Pioneering Ideas

Defining and Understanding Violent Video Games

Guest blogger Maria Chesley Fisk, Ph.D., is Deputy Director of Health Games Research, a national program of the Robert Wood Johnson Foundation’s Pioneer Portfolio, which funds research to advance the innovation and effectiveness of digital games and game technologies intended to improve health.

On November the 2^rd, the U.S. Supreme Court will hear the case of Schwarzenegger v. Entertainment Software Association.  The court will hear arguments for and against the state of California’s yet-to-be-enacted law banning the sale of violent video games to youth under the age of 18. Under the law, violent video games would be labeled 18 and those who sell them to minors could be fined up to $1000. Games used as examples include Resident Evil 4 and Tom Clancy Rainbow Six 3. The California law defines “violent video game” in 150 words as, in part, as “a video game in which the range of options available to a player includes killing, maiming, dismembering, or sexually assaulting an image of a human being.”

On October 22, at the Meaningful Play conference at Michigan State University, I facilitated a lively and thoughtful discussion about this case and its implications. A couple of themes emerged, and I will surely flavor them with my own opinion as I describe them here.  One theme was that whether there is an enacted law or not, parents should monitor their children’s gameplay (play with them even!) and teach their children positive strategies for handling conflict and frustration.  In short, parents should proactively take responsibility. 

A second theme of the discussion was that video games are powerful teachers. They teach whether they are designed for education, change, or entertainment and whether the teaching is intentional or unintentional. In other words, video games have effects on players. We as a society would benefit from honest, informative conversations about the nature and extent of those effects, as well as from more research that informs those conversations. 

A third theme was that parents should take into account the ratings assigned to games by the ESRB rating system in addition to their own evaluations of the appropriateness.  At least some participants wished we could use the resources consumed by the court cases that led to the Supreme Court case differently— informing parents about the rating system and the potential positive and negative consequences of playing games.  Game reviews from organizations like Common Sense Media are other tools that can help. 

I support a simple definition of violent video games:  Violent video games are those that represent violence as the best or only way to resolve conflict.  And I wholeheartedly agree with the discussants that parents are in the best position to monitor and help children process the messages they get from video games and other media.  Processing messages from media involves noticing them, evaluating them, and considering alternatives. In the case of violent games, an alternative is a peaceful approach to resolving differences. I hope the upcoming Supreme Court case will raise our country’s awareness and fuel productive, healthy conversations about the implications, responsibilities, and opportunities associated with children’s use of media.

Dr. David Eddy to Demo the Archimedes Outcomes Analyzer

This Thursday (Oct. 28, 3- 4:30 p.m. EST) Dr. David Eddy will demo the Archimedes Outcomes Analyzer (AOA), a Web application that expands access to datasets generated the Archimedes Model. This new tool will allow healthcare decision makers to compare and contrast information about costs and clinical effectiveness of various interventions and treatments, a functionality that we’re particularly excited to launch to the public sector.

The AOA is the first step toward the development of ARCHeS (ARChimedes Healthcare Simulator), a Pioneer-funded Web-based interface and delivery platform for the Archimedes Model which will enable healthcare organizations and policy leaders to reliably and quickly run their own queries on the health and economic outcomes of specific interventions and treatments for patients, providers and payers.

To learn more, register to join us for the Webcast demo.  

Tune-in to the TEDMED Conversation

The world’s preeminent health care innovation conference – TEDMED – begins October 26. We’re proud to help sponsor the event again this year, and we are looking forward to what promises to be a very robust discussion on accelerating change in health and health care.

Throughout the conference, we’ll be encouraging thought leaders in attendance to share their thoughts and experiences about exciting ideas and potential innovations with each other and with you. We invite you to participate in this conversation as it unfolds online. Here are a few ways you can:

Twitter: Follow the overall TEDMED conversation via #tedmed, and participate in the conversation Pioneer is facilitating via #ideapowered.

YouTube: Pioneer team members will ask attendees their thoughts on improving health care. You can watch these short video interviews at http://youtube.com/pioneerrwjf

Flickr: Share your best ideas by answering one of three questions and posting it to the Pioneer Flickr account. Just print out a downloadable word bubble, fill in your idea, take a photo of yourself holding your word bubble, and post it on Flickr to join the interactive dialogue.  

