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MOBILE

SOCIAL
AND FUN
GAMES FOR
HEALTH

SPONSORED BY:
CONTENTS
I. WHY ARE MOBILE HEALTH GAMES EMERGING NOW?...........3

II. WHO CARES AND WHY?.................................................................8

III. WHAT IS A GAME?...........................................................................10

IV. NEW APPROACHES.........................................................................12

V. BUILDING THE EVIDENCE BASE..................................................18

VI. NOTABLE HEALTH GAMES..........................................................21

VII. CONCLUSION.................................................................................41

VIII. APPENDIX.......................................................................................44

Research and Interviews conducted by Bonnie Feldman
Edited by Brian Dolan, Editor MobiHealthNews

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RESEARCH
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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RESEARCH
I. I. Why are mobile health games emerging now?

G
ames, once dismissed as pastimes for wastrels, “There may be silly applications out there, but we think
have become an increasingly acceptable part that this could be a multi-billion dollar business,” Dr.
of society; so much so that, according to the Bill Crounse, Senior Director of Worldwide Health at
Entertainment Software Association, consumers spent Microsoft, told MobiHealthNews in an interview. “Within
$25.1 billion on video games in 2010. Research firm DFC our gaming unit, as we look at intake from around the
Intelligence expects that number to top $70 billion by world, we see more inquiries in health and health-related
2015. industries than any other sector out there.”

Games jumped from the board to the television decades Dr. Crounse is not alone in thinking that health gaming is
ago, and console-based video gaming is still a massive trending. Game designer Jane McGonigal argues in her
industry. Since then computer games, handheld gaming recent book, Reality is Broken, that “games are already
devices, massive multiplayer online games, social improving the quality of our daily lives, fighting social
networking games, and games on mobile phones have problems such as depression and obesity, and addressing
entered the fray. Suffice it to say, there are -- and will vital twenty-first-century challenges.” McGonigal believes
continue to be -- games for every new platform. that gamers “will be able to leverage the collaborative
and motivational power of games in their own lives,
Just as games have spread to various types of screens, communities, and businesses” to change the world.
the types of games, their content and overall raison d’etre
has diversified, too. Leighton Read, a Venture Partner at Alloy Ventures and
Chairman of Seriosity, a startup that offers a playful
Take Nintendo’s Wii and Microsoft’s Xbox – both console- collaboration platform for businesses, believes that
based video game systems that launched in recent games will “change the way we work and the way
years. With the Wii, players interact with the console via businesses compete.” That’s actually the subtitle of the
a wireless, accelerometer-enabled controller that tracks book he wrote, called Total Engagement, which was co-
the player’s motions. For some of its games, the Xbox authored by Read’s business partner, Byron Reeves. Read
offers Kinect technology, which recognizes gestures is also the chair of the Health Games National Advisory
and movements that players make with their bodies Committee. Read argues that leveraging games at work
– no controller required. These innovations make the can improve employee job satisfaction while increasing
platforms more accessible to non-traditional gamers productivity.
and have led to the development of a number of fitness
games, sport games, and ultimately healthcare games.

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

Games increase engagement. “When someone is
THIS REPORT is
engaged, you have their attention,” Read wrote in a blog
post recently. “They are activated; they are in a better
sponsored by:
position to make choices and take action consistent with
their own values and their own wishes.”
mobi health news
In a high profile journal article, entitled “Interactive RESEARCH
Games to promote Behavior Change in Prevention and
Treatment,” published in the Journal of the American Subscribe to all of our reports from
Medical Association (JAMA) in March 2011, Read and
2011. Contact our Sales Director for
Stephen Shortell noted that “games targeting healthy
special year-end pricing.
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 Center’s
Dr. Yan Chow who said that “game thinking gives people
permission to fail, and that is new and important in
healthcare.”

What else does gaming bring that might also be new
and important in healthcare? Gaming may make it a little
more fun.
CONTACT JOE MAILLIE FOR MORE INFO
O: (617) 532-1030 M: (617) 223-1647
e: joe.maillie@mobihealthnews.com

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

Mobile trends and the gamer
KEY METRICS
According to mobile apps analytics company Flurry, • Pyramid Research predicts that the 200
the combined revenues earned by gaming apps for million mobile health applications in use
the Android and Apple iOS platforms surpassed the today will triple by 2012.
combined revenues of Sony’s PSP and Nintendo’s DS
for the first time in November 2011. What does that • Pew Research Center’s Internet and
mean? The mobile phone, specifically the smartphone, American Life Project estimates that close
is now the biggest handheld platform for gaming. to 20% of Americans with mobile phones
Flurry’s research found that the combined revenues have used them to look up health or
for smartphone gaming apps totaled $500 million, medical information.
$800 million and $1.9 billion in 2009, 2010 and 2011,
respectively, while the incumbent handheld video game • IDC predicts that in 2011, about 14% of adult
makers made $2.2 billion, $1.6 billion and $1.4 billion for Americans will use a mobile health app to
2009, 2010 and 2011. The age of the smartphone and manage their health, wellness and chronic
tablet as primary gaming devices is now upon us. condition.

These location-aware devices are often equipped with • Manhattan Research predicts that by 2012,
high-definition cameras and more computing power 81% of physicians will own a smart phone.
than was offered by a standard PC just a few years ago.
• More than 600,000 new devices running
In early 2011 research firm Gartner predicted that sales the Google Android operating system and
of smartphones in the US would hit 95 million units this Apple iOS (including iPhone and iPad) are
year since consumers were found to be more likely to activated every day.
purchase a smartphone over any other electronic gadget.
While the majority of mobile phone users in the US are • Asymco reports that worldwide more than
still not using smartphones, some 35 percent of US adults 30 million apps are downloaded each day.
now have smartphones, according to a survey conducted
by Pew Research Center’s Pew Internet Project. CTIA, the • Smartphone global shipments have been
wireless industry association, announced this fall that greater than PC shipments since q4:2010
there are now 96 million active smartphones in the US
market. In March 2010 there were half as many. • A recent Pew report found that 85%
of adults in the United States have cell
Suffice it to say, soon enough smartphones will be phones, with 35% of Americans having
ubiquitous. smart phones.

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

Mobile trends and the gamer (cont...) Mobile, social and fun

Gaming is also becoming more common. During the The steady adoption of smartphones and the rapid
course of the past few decades video games have gone uptake of tablets among US adults is putting cheap,
from being an immersive diversion for the few to a casual connected computing power into the hands of millions
mass medium that not only entertains, but can also help of consumers and healthcare providers.
people learn quicker and work better. According to the
Entertainment Software Association (ESA), the average In tandem to the growth in adoption of mobile phones,
gamer is 37 years old and has been playing for 12 years. online social networks have seen adoption by hundreds
Some 40 percent of gamers are women and more than a of millions of people the world over. The number
quarter are over the age of 50. of Facebook users now tops 750 million worldwide.
Some 300 million of those users are playing games
For any hangers on who still believe videos games are on Facebook – primarily a wildly popular game called
just for kids, these numbers dispel that myth. 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.

Adam Bosworth, the CEO of Keas, tends to agree. In an
Seniors enjoying Humana’s Dancetown game.
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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RESEARCH
I. Why are mobile health games emerging now? (continued...)

