaming and simulation in
the future of medical education where “physicians can
access just-in-time training at the point of need and
receive micro credits toward licensure requirements.”
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Industry heavyweights Intel and GE Healthcare have
also dabbled in health games. Intel spent years building
an in-depth knowledge of the aging population before
combining its Intel Digital Health Group with GE
Healthcare’s Home Health Division to create Intel-GE Care
Innovations. The new company is already using some
cognitive health games for an elderly population.
Although not currently offered, Muki Hansteen-Izora, a
senior researcher and strategist at Intel Labs, “sees a need
for games used in physical therapy and/or rehab in this
setting,” too.
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V.
V. Building the Evidence Base
T
here is a growing clinical trial evidence base that
shows that games can improve players’ health
behaviors and outcomes in areas such as addiction
control, healthy eating, physical activity, physical therapy,
cognitive therapy, smoking cessation, cancer treatment
adherence, asthma self-management and diabetes selfmanagement.
Perhaps one of the earliest success stories in health
gaming might be “Packy and Marlon”, a Super Nintendo
adventure game published in 1994, that Debra
Lieberman consulted on. The main character in the game
has diabetes and the challenge for players is to manage
the character’s blood glucose monitoring, insulin use and
food selection for four simulated days. Meanwhile, the
character tries to save a diabetes summer camp from rats
and mice that have invaded the premises.
To further build upon this early work, in September 2007,
the Robert Wood Johnson Foundation launched an $8.25
million national program called Health Games Research:
Advancing Effectiveness of Interactive Games for Health,
to advance innovation, design and effectiveness of
health games and game technologies.
“The goal of the program was to build the evidence base
and seed the market,” Paul Tarini, a senior program officer
for the Robert Wood Johnson Foundation’s Pioneer
Portfolio, stated. Current funding runs through 2012.
In a controlled clinical trial, diabetic children and
adolescents were randomly assigned to take home either
the “Packy and Marlon” game or an entertainment video
game with no health content. The study found that the
participants in each group played about 1.5 hours per
week on average over the course of 6 months, but the
“Packy and Marlon” group increased their communication
about diabetes with family and peers, gained more
diabetes knowledge, increased their perceived selfefficacy for diabetes self-care, and increased their
appropriate self-care behaviors.
As a result, their urgent care and emergency visits related
to diabetes decreased by 77 percent, dropping from an
average of 2.4 visits per child per year to 0.5 visits per
child per year.
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The RWJF’s mobile game projects include:
Lit to Quit, a game intervention for nicotine
smokers. Researchers at Columbia University
have smokers trying to quit puff into an iPhone
microphone instead of a cigarette and also use
a “rush” or a “relax” form of breathing that helps
reduce craving. Survey responses along with
EEGs of their brain while the study participant
is smoking versus playing will indicate whether
the game serves as a gratifying substitute for
smoking a cigarette.
Mindless Eating Challenge, a game created
by researchers at Cornell University. The game
uses eating tips, nurturing of virtual characters,
snapshots of foods, and an array of feedback to
promote good nutrition and a healthy lifestyle
for young adolescents.
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V. Building the evidence base (continued...)
In January 2011 the American Journal of Preventive
Medicine published the results of a clinical study on
whether children aged 10 to 12 years old who played
two particular health video games had better eating
habits and physical activity habits as a result. The study
compared about half of 133 kids who played the video
games to the control group who played diet and physical
activity related games on popular websites.
HopeLab’s health game, Re-Mission (pictured below),
is an epic fully-interactive battle game [played on the
computer] that focuses mainly on story-telling as its core
gaming mechanism.
The two video games tested were called “Escape from
Diab” (Diab) and “Nanoswarm: Invasion from Inner
Space” (Nano). The study found just a slight increase
in fruit and vegetable consumption among the Nano
and Diab playing group, but not water consumption or
activity level. The increase in health fruits and vegetables
was about 0.67 additional servings per day. While not
conclusive, the researchers suggested further study was
now warranted.
The study was the largest randomized controlled study
of a video game intervention ever conducted, according
to the researchers. The study followed 375 teen and
young adults with cancer at 34 medical centers in the
US, Canada and Australia during a three month period of
cancer treatment.
Clinical trial data showed that this well-designed video
game could have a positive impact on health behaviors
of young people.
Re-Mission
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V. Building the evidence base (continued...)
Results were published in August 2008 in the medical
journal Pediatrics. They showed that patients maintained
higher levels of chemo in their blood, took antibiotics
more consistently, showed greater acquisition of cancerrelated knowledge, and showed faster increase in self
efficacy as a result of playing the game. To identify the
psychological mechanism of action that drove behavior
change (i.e. treatment adherence), a subsequent fMRI
study of 53 young adults playing the game found that
several key areas of the brain, including neural structures
involved in emotion, motivation, learning, and memory,
were activated. These findings are consistent with results
from a preliminary questionnaire-based study suggesting
that a major component of Re-Mission’s effectiveness
stems from its impact on individual emotional and
motivational processes.
a chemo blaster to destroy cancer cells -- and provides
players with a ‘story’ they are part of within the game.”