And be sure to check out Pioneering Ideas beginning next week for thoughts from our grantees and team members.

Why I Want a Blue Button

This article appeared originally in the Huffington Post on 10/19/2010.

This morning my colleague, Dr. Carol Diamond of the Markle Foundation, appeared on the Today Show to talk about an initiative called “blue button.” 

As many have experienced, getting a copy of your medical records is rarely as simple as it sounds.  The process often involves making multiple phone calls, having to fax in requests, paying photocopying charges and waiting – often as much as a few weeks.  And at the end of the process all you have is a stack of paper – good for reading and for filing away, but not much else.  But today, as more and more hospitals, pharmacies, and physician offices are adopting electronic medical records, the process should get better.  Health care institutions in the vanguard of information technology and customer service are making it possible for their patients to review their records online.  But not necessarily take them with them.  That’s where the blue button idea comes in.  It’s a simple practice:  when a patient logs in to her account, provide a highly visible, clickable button to download her records in digital form.  As Dr. Diamond noted, the federal government has taken a leadership role in modeling this practice.   The Department of Veterans Affairs started providing blue button downloads to all patients of the VA system back in August and the Center for Medicare and Medicaid Services has launched a similar blue button service for all Medicare beneficiaries.  And their efforts have not gone unnoticed – more than 60,000 veterans have downloaded their medical data since the launch.  The Markle Foundation has also worked with experts from consumer and patient groups, health care provider, privacy advocates and technology companies to develop a set of recommended blue button practices that ensure high levels of security and privacy. 

So why does it matter?  For starters, reviewing your medical records is a step towards better engagement in your health.  You can learn more about your conditions, your lab results and the treatments you might be undergoing.  You can use the records as a springboard to conversations with your doctor.  But you can do that paper records.  Why does digital matter?  Two reasons:  sharing and apps.  Of course, when you get your paper records, you can always photocopy them and send them on to someone you’d like to review them.  But we all know that it’s so much easier to share digital information online.  So when you want your uncle the doctor to help you interpret a result, or when you and your sibling want to discuss Dad’s condition, it’s easily done. 

But the real power lies in the apps.  We now live in a world where there really is an app for just about everything.  There are 6,000 apps for the iPhone that focus on health and fitness.  They help  with day-to-day health-related tasks, like managing your diet, tracking your exercise, understanding your meds, or checking out your symptoms.  But these apps are, by and large, ignorant of the details of your health that could make them smarter and offer you more value.  Many of them, and many that will soon be invented, could be even better if they could draw upon the information contained in your medical records – to spot trends in your lab values and warn you when a trend is of concern; to correlate your moodiness with a new medication you’re taking; or to remind you it’s time order that prescription refill, to name a few.  And we’ve already seen that the data made available through blue button downloads will lead to new apps.  Earlier this month, the Markle Foundation and the Robert Wood Johnson Foundation announced the results of the blue button Challenge, held as part of the Health 2.0 Developer Challenge.  With only a modest prize, the challenge drew nine entries, including the winner, from Adobe Systems, which was a slick front-end for the VA’s data, making it easy for people to read, share and discuss the information.  It also included a set of tools and reminders related to medications.  Another significant entry came from Microsoft, which built a way for blue button downloads to go straight into its HealthVault personal health record service, which provides access to more than 50 different apps.  And this all happened over the course of a month.  As blue button becomes much more widespread, we can expect to see more and more apps designed to take the data you can download and turn it into useful information and valuable tools you can use to manage your health.

The federal government has taken a strong step forward to give people access to their medical records.  Now it’s time for more in the private sector to do the same.  I know I want a blue button on my doctor’s Website.  If you think this is a good idea – if you believe that people should be able to download their medical records, or if you would like your physician’s office to make yours available, or if you have a totally different take on this question, please join the conversation on Twitter – send a tweet with your opinion and be sure to use the hashtag #bluebutton.

And the Winners Are...

As I mentioned back in August, RWJF joined the Health 2.0 Developer Challenge by offering small prizes for three different challenges:  1) building apps that leveraged the Blue Button initiative; 2) apps that bring the data from County Health Rankings into everyday decisions; and 3) bringing Project HealthDesign designs to life by building apps that work on commercial PHR systems.  At the time I said that we wouldn’t know what to expect – that we might not get anything useful at all from this exercise.  WRONG!

