Mobile Social and Fun Games For Health Final

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
Copyright November 2011 Chester Street Publishing, Inc. All Rights Reserved.
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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.
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I. Why are mobile health games emerging now?
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. 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. Just as games have spread to various types of screens, the types of games, their content and overall raison detre has diversified, too. Take Nintendos Wii and Microsofts 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 players 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.
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. 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. 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. Thats actually the subtitle of the book he wrote, called Total Engagement, which was coauthored by Reads 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.
Copyright October 2011 Chester Street Publishing, Inc. All Rights Reserved.
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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. 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 Centers 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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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 Sonys PSP and Nintendos 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. Flurrys 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. 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. 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 Centers 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. Pyramid Research predicts that the 200 million mobile health applications in use today will triple by 2012. Pew Research Centers 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. IDC predicts that in 2011, about 14% of adult Americans will use a mobile health app to manage their health, wellness and chronic condition. Manhattan Research predicts that by 2012, 81% of physicians will own a smart phone. More than 600,000 new devices running the Google Android operating system and Apple iOS (including iPhone and iPad) are activated every day. Asymco reports that worldwide more than 30 million apps are downloaded each day. Smartphone global shipments have been greater than PC shipments since q4:2010 A recent Pew report found that 85% of adults in the United States have cell phones, with 35% of Americans having smart phones.
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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.
Mobile, social and fun

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 Humanas 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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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: to find or share healthcare information (11 percent) to comment on experiences using the health care system (6 percent) to learn about prescription drugs (5 percent) to communicate with an insurance company (2 percent) to communicate with a physician (2 percent)
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, its 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.
Its 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 Facebooks mobile users doubled to top 57 million users this year, while Twitters 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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II.
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address.
II. Who cares and why?
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
offerings, in order to stay competitive in a new and rapidly evolving ecosystem.
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.
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 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.
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
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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.
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 consumers 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. Before digging deeper into specific mobile health games, lets take a step back to define what games are and how they engage players.
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. Games for Health Serious Games Summit The Power of Play: Innovations in Getting Active Summit 2011 (A Science Panel Proceedings Report from the American Heart Association-sponsored by Nintendo) The first annual Games for Health in Europe 2011 A new medical journal: Games for Health: Research, Development, and Clinical Applications.
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III.
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III. What is a game?
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 todays 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 immersivevideo 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
GAME MECHANICS
GAMIFICATION
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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 worlds 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. Why do game mechanics work? Games satisfy some of our fundamental desires: reward, competition, status, achievement, and altruism.
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IV.
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IV. New Approaches
ame developers without experienced healthcare partners, advisors, or team members wont make an impact. Healthcare service providers with an eye on gamification but no experience creating beautifully designed and engaging apps, wont 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. Michael Bidu, the Founder and CEO of Canadas 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.
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 Franciscos 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.
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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 peoples 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? Its 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 Californias 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 users phone moves. Majid Sarrafzadeh, a Professor of Computer Science and Director of the UCLA Wireless Health Institute, said his institutes 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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Its 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.
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 cant even imagine but we know we need to be a part of it.
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Insurance companies are also rising to the challenge and opportunity by forming innovation centers. Humanas 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 insurers 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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In 2003, Kaisers 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 Nintendos 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. 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. 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. 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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NEED SOME
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. 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 Healthcares 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.
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V. Building the Evidence Base
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 characters 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. 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.
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 Foundations Pioneer Portfolio, stated. Current funding runs through 2012.
The RWJFs 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. 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.
HopeLabs 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. Clinical trial data showed that this well-designed video game could have a positive impact on health behaviors of young people. 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.
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-Missions effectiveness stems from its impact on individual emotional and motivational processes. 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
a chemo blaster to destroy cancer cells -- and provides players with a story they are part of within the game. 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. 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.
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VI.
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VI. Notable health games
eimbursement issues have not held up wellness focused health services like they have with some condition-specific or disease management focused apps, and thats why there are many more wellness apps in the market. Below, is a quick summary and preview of the types of wellness games and gamified services described in this section. 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.
Some consumers are beginning to use brain games to improve or enhance cognitive fitness. Below is a summary of what well discuss when it comes to chronic condition management services. 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. 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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VI. Notable health games (continued...)
Life Improvement and Self-Help
Mindbloom Life Game uses a tree metaphor to represent the different branches of a persons 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: Holistic: I can grow my tree with branches from different aspects of my life including health, lifestyle, career, creativity, relationships, finances and spirituality. Personal: I can include personally inspiring music, photos and quotes. Social: My forest has trees with my friends and family who can send notes and encourage my progress. Visual: I am rewarded by keeping my tree green and growing. 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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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 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.
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.
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MeYou Healtheveryday 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 dont 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. 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.
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.
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Consumer Health and Wellness
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. WorkSmarts 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.
WorkSmarts 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 were 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 dont 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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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 lets 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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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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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. The co-founders come from outside healthcare -- Sutha Kamal comes from the gaming world and Aza Raskin comes from the computer/design world.
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.
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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: Only use positive reinforcement: points, levels, badges Shared affinity: Players need to have a shared set of issues or challenges Team dynamics: Among the coworkers there needs to exist a social obligation. They need to depend on each other. Newsfeed: If you do the right thing you can brag about it and/or ask for help to your coworkers. 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 cant be about the data. We did not want to follow Silicon Valleys 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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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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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 individuals 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 individuals needs. The product is intended for individuals, employers, health plans and care managers.
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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. Their current engagement platform is a blend of gaming mechanics, social networking, and financial rewards, including lowering employee contributions to their health insurance premiums.
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.
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Brain Games
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. Dakims 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
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: 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 players job is to remember the orders and the customers 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 companys 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
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 didnt 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 companys gaming elements might take.
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Disease Management
Cellnovos 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
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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HealthPrize has a medication adherence platform that combines the power of financial incentives, education, reminders and fun. Dr. Katrina Firlik, HealthPrizes 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 Apples AppStore, but only participants in the two trials at Real Age and the pharma company can use it.
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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. PillJoggers 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 doesnt 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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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.
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. 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.
VII. Conclusion
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.
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.
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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. Intels Digital Health Group and GE Healthcares 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. 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. 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 Microsofts gaming division.
Wheres the money?

