Pioneering Ideas

How do we get health games to help millions of people?

By Brian Quinn, Pioneer team director

I attended the Games for Health Conference last week in Boston.  It was a great introduction to the gaming field and all of the work that’s being done in this space to try and improve healthy behaviors and increase healthy outcomes.  In addition to several of our Health Games Research grantees, I saw interesting presentations and demos on Kairos Labs’ livn.it, HopeLab’s Zamzee and Firsthand Technology’s game to promote better oral health habits among children.

One of the themes running throughout the conference is now that we’ve got all of this experience and evidence about how to use games to improve health, what are the next steps for the field?  That is, how does Games for Health get taken to scale to have an even broader impact?  The field has a lot of demonstrated success, energy and activity behind it, but health gamers face a unique challenge.  Successful health games need to simultaneously meet three requirements: 1) they need to make sure that the games are fun and entertaining; 2) they need to make sure that they have a real and measurable impact on health; and 3) they need to be marketable and revenue-generating.   Tackling all three goals simultaneously creates a unique set of challenges. The good news is that the field seems energized to take it on.

As we think about how to take the next step, the field needs to first consider what factors are necessary and sufficient for success.  Is it more research?  Is it better connections with providers?  Is it better inroads with non-gamers who would benefit from health games, such as seniors?  What can we learn from other fields?  What thoughts do you have?  How do we get health games to help millions of people?

 

 

Thoughts from Games for Health 2011: Sensors, Opportunity, Scale

Here are a few of my initial ideas from the 2011 Games for Health Conference, put on by Ben Sawyer and Beth Bryant:

1. The sensors are coming, the sensors are coming.  Sensors and the software to collect and analyze the data are on the verge of becoming retail products.  Green Goose is one company hoping to grab this market.  What does it mean for health games?  It means that soon we will be able to turn lots of things into data collection and data input devices.  So think about games that use household objects instead of, say, a wii remote.  You could turn your house into the playing field for a game.

2. Better seeds and more fertile ground.  The quality of health games—the game mechanics, the theory underlying design is getting better.  At the same time, the context in which we can use games to improve health is expanding.  We can now embed games in social networks, so think about linking someone’s facebook friends in with their game efforts to lose weight or manage their diabetes.

3. There’s likely more than one way for a game that has an impact at scale.  When we got into this space at RWJF, we were thinking about games as therapeutic interventions for individuals—one person with one game addressing one condition that a lot of individuals have.  But building off item 2 above, given what Nicholas Christakis and James Fowler are showing with their research on transmission of health behaviors through social networks, you could design a health game that requires social networks—teams—to play.  Still another level up is a game that could target a health problem that was a function of a system problem.  That is, a game that targeted a health problem that resulted not from someone’s genetics, but from set of processes and systems that are outside of any one individual’s control.  Imagine a game that’s designed to get some producers to make healthier food.

 

Games For Health Conference: A Q&A with Dan Baden, Centers for Disease Control and Prevention

Before this week's Games for Health Conference kicked-off, NewPublicHealth had the opportunity to interview panelist Dan Baden, M.D., director of the Centers for Disease Control and Prevention, Division of Public Health Practice, about gaming for health. Below is the full Q&A, which originally appeared on NewPublicHealth earier in the week. 

NPH: You’re a panelist at the conference. What will you be speaking about?

Baden: I’m talking about an overview of CDC and some of the activities that we’ve done in the past. We have several simulations that I’m going to focus on.  One is for people training miners–how they can safely evacuate mines during emergencies.  We’ve got a health policy game that I’m going to highlight.  And we have some flu activities for people to participate in, such as giving out information about  flu vaccines.

NPH: What is the critical mass that you need in order for the games to be able to deliver public health messages?