Mobile, social and fun (continued...)

The “anytime, anywhere” connectivity promised by For this report, we focus on the use of social tools as
mobile devices, which is fulfilled save for network a means to gather motivation and support for health-
coverage gaps or heavy data traffic areas, helps us stay related activities. Online support networks are taking on
connected to our online social networks as we go about new roles.
our day.
Facebook and other networks allow individuals to share
In April 2011 the Deloitte Center for Health Solutions fitness and wellness activities and receive motivation and
found that a small but increasing group of US healthcare encouragement from friends and followers. For employee
consumers use social networks: wellness programs, social games can encourage
teamwork, friendly competition, and accountability. For
• to find or share healthcare information (11 percent) chronic disease management, condition- or disease-
specific communities help people share information,
• to comment on experiences using the health care life-coping skills and other support.
system (6 percent)
Given the metrics noted above, it’s no surprise that the
• to learn about prescription drugs (5 percent) financial world often groups mobile and social gaming
into one bucket: Piper Jaffray estimates that the market
• to communicate with an insurance company (2 for mobile/social gaming will grow from $4.4 billion in
percent) 2010 to $17 billion in 2014.

• to communicate with a physician (2 percent) Much of that growth could come from the gamification
of apps: “Gamification of apps is the ultimate way to
It’s also likely that many of these users are accessing engage a new generation of audiences,” Kleiner Perkins’
social networks via their mobiles: Overall mobile social Bing Gordon said during a recent presentation.
networking has grown substantially in the past year. A
report published by ComScore in October 2011 found As the sections to follow illustrate, healthcare
that Facebook’s mobile users doubled to top 57 million incumbents and developers new to the field are
users this year, while Twitter’s mobile audience grew beginning to agree that gamification has quickly become
by 75 percent to top 13.4 million people. Interestingly, a popular strategy for many health offerings.
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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RESEARCH
II. II. Who cares and why?

P
ut simply, the potential users of mobile health offerings, in order to stay competitive in a new and
games include nearly everyone from the rapidly evolving ecosystem.
worried well to fitness fanatics and patients
living with chronic conditions to healthcare Pharmaceutical companies must reinvent themselves
providers themselves. to secure a strong position in a rapidly changing
ecosystem. They cannot rely on their old
Still, the expected stakeholders in the Providers model of success that was based on
healthcare industry each have the number of drug units sold.
particular needs that mobile Instead, they need to focus
health games could help Designers Payors on improving health
address. outcomes. Although
usually slow to adapt
The provider to new technology,
community is in Psychologists they see a pressing
need of better need to identify
educational Users Medical and market a
(Providers, Patients, Device
tools to improve new suite of
Fitness, Wellness)
efficiency and offerings that will
lower costs. Gaming function together
Care providers Entertainment to improve health
of all stripes outcomes.
Pharma
are interested
in employing new Medical device
ways to help patients developers are looking at
Hardware Health
understand their diseases gaming elements to bring
Software Marketers
and regimens to help them deeper customer engagement
better take care of themselves. with their products to increase sales,
improve compliance and make managing
The payor community is seeing their business chronic conditions or complicated regimens easier.
models changing from managing risk to providing Device manufactures are especially beginning
new services. They are developing innovation to understand the need for more “user friendly”
centers and experimenting with gaming elements to approaches, and are beginning to think more about
enhance both the depth and breadth of their service design and consumer engagement principles at the
early engineering design stages.

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RESEARCH
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 A number of interviewees were enthusiastic about
from the gaming and entertainment communities, mobile games moving into healthcare:
hardware and software engineers, behavioral
psychologists, cognitive psychologists, behavioral “Healthcare, in and of itself, is boring, while gaming is
economists, designers, and communication experts exciting, fun, and addicting,” Don Jones, Vice President
thinking about creating lasting behavior change. of Wireless Health Global Strategy and Market
Development, Qualcomm Labs said. “Applying game
theory [gamification] to health apps, you can capture the
Why now?
consumer’s imagination and engage them in their own
health.”
Given the widespread adoption of mobile phones and
social networks in addition to the popularity of casual Sutha Kamal, CEO of Massive Health, agrees. Kamal said
gaming, those focused on improving health outcomes that “it is time to measure success by how many times
see an opportunity to leverage these technologies to people smile.”
drive health behavior change.
Chuck Parker, who is the executive director of the
The medical community is clearly interested in the Continua Health Alliance, noted that he has heard about
topic, as demonstrated by the increasing number of a number of health and medical sensor companies are
conferences focused on the topic and the advent of a beginning to discuss partnerships with entertainment
new medical journal, for example. companies.

• Games for Health Admittedly, this sector is still in its early days, but given
the trends towards anytime, anywhere and personalized
• Serious Games Summit information with group influence, we expect that use of
games, game mechanics and gamification will increase in
• The Power of Play: Innovations in Getting Active healthcare services.
Summit 2011 (A Science Panel Proceedings Report
from the American Heart Association-sponsored by In recent months, talk of gaming and gamification during
Nintendo) onstage pitches by mobile health startups at industry
events has become increasingly commonplace.
• The first annual Games for Health in Europe 2011
Before digging deeper into specific mobile health games,
• A new medical journal: “Games for Health: Research, let’s take a step back to define what games are and how
Development, and Clinical Applications.” they engage players.

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RESEARCH
III. III. What is a game?

S
torytellers have been influencing people for Will storytelling be used in health games? While the
millennia. Telling and listening to stories is one of opportunity is not universally agreed upon, some of
the oldest forms of human entertainment, at least those interviewed saw it:
since our ancestors developed language, and forms a
deep foundation upon which games can be developed. “I believe narrative is critical to immersive…video
games,” Richard Buday of Playnormous said. “Humans
Health games pioneer Debra Lieberman, PhD, who is are hardwired to expect important information to be
director of the Health Games Research national program communicated through story.”
and a researcher at the University of California, Santa
Barbara said that storytelling is very important to You should “take a chore and make it a game with story,”
behavior change: according to Academy Award-winning producer Ed
Saxon, who is working alongside his sister, Dr. Leslie
“We learn from observation,” she said. “Storytelling Saxon, at the USC Center for Body Computing.
engages us and gives us a vicarious experience, lets us
learn what is likely to be rewarding and punishing. Some Storytelling can “do good and do well in the world,
people think about games only in terms of commercial marrying tech and entertainment,” according to Tim
games -- the look and feel of a video game, [but] I Jones, formerly of Disney and now at HealthNuts Media.
define it broadly as… a rule-based activity that involves
challenge to reach a goal and [it] provides feedback on
your progress to reach that goal.”

In this sense, people have always enjoyed playing
games, which fulfill fundamental desires for exploration
and mastery. For today’s games, the underlying human
motivations are the same, but the new media have given
game developers a broader array of tools to surprise and
delight us with new experiences. GAMIFICATION
GAMES GAME
MECHANICS

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RESEARCH
III. What is a game? (continued...)

