Pioneering Ideas

Games for Health Round Up

Last week’s Games for Health Conference in Baltimore generated a lot of excitement here on Pioneering Ideas and lots of folks are still talking about the sights, sounds and enthusiasm surrounding the conference and the building momentum in the games for health field. Here is a quick snapshot of what folks are saying…

Susan Promislo and Theresa Kanter shared their highlights from the conference here on Pioneering Ideas. Susan wrote about Zoron Popovich’s Fold It! game and Theresa shared photos and commentary from the conference’s opening session featuring Ben Heckerdorn’s modified Guitar Hero.

Mark at AbleGamers also blogged about Ben Heckerdorn and what his one-handed Guitar Hero will mean for amputees and those with limited movement in one arm.

Gamasutra recapped Noah Falstein’s conference session on the history of exergaming – a history that goes farther back than the recent high-profile games like Wii Fit. Neils Clark’s session on game addition and East Carolina University’s presentation on their research to explore casual games and stress reduction are also highlighted on Gamasutra.

Stephen from the Exergame Lab @ SUNY Cortland shares his Games for Health experience (with pictures) on the Exergame Lab blog.

Pioneer’s Chinwe Onyekere and Ben Sawyer, the co-director of the Games for Health project, talk about the growth of the games for health field and the excitement of the conference during an on-line tele-newscast.

And if you missed the conference – no worries, you can check out the conference presentations here.

Health 2.0: A Report on The Wisdom of Patients from CHCF

How is Web 2.0 technology affecting health care, and how might it shape its future? Health care economist and consultant Jane Sarasohn-Kahn distills a buzz of activity down to 24 pages of clarity for the California HealthCare Foundation: "The Wisdom of Patients: Health Care Meets Online Social Media."

Sarasohn-Kahn reviews the landscape of health-focused uses of social media and makes a few predictions for what might be next:

• Consumer ratings of physicians and providers. (Insurers and ratings groups are moving into this space, as it Zagat and Angie's List, notes Sarasohn-Kahn.)
• Networks where physicians and consumers can community peer to peer.
• Adoption of OpenSocial, a common set of standards for social media that allow users to move across social media sites without having to create a membership and load information at every single one.
• Disruptive innovations in health care brought about by new forms of collaboration.

In looking forward, Sarasohn-Kahn notes Carol.com may be an example of the "direct-to-consumer health care" of the future empowered by Health 2.0. Carol.com, a self-described health care marketplace based in Minnesota, allows users to investigate, compare price for and select health care in treatment bundles, whether or not you have insurance.

From Carol.com's Web site (a caution that the site is technologically lush and occasionally slow to load):

Carol, The Care Marketplace, allows Twin Cities' consumers to compare health care services, practitioner credentials, quality dimensions, and costs—with or without insurance. ...

Health care is sold in the Carol Marketplace in care packages—bundles of condition-specific services designed to treat everything from asthma to varicose veins. Care packages are created by clinical experts from each of the member institutions and include a range of traditional medical services that run the gamut from allergy evaluations to same-day surgeries. In the Web-based marketplace, consumers can compare diagnostic imaging packages such as MRI and CT scans, annual physical, dental and eye exams and the costs of physician-recommended services such as mammography or physical rehabilitation.

Read the whole report: The Wisdom of Patients: Health Care Meets Online Social Media.

Sarasohn-Kahn's own blog post on this report is here.

Game Drives Open-Source Biochemical Discoveries

On Day 1 of the Games for Health conference, Zoran Popovic of the University of Washington gave a demo of his Fold It! game project.  This unique effort, produced in partnership with Electronic Arts and others, is a massive multiplayer game that challenges thousands of players to work in competition and collaboratively to answer unknowns about the stucture and design of proteins.  I don't know a whole lot about proteins, beyond the fact that they play a big part in many diseases and also can contribute to cures, which is intriguing scientists like Zoran.  Ultimately, the answers uncovered through the game play contribute to the search for vaccines and cures related to HIV/AIDS, cancer, Alzheimers, etc.

    Here's a screen shot of Fold It!

Rockin' Out!