“Narrative is used as a device throughout Re-Mission,”
Richard Tate, the VP of Communications and Marketing
at HopeLab, said. “Players pilot the body of a microscopic
robot named Roxxi as she flies through the bodies of
fictional young cancer patients to fight their disease.
This narrative both informs the objective of the level of
game play – for example, in certain missions Roxxi uses
In his work on Mass Interpersonal Persuasion (MIP), Fogg
asserts that platforms, such as Facebook, give ordinary
individuals the ability to reach and influence millions
of people. Fogg thinks that the democratization of
persuasion will lead to far better outcomes than those
achieved back when persuasion was controlled by a few
powerful medical groups.
Complementing this body of academic research and
non-profit work, BJ Fogg and his team at the Stanford
Persuasion Technology have developed a systematic
way to think about behavior change. In their behavior
wizard, they outline three factors that must happen
together in order to get a change in behavior. A person
must be sufficiently motivated, be able to perform the
behavior, and be triggered to perform the behavior.
Core motivators include pleasure/pain, hope/fear, and
acceptance/rejection. The framework, which describes
15 types of behavior changes, helps researchers and
designers think about how to use mobile technology as
tools for persuasion.
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VI.
VI. Notable health games
R
eimbursement issues have not held up wellness
focused health services like they have with some
condition-specific or disease management focused
apps, and that’s why there are many more wellness apps
in the market.
Some consumers are beginning to use brain games to
improve or enhance cognitive fitness.
Below, is a quick summary and preview of the types of
wellness games and gamified services described in this
section.
When it comes to diabetes management, companies
want to use social networking and support to encourage
medication adherence and life style modification. People
with diabetes want easier ways to monitor and manage
blood sugar levels through insulin, diet and activity.
In the wellness arena the concept of health and wellness
is expanding to include “self-help” and life improvement.
Consumers are beginning to take charge of their own
health. In the fitness arena, consumers are buying apps
to track exercise, sleep and eating habits and want
to share and compete with other members of their
communities.
Employee benefit programs are looking to lower overall
health care costs by encouraging a wellness approach.
Previous attempts to engage employees in wellness
programs have been notably unsuccessful, so they are
using game elements to make health improvement
programs more engaging. These include: assigning
points to activities, allowing people to advance through
levels, letting them join together in teams and earn
individual or collective rewards, applying social pressure
and nudges, using badges as status and social rewards
along with monetary-equivalent rewards.
Below is a summary of what we’ll discuss when it comes
to chronic condition management services.
For medication adherence, companies are trying to
use gaming principles to help behavior change while
automating the process of reminding patients to fill
prescriptions and take their medications. Many patients
want help, especially those managing complex regimens
(like HIV antivirals, or elderly patients with multiple
prescriptions).
Health games also offer an opportunity for treating
addiction. This patient population is already recognized
as one that is highly motivated by rewards and social
pressure, which are traits associated with addictive
personalities. They can be reached through peer-to-peer
and mobile techniques that leverage those traits for
“staying on the wagon.”
Beginning with some of the wellness games in the
market, this section will summarize some of the mobile
health gaming activity currently ongoing.
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Life Improvement
and Self-Help
VI. Notable health games (continued...)
Mindbloom Life Game uses a tree metaphor to represent
the different branches of a person’s life -- health,
relationships, lifestyle, leisure, finances, spirituality,
creativity and career. Users focus on making small
meaningful changes to improve the quality of their lives.
There are five elements that drive consumer engagement
within this game:
t
“Holistic: I can grow my tree with branches from
different aspects of my life including health, lifestyle,
career, creativity, relationships, finances and
spirituality.
t
“Personal: I can include personally inspiring music,
photos and quotes.
t
“Social: My forest has trees with my friends and family
who can send notes and encourage my progress.
t
“Visual: I am rewarded by keeping my tree green and
growing.
t
“Fun: game is full of surprises - points take me to new
levels which reveal new opportunities for growth.”
“Our goal is to make life improvement accessible for
everybody in a fun and simple way -- initial iterations of
the product came from the life coaching community,” Paul
Ingram, the creative director at Mindbloom, said.
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Life Improvement
and Self-Help
VI. Notable health games (continued...)
Livn’ It is a mobile habit gaming network that helps users
master positive, sustainable daily habits like exercising
regularly, eating healthier, waking earlier, meditating, or
becoming more organized. The network was developed
with help from behavior change and cognitivebehavioral psychologists as a “simpler, easier, cheaper,
and more sustainable complement to traditional selfhelp resources or programs.”
Kairos Labs has also founded The Habit Design Meetup,
based in San Francisco with expansion chapters in
New York, Seattle, Boston, and Los Angeles, to foster
a broad cross-industry collaboration of best-practices
in behavior-change habit development research,
methodologies, and practices that “really work beyond
100 days”.
Kairos Labs is a startup founded in Seattle by former
Xbox LIVE executive Michael Kim and other Microsoft and
Adaptive Path technologists. The network is currently in
field-testing with an expanded release planned soon.