THIS REPORT is
sponsored by:
The use of game mechanics to influence customer
behavior is not entirely new online or offline. Airline and mobi health news
hotel reward programs have an element of competition RESEARCH
and reward about them. Online services have long
leaned on gaming precepts: eBay auctions feed
competitive instincts and social media sites have made Subscribe to all of our reports from
a game of accumulating friends and followers. Nike, the 2011. Contact our Sales Director for
world’s largest manufacturer of footwear and apparel, special year-end pricing.
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.

CONTACT JOE MAILLIE FOR MORE INFO
O: (617) 532-1030 M: (617) 223-1647
e: joe.maillie@mobihealthnews.com

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RESEARCH
IV. IV. New Approaches

G
ame developers without experienced healthcare Often times these multidisciplinary teams are brought
partners, advisors, or team members won’t together by design innovation firms like Frog Design and
make an impact. Healthcare service providers Continuum.
with an eye on gamification but no experience creating
beautifully designed and engaging apps, won’t either. Frog Design is an active member of the Innovation
Health games are under development or have launched Learning Network, an international non-profit network
by teams going about these types of partnerships in of noncompeting healthcare innovators who come
various ways. together to share best practices. Describing the Frog
Design San Francisco’s team approach, Aimee Jungman,
Anne DeGheest, a managing partner at MedStars a Vice President of Strategy, said that she “believes
Ventures Partners, agreed that it is “hard to find a team multidisciplinary collaboration is essential in developing
with the right mix of skills [because] you need people mobile healthcare games that are engaging and drive
from the healthcare, technology, and consumer sectors.” lasting health outcomes.”

Rock Health, an incubator for mobile health and Health “Frog brings together designers with deep expertise in
2.0 startups, leverages multidisciplinary teams for its motivating behavior change, strategists experienced in
screening process of startup applicants, according to the healthcare industry, and technologists with skills in
managing director Halle Tecco. “Applications are vetted developing medical communication platforms to build
with expert teams that include multiple disciplines,” mHealth connectivity and then translate the game data
she said. “It takes a village, so we need deep level of into meaningful health information,” Jungman said.
engagement with the medical community, as well as
with the consumer health and wellness community.”

Michael Bidu, the Founder and CEO of Canada’s Centre
for Wireless and Digital Health Innovation, has a front
row seat for the types of partnerships that could lead
to future health games: “Seasoned executives from
Electronic Arts Canada, Microsoft Interactive Games,
as well as young video game designers [are] coming
together with healthcare and wellness professionals to
partner on consumer engagement [to] deliver fun and
meaningful consumer or patient experiences.”

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RESEARCH
IV. New approaches (continued...)

Continuum, a global design and innovation consultancy, The Center for Body Computing is also developing a
says it uses a human-centered approach. As part of its pulmonary rehabilitation game called “The Magic Carpet”
methodology, Continuum commonly incorporates a game where the harder the user blows into their phone,
behavior change framework — designing to “support the more an interactive magic carpet pictured on the
people’s actual goals, not the goals we might wish user’s phone moves.
they had,” Continuum Principal Devorah Klein said. The
hoped for outcome: products, services and experiences Majid Sarrafzadeh, a Professor of Computer Science and
designed for how people actually live, not how Director of the UCLA Wireless Health Institute, said his
companies think they should live. institute’s community also includes an interdisciplinary
group of experts and innovators from many UCLA
Multidisciplinary teams? “It’s how we work every day,” Schools including Engineering, Law, Management,
says Continuum Director Stuart Perry. A typical team Medicine, Nursing, Public Health, and Theater, Film &
includes a cognitive psychologist, graphic designer, Television.
interaction designer, industrial designer, and an engineer.
“We think the only way to make progress in this field
When asked about interdisciplinary collaboration, Dr. to ensure we are solving the right problem is to work
Leslie Saxon, the Chief of Cardiovascular Medicine at with other disciplines,” Sarrafzadeh said. “In fact the
the University of Southern California’s Keck School collaboration has to be a tight collaboration, where you
of Medicine and founder of the USC Center for Body meet and discuss on a regular basis – truly as partners.”
Computing said: “We love other disciplines, we are
not afraid of them. USC, from the president down, is Kevin Patrick, M.D. M.S., a Professor of Family and
dedicated to interdisciplinary work.” Preventive Medicine at University of California, San
Diego, is doing research using social media and mobile
In her gaming work, Saxon collaborates with the USC technologies to promote improved health behaviors.
School of Cinematic Arts, the Institute for Creative
Technologies, the Viterbi School of Engineering and the Mobile technology has created a new field that is “very
Marshall School of Business. That approach gives the CBC multidisciplinary, with teams composed of psychologists,
a “360 approach to mobile gaming,” according to Saxon. cognitive science experts, computer design, electrical
and computer engineers, software engineers, nutritional
One of the games in development at the CBC is “Beating scientists, exercise scientists and physicians working
Heart,” which “introduces heart health to young adults by together,” Patrick said. “No one discipline owns more than
letting them get their heart rate when they touch their a minority share.”
iPhone and also allowing them to share this information
with friends.” 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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RESEARCH
IV. New approaches (continued...)

It’s not just academics and researchers who are “We want to understand the new ecosystem and
beginning to look at mobile health gaming. Perhaps participate in its growth and development. We see
unsurprisingly, pharma companies are, too. About a an opportunity to collaborate with non-traditional
year ago Janssen Healthcare Innovation was formed to partners, to co-develop and to scale up many exciting
accelerate the transformation of Johnson & Johnson from new solutions that facilitate consumer empowerment
a healthcare product company to a broader health care for optimal health management. We also see the need
company. for integration of systems throughout the healthcare
continuum and believe we can be a leader in driving
The “purpose of the group is twofold; one is to help these types of advancements.”
optimize our existing businesses, and the other is
to build additional businesses in the new spaces in Janssen Healthcare Innovation is actively looking for
healthcare” said Dr. Diego Miralles, who heads the strategic partnerships, from both inside and outside
team. With significant support from the company of healthcare, including mobile behavior modification
leadership, Miralles said he has built a dedicated solutions.
multidisciplinary team with diverse sector experience
from pharmaceuticals, devices, telecommunications, IT, Dr. Miralles said he had a sense of “wonderment and
consumer and financial/consulting. excitement” when he first began to explore this new
ecosystem. “This is a time of rapid change, some of
which we can’t even imagine… but we know we need to
be a part of it.”

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RESEARCH
IV. New approaches (continued...)

Insurance companies are also rising to the challenge and
opportunity by forming innovation centers. Humana’s
Innovation Center was founded in 2000 to create services
based upon their understanding of the rise of consumer
empowerment in healthcare. In 2007 the center
recognized “the prevalence of gaming across all ages,”
Nate Bellinger, Director of Consumer Innovation, said. By
then “gaming was done by kids, seniors and parents and
we wanted to work with all age groups around health.
This initiated Humana Games for Health.”

Humana has a dedicated website for its health games,
called HumanaGames.com. The health insurer’s current
offerings include Colorfall and Goldwalker (pictured
right).
Colorfall: A puzzle game based on the color spectrum
where you arrange cascading colored tokens in the order
“We expect to use what we have learned in developing
of the colors of the rainbow.
these games as we expand our gamification approaches
to health and wellness,” Tony Tomazic, Consumer
Innovation Director, said.

