The ‘Gamification’ of Healthcare

The average 14-year-old boy spends 23 hours per week playing video games. Are there ways to put that predilection to educational use?

Wikipedia defines “gamification” as the use of game mechanics and game design techniques in non-game contexts. By making educational material more engaging and fun, games can be valuable teaching tools. For instance, simulation games such as SimCity allow students to see the impact of their choices on a civic ecosystem.

Last week I saw a great talk by Nancy Hanrahan, PhD, RN, an associate professor of nursing at the University of Pennsylvania, about her experience working with multidisciplinary student teams to create games and simulations. This year the Penn School of Nursing led a competition and gave prizes for the best healthcare-related “serious games” that help people with real tasks. Teams of students, faculty, and staff worked together to build new tools and applications.  “We have engineering, computer science and business students hungry for real-world experience, and we became the portal for that,” said Hanrahan, who was speaking at the Children’s Hospital of Philadelphia Center for Biomedical Informatics.

The 15 interdisciplinary teams focused on areas such as consumer-to-provider feedback and games that focus consumers’ attention with awards and connections to social networking to promote healthier lifestyles. They created games such as Trigger Buster, a smartphone asthma game that teaches children how to control asthma with inhalers and other mechanisms. Points are gained as time elapses without asthma trigger encounters. Another game is to help young people living with HIV improve adherence to care plans.

But perhaps the most interesting project Hanrahan described is a SimCity-like simulation to model the behavioral health system of the City of Philadelphia. She worked with Barry Silverman, a Penn engineering professor, to create agent-based models to capture the dynamics of the behavioral health system. The objective is to provide decision support for public health administrators who have few tools to compare the effectiveness of interventions and manage the complexity of systems.

Providing behavioral health care for the city’s seriously mentally ill costs $850 million annually, in part due to high hospital readmission rates of up to 30 percent. The simulation, called SUMHO (Simulating Urban Mental Health Operations), allows users to experiment with different government policies, organizational structures, and performance indicators to determine optimal designs for lowering readmission rates. A users’ goal is to develop a solution that reduces readmission rates, increases the overall health of the seriously mentally ill population and lowers costs.

“It allows users to assess the value of alternative interventions,” Hanrahan explained. Built on game theory, the simulation uses artificial intelligence to simulate interactions of 100,000 different “agents” within the system and allows policy makers to test hypotheses and consider and choose the most effective option among competing interventions. For instance, a user could study the cost and treatment success rate of various interventions such as a transitional care nurse intervention to reduce 100-day readmission rates.

Another project at the Hospital of the University of Pennsylvania will simulate the hospital’s approach to patients with congestive heart failure with the hope of lowering readmission rates.

Yet another simulation, called Healthy Cities, Healthy Women, is being redesigned to a 3D avatar-based game, is an education tool for healthcare providers who need exposure to what it is like to be a low-income, single parent in Philadelphia and the types of decisions they have to make. The game poses questions to the player: Do they work longer hours to make more money for food and medicine, or leave work early to get their child to a doctor’s appointment. Each decision has trade-offs and powerful ethical implications.

Getting back to the 14-year-old who spends three or four hours a day playing video games: It sounds like targeting them with apps that provide both health education and a fun experience is a difficult but very worthwhile activity. And simulations of complex health systems that allow researchers to study the potential impact of interventions sound even more valuable.