The response was terrific.  I won’t say overwhelming, but given the modest amount of prize money (okay, Markle scored coffee with Clay Shirky, which is no small deal) and the relative short amount of time to respond (barely a month), I’d say pretty darn good.  And definitely useful.

I’m a big fan of the Blue Button initiative for two reasons:  1) it gets the data out of the health care system and into the hands of users, where a marketplace of translators, interpreters and other tools can grow around making data useful to people; and 2) it’s beautifully simple.  The response highlighted the potential of this market:  we had large companies like Adobe and Microsoft build really valuable utilities – to translate a largely unreadable ASCII text files into very nicely designed PDF documents and to import Blue Button data into HealthVault, respectively.  But we also saw smaller organizations (seven in all) like MedCommons and RememberItNow showcase more narrowly focused apps that deal with important tasks – like getting a second opinion on a radiology image or remembering to take your meds.  Adobe came out on top in the end – and deservedly so as they built a really nice app – but the key takeaway is that they’re just the tip of the iceberg of what could come.  Hats off to the Markle Foundation, CMS and the VA for bringing Blue Button so far along so quickly.

The County Health Rankings challenge drew a number of interesting submissions.  Where we live, work, learn and play dramatically affects our health.  So when you’re choosing a place to live, wouldn’t you want to look up health indicators the way parents look up data on the quality of the schools?  That’s what the challenge winner, Acsys Interactive, makes possible.  They embedded the county health rankings data into their mobile real estate app.  So now when you want to get the scoop on the house for sale you’re driving by, you point your phone at it and get both real estate data and easy access to county health data.  The challenge drew four other submissions, which also included a utility to have the data texted to your phone when you text in a zip code and a tool to help understand asthma risks in a given county.

The Project HealthDesign Developer Challenge was won by Ringful Health, which produced a really slick app for managing chronic pain.  With it, you can use your iPhone to jot down your pain levels and triggers, get feedback on frequent triggers and how effective your medications have been at controlling your pain, and generate reports that you can share with your doctor.  Ringful had been working on this app, but, inspired by the design from Roger Luckmann’s team at UMass, added several new features and then built back end integration with the HealthVault, Google Health and Dossia personal health record services.  Another competitor, CureTogether, extended their site, which helps people track their observations of daily living (ODLs) like sleep, exercise, and food intake, to include lab test data.  A third, and very intriguing, submission came from Fred Trotter, who built an open source utility to track ODLs and store them on Twitter (in a protected account) and then use Grafitter to analyze the data and display patterns.  Fred’s solution is especially interesting because he’s leveraging existing infrastructure and by building an open source tool, he’s inviting others to take it further.

So all in all, I’m quite pleased with how the challenges went.  And it makes me wonder what challenges we should put out next.  Any ideas?

NOT FOR NURSES ONLY!

Pioneering Ideas guest post by :

Patricia Flatley Brennan RN, PhD,  Project HealthDesign National Program Director

 

The Institute of Medicine released its blue ribbon panel's report on the future of nursing yesterday, raising the call for nurses to lead change and advance health. The Robert Wood Johnson Foundation Initiative on the Future of Nursing advanced four recommendations, paraphrased here: (1) let nurses do what they know how to do; (2) accelerate educational advancement through an educational system that promotes seamless academic progression; (3) step forward as full partners in health care redesign; and (4) systematically account for and deploy the nursing workforce in a manner that best meets the needs of society.

 

THESE RECOMMENDATIONS ARE NOT FOR NURSES ONLY! In fact, achieving the bold vision of health care, advanced by the panel, requires active engagement with other clinicians, the business community and health policy makers. Melding the interests of the health sector with the industrial sector will not only lead to innovations in the ways nurses practice and the manner in which they exert leadership, but also insures that these alliances will result in the power to create change.

 

Everyone stands to gain when nurses do what they are prepared to do, when innovations in educational systems not only create new beginning practitioners, but also helps them transition from novice to expert, when redesign of the health care system emerges from collaborative models of practice and when the human capital of health care, properly enumerated, is distributed in a balanced and principled way.