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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RESEARCH
IV. New approaches (continued...)

In 2003, Kaiser’s Innovation Consultancy began working
with design firm IDEO to better understand which design
methodology would work in a healthcare setting.

According to Chris McCarthy, an innovation consultant
for the Innovation Center, “it was challenging to try to
use a product design methodology in a service design
company.”

Now, in 2011, the team is made up of an industrial
designer, a communication designer, a design strategist
and several generalists. McCarthy explains that “our
design thinking is becoming more sophisticated,
blending the best thinking from product design, service
design and now behavioral design thinking.”

Games from the consultancy now include “The Amazing The Amazing Food Detective: Based on a
Food Detective” (pictured right) and “Dr. Hero”. skit developed internally at Kaiser and then
produced by an outside game designer, the
Another pilot is addressing pediatric obesity using FitBit, game utilizes eight short mysteries and 24
BodyMedia, and Nintendo’s Wii Fit to encourage exercise. fun arcade mind-games. Kids play the role of
detectives fighting childhood obesity.
The Kaiser team is also very enthusiastic about clinical
gaming. Dr. Yan Chow, Director, Innovation and Dr. Hero (no image available): A training game
Advanced Technology, believes that gaming “gives us the that simulates an emergency in labor and
freedom to fail in a safe environment, and could expand delivery. Innovation Labs manager Richard
our abilities to observe and analyze user behavior in a Chennault describes the game as an “immersive
richer way.” learning environment that adds the stress of
a simulation yet gives the freedom to make
According to Chow, the hospital patient of the future mistakes and recover from the mistake.” The
may be playing games for personal entertainment or first version of “Dr. Hero” was done on a
learning about aftercare on a large screen, while an noncommercial budget and is designed as a
attached Kinect-type motion sensor could assist with platform that could be applied to other medical
physical therapy rehabilitation or monitor physical scenarios or even to giving a patient a simulated
activity to track recovery. experience ahead of a procedure.

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RESEARCH
IV. New approaches (continued...)

NEED SOME
ADDITIONAL PERSPECTIVE?

Are doctors likely to benefit? mobi health news
CUSTOM RESEARCH

Doctors at Kaiser Permanente may soon benefit from
new approaches to gaming: “With electronic medical
OUR CUSTOM RESEARCH
records [already] implemented at Kaiser, we can now REPORTS ARE DESIGNED
think about layering gaming technologies like scenario TO HELP YOUR TEAM WORK
modeling, real-time analytics, and decision support on
THROUGH THE CHALLENGES
top to increase productivity and engage clinicians more
effectively,” Chow said. FACING YOUR MOBILE
HEALTH PROJECTS.
Importantly, he sees uses for gaming and simulation in
the future of medical education where “physicians can To discuss your next
access just-in-time training at the point of need and custom research project,
receive micro credits toward licensure requirements.” email Brian Dolan at:
brian.dolan@mobihealthnews.com
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 Join the growing list of
combining its Intel Digital Health Group with GE Fortune 500 companies that
Healthcare’s Home Health Division to create Intel-GE Care turn to MobiHealthNews for
Innovations. The new company is already using some their custom research needs.
cognitive health games for an elderly population. Our current clients include:
Although not currently offered, Muki Hansteen-Izora, a
Medical Device Companies
senior researcher and strategist at Intel Labs, “sees a need
for games used in physical therapy and/or rehab in this Pharma Companies
setting,” too. Mobile Operators

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V. V. Building the Evidence Base

T
here is a growing clinical trial evidence base that To further build upon this early work, in September 2007,
shows that games can improve players’ health the Robert Wood Johnson Foundation launched an $8.25
behaviors and outcomes in areas such as addiction million national program called Health Games Research:
control, healthy eating, physical activity, physical therapy, Advancing Effectiveness of Interactive Games for Health,
cognitive therapy, smoking cessation, cancer treatment to advance innovation, design and effectiveness of
adherence, asthma self-management and diabetes self- health games and game technologies.
management.
“The goal of the program was to build the evidence base
Perhaps one of the earliest success stories in health and seed the market,” Paul Tarini, a senior program officer
gaming might be “Packy and Marlon”, a Super Nintendo for the Robert Wood Johnson Foundation’s Pioneer
adventure game published in 1994, that Debra Portfolio, stated. Current funding runs through 2012.
Lieberman consulted on. The main character in the game
has diabetes and the challenge for players is to manage
the character’s blood glucose monitoring, insulin use and
food selection for four simulated days. Meanwhile, the The RWJF’s mobile game projects include:
character tries to save a diabetes summer camp from rats
and mice that have invaded the premises. Lit to Quit, a game intervention for nicotine
smokers. Researchers at Columbia University
In a controlled clinical trial, diabetic children and have smokers trying to quit puff into an iPhone
adolescents were randomly assigned to take home either microphone instead of a cigarette and also use
the “Packy and Marlon” game or an entertainment video a “rush” or a “relax” form of breathing that helps
game with no health content. The study found that the reduce craving. Survey responses along with
participants in each group played about 1.5 hours per EEGs of their brain while the study participant
week on average over the course of 6 months, but the is smoking versus playing will indicate whether
“Packy and Marlon” group increased their communication the game serves as a gratifying substitute for
about diabetes with family and peers, gained more smoking a cigarette.
diabetes knowledge, increased their perceived self-
efficacy for diabetes self-care, and increased their Mindless Eating Challenge, a game created
appropriate self-care behaviors. by researchers at Cornell University. The game
uses eating tips, nurturing of virtual characters,
As a result, their urgent care and emergency visits related snapshots of foods, and an array of feedback to
to diabetes decreased by 77 percent, dropping from an promote good nutrition and a healthy lifestyle
average of 2.4 visits per child per year to 0.5 visits per for young adolescents.
child per year.

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RESEARCH
V. Building the evidence base (continued...)

In January 2011 the American Journal of Preventive HopeLab’s health game, Re-Mission (pictured below),
Medicine published the results of a clinical study on is an epic fully-interactive battle game [played on the
whether children aged 10 to 12 years old who played computer] that focuses mainly on story-telling as its core
two particular health video games had better eating gaming mechanism.
habits and physical activity habits as a result. The study
compared about half of 133 kids who played the video Clinical trial data showed that this well-designed video
games to the control group who played diet and physical game could have a positive impact on health behaviors
activity related games on popular websites. of young people.

The two video games tested were called “Escape from The study was the largest randomized controlled study
Diab” (Diab) and “Nanoswarm: Invasion from Inner of a video game intervention ever conducted, according
Space” (Nano). The study found just a slight increase to the researchers. The study followed 375 teen and
in fruit and vegetable consumption among the Nano young adults with cancer at 34 medical centers in the
and Diab playing group, but not water consumption or US, Canada and Australia during a three month period of
activity level. The increase in health fruits and vegetables cancer treatment.
was about 0.67 additional servings per day. While not
conclusive, the researchers suggested further study was
now warranted.

Re-Mission

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RESEARCH
V. Building the evidence base (continued...)