Baden: I think that they can be used to deliver public health messages at any size.  But actually the number of people involved in games is enormous.  The organizer of the conference was speaking in the same panel as I was in earlier today and was saying that of all demographic groups, only males over age 55 indicate that they watch more TV than use  the computer.  All the other demographic groups say they use the computer for multiple purposes  and more than they watch TV. And the largest group of people to use what are called “‘casual games” is women between the age-mid 20s to mid 50s.  There are lots of people that are doing this right now.

Back to the other part of your question, an individual game I think can have an impact.  There is one called Madden Football. It’s a video game where you have a football team and you run them through different games.  But for this year’s version they are incorporating a new concussion policy.  So if your player has a concussion during the game, your player is out for the game, and you’re not allowed to bring them in.  Whereas in the past you could bring them in the next quarter. [The new rules of the game are ]consistent with current concussion therapy.

NPH:  Can you think of other examples where the game isn’t set up to be a public health game–but what you can do is incorporate appropriate, correct, accurate, vetted public health messages in almost any game?

Baden: There are many.  There are lots of car race games, for example.  And you can have people in the race game who are using seat belts and restraints or helmets. Or if you want to twist it the other way–I don’t know if this is out there–but if you have a game where someone’s driving around recklessly in their car–if they don’t wear their seat belt–maybe they have a higher chance of being ejected from the car and having consequences from not following that preventive measure. There’s many ways you can incorporate public health messages into these games without converting or corrupting the game itself.

NPH:  What’s something at next year’s conference you’d like to see–a game that has a larger message or a particular message–maybe HIV prevention?

Baden: I would like to see games that focus on other winnable battles that CDC has  priorities such as tobacco control, improved nutrition, increased physical activity and tobacco control, for example.

NPH: You were talking about men over 55 not being a particular demographic group that uses computers more than they watch television.  But that is a demographic group that could use some of the benefits you have shown in the games–like seat belt protection, safe driving, safe sex.  Will that be a goal for you do you think?  To figure out how to engage men in that age group in using these games for positive impact as well?

Baden: I think we’ll probably stick with our traditional methods for now. We’re already having outreach to them–rather than try and drive people to games. Though they’re probably going to go there eventually on their own, and at that point are likely to find even more public health messages than now.

 

Project ECHO Profiled in Health Affairs

 Project ECHO, a Pioneer supported project, is fundamentally changing the way health care is provided across the United States, bringing best-practice specialty care to patients with chronic health conditions, wherever they are. Millions of Americans suffering from serious chronic illnesses have severely limited access to specialty care because they live in underserved areas, both rural and urban. At the University of New Mexico Health Sciences Center, social innovator Sanjeev Arora, M.D., developed this disruptive model of health education and delivery to eliminate the distance barrier so that primary care doctors in underserved areas can provide top-quality care for complex conditions locally.

A Health Affairs Web First, released online today and appearing in the June edition of the journal, provides an in-depth profile of Project ECHO as an example of delivery system innovation, describing how the program leverages videoconferencing technology to train primary care doctors to deliver specialty care in their local settings and create large, real-time knowledge networks. In this way, ECHO exponentially expands the capacities of the health care workforce, providing “health care without walls.”

 

2011 Games for Health Conference Wraps up Today

After a riveting two days of presentations and demonstrations at the 2011 Games for Health Conference, we’re a bit sad to say that today’s activities mark the close of another amazing event. Now in our seventh year of sponsoring the Conference, we’ve seen it grow from a humble gathering  consisting mostly of videogame developers to what we witnessed this week – a highly energized event that attracted nearly 500 multi-disciplinary thought leaders in health care, academia, research, policy making, and – of course – game development.

The content at this year’s Conference has been just as diverse as those attending it. From the inclusion of new tracks focused on mobile gaming and sensor technology, to yesterday’s keynote address delivered by the founding father of Positive Psychology, Dr. Martin Seligman, we saw first-hand just how much the landscape is broadening. The amount of legitimate excitement arising across so many disciplines and specialties is truly exciting.