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Life Improvement
and Self-Help
VI. Notable health games (continued...)
MeYou Health—everyday wellbeing with small actions using community support
MeYou Health promotes everyday wellbeing by
encouraging small actions and fostering social ties that
drive meaningful behavior change. Daily Challenge is
the application that encourages users to take small,
achievable steps toward healthy living every day. Getting
started only takes a few minutes. Once you sign up, you
get an email at 7 am to do one small task, across a wide
range of wellbeing domains, from physical activity to
eating well to emotional health and more.
Feedback includes social proof of action from your
personal connections. If you don’t do the task, you get a
reminder in the afternoon. If you have accomplished your
challenge, by clicking “DONE” you can choose to share
how you accomplished the task with your network.
The MeYou Health team, which has designers and
engineers from the web, mobile and gaming sectors,
is experimenting with ways to use algorithms to
understand the power of influence and build online
communities. The goal is to create smarter ways to
leverage social networks and build a rich user experience.
Notably, MeYou Health, founded in 2009, is a whollyowned subsidiary of Healthways, a publically traded
wellbeing company which co-developed the GallupHealthways Well-Being Index.
“In our design research, we sought to understand the key
components of a successful well-being product,” Trapper
Markelz, Head of Product said. “We discovered four
principals that guide our solutions: Be realistic in what we
ask participants to do; be convenient enough to factor
into their time-impoverished lives; immediately create
a positive experience and sense of progress; genuinely
care for the challenges that participants face and the
information they provide.”
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Consumer Health
and Wellness
VI. Notable health games (continued...)
Worksmart Labs is a wellness technology firm focusing
on smartphone apps that allow users to record workouts,
track eating habits and follow a personalized weight
loss plan. WorkSmart’s products include CardioTrainer,
CardioTrainer Pro, Calorific, and Noom Weight Loss. All
of their applications are designed to be “simple with
actionable information” said Artem Petakov, Co-Founder
and CTO.
CardioTrainer allows users to track any kind of indoor
or outdoor exercise and then review statistics such as
distance, speed and number of calories burned after a
workout. Users can also compare themselves to other
CardioTrainer users around the globe via the World High
Scores feature.
WorkSmart’s newest application, Noom Weight Loss, has
already seen over 2 million downloads since its debut in
May. “Our users have really enjoyed Noom Weight Loss,”
says Petakov, “and we’re trying to build out more features
to that application, such as a ‘Personal Trainer in your
pocket.’”
Petakov said that “game mechanics are a multiplier of
behavior… they do not change behavior.” He also noted
that “leaderboards don’t work well with weight loss,”
according to their tests. He said leaderboards “need more
rigorous experimentation.”
WorkSmart Labs has spent 3 years working with their
user base of 6 million to help them refine their products
on the Android platform. This year it also introduced its
first iPhone app, Calorific Lite.
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Consumer Health
and Wellness
VI. Notable health games (continued...)
Zamzee is an online rewards program for teens that is
powered by their physical activity. The activity meter
records short bursts of movement, as well as vigorous
activity. The amount of movement powers the online
rewards account, where a virtual currency can be used to
purchase both virtual and real goods.
The game takes advantage of popular trends such as
life style tracking, social gaming, virtual economies and
customer rewards. Building upon the methodology
that HopeLab used in the development of Re-Mission,
Zamzee started with clear behavioral targets, built the
game with those targets in mind, and did extensive
iterations with their target audience. In order to
personalize the experience and gain sustained
engagement, the company is experimenting with
adaptive rewards and an element of surprise.
Early studies show that teens using Zamzee increased
their movement by 30 percent each month, according to
the company.
“The game let’s kids do what they do want to do and get
rewarded for it,” CEO Jonathan Atwood said. “We hope
it will shift attitudes among teens about the value of
regular physical activity.”
A public launch is expected this year.
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Consumer Health
and Wellness
VI. Notable health games (continued...)
The Basis Band is a connected health and heart rate
monitor intended to be worn around the wrist. Taking
advantage of the decreasing cost and increasing power
of sensors, the Basis Band has a number of sensors: an
optical blood flow sensor that can ”see” your heart rate,
a 3D accelerometer that records even tiny movements, a
sensor that tracks skin and ambient heat levels and one
that tracks your sweat.
Nadeem Kassam, founder and Chief Alliance Officer of
Basis, describes his “sweet spot as the intersection of
entertainment and healthcare.” He believes that it is
easier to stay healthy when wellness is fun, social and
informative.
“We are taking what we have learned from console
and casual games and experimenting with all sorts of
game mechanics applied to wellness,” Kassam said. That
ranges “from badges, leaderboards, points, individual
competition, and group competition.” According to
Kassam, the final platform will be part of an “awesome
user experience” once they finish their beta.