Results were published in August 2008 in the medical a chemo blaster to destroy cancer cells -- and provides
journal Pediatrics. They showed that patients maintained players with a ‘story’ they are part of within the game.”
higher levels of chemo in their blood, took antibiotics
more consistently, showed greater acquisition of cancer- Complementing this body of academic research and
related knowledge, and showed faster increase in self non-profit work, BJ Fogg and his team at the Stanford
efficacy as a result of playing the game. To identify the Persuasion Technology have developed a systematic
psychological mechanism of action that drove behavior way to think about behavior change. In their behavior
change (i.e. treatment adherence), a subsequent fMRI wizard, they outline three factors that must happen
study of 53 young adults playing the game found that together in order to get a change in behavior. A person
several key areas of the brain, including neural structures must be sufficiently motivated, be able to perform the
involved in emotion, motivation, learning, and memory, behavior, and be triggered to perform the behavior.
were activated. These findings are consistent with results Core motivators include pleasure/pain, hope/fear, and
from a preliminary questionnaire-based study suggesting acceptance/rejection. The framework, which describes
that a major component of Re-Mission’s effectiveness 15 types of behavior changes, helps researchers and
stems from its impact on individual emotional and designers think about how to use mobile technology as
motivational processes. tools for persuasion.

“Narrative is used as a device throughout Re-Mission,” In his work on Mass Interpersonal Persuasion (MIP), Fogg
Richard Tate, the VP of Communications and Marketing asserts that platforms, such as Facebook, give ordinary
at HopeLab, said. “Players pilot the body of a microscopic individuals the ability to reach and influence millions
robot named Roxxi as she flies through the bodies of of people. Fogg thinks that the democratization of
fictional young cancer patients to fight their disease. persuasion will lead to far better outcomes than those
This narrative both informs the objective of the level of achieved back when persuasion was controlled by a few
game play – for example, in certain missions Roxxi uses powerful medical groups.

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RESEARCH
VI. VI. Notable health games

R
eimbursement issues have not held up wellness Some consumers are beginning to use brain games to
focused health services like they have with some improve or enhance cognitive fitness.
condition-specific or disease management focused
apps, and that’s why there are many more wellness apps Below is a summary of what we’ll discuss when it comes
in the market. to chronic condition management services.

Below, is a quick summary and preview of the types of When it comes to diabetes management, companies
wellness games and gamified services described in this want to use social networking and support to encourage
section. medication adherence and life style modification. People
with diabetes want easier ways to monitor and manage
In the wellness arena the concept of health and wellness blood sugar levels through insulin, diet and activity.
is expanding to include “self-help” and life improvement.
For medication adherence, companies are trying to
Consumers are beginning to take charge of their own use gaming principles to help behavior change while
health. In the fitness arena, consumers are buying apps automating the process of reminding patients to fill
to track exercise, sleep and eating habits and want prescriptions and take their medications. Many patients
to share and compete with other members of their want help, especially those managing complex regimens
communities. (like HIV antivirals, or elderly patients with multiple
prescriptions).
Employee benefit programs are looking to lower overall
health care costs by encouraging a wellness approach. Health games also offer an opportunity for treating
Previous attempts to engage employees in wellness addiction. This patient population is already recognized
programs have been notably unsuccessful, so they are as one that is highly motivated by rewards and social
using game elements to make health improvement pressure, which are traits associated with addictive
programs more engaging. These include: assigning personalities. They can be reached through peer-to-peer
points to activities, allowing people to advance through and mobile techniques that leverage those traits for
levels, letting them join together in teams and earn “staying on the wagon.”
individual or collective rewards, applying social pressure
and nudges, using badges as status and social rewards Beginning with some of the wellness games in the
along with monetary-equivalent rewards. market, this section will summarize some of the mobile
health gaming activity currently ongoing.

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RESEARCH
Life Improvement
VI. Notable health games (continued...) and Self-Help

Mindbloom Life Game uses a tree metaphor to represent
the different branches of a person’s life -- health,
relationships, lifestyle, leisure, finances, spirituality,
creativity and career. Users focus on making small
meaningful changes to improve the quality of their lives.
There are five elements that drive consumer engagement
within this game:

• “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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Life Improvement
VI. Notable health games (continued...) and Self-Help

Livn’ It is a mobile habit gaming network that helps users Kairos Labs has also founded The Habit Design Meetup,
master positive, sustainable daily habits like exercising based in San Francisco with expansion chapters in
regularly, eating healthier, waking earlier, meditating, or New York, Seattle, Boston, and Los Angeles, to foster
becoming more organized. The network was developed a broad cross-industry collaboration of best-practices
with help from behavior change and cognitive- in behavior-change habit development research,
behavioral psychologists as a “simpler, easier, cheaper, methodologies, and practices that “really work beyond
and more sustainable complement to traditional self- 100 days”.
help 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.

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Life Improvement
VI. Notable health games (continued...) and Self-Help

MeYou Health—everyday wellbeing with small actions using community support

MeYou Health promotes everyday wellbeing by
encouraging small actions and fostering social ties that The MeYou Health team, which has designers and
drive meaningful behavior change. Daily Challenge is engineers from the web, mobile and gaming sectors,
the application that encourages users to take small, is experimenting with ways to use algorithms to
achievable steps toward healthy living every day. Getting understand the power of influence and build online
started only takes a few minutes. Once you sign up, you communities. The goal is to create smarter ways to
get an email at 7 am to do one small task, across a wide leverage social networks and build a rich user experience.
range of wellbeing domains, from physical activity to
eating well to emotional health and more. Notably, MeYou Health, founded in 2009, is a wholly-
owned subsidiary of Healthways, a publically traded
Feedback includes social proof of action from your wellbeing company which co-developed the Gallup-
personal connections. If you don’t do the task, you get a Healthways Well-Being Index.
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.”

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RESEARCH
Consumer Health
VI. Notable health games (continued...) and Wellness

Worksmart Labs is a wellness technology firm focusing WorkSmart’s newest application, Noom Weight Loss, has
on smartphone apps that allow users to record workouts, already seen over 2 million downloads since its debut in
track eating habits and follow a personalized weight May. “Our users have really enjoyed Noom Weight Loss,”
loss plan. WorkSmart’s products include CardioTrainer, says Petakov, “and we’re trying to build out more features
CardioTrainer Pro, Calorific, and Noom Weight Loss. All to that application, such as a ‘Personal Trainer in your
of their applications are designed to be “simple with pocket.’”
actionable information” said Artem Petakov, Co-Founder
and CTO. Petakov said that “game mechanics are a multiplier of
behavior… they do not change behavior.” He also noted
CardioTrainer allows users to track any kind of indoor that “leaderboards don’t work well with weight loss,”
or outdoor exercise and then review statistics such as according to their tests. He said leaderboards “need more
distance, speed and number of calories burned after a rigorous experimentation.”
workout. Users can also compare themselves to other
CardioTrainer users around the globe via the World High WorkSmart Labs has spent 3 years working with their
Scores feature. 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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RESEARCH
Consumer Health
VI. Notable health games (continued...) and Wellness

Zamzee is an online rewards program for teens that is
powered by their physical activity. The activity meter
records short bursts of movement, as well as vigorous
activity. The amount of movement powers the online
rewards account, where a virtual currency can be used to
purchase both virtual and real goods.

