The Serious Games Blog

My first Games for Health was a blast. I wish I could clone myself and have attended every single presentation at G4H. The notes are not at all comprehensive; they reflect my whims and biases. I did scribble some names down but pretty much everything else is written from memory, quick Googling or business cards. If I have gotten anything wrong, please send me a correction:

Is the thematic umbrella of Games for Health too broad to endure and grow? I noticed the sparseness of interests presented and not enough crosstalk. Granted the field is relatively new, but as the concept of serious gaming in spreads into health, will we see even more specialization and coalescing around finer topics, such as brain fitness games and public health games, or the quiet assimilation of gaming as yet another mode of transfer, as ordinary as pen and paper or powerpoint, by established parent fields or broader categorizations. (For example, CyberTherapy 13 is coming up.)

Will what Jurvetson recently said of nanotech hold for serious games, health or anything else, too?

But you don't talk about nanotech as an industry?
There is no business concept of nanotech. It doesn't describe the customer, and there's no synergy at the business level. The only synergy in the concept of nanotech is on the R&D technology level--researchers all over these disparate fields: biotech or biology and genetics, all the way to software to computer design.

Nanotech didn't disappear, it just went into the fabric of other industries, where the company that has got a nanotech solar cell, and if they're shipping a product they want to talk about a solar cell--they don't want to say, "Oh yeah, it's nano inside."

When the Wii generation grows up, will anybody need or want to emphasize the "gaming inside?"

(Re)positioning Ideas for Health Applications

Touchdown demoed a dancetown fitness game for senior centers. Of course, Dance Dance Revolution has been a runaway hit for the youth video gamers, with health benefits touted as a side benefit. Touchdown has repositioned DDR for seniors, to deliver health with entertainment as the vehicle. Director of Project Management Jia Ji commented on how for the senior market it was important to strip out the bells and whistles and build up to what is minimal and necessary for seniors to understand. (In case you are wondering about Touchdown's relationship with Humana, as revealed in press releases of 9/2007, Touchdown will be also positioning the same technology for home use.)

Forterra had a booth. I had seen their website, and read about their OLIVE engine, but it wasn't evident how Second Life-like their simulations were until I saw their demo application on screen. According to the presenter, their environment is adapted from the There.com virtual world. While these ambitious platforms seem to flounder as popular applications, Forterra has smartly created value by exploiting the them for military and public safety training.

I met Francis Kong, M.D. at lunch. He is an avid gamer and game critic turned pediatrician now turned entrepreneur looking to help children in the pediatric wards. His idea, Hospital based Online Pediatric Environment (HOPE), is to shorten their hospital stays and improve patient experience through video games. Social networking and online gaming through the Xbox Live is a reality for millions of gamers… except for those in hospital beds. If you're stuck in a hospital bed for weeks at a time getting chemo for a rare disorder, wouldn't you want to be gaming and meeting others like yourself on a gaming network? Kong wants to make this happen. (Kong and his partner in the venture, Arun Matthews, M.D., tested this concept successfully at Hopkins.)

Henrik Hautop Lund demonstrated Robotic Therapy Tiles. Very cool. The tiles are so useful and versatile for a wide range of sporting and rehabilitation applications that it has the marketing danger like Second Life of seeming not useful to anyone in particular. Departments and specialties buy solutions for their specific problems, not Swiss Army knives for everything. Granted, this was an academic presentation, but my marketing mind kept ringing alarm bells. Interestingly, I had a great time throwing the dodgeball at the electronic targets on the SportWall in the demo room. It was fun and a good workout for the fast twitch fibers and the anaerobic system. Sportwall's specific application is exactly one of the examples Lund illustrated in his slideshow (with soccer balls instead of dodge balls).

Metrics and Benchmarks Must Emerge to Demonstrate Value to Buyers

SharpBrains CEO Alvaro Fernandez brought home this idea. Naturally as someone who offers market intelligence on brain fitness games, Fernandez is particularly keen on the needs of buyers. Think of how we have guidelines for buying a wedding diamond, taking a mortgage (pre-bust), or elevating exercise heart rate. Right or wrong the guidelines are, they form conventional wisdom that facilitates transactions. Buyers need a basis for their decisions and want proof that the shiny new thing adds value.