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Consumer Health
and Wellness
VI. Notable health games (continued...)
Massive Health is focused on developing patientcentered tools for behavior change to help people
get and stay healthy. The startup launched their first
“experiment” in the fall of 2011: The Eatery. The app
encourages users to snap photos of the food they eat
and submit it to the community of users for ratings
on a scale of “Fit or Fat.” The app also helps users track
how healthy they are eating day to day. Another app
in development by Massive Health is code-named
Penguine. It is focused on diabetes management, but the
specifics of the approach are still private.
According to Sutha, “mobile is an opportunity because
the device is always with you, there is tremendous
computational power and the number of sensors that
you can carry in your pocket” could lead to interesting
health applications.
What is their approach to gaming? “We want to bring
joy to our users,” Kamal said. “Gaming is one tool along
with data analysis and using social hooks for support and
encouragement.”
The co-founders come from outside healthcare -- Sutha
Kamal comes from the gaming world and Aza Raskin
comes from the computer/design world.
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Corporate Health
and Wellness
VI. Notable health games (continued...)
Corporate Health and Wellness
Employee-focused wellness programs have a history
of failure. Will games finally make employee health
and wellness programs effective tools to spur behavior
change? Will social gaming help solve the employee
engagement issue? A number of companies believe it
will.
Social health games encourage three behaviors:
teamwork, friendly competition and accountability.
“Keas helps people develop the habits to be healthier,
and this makes them happier and more productive,” CEO
Adam Bosworth said. “We use the power of play to do it.”
Bosworth believes that he has found five simple
approaches to get people to eat less, eat more
vegetables, exercise and manage stress:
t
Only use positive reinforcement: points, levels,
badges
t
Shared affinity: Players need to have a shared set of
issues or challenges
t
Team dynamics: Among the coworkers there needs
to exist a social obligation. They need to depend on
each other.
t
Newsfeed: If you do the right thing you can brag
about it and/or ask for help to your coworkers.
t
Make the games fun: Players need to have a strategy
on how to win and how to get rewards.
Above all else, Bosworth is adamant that the key element
is “no negative reinforcement.” He also stresses that the
game can’t be about the data.
“We did not want to follow Silicon Valley’s infatuation
with data at the expense of psychology,” Bosworth said.
“So we ripped out all the data.” Bosworth said Keas does
a lot of experiments and thrives on iterative learning.
Mobile is seen as key because of its convenience to Keas
users, he said. Bosworth describes Keas as a “pure-play”
when it comes to gaming: “We can use games incredibly
effectively to change behavior,” he said.
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Corporate Health
and Wellness
VI. Notable health games (continued...)
Vivecoach team wellness challenges combine the
convenience of mobility, the power of community and
the appeal of gaming to get employees excited about
doing something good about their health.
Jennifer Gill Roberts, the Chief Marketing Officer, says
Vivecoach enables customers to “change the game in
wellness by easily launching fun challenges of all shapes
and sizes that help them create a healthy culture.”
Vivecoach challenges include step count competitions,
weight loss challenges, and exercise challenges that
may appeal to large groups. They also include smaller
group or niche challenges called “Cold Turkey” challenges
focused on giving up things like soda, sweets, junkfood, or cigarettes. Challenges for flossing and sleeping
have also been used. Vivecoach encourages the
company administrators or any employee to create new
challenges.
“What has been missing in corporate wellness is a
focus on using employees’ interests and energy to
create programs that will work in a given corporate
environment,” CEO Doug Keare said. “Combining this
focus with gaming and competition is proving to really
work.”
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Corporate Health
and Wellness
VI. Notable health games (continued...)
Healthrageous is a software platform designed to give
personalized advice to help individuals reach their health
goals: eating a healthier diet, getting more exercise,
or managing hypertension. Martin Adler, Co-Founder
and Product Manager at Healthrageous, describes the
experience as “a personalized health journey, utilizing
game mechanics, social support and expert advice,” that
it is customized to each individual and tailored to each
corporate culture. “We combine coaching, social support,
device data, self report data, game play and educational
data to make taking care of yourself a rewarding
experience.” The company was launched out of the
Center for Connected Health at Partners HealthCare.
Here is how it works:
The Healthrageous automated expert system
combines participant input and device data to create a
personalized plan to achieve an individual’s goals.
Healthrageous gives advice, adjusts goals and suggests
features such as the online community for support.
The system continues to tailor the experience to the
individual’s needs.
The product is intended for individuals, employers,
health plans and care managers.
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Corporate Health
and Wellness
VI. Notable health games (continued...)
RedBrick, the most established company in this group,
was founded in 2006 and works with large, self-insured
employers and employees to create healthier, more
productive workforces. Its platform is driven by data
analytics to understand the population, and it believes
that extrinsic rewards, such as financial incentives, work.
”We think it is important to give people a simple,
personalized and easily accessible experience so wellness
just fits into their daily lives, like email and Facebook,”
said Eric Zimmerman, Chief Marketing Officer.
Their current engagement platform is a blend of gaming
mechanics, social networking, and financial rewards,
including lowering employee contributions to their
health insurance premiums.