The game takes advantage of popular trends such as
life style tracking, social gaming, virtual economies and
customer rewards. Building upon the methodology
that HopeLab used in the development of Re-Mission,
Zamzee started with clear behavioral targets, built the
game with those targets in mind, and did extensive
iterations with their target audience. In order to
personalize the experience and gain sustained
engagement, the company is experimenting with
adaptive rewards and an element of surprise.

Early studies show that teens using Zamzee increased
their movement by 30 percent each month, according to
the company.

“The game let’s kids do what they do want to do and get
rewarded for it,” CEO Jonathan Atwood said. “We hope
it will shift attitudes among teens about the value of
regular physical activity.”

A public launch is expected this year.

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RESEARCH
Consumer Health
VI. Notable health games (continued...) and Wellness

The Basis Band is a connected health and heart rate
monitor intended to be worn around the wrist. Taking
advantage of the decreasing cost and increasing power
of sensors, the Basis Band has a number of sensors: an
optical blood flow sensor that can ”see” your heart rate,
a 3D accelerometer that records even tiny movements, a
sensor that tracks skin and ambient heat levels and one
that tracks your sweat.

Nadeem Kassam, founder and Chief Alliance Officer of
Basis, describes his “sweet spot as the intersection of
entertainment and healthcare.” He believes that it is
easier to stay healthy when wellness is fun, social and
informative.

“We are taking what we have learned from console
and casual games and experimenting with all sorts of
game mechanics applied to wellness,” Kassam said. That
ranges “from badges, leaderboards, points, individual
competition, and group competition.” According to
Kassam, the final platform will be part of an “awesome
user experience” once they finish their beta.

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Consumer Health
VI. Notable health games (continued...) and Wellness

Massive Health is focused on developing patient- According to Sutha, “mobile is an opportunity because
centered tools for behavior change to help people the device is always with you, there is tremendous
get and stay healthy. The startup launched their first computational power and the number of sensors that
“experiment” in the fall of 2011: The Eatery. The app you can carry in your pocket” could lead to interesting
encourages users to snap photos of the food they eat health applications.
and submit it to the community of users for ratings
on a scale of “Fit or Fat.” The app also helps users track What is their approach to gaming? “We want to bring
how healthy they are eating day to day. Another app joy to our users,” Kamal said. “Gaming is one tool along
in development by Massive Health is code-named with data analysis and using social hooks for support and
Penguine. It is focused on diabetes management, but the encouragement.”
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.

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RESEARCH
Corporate Health
VI. Notable health games (continued...) and Wellness

Corporate Health and Wellness
“Keas helps people develop the habits to be healthier,
Employee-focused wellness programs have a history and this makes them happier and more productive,” CEO
of failure. Will games finally make employee health Adam Bosworth said. “We use the power of play to do it.”
and wellness programs effective tools to spur behavior
change? Will social gaming help solve the employee Bosworth believes that he has found five simple
engagement issue? A number of companies believe it approaches to get people to eat less, eat more
will. vegetables, exercise and manage stress:

Social health games encourage three behaviors: • Only use positive reinforcement: points, levels,
teamwork, friendly competition and accountability. 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 can’t be about the data.

“We did not want to follow Silicon Valley’s infatuation
with data at the expense of psychology,” Bosworth said.
“So we ripped out all the data.” Bosworth said Keas does
a lot of experiments and thrives on iterative learning.
Mobile is seen as key because of its convenience to Keas
users, he said. Bosworth describes Keas as a “pure-play”
when it comes to gaming: “We can use games incredibly
effectively to change behavior,” he said.

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RESEARCH
Corporate Health
VI. Notable health games (continued...) and Wellness

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, junk-
food, 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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RESEARCH
Corporate Health
VI. Notable health games (continued...) and Wellness

Healthrageous is a software platform designed to give
personalized advice to help individuals reach their health
goals: eating a healthier diet, getting more exercise,
or managing hypertension. Martin Adler, Co-Founder
and Product Manager at Healthrageous, describes the
experience as “a personalized health journey, utilizing
game mechanics, social support and expert advice,” that
it is customized to each individual and tailored to each
corporate culture. “We combine coaching, social support,
device data, self report data, game play and educational
data to make taking care of yourself a rewarding
experience.” The company was launched out of the
Center for Connected Health at Partners HealthCare.

Here is how it works:

The Healthrageous automated expert system
combines participant input and device data to create a
personalized plan to achieve an individual’s goals.

Healthrageous gives advice, adjusts goals and suggests
features such as the online community for support.
The system continues to tailor the experience to the
individual’s needs.

The product is intended for individuals, employers,
health plans and care managers.

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Corporate Health
VI. Notable health games (continued...) and Wellness

RedBrick, the most established company in this group, ”We think it is important to give people a simple,
was founded in 2006 and works with large, self-insured personalized and easily accessible experience so wellness
employers and employees to create healthier, more just fits into their daily lives, like email and Facebook,”
productive workforces. Its platform is driven by data said Eric Zimmerman, Chief Marketing Officer.
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.

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RESEARCH
VI. Notable health games (continued...) 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. Dakim’s CEO Dan Michel is “passionate
about bringing fun and entertainment to help his users
maintain their abilities to enjoy life.”

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RESEARCH
VI. Notable health games (continued...) Brain Games

Lumosity brain training games are developed to train “Everything is oriented towards the end user, and we
five core areas of cognitive function: processing speed, have gotten a lot of customer feedback telling us that
attention, memory, flexibility and problem solving. they feel it is personalized to them,” said Joe Hardy, the
Games by Luminosity include: Vice President of Research and Development at Lumosity.
The company’s secret sauce lies in its adaptive training
• Playing Koi -- An exercise of visual divided attention algorithm, he said.
and working memory. The goal is to feed the fish.
The business model is a consumer product with a
• Familiar Faces -- An exercise of associative memory. subscription-based service.
The game takes place in a restaurant and the player’s
job is to remember the orders and the customer’s Lumosity also makes its software available for free on
names to earn large tips. corporate web sites such as Blue Cross or the New York
Times crossword puzzle page. Another project is with
• By the Rules -- An exercise of mental flexibility Abbott in Italy, where they make the Lumosity product
and working memory. The user is challenged to available to patients with HIV who have a cognitive side
formulate hypotheses about what the current effect called Neuro-AIDS. Lumosity Education Access
rule might be and then dynamically update that Program (LEAP) provides the product to educators,
hypothesis as new information becomes available. teachers and school psychologists so the company can
determine new uses for their product.

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RESEARCH
VI. Notable health games (continued...) 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
Telcare aims to connect doctors, patients and family
engagement is key to good outcomes and lower
members around the care of a chronic illness.
costs.
Beginning with diabetes, they will be building a
cross-platform social community where people with
A key goal is to empower patients by giving
diabetes and healthcare professionals can interact,
them more control over all aspects of disease
share stories, discuss diabetes technology and learn
management, and facilitate a coordinated and
from one another.
holistic approach where patients manage their
blood sugar and other areas, such as diet and
The startup is better known for its Telcare BGM, the
exercise, with less need to be supervised by
first cellular-enabled glucose meter, combined with
providers.
an FDA-cleared database to aid in the management
of diabetes. The device allows patients to transmit
their blood glucose readings to caregivers and
family members and receive immediate coaching
and clinical feedback relayed to the screen of the
glucose meter.

