Checking in to his last instalment of the series for 2011, Michael Spitz discusses how gamification has impacted on mobile health. The rapid evolution of smartphones, app stores, and healthcare user behaviours has created an mHealth revolution, one so exponential in...Checking in to his last instalment of the series for 2011, Michael Spitz discusses how gamification has impacted on mobile health. The rapid evolution of smartphones, app stores, and healthcare user behaviours has created an mHealth revolution, one so exponential in... Michael Spitz

Ignite Health

Continued from mHealth Monthly Mashup: release 5.0 – the challenges and opportunities facing mobile electronic health records

The rapid evolution of smartphones, app stores, and healthcare user behaviours has created an mHealth revolution, one so exponential in growth that Juniper Research has predicted 44 million app downloads by next year and 142 million by 2016, with revenue, as forecast by ABI Research, to grow from $120 million currently to over $400 million within those four years.

Given these numbers alone, few doubt the significance of mHealth, not merely as an exciting new healthcare information channel, but as a seismic paradigm shift in the way physicians practise medicine, and patients actively participate in their care.

Similar to how cellular phones enabled devices to connect people with people instead of locations, mhealth has transformed healthcare by enabling data to be acquired, analysed, shared, and stored in a manner reflective of how healthcare is naturally researched and administered.

As mHealth continues to grow, innovative ways are being explored to heighten its seemingly limitless potential. Central to that promise is the idea of facilitating and stimulating physician and patient engagement, a goal already analogously realised with phenomenal success in the gaming industry.

So let’s define 'gamification' and describe how it has already made a significant impact on healthcare, and then provide a few examples of gamification of mHealth and what they augur for a very bright future.

Why are games relevant and what is 'gamification'?

Marketing and communications experts have historically focussed on maximizing their ability to share information with a relevant audience in order to induce some form of behavioural change.

The advent of digital technology has transformed passive receptivity into active, highly targeted two-way conversations, creating dynamic opportunities for qualified engagement that carry well beyond the immediate exposure to the messaging.

"The advent of digital technology has transformed passive receptivity into active, highly targeted two-way conversations..."

Always looking to measure and optimise their capacity for engagement, professionals have been astonished by the success of the gaming industry to capture the attention and stimulate the involvement of billions of people from every demographic across the planet.

The sheer numbers boggle the mind: the Entertainment Software Association reveals consumers spent $25.1 billion on video games in 2010, while DFC Intelligence predicts revenue of over $70 billion by 2015 – numbers that dwarf Hollywood, Bollywood, and even the pornography industry.

Enter 'gamification', which essentially uses game design techniques and mechanics to connect and engage with audiences in an otherwise non-gaming environment.

The goal is to catapult basic messaging and campaigning to ultimately encourage users to make decisions and participate in a desired behaviour that integrates as seamlessly as possible into the gaming experience.

So long as the gaming prerequisites are met, such as emotionally connecting with the user through compelling storytelling, incentives, and feedback through a well-defined trajectory of continuous, self-reinforcing advancement, marketing professionals have been able to 'gamify' otherwise droll communications initiatives with the energy and self-sustaining momentum of video games.

What is the 'gamification of healthcare'?

The practice of medicine often involves tedious, repetitive, boring, or even painful routines on the part of both practitioner and patient.

From diagnostics to treatment, from administration to side effects, from adherence obstacles to long-term care, healthcare is an involuntary need that forces participation and challenges even the most ardent advocate with almost insurmountable difficulties.

Enter gamification, the goal of which in healthcare is to take these difficulties and transform them through gaming principles into an engaging, positively reinforcing, and perhaps even fun experience that encourages users to make sound decisions and activate the desired behaviour for the betterment of their health and wellness.

"Enter gamification, the goal of which in healthcare is to take these difficulties and transform them through gaming principles into an engaging, positively reinforcing, and perhaps even fun experience…"

Success in realising healthcare goals has already been attained through gamification in such categories as cognitive and emotional health, participatory health, active fitness, and rehabilitation.

In terms of health and wellness, companies like zamzee, basis, and Massive Health have gamified diet, exercise, and monitoring routines, while companies such as BreakAway have launched successful medical education, training and simulation modules. These use 3D spatial rendering and virtual environment technology characteristic of the most popular action games and recreate clinical environments for physicians and patients to explore, learn and improve their capacity to heal.