At the opening plenary session of today's Games for Health conference, Ben Sawyer introduced modded (modified) guitars that allow Guitar Hero to be played with one arm. The modded guitars followed a discussion with a rehabilitation therapist in North Carolina and a game developer in Wisconsin. The therapist asked for a version of Guitar Hero for her patients who had lost an arm or had limited use of an arm. Guitar Hero provided guitars to Ben Heckendorn who created a modified pedal that allows the player to strum the guitar with her foot. This is a big contribution towards accessible video games, but it also illustrates the power of collaboration. Games for Health brings together people who work (and face challenges) in health and health care to designers and developers from the video game industry with new solutions.

Below are some pics of Ben Sawyer (with tie around his head) and Ben Heckendorn rocking out with the modded Guitar Hero.

The role of a predictive model

Yesterday’s blog post focused on the value and future of comparative effectiveness analysis; today's second part of our interview with Lynn explores how the Archimedes predictive model has implications for comparative effectiveness research. You’ll remember that last October, Pioneer awarded an $15.6 million grant to Archimedes to support the development of ARCHeS, (ARChimedes Health care Simulator), an online interface and delivery system that will enable many more health experts to use the Archimedes model to answer health care questions with greater speed and precision.

How does ARCHeS and the Archimedes predictive model relate to comparative effectiveness research?

I see three major advances from Archimedes and its efforts to expand access to the model through the ARCHeS online delivery platform. First, more widespread use of the model will allow us, quickly and efficiently, to make confident, science-based predictions about treatment options. Archimedes founder David Eddy says it’s like building a house. If we can establish strong foundations at key knowledge points (e.g., through clinical trials), evidence-based predictive models can reliably fill in what hasn’t been studied directly.

Second, Archimedes can incorporate vastly more information—from physiology, systems biology, clinical studies and databases—about patients with complex, multiple conditions, and often on multiple treatment regimens, than even the best clinician can have in his or her mind and use well.

Third, Archimedes achieves a quantum advance in clinical care as a science. The leading-edge sciences, such as physics, start with careful experimental studies (like clinical trials in medicine) – and then use these results to build predictive models. They then use the models to predict observational data, and learn from how well these models work to design new experiments and develop better theories and models for prediction. The ultimate goal of other sciences is the ability to predict observed reality.

In the same way, accurate predictions of treatment options for patients should be the goal of clinical science. But clinical research is now focused mostly on perfecting and using the “randomized clinical trial” method, i.e., collecting careful experimental data. To move forward as a science, clinical research needs to use these understandings to develop useful predictive models that are tested and refined using large observational databases. Archimedes fast-forwards clinical care as science. And by using the new large EHR databases, it will put comparative effectiveness research on turbo.

We know Archimedes can provide reliable answers to a range of key health care and health policy questions – why is this area particularly important?

Expanding coverage for 47 million uninsured persons will soon be, we can hope, on the top of the national agenda. It will be important to be able to afford the expenses that come with that, particularly with forecasts of large deficits. Several of the leading health care proposals look to new “best practice” initiatives that will advance and – and apply – evidence-based health care to achieve economies. Effectiveness research is the foundation for evidence-based health care, although it will have to be supplemented by quality measures (identifying who provides effective care) and payment reforms.

What impact will the IOM’s recent recommendation to develop an independent entity dedicated to clinical effectiveness research and recent legislative proposals to set up a comparative effectiveness research body have on the future of this field?

The IOM and the new legislative proposals recognize that there must be broad political support for a national comparative effectiveness initiative, that this kind of initiative needs to address national priorities and to be generously funded, and that it is critical that comparative effectiveness research be first-rate science and guided by a trusted organization. The IOM report brings leadership and strong support from one of the most respected national health organizations.

What else needs to happen now to continue to make comparative effectiveness research an accepted part of health care?

We need the clinical research community to enthusiastically adopt these new “rapid learning” approaches. This is starting to happen, for example, with the Cancer Biomedical Informatics Grid (CaBIG), a World Wide Web specifically designed for health research, that enables researchers to access and share very large amounts of data. We also see this with the Cancer Research Network – it creates a new “virtual research organization” among 10 of the nation’s HMOs with large electronic health records databases. We also need many more physicians and hospitals to adopt electronic health records and make rapid learning from tens of millions of patients annually an integral part of the healthcare system.

