Andy Oram is an editor at the technical publisher and information provider O’Reilly Media, specializing currently in open source, programming, and health IT.
The overarching challenge of last week’s Games for Health conference shone through in a half-joking offer I heard a health care researcher make to a programmer: “Develop a game for me, and I’ll justify the ROI on it for you.”
How to please: the funding dilemma
This is, in fact, the theme I heard from nearly everybody at the conference, whether in the hallway or on the podium. Some game developers subsist on grants, which can’t last forever, while others struggle to earn back their development costs at $1.99 a pop. Most realize that a sustainable business model depends on persuading health care institutions that games will contribute to their bottom line, a point I made in another article.
Most games, along with other apps, face extra hurdles when they take on health. The people who can benefit most from the apps are unlikely to know about them or understand how they fit into a treatment plan. So instead of marketing to a single focus–a consumer–health apps have to make two parties happy: the end-user and the health care provider who is likely to select and recommend the app. In a global health context, add a third stakeholder you have to impress: an NGO or other funder that will distribute the app to providers.
Global health introduces other complexities. For instance, many games and apps access servers in order to store end-user data and run analytics comparing the end-user to other people in her demographic. If you want to make games social and introduce competition (as recommended in one recent posting), data sharing is critical. But if you distribute a game in rural Nigeria, where do you put the back-end information? You could end up asking village residents to sync with servers in Europe.
But the great benefit of successful games is to reduce treatment, which is basically asking a health care provider to pay in order to shrink its practice. Paradoxically, to be adopted by a health care provider under today’s payment regime, a game has to increase the patient’s use of the institution, not reduce it. Pay-for-outcome will hopefully tip the health field toward the use of games when they improve care.
Games move to the inner lane
Leaders in health care have appreciated games for a long time. They are the visionaries who are excited, not threatened, by the offer of something that helps sufferers avoid expensive, uncomfortable drugs or procedures–and is fun on top of that! But at Games for Health, I still met a lot more people from academic departments and training hospitals than from mainstream institutions. I would be surprised to hear from any of my readers that they walked into their family practice and were encouraged to sign up for a game to control heart disease and ADHD.
The problem seems to be that each game needs to prove itself through controlled studies. Doctors are inherently (and admirably) cautious. I heard, for instance, that the Gates Foundation is interested in funding games in developing regions of the world, but requires validation of their effectiveness. Games that promise clinical results may also get mired in the no-man’s land of FDA regulation for apps and mobile devices, which is currently being reviewed by both the agency and Congress.
However, I’ve heard about many games that made the grade. Re-Mission, something of a health game classic, raises adherence to treatment among the young cancer patients who play it. Snow World works where morphine does not in reducing pain among burn patients as they get treatment–and it’s not merely a perceptual difference: MRIs show that patients are reacting less to pain.
There are lots of such examples, but funding controlled studies for every game is obviously unfeasible.
Nevertheless, the field of health games seems poised for a boom. Dr. Bonnie Feldman cited cheaper hardware and better software platforms as factors that lower barriers to entry. In his Wednesday morning keynote, conference lead Ben Sawyer underscored these advances in a comprehensive look at the gaming industry. For instance, Apple stores will soon sell standardized Made for iPhone (MFi) controllers. JawBone is expanding into gaming through acquisitions, and companies traditionally interested in health (such as Fitbit and Nike) are also showing interest.
What’s really exciting is the new, miniaturized digital devices that will up-end our relationship to computing. If you thought the transition for desktop systems to cell phones was revolutionary, just try out the wristband devices, the Shine activity tracker, and sensors that have shrunk to the thinness of a skin patch. ViviTouch offers a flexible haptic device that can double as a pressure sensor or accelerometer. As a polymer-based capacitor, it is thin and soft, with very low battery use. At the conference, ViviTouch’s Dirk Schepeler said that people can naturally distinguish 85 different haptic effects, and can recognize even more with some training.
Sawyer said that hardware in the gaming field is currently earning money, unlike most software. And advances in hardware devices enable really innovative health apps. But what will happen to the hardware companies when competition and commodification bring costs down to the point where devices can be distributed in cereal boxes?
We are left once again with the funding question. I don’t believe that either the game developers or the academic experts at Games for Health can hit that ball through the end-posts. It will take a wake-up call to the health care industry to do that.
Photo by Steve Petrucelli.