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Brain Games
VI. Notable health games (continued...)
Brain Games
Until quite recently, most neuroscientists and
psychologists believed that the core aspects of
cognitive processing were fixed from a young
age. We now understand that with the right kind
of stimulation and activity, the brain can change
and remodel itself to become more efficient
and effective in processing information, paying
attention, remembering, thinking creatively and
solving novel problems.
Dakim is a comprehensive brain fitness program that has
been shown in a clinical trial to improve memory. Dakim
has created an entertaining approach to engage its
50-year-old and up user base. Videos, music, humor, and
an adult aesthetic add to the user experience.
Games include word definitions, famous people, little
known facts, picture puzzle, pheonician decoder, word
association, memory mambo, anagrams, and more. The
games automatically adjust to your abilities in real-time:
if you get one right, then the next question is harder than
the previous one.
These games are aimed at developing six cognitive
domains: short-term memory, long-term memory,
language, critical thinking, visual spatial orientation and
computation. Dakim’s CEO Dan Michel is “passionate
about bringing fun and entertainment to help his users
maintain their abilities to enjoy life.”
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Brain Games
VI. Notable health games (continued...)
Lumosity brain training games are developed to train
five core areas of cognitive function: processing speed,
attention, memory, flexibility and problem solving.
Games by Luminosity include:
t
t
t
Playing Koi -- An exercise of visual divided attention
and working memory. The goal is to feed the fish.
Familiar Faces -- An exercise of associative memory.
The game takes place in a restaurant and the player’s
job is to remember the orders and the customer’s
names to earn large tips.
By the Rules -- An exercise of mental flexibility
and working memory. The user is challenged to
formulate hypotheses about what the current
rule might be and then dynamically update that
hypothesis as new information becomes available.
“Everything is oriented towards the end user, and we
have gotten a lot of customer feedback telling us that
they feel it is personalized to them,” said Joe Hardy, the
Vice President of Research and Development at Lumosity.
The company’s secret sauce lies in its adaptive training
algorithm, he said.
The business model is a consumer product with a
subscription-based service.
Lumosity also makes its software available for free on
corporate web sites such as Blue Cross or the New York
Times crossword puzzle page. Another project is with
Abbott in Italy, where they make the Lumosity product
available to patients with HIV who have a cognitive side
effect called Neuro-AIDS. Lumosity Education Access
Program (LEAP) provides the product to educators,
teachers and school psychologists so the company can
determine new uses for their product.
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Disease Management
VI. Notable health games (continued...)
Disease Management
While a number of chronic conditions may benefit
from gaming, much of the focus to date has been
on diabetes management. Diabetes is emerging
as an area of focus for health game developers
for several reasons. The number of people with
diabetes is huge and growing. Management is
a longterm chronic disease and it involves high
costs for the healthcare system. Ongoing patient
engagement is key to good outcomes and lower
costs.
A key goal is to empower patients by giving
them more control over all aspects of disease
management, and facilitate a coordinated and
holistic approach where patients manage their
blood sugar and other areas, such as diet and
exercise, with less need to be supervised by
providers.
Telcare aims to connect doctors, patients and family
members around the care of a chronic illness.
Beginning with diabetes, they will be building a
cross-platform social community where people with
diabetes and healthcare professionals can interact,
share stories, discuss diabetes technology and learn
from one another.
The startup is better known for its Telcare BGM, the
first cellular-enabled glucose meter, combined with
an FDA-cleared database to aid in the management
of diabetes. The device allows patients to transmit
their blood glucose readings to caregivers and
family members and receive immediate coaching
and clinical feedback relayed to the screen of the
glucose meter.
“The people who built Facebook didn’t know what
the people were going to do there; they just knew
they were inviting them to the party,” CEO Jonathan
Javitt said when asked what shape the company’s
gaming elements might take.
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Disease Management
VI. Notable health games (continued...)
Cellnovo’s offering is comprised of a mobile connected
patch pump, a mobile touch-screen controller, blood
glucose meter and applications, plus real time activity
tracking.
The company states that every element and interaction
was designed to be easy to understand and operate.
Most of the daily tasks can be done by wearing the
pump, which has an accelerometer built in to measure
daily activity. When blood glucose testing is required,
the handset records the readings. Simply clicking an icon
records how the patient is feeling. The company also
hopes that its personalized food library makes recording
a daily food diary less taxing for users.
“Borrowing from the beautiful execution from the
consumer industry in Apple products, we used design
and simplicity as the foundation to putting together
a system to solve a critical medical need in diabetes,”
CEO Bill McKeon said. “It is important to think about the
system, not a widget. It is the system that has the power.”
Once the system launches McKeon says that it will mark
“the first time that real time data will be available. We
are excited to see how this data is used and what type of
connected learning will evolve.”
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Medication Adherence
VI. Notable health games (continued...)
Medication Adherence
Will games help improve medication adherence?
It is a challenging area according to Anne
DeGheest, a managing partner at MedStars
Ventures Partners, who “looked at 50 drug
adherence companies in 30 years of investing
and none of them have made it.” Perhaps mobile
technology and new understanding of behavioral
economics may help.