“The people who built Facebook didn’t know what
the people were going to do there; they just knew
they were inviting them to the party,” CEO Jonathan
Javitt said when asked what shape the company’s
gaming elements might take.

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RESEARCH
VI. Notable health games (continued...) Disease Management

Cellnovo’s offering is comprised of a mobile connected “Borrowing from the beautiful execution from the
patch pump, a mobile touch-screen controller, blood consumer industry in Apple products, we used design
glucose meter and applications, plus real time activity and simplicity as the foundation to putting together
tracking. a system to solve a critical medical need in diabetes,”
CEO Bill McKeon said. “It is important to think about the
The company states that every element and interaction system, not a widget. It is the system that has the power.”
was designed to be easy to understand and operate.
Most of the daily tasks can be done by wearing the Once the system launches McKeon says that it will mark
pump, which has an accelerometer built in to measure “the first time that real time data will be available. We
daily activity. When blood glucose testing is required, are excited to see how this data is used and what type of
the handset records the readings. Simply clicking an icon connected learning will evolve.”
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.

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RESEARCH
VI. Notable health games (continued...) Medication Adherence

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 on-
body 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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RESEARCH
VI. Notable health games (continued...) Medication Adherence

HealthPrize has a medication adherence platform that The financial incentives include loyalty points, weekly
combines the power of financial incentives, education, sweepstakes and monthly competitions, with a prize
reminders and fun. to the highest point earner per month. Educational
tidbits are presented in the form of short weekly quizzes
Dr. Katrina Firlik, HealthPrize’s cofounder and Chief and surveys, as well as daily “fortune cookies,” all for
Medical Officer, thinks that “we need to add the fun additional points.
factor, as well as an element of surprise and delight,
to attack the medication adherence problem, which is The business plan is to sell on a brand-by-brand basis to
partly rooted in irrational thinking.” pharmaceutical companies, and early interest has already
been demonstrated “from acne to oncology brands, and
To solve this irrational problem, James Jorasch, another pretty much everything in between.”
HealthPrize cofounder, brings deep expertise in gaming
and lotteries. He is the creator of the ten patents that The company is currently conducting an asthma pilot
form the basis for the company, linking gaming and with Real Age and the company just signed its first
rewards to medication adherence. pharmaceutical partner. Plans for a 10,000-person pilot at
the pharma company are in the works. In November the
Adds Firlik: “We realized early on that it is difficult to get company announced the launch of its first iPhone app to
people to sign up for adherence programs, so rewards Apple’s AppStore, but only participants in the two trials
are key.” at Real Age and the pharma company can use it.

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RESEARCH
VI. Notable health games (continued...) Medication Adherence

Addiction Recovery Treatment

PillJogger is a motivation engine that CEO Dr. Robert
Pakter wants to “engage, entertain, excite and reward
people for taking their medicine.” To those ends, Pakter
has brought together a multidisciplinary team including
a lawyer/software engineer, and a designer.

PillJogger’s design philosophy is to make the user
interface simple and intuitive as well as “fresh and non-
doctrinaire,” Dr. Pakter said. “Even if the dosage reminder
time is predictable, the user experience doesn’t have
to be.” PillJogger aims to accomplish this with elements
of surprise and discovery, using what they refer to as
“micro-media,” or short snippets of entertainment that
typically take a game form. Patients also earn prizes and
rewards provided by sponsors who also use the platform
for marketing and education outreach.

The server-based architecture allows for secure
recordkeeping of adherence history and HIPAA
compliance. The syncing of the mobile device with the
server allows caregivers and other authorized parties the
opportunity to evaluate and manage patient behavior.

Retail pharmacies, pharmaceutical companies, employers
and insurance plans may all sponsor patients so “the
product will always be free to the user.”

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VI. Notable health games (continued...)

Addiction Recovery Treatment

OneRecovery is an online support network for individuals
in recovery from alcoholism, drug abuse and eating
disorders. It is a place for members to share stories, work
on their recovery and mutually support one another
in real time. The web and mobile program combines
social networking technology, game mechanics and
evidence-based clinical principals to support sustained
engagement and behavior change.

The site offers what it calls “applied social technology”
that is customized to personal needs with varying levels
of privacy, ways to form groups, and ways to get support
from peers and providers. Users can participate in blogs,
forums, group chats and more. The service includes
mood and emotion tracking. Users get different colored
badges for sharing stories, setting a “recovery” clock for
one disease or many, or attending meetings.

“Our Social Solutioning platform engages people
to improve their health, reduces the risk of relapse
and improves outcomes for addiction recovery while
lowering medical costs,” Chief Marketing Officer Drew
Paxton said.

At the end of October 2011 the company launched
OnTheGo, a mobile 12-Step Program meeting finder
for iPhone users. The app should be coming to Android
devices soon. The app aims to help support recovery
from alcoholism, chemical dependency and process
addiction, according to the company.

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RESEARCH
VII. VII. Conclusion

A
lthough the sector is still in the early days, we 2. While many games for health initiatives make use
expect that the use of games, game mechanics of common mechanics, the activity in the market
and gamification will ramp up in healthcare today is by no means a one-size-fits-all story.
and that the popularity of the mobile platform both in
general and as a gaming platform will accelerate the Each sector has a characteristic way to mix and match
trend. game elements: Addiction recovery programs use
applied social support and game mechanics. Corporate
To recap, a number of trends have emerged from this wellness programs use game mechanics and social
study: games. Medical device companies in chronic diseases
(starting with diabetes) build online communities and
1. Healthcare incumbents and new consumer health- use peer-peer support for information sharing and
focused startups alike are eyeing gamification and support. Consumer fitness companies use peer-to-peer
working with multidisciplinary teams to bring their support to improve motivation. Medication adherence
wares to market. programs use reward programs and pure entertainment.

Multidisciplinary collaboration, which was commonplace 3. New ways of learning in healthcare have emerged
in design firms such as Frog and Continuum, is now that feed short bits of information into your day,
appearing at academic centers such as UCLA, USC and fitting into the small screens and 24/7 connectivity of
UCSD and emerging in some of the biggest providers mobile communications and suitable for shorter user
and payors (Kaiser, Humana, GE/Intel, Janssen) as well as attention spans.
being intrinsic to the culture of most of the early-stage
companies highlighted in this report. Keas uses short quizzes that test knowledge of healthy
living.
Tellingly, several of those emerging company
management teams have founders from outside PillJogger uses short snippets of entertainment.
of healthcare, including: Mindbloom, Kairos Labs,
Worksmart Labs, Basis, Massive Health, Vivecoach, Keas, HealthPrize creates educational tidbits ranging from
and OneRecovery. short quizzes to surveys.

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RESEARCH
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. Where’s the money?
Humana uses its Innovation center to learn more about
using games for health. Venture Capital is showing some appetite.