If you’re just tuning into the conversation now, we encourage you to read full coverage of the conference and a few great perspectives on the future of the field, as wonderfully detailed by our blogger friends in attendance. Notably, Gamasutra’s Dennis Scimmeca posted a fantastic Q&A yesterday with Seligman and Games for Health Director Ben Sawyer, which details the potential Positive Psychology has to move health games forward. Also, Bridgett Collado provided a nice overview of Monday’s preconference happenings on Pulse + Signal.

Today’s presentations – highlighted by a discussion from Google Health Chief Strategist Roni Zeiger – promise to be just as impactful as the previous two days’. Our team will continue to tweet highlights and capture other content that we will share with you soon, including some of the innovative ideas our on-site thought activity is capturing. You can follow the conversation as it unfolds via the hashtag #g4h11.  If you’re attending the Games for Health Conference, feel free to leave us a comment and let us know what you think of this year’s event. 

 

Games for Health 2011: Play as Written

The 7^th annual Pioneer-sponsored Games for Health Conference got underway this morning, with a preconference day that focuses on the intersection of mobile platforms/technologies, videogames and health. (For a real-world example of health videogame work being pursued with an eye towards mobility, check out a project that one of our Health Games Research grantees is working on called Lit2Quit). The main event starts tomorrow and will continue on until Thursday, with hundreds of thought leaders converging in Boston to discuss how to move the field forward.

Games for Health director Ben Sawyer kicked things off this morning, framing this year’s convening as an opportunity to form collaborations that will scale-up the amazing body of work that has been happening over the last several years.  And as more projects come to fruition and consumers begin to engage – and rely upon – technologies like games as tools to manage their day-to-day health, it’s important we start thinking of these technologies as legitimate medical interventions.

To that end, we’re supporting a "What's Your Game Prescription" thought activity where we will ask attendees to fill out game prescriptions that share their visions for how videogames could impact a certain health condition.  This is a chance for those in the health games field to envision a moment in the not so distant future, when some health professional writes you, or someone you care for, a prescription to play a videogame to improve a specific component of your health – be it management of a chronic disease or preventative in nature. It can be for games and functionality that exist now, or ideas yet to be developed.

 By thinking now about a future in which games are actively prescribed, we can be better prepared to identify the right paths, the best targets, and the work that’s needed to make game prescriptions a reality.

The “prescriptions” will be posted at the conference and we will be tweeting highlights of them throughout the week, in addition to posing questions to build on the conversation. You can follow along on Twitter (@pioneerrwjf) or the main conference hashtag #G4H11.  

 

Building the mHealth Evidence Base

By Brian Quinn, Pioneer team director

Last week at Stanford, innovation guru B.J. Fogg hosted a conference called Mobile Health 2011: What Really Works.  As a new member of the Pioneer team, the conference was a great opportunity to learn more about mHealth and meet some of the key players in the field.  As the title suggests, this year’s conference focused on what we know about how mHealth is changing behavior and improving health outcomes.  Here are three reflections on the conversations that took place during the conference:

1. There is widespread recognition that mHealth has the potential to change behavior and improve health.  The good news is that we’re starting to develop some evidence that backs up this belief.  But as Eric Hekler said during his presentation, we need to know more. We can’t rest on the basic understanding that if we throw the mHealth kitchen sink at a problem, it can work. We need to learn more about the subtleties of when and where and why and how mHealth works. We also need more research on the long-term effects and sustainability of mHealth technologies on health outcomes. These aren’t trivial issues; they get to the heart of the difference that mHealth can make.
2. Many speakers at the conference expressed frustration with the medical research community and its focus on the randomized controlled trial (RCT) as the gold standard of research. These criticisms are not new, nor are ones that point out the extremely slow nature of the research process, which can deter learning and innovation. Yet what a lot of mHealth’s RCT critics perhaps don’t realize is that for the last several decades, the health services research community has developed a wide range of observational, quasi-experimental and qualitative research techniques. These rigorous analytical approaches offer a credible alternative to RCTs and are best used in the messy real world situations where mobile technologies live.  Just as Fred Muench pointed out that the mHealth field would be well served to build off the literature on public health messaging, it may also benefit from use of some public health research methods.    
3. Finally, members of the aforementioned health services research community need to pay more attention to mHealth and get involved in research on the topic. I suspect many health services researchers are unaware of all the activity taking place around mHealth. The truth is that mHealth research should be front and center on their list of research priorities. mHealth offers ample supply of the thing that researchers crave most: data. And because that data is rich and produced in real time, mHealth offers a tremendous opportunity for researchers to explore new issues and analytic methods.