As confirmed in a recent JAMA article, the gamification of healthcare is more than a trend, and holds both the perils and promise of a truly revolutionary approach to care.

The 'gamification of mHealth'

Gaming and mobile health have been on parallel, proportionately successful courses. While Pew Research estimates that close to 20% of Americans with mobile phones have used them to look up health or medical information, the IDC has predicted that about 14% of adult Americans will use a mobile health app to manage their health.

On the physician side, Manhattan Research asserts that 81% will own a smart phone by 2012, augmenting their already enthusiastic and unprecedented adoption of tablets, especially the iPad.

The potential for the gamification of mHealth is electrifying and already under way. Once desktop-bound healthcare platforms are increasingly acquiring mobile extensions, ones where the portability and sensing capabilities of the latest smartphones provide increasingly sophisticated and unobtrusive input and feedback in real time.

So let’s take a look at a few examples of the gamification of mHealth extracted from Bonnie Feldman’s timely and comprehensive “Mobile Social and Fun: Games for Health” report, and extrapolate the premise into the promise of an amazing, gamified mHealth future.

cellnovo

Diabetes is a chronic condition lending itself particularly well to mobile gamification, as the continuous and ever-changing interconnectivity of lifestyle with glucose levels necessitates routine monitoring and behavioural modification.

The next generation of devices and apps are therefore not standalone, but take advantage of what mobile technology can offer as exemplified by cellnovo’s fully integrated patch pump, touch-screen controller, blood glucose meter and applications, and real time activity-tracking software.

But the hardware and connectivity are only the foundation, the ability to receive real time biometric data and share that information opens the door to gamification, where goals can be set and monitored, and results communicated in a manner that self-reinforces the whole process, ultimately translating into positive lifestyle changes embraced with the energy and enthusiasm of a competitive gamer.

Cellnovo diabetes blood glucose monitor

Figure 1: Cellnovo diabetes blood glucose monitor1

Health Prize

Medication adherence is typically the most challenging obstacle facing the healthcare system, with alarming drop-off rates measured in virtually every disease state, despite many robust reimbursement and support programs.

"…the gamification of healthcare is more than a trend, and holds both the perils and promise of a truly revolutionary approach to care."

Consider gamification, where patients are given incentive to comply with their regimens through a mobile-optimised gaming system that rewards adherence with prizes and social recognition.

Integrating intuitive mobile input with a dynamic dashboard that shows progress towards a goal transforms an otherwise tedious and often disregarded compliance routine into a dynamic and fun game where patients play to win, their health and wellness winning in the process.

Figure 2: Health Prize’s tool to aid compliance

Figure 2: Health Prize’s tool to aid compliance2

Proteus Biomedical

From keyboards and mice to touchscreens, and from touchscreens to body kinetics and voice activation, the major technological trend in mobile is the elimination of barriers between the user and the device.

As we look to mHealth and gamification the opportunity is exemplified by this integrated body monitoring and pill-sensing adherence program, where the patient’s burden of having to monitor and input data is automated.

Specifically, a patch is worn to automatically sense and transmit vitals, while each pill is equipped with its own sensor that remotely communicates with the software following ingestion.

Gamification components, including personal and social incentives, are part of the plan, as patients spend time otherwise devoted to data collection on the positively reinforcing gaming elements.

Most significantly, this system provides a taste of what 'mobile health' will be like in the not-too-distant future, where inputs are unobtrusive and automatic, feedback is instantaneous, and a virtual construct is created that entices and energises in a manner akin to the most popular game consoles.

Integrated body monitoring and pill sensing adherence program by Proteus Biomedical

Figure 3: Integrated body monitoring and pill sensing adherence program by Proteus Biomedical3

References

1. Cellnovo

2. Health Prize

3. Proteus Biomedical

About the author:

Michael Spitz is VP of Digital Strategy at Ignite Health, with offices in New York City and Irvine, California.

Spitz combines his passion for technology with more than 15 years of clinical content expertise to help engineer healthcare communications solutions across numerous treatment areas for many of the pharmaceutical industry’s major companies.

Follow @SpitzStrategy on Twitter for his daily – often hourly – updates on all things digital for the ultimate benefit of patients worldwide.

How might mobile health benefit from the power of gamification?