Intel’s Digital Health Group and GE Healthcare’s Home • Proteus and Redbrick have recently received
Health Division combined to form Care Innovations to Series D investments,
use technology to improve independent living.
Johnson & Johnson has created the Janssen Health • Lumosity and Dakim have tapped Series C
Institute to accelerate its transformation from a investment,
healthcare product company to a broader health care
company. • Cellnovo has received a Series B investment,

What about big entertainment or gaming companies? • Telcare, Worksmart Labs, Basis, Massive
Andy Donner, a director of venture capital firm Physic Health and OneRecovery have all received
Ventures thinks “it is doubtful” those companies will Series A support,
move into health games. He noted that even “Zynga has
not moved toward health games.” • ViveCoach and PillJogger are angel-funded,

Still, a number of those interviewed believed that a • Mindbloom, Kairos, and HealthPrize are
company like Facebook could move into health games currently self-funded.
and several predicted that Microsoft Health Vault will
integrate with Microsoft’s gaming division.

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RESEARCH
VII. Conclusion (continued...)

What’s next?

Michael Kim, CEO of Kairos Labs, envisions the Building upon growing consumer desires for simpler and
emergence of “behavior-change games” that combine more personalized healthcare information, we predict
aspects of behavior-change psychology, alternative that the tools of game mechanics and online social
reality games, and quantified self methods and support will become more sophisticated and easier
techniques to create a foundation for simpler, easier, to use. Simultaneously, better sensors and easier-to-
sustainable and fun ways to develop healthier habits. understand biometrics will give us more information,
which will further facilitate learning from other people
Chuck Parker, Executive Director of the Continua Health with similar health and wellness concerns.
Alliance, sees a new category of “diagnostic gaming”
where games will have sensors that give biometric The use of peer-to-peer support for chronic diseases and
readings which will be used to take gaming to the next rare diseases will increase.
level.” Parker predicted that games with sensors should
be going into the commercial phase in the next 18 With new data, sophisticated applications, and
months. established online support communities, more
stakeholders will be finding, using and adapting these
Nadeem Kassam, the CEO of Basis, thinks that Nintendo’s tools in a variety of ways to improve the health and
concept for a pulse oximetry sensor, along with Kinect’s wellbeing of the increasingly common gamer.
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.

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RESEARCH
VIII. APPENDIX

The following people were interviewed by Bonnie Feldman for this report:

Name Title Company
Kyra Bobinet, MD, MPH Managing Director, Strategic Diversification Aetna
Gordon Norman, MD, MBA EVP & Chief Innovation Officer Alere
Katie Stogner Manager, Consumer Health American Heart Association
Communications
Nadeem Kassam Founder and Chief Alliance Officer Basis
Mara Brazer CEO Brazer Communications/Keas
Darcy Provo Director Brazer Communications/Keas
Mollie Kittle Director Creative Strategy and Insights Bunchball
Nick Vassilakis Wireless Business Development Cambridge Consultants
Michael Bidu Founder Canada's Center for Wireless Health
Innovation
Bill McKeon CEO Cellnovo
Chuck Parker Executive Director Continua Health Alliance
Devorah Klein Principal Continuum
Rick McMullen Designer Continuum
Stuart Perry Director Continuum
Geri Gay, PhD Professor of Communication Cornell University
Dan Michel CEO Dakim
Alan Price CEO DigiDo Interactive
Ed Saxon Principal Ed Saxon Productions
Mary Vegh Investor Relations Electronic Arts
Brian Wang Co-Founder and CEO Fitocracy
Aimee Jungman Vice President, Strategy Frog
Steve Selzer Senior Interaction Designer Frog
Ben Sawyer Co-Founder Games for Health
Brian Krejcarek Founder Green Goose
Ellen Martin Prinicipal, Life Sciences Division Haddon Hill Group
Debra Lieberman, Ph.D. Director Innovation and Advanced Health Games Research
Technology

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RESEARCH
VIII. APPENDIX

Name Title Company
Tim Jones CEO Healthnuts Media
Katrina Firlik, MD Co-Founder and Chief Medical Officer HealthPrize
Martin Adler Co-Founder and Product Manager Healthrageous
Richard Tate Vice President Communications and HopeLab
Marketing
Ellen LaPointe Vice President, Strategic Partnerships HopeLab
Nate Bellinger Director of Consumer Innovation Humana Innovation Center
Nate Kvamme Director Strategic Partnerships Humana Innovation Center
Tony Tomazic Consumer Innovation Director Humana Innovation Center
Douglas Goldstein President iConecto
Muki Hansteen-Izora Health Research & Innovation Intel Labs Intel Labs
Meghan Marschall Director of Communications Janssen Healthcare Innovation
Diego Miralles, MD Head, Janssen Healthcare Innovation Janssen Healthcare Innovation
Michael Kim CEO Kairos Labs
Yan Chow, MD, MBA Director Innovation and Advanced Kaiser
Technology
Richard Channault Principal and Manager, Innovation Labs Kaiser
Aaron Hardisty Business Consultant, Innovation and Kaiser
Advanced Technology
Chris McCarthy, MPH MBA Director Innovation Learning Network Kaiser
Adam Bosworth CEO Keas
Frank Chindamo President LaughMD
Joe Hardy, Ph.D Vice President, Research and Development Lumos Labs
Sutha Kamal CEO Massive Health
Ernie Medina, Dr.PH Co-Founder and CEO Medplay Technologies
Anne DeGheest Managing Partner and Founder Medstars
Trapper Markelz Head of Product MeYouHealth
Bill Crounse, MD Senior Director Worldwide Health, Exective Microsoft
Producer Health Tech Today

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RESEARCH
VIII. APPENDIX

Name Title Company
Christopher Hewett Creative Director Mindbloom
Julie Price Founder Mobile Adventure Walks
Hallie Kotria Co-Founder OneRecovery
Andy Donner Director Physic Ventures
Rober Pakter, MD CEO PillJogger
Gil Silberman Chief Technologist PillJogger
Christoph Oppermann Designer PillJogger
Paul Tarini Senior Program Officer Pioneer Portfolio of RWJF
Richard Buday President Playnormous/Archimage
Michael Merzenich, PhD Chief Scientific Officer Posit Science
Rob Weedn Founder Productive Play
Arna Ionescu Director of Product Development Proteus Biomedical
Don Jones Vice President Wireless Health Qualcomm
Pat Sukhum Founder RedBrick Health
Halle Tecco Managing Director Rock Health
Jonathan Javitt, MD, MPH CEO Telcare
Matthew Tendler Vice President of Product Telcare
Teri Louden President The Louden Network
Majid Sarrafzadeh Director and Professor Computer Science UCLA Wireless Health Institute
Kevin Patrick Professor of Preventive Medicine UCSD Center for Wireless Health
Alexandrea Smith Project Coordinator USC Center for Body Computing
Leslie Saxon, MD Chief, Division of CV Medicine and USC Center for Body Computing
Executive Director of Body Computing
Center
Doug Keare Founder and CEO Vivecoach
Jennifer Roberts Founder and CMO Vivecoach
Artem Petakov Co-Founder and CTO Worksmart Labs
Jonathan Atwood CEO Zamzee

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RESEARCH
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