SharpBrains will soon be publishing buying guidelines for senior care centers on brain fitness products. (In case the connection is not clear, a search of pubmed will show studies linking exercise to brain function.) Of course, I introduced him to Ji who voiced his own need to provide skeptical senior care buyers with convincing proof of value. Ji commented that neurological tests tend to be too soft, they tend to be surveys of experience rather than quantitative metrics on specific functions, which would be more convincing.

During Fernandez's joint presentation with Happy Neuron, I asked CEO Laura Fay "about incumbent games such as chess, go, backgammon, bridge" and she gave a diplomatic answer about the value of these games, while Fernandez gave a nuanced answer about how future brain studies should demonstrate what kinds of games bolster which brain functions. Like Progressive Insurance, a confident seller invites comparison shopping. (The game theoretic basis for inviting such comparison is provided by Eric Rasmusen in his Games and Information.) While one might suppress such comparison for novelty seeking end users, one might need such information to convince critical and financially sensitive bulk buyers such as school systems or hospitals. (Even Dannon's funded research on Immunitas' impact on immune function includes comparison to plain unpatented yogurt.)

Benchmarks also came up in the Red Hill Studios' talk on using the WiiMote as an interface. Red Hill is collaborating with the School of Nursing at UCSF on computer based feedback systems for rehabilitating Alzheimer and stroke patients. For the phase 2 grant application, they will demonstrate the value of their computer solution over traditional methods, looking at metrics such as patient compliance.

Open Sourcing or Sharing Work

This one came to me when I saw Playnormous' Food Fury anti-obesity, food choice game and then saw a student developed game at American University with a similar goal but a different style of play. Both employ Flash. Food Fury is a slot machine / Tetris type match game while the AU game is Space Invaders like. I thought gee, why can't someone catalogue these game archetypes and share the code so that others can quickly write new games? For example, if you don't like the embedded food selections, you could quickly substitute your own, or even use the same code for diseases or some other problem domain. Too many people are reinventing the wheel. With OOP and modules in ActionScript, code sharing and re-use should be easy.

This sentiment was echoed at the Immune Attack presentation. The developers at FAS were able to borrow interstitial animations of immune system processes from Harvard's The Inner Life of the Cell project. (Go Crimson!) Professional animations are expensive and pharmaceutical companies, who produce many of these, don't share. USC GamePipe Lab Director Michael Zyda chimed in that health game assets ought to be shared open source style between independent projects. He mentioned to me an example from his own projects on the value but political difficulties of getting work shared.

(To illustrate Jurvetson's point, will a future edition of Janeway's Immunobiology Interactive CD-ROM, contain a game developed without participation in the "games for health" community the same way the current animations were developed without participation in an "animations for health" community?)

Crosstalk

Related to work sharing is idea sharing. At the Immune Attack presentation, transplant surgeon Leslie Wong, MD lamented about meeting people from his own campus, University of Washington, for the first time at conferences. Zyda quipped, paraphrasing, if you want to meet people from campus in a given domain, you attend a conference in that domain. I asked if Wong had spoken to Zoran, the Fold-It guy, from UW, and of course hadn't. :-) (Zoran says Fold It is so popular that he needs to round robin multiple instances of the Drupal site. But he said this a few minutes before he checked his iphone and learned that the project had been mentioned in the Economist and then SlashDotted. (If they haven't, his students should reverse proxy the squid cache in front of the webservers. Remember to expire cache entries using the Drupal API hooks when content is changed or deleted! That's my contribution to Fold It! Until I install and play the beta.))

Colloquia are open to everybody on a campus , and one just has to look and make the time. But that’s just it. Back in normal life, one has a fixed role to play and the time to look around isn't scheduled. Attending a conference is the main way of breaking routine and carving out that time; and the people of shared interest are selected or self-selected for you. You may be married to a domain but it should be okay to look between conferences. At a conference, one should still strive to maintain a healthy tension between directed learning (or dissemination) and random discovery. A genetic algorithm won't find an optimal solution without random mutations and crossover events.

Mass Market for Health Applications

Fernandez gave a comprehensive overview of the Brain Fitness games market and it covers a lot so I won't go through the details here. Because neuroscience is exciting; many are afraid of age related cognitive decline; and Brain Age for the DS has demonstrated the interest, brain fitness is surely one of the big consumer markets for health games to come.