Venture Capital is showing some appetite. Proteus and Redbrick have recently received Series D investments, Lumosity and Dakim have tapped Series C investment, Cellnovo has received a Series B investment, Telcare, Worksmart Labs, Basis, Massive Health and OneRecovery have all received Series A support, ViveCoach and PillJogger are angel-funded, Mindbloom, Kairos, and HealthPrize are currently self-funded.
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VII. Conclusion (continued...)
Whats 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 Nintendos concept for a pulse oximetry sensor, along with Kinects use of motion capture, indicates that games in the future will use the human body as their controller. 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. 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.
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VIII. APPENDIX
The following people were interviewed by Bonnie Feldman for this report:
Name Kyra Bobinet, MD, MPH Gordon Norman, MD, MBA Katie Stogner Nadeem Kassam Mara Brazer Darcy Provo Mollie Kittle Nick Vassilakis Michael Bidu Bill McKeon Chuck Parker Devorah Klein Rick McMullen Stuart Perry Geri Gay, PhD Dan Michel Alan Price Ed Saxon Mary Vegh Brian Wang Aimee Jungman Steve Selzer Ben Sawyer Brian Krejcarek Ellen Martin Debra Lieberman, Ph.D.
Title Managing Director, Strategic Diversification EVP & Chief Innovation Officer Manager, Consumer Health Communications Founder and Chief Alliance Officer CEO Director Director Creative Strategy and Insights Wireless Business Development Founder CEO Executive Director Principal Designer Director Professor of Communication CEO CEO Principal Investor Relations Co-Founder and CEO Vice President, Strategy Senior Interaction Designer Co-Founder Founder Prinicipal, Life Sciences Division Director Innovation and Advanced Technology
Company Aetna Alere American Heart Association Basis Brazer Communications/Keas Brazer Communications/Keas Bunchball Cambridge Consultants Canada's Center for Wireless Health Innovation Cellnovo Continua Health Alliance Continuum Continuum Continuum Cornell University Dakim DigiDo Interactive Ed Saxon Productions Electronic Arts Fitocracy Frog Frog Games for Health Green Goose Haddon Hill Group Health Games Research
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VIII. APPENDIX
Name Tim Jones Katrina Firlik, MD Martin Adler Richard Tate Ellen LaPointe Nate Bellinger Nate Kvamme Tony Tomazic Douglas Goldstein Muki Hansteen-Izora Meghan Marschall Diego Miralles, MD Michael Kim Yan Chow, MD, MBA Richard Channault Aaron Hardisty Chris McCarthy, MPH MBA Adam Bosworth Frank Chindamo Joe Hardy, Ph.D Sutha Kamal Ernie Medina, Dr.PH Anne DeGheest Trapper Markelz Bill Crounse, MD
Title CEO Co-Founder and Chief Medical Officer Co-Founder and Product Manager Vice President Communications and Marketing Vice President, Strategic Partnerships Director of Consumer Innovation Director Strategic Partnerships Consumer Innovation Director President Health Research & Innovation Intel Labs Director of Communications Head, Janssen Healthcare Innovation CEO Director Innovation and Advanced Technology Principal and Manager, Innovation Labs Business Consultant, Innovation and Advanced Technology Director Innovation Learning Network CEO President CEO Co-Founder and CEO Managing Partner and Founder Head of Product Senior Director Worldwide Health, Exective Producer Health Tech Today
Company Healthnuts Media HealthPrize Healthrageous HopeLab HopeLab Humana Innovation Center Humana Innovation Center Humana Innovation Center iConecto Intel Labs Janssen Healthcare Innovation Janssen Healthcare Innovation Kairos Labs Kaiser Kaiser Kaiser Kaiser Keas LaughMD Massive Health Medplay Technologies Medstars MeYouHealth Microsoft