“What really works” is the key question that should be driving all of our work right now, whether you’re a patient or a provider, a funder or a developer. If we really believe that mHealth can transform our ability to lead healthy lives, we need to develop a solid evidence base that helps us advance the field.  RWJF’s Pioneer team is doing more work in this area, sponsoring an mHealth Evidence meeting Aug. 16, along with the National Institutes of Health, the McKesson Foundation, the U.S. Department of Health and Human Services and the National Science Foundation. If you’d like to contribute to developing this critical evidence base, we encourage you to share your knowledge by contributing a whitepaper on the subject and submitting it by May 27. Authors of accepted papers will be invited to attend the mHealth Evidence meeting and will have their travel expenses paid for. 

 

Time to Evolve Health Care's Gold Standard? Thoughts From 2011 Mobile Health Health Conference

What does "works" mean? Like many things that seem superficially simple, the reality is much deeper. When BJ Fogg chose that as his theme and condition for the recent Mobile Health 2011 conference, he set the bar very high. The good news is that at some level the sessions all had an aspect of things working.

But there was some not so good news as well. Many still see Randomized Controlled Trials (RCT) as the universal and exclusive gold standard for evidence.  For a number of reasons, I think that's unfortunate in the mobile health field. First, to be realistic, the time scale for testing an mHealth intervention needs to be short, often on the order of at most 90 days. That will not provide sufficient evidence for dealing with a long term chronic illness where the time scale is measured in years, not days. I believe that many mobile health treatments that work in the short term will not be sustained long term, unless they change – and change is something that is generally not part of an RCT model.

Second, RCTs generally take a long time and require a fixed methodology, something that doesn't make much sense when dealing in a space where the technology is rapidly changing. By the time you can reach a conclusion, the intervention is often obsolete.

Finally, and perhaps most importantly, by its nature, mobile technology generates a large amount of data that can't be well controlled and is generally discarded (or ignored) in an RCT. Medicine may be the only field that I know of where we discard real life data in favor of clean, laboratory controlled measures. Imagine if the manufactures and maintainers of jet engines relied only on controlled tests and ignored measuring the real world wear and tear on an engine. If that were the case, I would certainly fly a lot less.The United States dropped the monetary gold standard in 1933. Isn't it about time that we at least consider the same thing for medicine?

We recognize this, as do others, and an mHealth Evidence meeting that we are cosponsoring with National Institutes of Health, McKesson, Department of Health and Human Services and the National Science Foundation on August 16 is focused on dealing with this directly. I'm happy to say that the response to the call for white papers for the mHealth Evidence workshop was such that the flyers I brought to Mobile Health 2011 were insufficient to meet the demand, and copies had to be made, not once, but twice.

Luckily, there were enough people with whom this resonates.

You can submit a white paper here on our website. If yours is accepted, you will be invited to attend the mHealth Evidence workshop (travel support will be provided).

Hope to see you there!

 

mHealth Evidence: Call for Whitepapers

Mobile health (mHealth) has the potential to simultaneously reduce the cost of health care and improve our health by encouraging healthy behaviors, providing continuous monitoring to prevent or reduce health problems, reducing acute health care visits, and providing personalized, real-time intervention in the mobile environment. However, traditional methods of evaluation needed to address efficacy and safety in mHealth are not well aligned to the pace of technological development.