Proteus Biomedical is developing networked-in and
on-body sensor technologies that capture and correlate
health behaviors and physiologic responses. The onbody sensor is a low-cost patch worn on the torso that
tracks activity levels and sleep quality and quantity. A
small ingestible sensor that can be encapsulated within
existing medications communicates with the patch when
swallowed, capturing at-home adherence to medication
regimens.
Arna Ionescu, formerly Connected Health domain lead
at the global design and innovation firm IDEO and now
Director of Product Development, leads a team that
leverages human centered design to create products that
empower consumers.
Proteus’ technology will have an open application
programming interface (API), allowing them and external
developers to build gamification layers on top of the
sensor data. When asked about Proteus’ plans to use
game mechanics, Ionescu said, “We will use elements
of gamification, such as rewards, incentives, and
competition, to help motivate people to take better care
of their health and to drive consumer engagement.”
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Medication Adherence
VI. Notable health games (continued...)
HealthPrize has a medication adherence platform that
combines the power of financial incentives, education,
reminders and fun.
Dr. Katrina Firlik, HealthPrize’s cofounder and Chief
Medical Officer, thinks that “we need to add the fun
factor, as well as an element of surprise and delight,
to attack the medication adherence problem, which is
partly rooted in irrational thinking.”
To solve this irrational problem, James Jorasch, another
HealthPrize cofounder, brings deep expertise in gaming
and lotteries. He is the creator of the ten patents that
form the basis for the company, linking gaming and
rewards to medication adherence.
Adds Firlik: “We realized early on that it is difficult to get
people to sign up for adherence programs, so rewards
are key.”
The financial incentives include loyalty points, weekly
sweepstakes and monthly competitions, with a prize
to the highest point earner per month. Educational
tidbits are presented in the form of short weekly quizzes
and surveys, as well as daily “fortune cookies,” all for
additional points.
The business plan is to sell on a brand-by-brand basis to
pharmaceutical companies, and early interest has already
been demonstrated “from acne to oncology brands, and
pretty much everything in between.”
The company is currently conducting an asthma pilot
with Real Age and the company just signed its first
pharmaceutical partner. Plans for a 10,000-person pilot at
the pharma company are in the works. In November the
company announced the launch of its first iPhone app to
Apple’s AppStore, but only participants in the two trials
at Real Age and the pharma company can use it.
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Medication Adherence
VI. Notable health games (continued...)
Addiction Recovery Treatment
PillJogger is a motivation engine that CEO Dr. Robert
Pakter wants to “engage, entertain, excite and reward
people for taking their medicine.” To those ends, Pakter
has brought together a multidisciplinary team including
a lawyer/software engineer, and a designer.
PillJogger’s design philosophy is to make the user
interface simple and intuitive as well as “fresh and nondoctrinaire,” Dr. Pakter said. “Even if the dosage reminder
time is predictable, the user experience doesn’t have
to be.” PillJogger aims to accomplish this with elements
of surprise and discovery, using what they refer to as
“micro-media,” or short snippets of entertainment that
typically take a game form. Patients also earn prizes and
rewards provided by sponsors who also use the platform
for marketing and education outreach.
The server-based architecture allows for secure
recordkeeping of adherence history and HIPAA
compliance. The syncing of the mobile device with the
server allows caregivers and other authorized parties the
opportunity to evaluate and manage patient behavior.
Retail pharmacies, pharmaceutical companies, employers
and insurance plans may all sponsor patients so “the
product will always be free to the user.”
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VI. Notable health games (continued...)
Addiction Recovery Treatment
OneRecovery is an online support network for individuals
in recovery from alcoholism, drug abuse and eating
disorders. It is a place for members to share stories, work
on their recovery and mutually support one another
in real time. The web and mobile program combines
social networking technology, game mechanics and
evidence-based clinical principals to support sustained
engagement and behavior change.
The site offers what it calls “applied social technology”
that is customized to personal needs with varying levels
of privacy, ways to form groups, and ways to get support
from peers and providers. Users can participate in blogs,
forums, group chats and more. The service includes
mood and emotion tracking. Users get different colored
badges for sharing stories, setting a “recovery” clock for
one disease or many, or attending meetings.
“Our Social Solutioning platform engages people
to improve their health, reduces the risk of relapse
and improves outcomes for addiction recovery while
lowering medical costs,” Chief Marketing Officer Drew
Paxton said.
At the end of October 2011 the company launched
OnTheGo, a mobile 12-Step Program meeting finder
for iPhone users. The app should be coming to Android
devices soon. The app aims to help support recovery
from alcoholism, chemical dependency and process
addiction, according to the company.
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VII.
VII. Conclusion
A
lthough the sector is still in the early days, we
expect that the use of games, game mechanics
and gamification will ramp up in healthcare
and that the popularity of the mobile platform both in
general and as a gaming platform will accelerate the
trend.
To recap, a number of trends have emerged from this
study:
1. Healthcare incumbents and new consumer healthfocused startups alike are eyeing gamification and
working with multidisciplinary teams to bring their
wares to market.