Perhaps better categorized as brain wellness than brain fitness is stress reduction.

Vyro Paul Kewene-Hite founder took a page out of Chip Heath's Made to Stick with an emotional introduction to the notion of technology aided stress reduction. He told the story of how alleviated the nightmares of a tormented child fighter in Africa with the music from his walkman headphones. Then came a short presentation on the important of stress reduction and the role Vyro's PIP, a bluetooth enabled skin resistance monitor, could play. They sought business partners to develop the market for the product. The presentation reminded me of BBC's Dragon's Den, all except for the absence of haughty VCs.

The ultimate stress reducing bluetooth device on the market today is the GPS receiver. I passed up investing in Garmin a few years back when it was in the dumps because I was so sure that bluetooth meant that people would prefer to compose their own GPS device from components, nuking the market for integrated devices. Being the iconoclast that I am, I installed TomTom on my Dell Axim PDA and hooked it up to my mail order GPS receiver. I loved then quickly hated this combination until I replaced the whole thing with an integrated TomTom device.

Are PIP's prospects better than a fraction of that for GPS bluetooth enabled receivers? At least in GPS, there is a clear platform, with bluetooth enabled PDAs running run of one of half a dozen mapping applications; and a demonstrated value, getting from A to B as quickly as possible. Also, the value from GPS receivers is largely extracted by one of small handful of GPS chipmakers such as SiRF. PIP is far simpler device. Their expected pricing is $50-$80 but with competition on this relatively simple technology, prices will drop and so will margins. What's to keep Nintendo from putting a little resistivity sensor on a future version of the WiiMote?

What is the killer app? The incumbent technology for stress reduction is meditation and yoga…

Sponsors of Health Games

The business side of commercial videos games is pretty simple -- it's just like books -- aside from the twists of advertising supported games. Because of the breadth of the games for health umbrella, health games get paid for in a multiplicity of ways.

At the most recent DC Games Gateway meeting, I commented on how Flash-based serious games would quickly be a must-have for any branded or themed website. Companies or non-profits would sponsor games for their PR campaigns. Slick flash games would redefine sticky. I mentioned this to the Playnormous President Jerald Reichstein, and he retorted that there would be serious serious games, ones that would educate users on complex health issues without being just eye candy. He mentioned the example of a project in the works contracted with The Abrahamson Center for the Future of Health to help patients of a prostate cancer navigate the thicket of different treatment options. Millions of patients could concretely benefit from this work yet they would probably not pay for it and only a foundation would step in to make it happen.

Another example is the government funded work done by Respiratory Epidemiologist Shawn Richards and her colleagues at the Indiana State Department of Health on the Public Health Staff Trainer (PHST) for pandemic influenza response. Shawn generously walked me through the program. An effective response to an instance of flu pandemic requires everyone in the public health chain to do their job. The chain of response and the duties entailed is pretty much the same in every public health system in America. Yet how do you train everyone uniformly and keep them sharp until the timing unpredictable but expected pandemic hits? The money comes from government grants and Shawn explained to me some of the challenges posed by the requirement to specify the changes to the software in funding requests before knowing what they are. If you look for the game on the open web, through google, you'd have a hard time finding it. The game is not a showpiece glitz game, but a real teaching tool for a course, one out of 3,000 courses in the Indiana Learning Management System. (I should point out that although the training game is developed by Indiana, it can be used to train roles in all states, as it contains state specific knowledge.)

Humana was one of the big industry sponsors of the event and it took me a while to wrap my mind around their participation in this subject. Their 2007 financials show $824 million earned on $25 billion in revenue. They are a big insurance company and not likely to directly benefit from any of their dollars expended on serious games initiative. The keynote discussion panel confirmed this. Developing games is not their expertise nor can they force games as treatment on anybody. But as a heavyweight, they can use a sliver of their budget to nurture and highlight important developments in healthcare. Giving a movement a name; gathering people to discuss it; and funding research lends legitimacy and encourages others to participate. Two of the projects they announced during the conference were the humanagames.com website and the results of the Horsepower Challenge for kids in Louisville, KY school system.