 

Come along and join the initiative – there is room – indeed, a need, for everyone!

How to Game a Cure

With the Myelin Repair Foundation’s Breakthrough to Cures online game taking place next week, we’ve been fortunate enough to have some great support recently from our friends in the media when it comes to promoting this innovative idea for crowdsourcing ideas to improve medical research and development.

If you’re intrigued by the prospect of having your voice heard (and listened to) by one of the most pioneering organizations focused on radically transforming R&D, check out these links or read the fantastic post we’ve included below by our friend Faisal Qureshi, who runs the blog Meaningfuluses:

Online Gaming Event Seeks to Spur Search for Cures to Intractable Diseases (E-Week)

Gaming Health Care Breakthroughs (Nextgov)

Foundation uses gaming to inspire rad R&D thinking (Fierce Biotech)

How to Game a Cure

By Faisal Qureshi

9/27/2010

Original article link: http://www.fiercebiotechresearch.com/story/foundation-hopes-gaming-can-inspire-rad-r-d-thinking/2010-09-14

Medicine and social media are just getting to know each other. The engaged patient is shaking hands with Facebook, Twitter and a mountain of medical websites. As the patient is busy consuming and disseminating these media inlets, how does one get to retroactively participate?

That's what the folks at the Institute for the Futureare trying to partly answer. Together with the Myelin Repair Foundationand the Robert Wood Johnson Foundation, they've developed breakthroughstocures.org– a web-based game that tries to solve neurological disease by relying on sourcing shared participatory discussion.

Their idea being that clear and original thinking can surface to the top of drug discovery for such diseases as Multiple Sclerosis. Discussion from a crowd who are unrelated to the research itself, can yield agreeable answers or predictions. This can then shape future drug discovery patterns and processes.

Earlier this month, I was given a tour of the The Foresight Engine Game. If you understand how to use Twitter, you're on your way to playing. As with tweets, you respond to a game scenario, with a card, of 140 characters or less. Everyone is given the same scenario question. Players then decide to respond positively, negatively or investigate further via their chosen card category.

Responses are seen by everyone and it's up to you to followup on another player's response to a question or create your own in hopes of gathering a following. Points are given to the number of followers, your level of engagement or if others consider your idea as interesting.

Is the wisdom of a crowd enough?
Justin Beiber has 5.4 million twitter followers. Promoting his videoson twitter may increase his music sales. He garners his follower's attention on the perception that his music is worth buying into. The theory of twitter is that the ones with the highest number of followers change societal perceptions through short bursts of attention over time. But can we put this kind of retention towards innovation? According to a recent Newsweek article, Microsoft's Nathan Myhrvold said, “Today almost everyone in the [Silicon] Valley will tell you there is too much ‘me-tooism,’ too much looking for a gold rush and not enough people who are looking to solve really hard problems.”

The collective problem:

Can the wisdom of Foresight Engine Game players, who are themselves outside the research community, innovate healthcare research?

Can it yield a better way to research for cures in the future? The game was designed to give us these answers. Better yet, it will begin to answer these questions. There's really no failure on the part of their objectives, if you understand that social game play can profoundly keep one's attention and engagement. Thanks to Zynga, there's a reason we're at the watercooler chatting up on how to grow pumpkins. The game's theory is that repeated micro bursts of attention (cards) gives the player a better understanding of Multiple Sclerosis drug research. Especially if you realize the mass clutter of information (and misinformation) that today's patient is being asked to sort through.

Ideas to task.

If you put enough smart people in a room, in this case a virtual room, good things are bound to happen. But turning brainstorms, even with popular follower sentiment, to a deployable drug research model that works is difficult. The Foresight Engine Game takes care of harvesting ideas but it's up to the foundation sponsors to carry it through. Drug discovery is a multi-year approach taking close to $1 billionto get to market. Mixing gameplay, social media and healthcare is going to be an exciting new arena. I recently tweetedon Mark Pinkus, Zynga's CEO who said, "Health is waiting for someone to turn it into a consumer product." It's too early to speculate if social game play can simplify the drug to market dilemma, but it's clear that patient engagement is going to be a required ingredient to the future of medicine.

The Foresight Engine Game will be launching to the public from October 7th to the 8th.