Multidisciplinary collaboration, which was commonplace
in design firms such as Frog and Continuum, is now
appearing at academic centers such as UCLA, USC and
UCSD and emerging in some of the biggest providers
and payors (Kaiser, Humana, GE/Intel, Janssen) as well as
being intrinsic to the culture of most of the early-stage
companies highlighted in this report.
Tellingly, several of those emerging company
management teams have founders from outside
of healthcare, including: Mindbloom, Kairos Labs,
Worksmart Labs, Basis, Massive Health, Vivecoach, Keas,
and OneRecovery.
2. While many games for health initiatives make use
of common mechanics, the activity in the market
today is by no means a one-size-fits-all story.
Each sector has a characteristic way to mix and match
game elements: Addiction recovery programs use
applied social support and game mechanics. Corporate
wellness programs use game mechanics and social
games. Medical device companies in chronic diseases
(starting with diabetes) build online communities and
use peer-peer support for information sharing and
support. Consumer fitness companies use peer-to-peer
support to improve motivation. Medication adherence
programs use reward programs and pure entertainment.
3. New ways of learning in healthcare have emerged
that feed short bits of information into your day,
fitting into the small screens and 24/7 connectivity of
mobile communications and suitable for shorter user
attention spans.
Keas uses short quizzes that test knowledge of healthy
living.
PillJogger uses short snippets of entertainment.
HealthPrize creates educational tidbits ranging from
short quizzes to surveys.
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VII. Conclusion (continued...)
4. The big players are waking up to the potential in
the arena.
Healthways, a publically traded wellness company,
has spun out MeYou Health to create web and mobile
experiences that encourage healthy choices.
The Center for Connected Health, part of Partners
HealthCare, spun out Healthrageous to create an
interactive and personalized experience supporting
lifelong journeys to wellness.
Kaiser is experimenting with varieties of “game-like
thinking” in its Kaiser Innovation Center.
Humana uses its Innovation center to learn more about
using games for health.
Where’s the money?
Venture Capital is showing some appetite.
Intel’s Digital Health Group and GE Healthcare’s Home
Health Division combined to form Care Innovations to
use technology to improve independent living.
Johnson & Johnson has created the Janssen Health
Institute to accelerate its transformation from a
healthcare product company to a broader health care
company.
t
Proteus and Redbrick have recently received
Series D investments,
t
Lumosity and Dakim have tapped Series C
investment,
t
Cellnovo has received a Series B investment,
What about big entertainment or gaming companies?
Andy Donner, a director of venture capital firm Physic
Ventures thinks “it is doubtful” those companies will
move into health games. He noted that even “Zynga has
not moved toward health games.”
t
Telcare, Worksmart Labs, Basis, Massive
Health and OneRecovery have all received
Series A support,
t
ViveCoach and PillJogger are angel-funded,
Still, a number of those interviewed believed that a
company like Facebook could move into health games
and several predicted that Microsoft Health Vault will
integrate with Microsoft’s gaming division.
t
Mindbloom, Kairos, and HealthPrize are
currently self-funded.
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VII. Conclusion (continued...)
What’s next?
Michael Kim, CEO of Kairos Labs, envisions the
emergence of “behavior-change games” that combine
aspects of behavior-change psychology, alternative
reality games, and quantified self methods and
techniques to create a foundation for simpler, easier,
sustainable and fun ways to develop healthier habits.
Chuck Parker, Executive Director of the Continua Health
Alliance, sees a new category of “diagnostic gaming”
where games will have sensors that give biometric
readings which will be used to take gaming to the next
level.” Parker predicted that games with sensors should
be going into the commercial phase in the next 18
months.
Nadeem Kassam, the CEO of Basis, thinks that Nintendo’s
concept for a pulse oximetry sensor, along with Kinect’s
use of motion capture, indicates that games in the future
will use the human body as their controller.
Building upon growing consumer desires for simpler and
more personalized healthcare information, we predict
that the tools of game mechanics and online social
support will become more sophisticated and easier
to use. Simultaneously, better sensors and easier-tounderstand biometrics will give us more information,
which will further facilitate learning from other people
with similar health and wellness concerns.
The use of peer-to-peer support for chronic diseases and
rare diseases will increase.
With new data, sophisticated applications, and
established online support communities, more
stakeholders will be finding, using and adapting these
tools in a variety of ways to improve the health and
wellbeing of the increasingly common gamer.
Ben Sawyer, a founder of the Games for Health project,
also agreed that sensors will be important.
“Just like major airline frequent flyer programs evolved
beyond frequent flyer miles into a form of currency
for travel, rental cars, cruises and more, I think that
healthcare incentives will emerge as a popular
consumer currency that will ultimately be used to
purchase items outside of healthcare,” Don Jones, Vice
President of Wireless Health Global Strategy and Market
Development, Qualcomm Labs predicted.