Vice President, Research and Development Lumos Labs
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VIII. APPENDIX
Name Christopher Hewett Julie Price Hallie Kotria Andy Donner Rober Pakter, MD Gil Silberman Christoph Oppermann Paul Tarini Richard Buday Michael Merzenich, PhD Rob Weedn Arna Ionescu Don Jones Pat Sukhum Halle Tecco Jonathan Javitt, MD, MPH Matthew Tendler Teri Louden Majid Sarrafzadeh Kevin Patrick Alexandrea Smith Leslie Saxon, MD
Title Creative Director Founder Co-Founder Director CEO Chief Technologist Designer Senior Program Officer President Chief Scientific Officer Founder Director of Product Development Vice President Wireless Health Founder Managing Director CEO Vice President of Product President Director and Professor Computer Science Professor of Preventive Medicine Project Coordinator Chief, Division of CV Medicine and Executive Director of Body Computing Center Founder and CEO Founder and CMO Co-Founder and CTO CEO
Company Mindbloom Mobile Adventure Walks OneRecovery Physic Ventures PillJogger PillJogger PillJogger Pioneer Portfolio of RWJF Playnormous/Archimage Posit Science Productive Play Proteus Biomedical Qualcomm RedBrick Health Rock Health Telcare Telcare The Louden Network UCLA Wireless Health Institute UCSD Center for Wireless Health USC Center for Body Computing USC Center for Body Computing
Doug Keare Jennifer Roberts Artem Petakov Jonathan Atwood
Vivecoach Vivecoach Worksmart Labs Zamzee
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TERMS AND CONDITIONS
Chester Street Publishing, Inc. (Chester Street) is pleased to to publish Social Mobile and Fun: Games for Health (the Publication or the Report) for viewing and download via the World Wide Web. The Report is available under the following Terms and Conditions: NO ADVICE: The Material of this Report is for informational purposes only. LIMITATION OF LIABILITY: You (the Reader) are entirely liable for activities conducted by you or anyone else in connection with the your use of the Material of this Report. If you are dissatisfied with the Report or with these Terms of Use, your sole and exclusive remedy is to stop using the Report. Chester Street will not pay the you any damages. Chester Street does not warrant the accuracy, completeness, currentness or other characteristics of any Material available in this Report. Chester Street will not be liable for any loss or injury resulting directly or indirectly from the your interpretation and/or use of the content of this Report, whether or not caused in whole or in part by Chester Streets negligence or by contingencies within or beyond Chester Streets control. Neither Chester Street, nor suppliers of Third-Party Content, are responsible or liable, directly or indirectly, for any loss or damage caused by use of or reliance on or inability to use or access this Report. YOUR ACCESS TO AND USE OF CHESTER STREETS REPORT MATERIALS ARE AT YOUR SOLE RISK. CHESTER STREET REPORTS ARE PROVIDED AS IS AND AS AVAILABLE. CHESTER STREET REPORTS ARE FOR YOUR PERSONAL USE ONLY AND CHESTER STREET MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. CHESTER STREET EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE.
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MOBILE

SOCIAL AND FUN GAMES FOR

mobi health news

ABOUT THE AUTHOR

mobi health news

I. Why are mobile health games emerging now?

mobi health news

I. Why are mobile health games emerging now? (continued...)

mobi health news

I. Why are mobile health games emerging now? (continued...)

Mobile trends and the gamer

mobi health news

I. Why are mobile health games emerging now? (continued...)

Mobile trends and the gamer (cont...)