 To address this need, we’ve formed a partnership with the McKesson Foundation, the National Science Foundation and the Office of Behavioral and Social Sciences Research at NIH. As part of this partnership, we are issuing a call for white papers on alternative research designs to the traditional randomized control trial that could be applied to mHealth intervention research or in analyses of rich longitudinal data sets that could be applied to analyzing the data obtained from mHealth applications.

Authors of accepted whitepapers will be invited to attend the August 2011 mHealth Evidence Meeting in Bethesda, MD, which will bring together individuals with diverse expertise in data analysis and experimental design to identify innovative methods that can accelerate the evaluation of the efficacy and safety of mHealth technologies. Travel will be reimbursed by the event’s sponsors. Results from the workshop will be used to define the research agenda for evaluation of mobile health technology.

A couple of important dates to keep in mind:

Deadline for submission: May 27 (11:59 EST)

Notification of Invitation: June 10

 

 

 

Complete Self-Tracking Resource Guide (beta) to be Unveiled at Quantified Self Conference

"We use numbers when we want to tune up a car, analyze a chemical reaction, predict the outcome of an election. We use numbers to optimize an assembly line. Why not use numbers on ourselves?" – The New York Times on The Data Driven Life

In so many aspects of our lives, we crave quality information to help us make more informed decisions. In our work, it is essential. In our homes, we can tell you the price of almost everything. Even in our leisure time, we can recite facts and figures on how many homeruns a baseball player has hit or the number of Oscar nominations a film has received.

Yet in perhaps the most important area–our own personal health–Americans seem to have very little information. For example, only 30% of us know our own blood type and less than 20% of older Americans can tell you their blood pressure. If information is king, when it comes to our health most of us are paupers.

Fortunately, a small group of pioneers are developing the tools and technologies that allow us to collect and track a whole host of quantifiable qualities that can provide insight into our health and health-related behaviors—heart rate, mood, footsteps, attention span, body motion, blood pressure and beyond. Their goal is to enable people to collect their own data, aggregate and analyze it so that they are empowered to be active stakeholders in their own care and understand how their decisions impact their health. Visionaries like Gary Wolf, co-founder of The Quantified Self, are making personalized metrics easier to track and more meaningful to apply.

At Pioneer, we are intrigued by self-tracking and the quantified self movement, and are eager to explore its potential to transform health and health care. To that end, we will be participating in the first Quantified Self Conference to explore, collect and share ideas and collaborate with those on the cutting edge of this movement—leading users, self-trackers, software developers, business leaders, academics and health practitioners.

At the conference, Gary will also debut a beta version of a complete self-tracking resource guide. Quantified Self and the Institute for the Future (IFTF), through an RWJF Pioneer grant, will work with self-tracking leaders to develop this online guide, which assembles many of the tools people are creating, in order to share evolving strategies with the next generation of self-trackers. According to Pioneer team member and RWJF Chief Technology and Information Officer Steve Downs, "The first wave of quantified self practitioners is largely made up of those with the technical skills to build their own self-tracking tools. The next wave will not have those same skills, so it will be important to make available the tools that have already been built and see how they are adopted."

If these ideas get your brain synapses firing, too, we encourage you to join us at the Conference.  Come rub elbows with cutting-edge thought leaders and explore with us the potential this movement could have on improving your health and the health of our country.  

 

Pioneer Heads to Mobile Health 2011: What Really Works Conference

On Wednesday, Pioneer team members Brian Quinn and Al Shar will be attending Stanford University’s two-day Mobile Health 2011: What Really Works conference (Pioneer is also a sponsor of the event). This event, which is being led by Stanford’s B.J. Fogg, promises to be yet another great opportunity to explore how mobile technologies are improving the health of everyday people.

If you’re on Twitter, you can follow along with Brian and Al as they live tweet from the event. You can also join the conversation by using the hashtag #MH11. We will post a few key takeaways from the event next week, so check back on Pioneering Ideas often and be sure to let us know your thoughts by leaving a comment.