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VIII. APPENDIX
The following people were interviewed by Bonnie Feldman for this report:
Name
Title
Company
Kyra Bobinet, MD, MPH
Managing Director, Strategic Diversification
Aetna
Gordon Norman, MD, MBA
EVP & Chief Innovation Officer
Alere
Katie Stogner
Manager, Consumer Health Communications
American Heart Association
Nadeem Kassam
Founder and Chief Alliance Officer
Basis
Mara Brazer
CEO
Brazer Communications/Keas
Darcy Provo
Director
Brazer Communications/Keas
Mollie Kittle
Director Creative Strategy and Insights
Bunchball
Nick Vassilakis
Wireless Business Development
Cambridge Consultants
Michael Bidu
Founder
Canada's Center for Wireless Health Innovation
Bill McKeon
CEO
Cellnovo
Chuck Parker
Executive Director
Continua Health Alliance
Devorah Klein
Principal
Continuum
Rick McMullen
Designer
Continuum
Stuart Perry
Director
Continuum
Geri Gay, PhD
Professor of Communication
Cornell University
Dan Michel
CEO
Dakim
Alan Price
CEO
DigiDo Interactive
Ed Saxon
Principal
Ed Saxon Productions
Mary Vegh
Investor Relations
Electronic Arts
Brian Wang
Co-­Founder and CEO
Fitocracy
Aimee Jungman
Vice President, Strategy
Frog
Steve Selzer
Senior Interaction Designer
Frog
Ben Sawyer
Co-­Founder
Games for Health
Brian Krejcarek
Founder
Green Goose
Ellen Martin
Prinicipal, Life Sciences Division
Haddon Hill Group
Debra Lieberman, Ph.D.
Director Innovation and Advanced Technology
Health Games Research
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VIII. APPENDIX
Name
Title
Company
Tim Jones
CEO
Healthnuts Media
Katrina Firlik, MD
Co-­Founder and Chief Medical Officer
HealthPrize
Martin Adler
Co-­Founder and Product Manager
Healthrageous
Richard Tate
Vice President Communications and Marketing
HopeLab
Ellen LaPointe
Vice President, Strategic Partnerships
HopeLab
Nate Bellinger
Director of Consumer Innovation
Humana Innovation Center
Nate Kvamme
Director Strategic Partnerships
Humana Innovation Center
Tony Tomazic
Consumer Innovation Director
Humana Innovation Center
Douglas Goldstein
President
iConecto
Muki Hansteen-­Izora
Health Research & Innovation Intel Labs
Intel Labs
Meghan Marschall
Director of Communications
Janssen Healthcare Innovation
Diego Miralles, MD
Head, Janssen Healthcare Innovation
Janssen Healthcare Innovation
Michael Kim
CEO
Kairos Labs
Yan Chow, MD, MBA
Director Innovation and Advanced Technology
Kaiser
Richard Channault
Principal and Manager, Innovation Labs
Kaiser
Aaron Hardisty
Business Consultant, Innovation and Advanced Technology
Kaiser
Chris McCarthy, MPH MBA
Director Innovation Learning Network
Kaiser
Adam Bosworth
CEO
Keas
Frank Chindamo
President
LaughMD
Joe Hardy, Ph.D
Vice President, Research and Development Lumos Labs
Sutha Kamal
CEO
Massive Health
Ernie Medina, Dr.PH
Co-­Founder and CEO
Medplay Technologies
Anne DeGheest
Managing Partner and Founder
Medstars
Trapper Markelz
Head of Product
MeYouHealth
Bill Crounse, MD
Senior Director Worldwide Health, Exective Microsoft
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VIII. APPENDIX
Name
Title
Company
Christopher Hewett
Creative Director
Mindbloom
Julie Price
Founder
Mobile Adventure Walks
Hallie Kotria
Co-­Founder
OneRecovery
Andy Donner
Director
Physic Ventures
Rober Pakter, MD
CEO
PillJogger
Gil Silberman
Chief Technologist
PillJogger
Christoph Oppermann
Designer
PillJogger
Paul Tarini
Senior Program Officer
Pioneer Portfolio of RWJF
Richard Buday
President
Playnormous/Archimage
Michael Merzenich, PhD
Chief Scientific Officer
Posit Science
Rob Weedn
Founder
Productive Play
Arna Ionescu
Director of Product Development
Proteus Biomedical
Don Jones
Vice President Wireless Health
Qualcomm
Pat Sukhum
Founder
RedBrick Health
Halle Tecco
Managing Director
Rock Health
Jonathan Javitt, MD, MPH
CEO
Telcare
Matthew Tendler
Vice President of Product
Telcare
Teri Louden
President
The Louden Network
Majid Sarrafzadeh
Director and Professor Computer Science
UCLA Wireless Health Institute
Kevin Patrick
Professor of Preventive Medicine UCSD Center for Wireless Health
Alexandrea Smith
Project Coordinator
USC Center for Body Computing
Leslie Saxon, MD
Chief, Division of CV Medicine and Executive Director of Body Computing Center
USC Center for Body Computing
Doug Keare
Founder and CEO
Vivecoach
Jennifer Roberts
Founder and CMO
Vivecoach
Artem Petakov
Co-­Founder and CTO
Worksmart Labs
Jonathan Atwood
CEO
Zamzee
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