Lynn Etheredge on comparative effectiveness research

As Abbey Cofsky told us yesterday, a new feature begins today on Pioneering Ideas: interviews with selected Pioneer Portfolio grantees. We are talking with Lynn Etheredge (see photo at left), an independent consultant working on health care and social policy issues with a long track record in the fields of health finance and health reform (see his bio, below), about his work on comparative effectiveness research.

What is comparative effectiveness research?

Today, there are generally at least several treatment options for most health problems – and many more coming from the R&D pipeline. Comparative effectiveness research aims to identify the best treatment for each patient. Among the objectives of a national comparative effectiveness program would be to understand the best uses of medical technologies, as soon as possible after they are available, and to allow patients and physicians to make fully-informed choices for personalized health care.

Why is so much attention being given to comparative effectiveness research today? 

In the Washington health policy milieu, there is a growing concern about our country’s health spending —$2.3 trillion per year, the highest in the world, and with significant projected increases. This year, the federal government will pay over $650 billion for Medicare and Medicaid’s 85 million enrollees – and this spending is projected to be over $10 trillion in the coming decade.

Despite this high price tag, there are large variations in clinical care, a lot of uncertainty about best practices when it comes to treatments and technologies, and pervasive problems with the quality of care that people receive. In particular, the evidence base for medical care is weakest for the Medicare and Medicaid populations. This is largely due to the fact that seniors, pregnant women, children, persons with serious disabilities and patients with multiple chronic conditions are usually excluded from clinical trials.

These problems have been around for a while, but there are important recent developments that will allow rapid learning about new technologies soon after they are introduced, without requiring more pre-market entry testing that could slow medical progress. Among these tools are large electronic health record databases, with clinically rich, individual longitudinal data for millions of patients (over 8 million patients in the Kaiser-Permanente system, for example); radically more productive ways of organizing and using data by creating national research databases, such as the Human Genome Project (and its follow-on HapMap project and new Genome Wide Association Study database); and the potential of new predictive models, such as Archimedes.

Conversations with Today’s Pioneers in Health and Health Care

The programs and projects that Pioneer grantees are leading give all of us here at the Foundation a lot to think about. Their work presents us with new perspectives and new questions, and fosters many great discussions about the role of innovation in health and health care. Some of those discussions have been shared here on the Pioneering Ideas blog and we appreciate the opportunity to have such conversations with you about the work of our grantees, promising ideas for the future, and the importance of innovation in health.

While we all enjoy talking and writing about the work of our grantees, there is something special about hearing from them directly about what’s on their minds. To that end, we are beginning a new series of interviews with Pioneer grantees - putting them on the spot, asking important questions about their work and sharing those insights here on the blog.

We hope that you too will feel free to ask questions of these health and health care pioneers.

Our first grantee feature will be posted tomorrow; an interview with Lynn Etheredge, a health care consultant who is working with a team of researchers at the George Washington University on how to move the nation toward a rapid learning health care system, one that uses health data in more powerful ways to answer key questions and deliver evidence-based medicine to patients. Comparative effectiveness analysis is helping researchers assess which treatments and technologies work best and most cost-effectively for which populations, and it’s getting a lot of attention in health policy spheres. Check back tomorrow to see what Lynn has to say about rapid learning and comparative effectiveness research, and how these trends might spark dramatic improvements in the future of health and health care.

Crowdsourced blogs for Council on Foundations annual meeting

Sean Stannard-Stockton has organized a group of bloggers to cover the Council on Foundations annual meeting.  Their posts are just beginning to appear on his blog, Tactical Philanthropy.  For those of you interested in the ideas coming out of this meeting, these posts will give you an early glimpse.

The "Second Life" of NY Times Magazine Cover Feature, CeaseFire

This weekend's New York Times Magazine cover story profiles CeaseFire, a violence prevention program built on a public health model that attacks the spread of violence much like epidemiologists attack the spread of infectious diseases.  The charge it issues in its ads and print materials is clear-cut:  Stop. Shooting. People.  CeaseFire is supported by RWJF's Vulnerable Populations portfolio, and its innovative "violence interruption" strategies are making a real difference on the streets of Chicago and increasingly, as the article notes, in other urban centers plagued by gun crimes and deaths. 

Among RWJF programs, CeaseFire also has been out in front in testing virtual world tools and techniques to enhance its real world impact.  In 2006, CeaseFire Deputy Director Candice Kane and her partners at the University of Illinois at Chicago's Center for the Advancement of Distance Education (CADE) attended a Games for Health West Coast meet-up in LA.  Since then, they have developed two islands in Second Life as part of their training protocol for violence interrupters and community outreach staff, helping them learn how to diffuse situations that otherwise might escalate in to violent attacks or acts of retribution. 

CeaseFire Island avatars and streetscapes are closely modeled on real-life Chicago staff and neighborhoods...right down to the graffiti and cigarette ads plastered on the buildings.  A slide deck from CADE provides some great screenshots -- if you read the Times story, you'll recognize Janell, Tio, and others and see what their avatars look like.

Coming up, we'll get the chance to talk to Candice about CeaseFire's experience in using Second Life to complement its offline training efforts, though we might have to wait for their phones to stop ringing off the hook, given the interest the Times article might spark.  Stay tuned...

P.S.  The slide presentation also highlights other ways in which CADE is using virtual worlds to improve pandemic flu and bioterror-related disaster preparedness.  Find out more at www.virtualpublichealth.com.

Web Radio/Podcast to Feature Games' Ben Sawyer

Ben Sawyer of Games for Health will be a guest on Jack Olmsted’s internet radio show and Podcast this Tuesday at 2pm EST.  Ben will be talking about the intersections of games and health as well as the upcoming Games for Health Conference. Click here tomorrow to listen to the live show. To chat during the show, you will need to set-up a Now Live account here. The Podcast of the interview will be available on the Seattle PI Reader Blog.

This Thursday’s Bill of Health: Greening the Health Care Industry

Last month, in a post entitled, Does ZipCar have lessons for health care?Rosemary Gibson wrote about Health Care Without Harm, a new Pioneer grantee, and their efforts to make the health care sector environmentally sustainable in ways that improve peoples’ health.

This Thursday, April 24, PBS Nightly Business Report will air a story about the growing movement to green the health care industry as part of their Bill of Health series. The story will report on the efforts the nation's hospitals are making to become more environmentally friendly and better members of the community -- all while controlling costs. We are excited to see that the story will feature an interview with Anna Gilmore Hall, RN, executive director of Health Care Without Harm.

Check the PBS website to find out what time and on what channel the program will air in your area.

In the long run...

Last Friday, in his thoughtful blog, Tactical Philanthropy, Sean Stannard-Stockton, wrote about the often-missed opportunity philanthropies have to focus on the long run.  Stannard-Stockton directs the philanthropy practice at Ensemble Capital Management, a position which informs his perspective, as you’ll see in this excerpt from his blog:

It is human nature to want results as quickly as possible. But to achieve success, we must match our investment decisions to our time horizon. If we want to fix a local school because our child will be attending starting next year, then it might make sense to focus on short-term solutions. But most donors fund issues because they want to have a sustained impact on a situation. The techniques that might reduce crime in a bad neighborhood the most over the next month are unlikely to be the techniques that will have the largest, permanent impact on reducing crime rates over the next couple of decades.

Financial market participants are often short-term focused. They often focus on metrics which describe short-term conditions, but do little to illuminate long-term trends. But great investors and great philanthropists must focus on the information that matters to the long-term success of their projects.

On the Pioneer Portfolio, we’re interested in understanding those long-term trends, because they are driven by forces and create conditions that make today’s radical ideas tomorrow’s successes.

Recently, we’ve been watching trends of patient empowerment, IT/communications technology, and data mining/rapid learning.  What trends are you watching and what implications do you think they have—long term—for health and health care?