mhealth Summit 2013 Using the Digital Tools of Play to Personalize the Health and Wellness Journey

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  • Can the digital tools of play help personalize the health and wellness journey?
    I am delighted to be back thanks to Ben, who like many of the gamers that I love puts his heart and soul into all of his work, including running the Games for the Health Conference.
    With mindfulness and gratitude, I want to start the story of my journey by thanking the 150 company teams that I have interviewed.
    For many years I was a practicing clinical dentist using behavior change techniques to help my fearful patients. I can still remember a few of these who would come to my waiting room with their shirts drenched in sweat before we even got started. What was I supposed to do?
    Later, when I worked on Wall Street, I affectively nicknamed the “Due Diligence Hound Dog.” I think this was a compliment. Those who know me, understand I just can’t stop myself from asking “Why?”
    So how does a dentist interested in behavior change and an analyst who can not stop asking why learn about mobile games in health?
    I started out meeting Debra Lieberman, Dr. Leslie Saxon at the Center for Body Computing and Ed Saxon her brother, who is an executive producer of Silence of the Lambs fame, I was convinced that the power of story would be part of the answer.
    My patients and even perfect strangers on airplanes tell me their life stories. Even on Southwest- in the middle seat there was a stranger who wanted to share his dreams of owning a yacht. He showed me pictures of big ones and little ones. He turned out to be Dick Wolfe of Law and Order fame.
  •  And so with the power of story in mind, My Ahh Ah moment in my original research is when I found an evolving ecosystem of experimenters trying to trigger behavior change across the disease spectrum.
    This slide summarizes my original research-done in 2010 Mobile Social Games for Health published by Mobihealthnews and published in 2011.
    As shown in this picture, we have companies using technologies in health and wellness, in the workplace in the form of social games, in brain health and in chronic disease management.
    This was the time of angry birds and farmville. Many folks thought that games would be a one size fits all quick fix.
    But reflecting my days as a practicing dentist, I always believed that these new tools would be just one element of a growing toolkit.
    A few quick definitions:
    Thinking about the Big Picture- Engagement is the first step Behavior Change/
    Behavior change is hard: how many times you have tried to change a habit that doesn’t stick, such as brushing and flossing daily or even just showing up at the dentist for regular cleanings.
    Thinking about the details: Tools in the toolkit include game mechanics and game elements to get us started and keep us going on a path to change. 
    Game Elements Motivate Behaviors
    Game elements trigger other natural human motivators, such as status, achievement, self-expression, competition and altruism.
    Game mechanics are elements that gamify an activity. These include points, levels, challenges, virtual goods, leaderboards, and donations, which act as rewards, playing to a natural human desire. As a practicing dentist who spent much time trying to get my patients to take care of their oral health, using game techniques with elements of positive reinforcement is a lot more xx than threatening is appealing.
    What about the power of story and social support via Dr. Saxon?
    In fact, it was listening to other people’s stories in weight watchers that helped me change my eating habits. When I was a chubby high school student studying Calculus in high school, I decided that I needed to go to Weight Watchers. As I studied, I loved to eat pie. Not just one piece, it was the whole pie- chocolate pudding with graham cracker.
    It is people’s stories in Alcoholics Anonymous that has worked offline for years.
    Imagine taking something that works like AA and making it better, by having your support network available 24/7 in your pocket. So you have One Recovery- began in addiction relapse- The CEO, Bruce Springer does a great job telling about their progress in a recent StrataRX panel “Community, Platforms and Data which you can find on my blog.
  • IF there is no one size fits all magic bullet and we can’t have the angry birds or Farmville of health. What does work?
    Engage, Personalize and Iterate, all united by a need to demonstrate effectiveness with some kind of evidence.
    First, capture people’s interest- engage them with the use of gaming elements such as reward, status, achievement, self- expression, competition and altruism. Putting game developers as part of the management team seems to help with this.
    The second is to personalize, giving people what they need at the time of need is crucial to keeping their limited attention.
    The third element is to iterate and experiment.
    Experimentation with incentives such as monetary rewards and prizes, gift certificates or
    experimentation with business models such as incentive based or fee for service
    as well as new types of peer to peer healthcare and other social support networks give power to the consumer.
    Since the original research was published there has been an explosion of innovation in this ecosystem- in particular in two areas where games have flourished:
    Corporate health and wellness and brain games
    Why now?
    Convergence of many factors
    Ease of entry
    Receptive end user markets
    Access to capital
    Societal shift toward health and wellness
    Societal shift toward health and wellness
    Mrs Obama’s healthy eating
    Celebrities such as Sanjay Gupta and Dr. Oz at CES
    More self insured employers are embracing health and wellness as part of a productive culture
  • One of the trends that is working- corporations are embracing games to spur employee wellness. As you can see in this slide there are Companies such as Shapeup, Limeaide, Keas, Redbrick and others
    What are social games in the workplace?
    Small teams, put together in the workplace can play social games which encourage teamwork, friendly competition.
    Accountability is an interesting motivator, because people feel obligated to participate so they do not let down their team members.
    Building upon basic human nature for competition, status and peer recognition, social games can help promote a positive collaborative culture and translate into increased overall productivity.
    A recent IMS study told us what we be thinking- although there are 96,000 apps very little in digital health is actually working. Let’s step back and examine where pockets of evidence are building: the first step for those who are using digital tools
    In corporate wellness - Shapeup- invested in research early on - 5 peer-reviewed articles in scientific journals - with more in the pipeline. Showing that using teammates and social competition can help increase physical activities and weight loss.
    Most interestingly, in terms of the big picture of applying to digital tools to existing evidence - In diabetes prevention- Omada’s Prevent, created a new digital program based upon the 2002 Diabetes Prevention Program known as DPP, in a 27-center study with over 3000 patients- they found that a modest weight loss of 5-7% could reduce type 2 diabetes by 58%.
    There are other examples in the bibliography and on my blog-
    All of the companies agree that their established evidence base has been invaluable as it has provided them instant credibility during their discussions with insurance companies and self-insured corporations.
  • One strand of evidence is adoption. Who is using these tools?
    I would have guessed that most of these apps were being used for diet and exercise and was surprised to find that according to a recent study by Parks and Associates,
    70% are being used for memory training.
  • The area of brain games is expanding to include brain fitness and fitness is expanding to include:
    Lumosity- captured the consumer market- now has the Human Cognition Project which mines the data of 40 M users with 780 M gameplays
    Brain Resource- which has a large database of standardized brain data, is considered to be one one of the largest vendor of brain health programs to corporate america and is now in clinical trials on depression.
  • We have seen an expansion of social games in the workplace and brain games but there is more This visual shows a further expansion of overall health and wellness.
    New areas of experimentation include: deeper connection between the mind/body and spirit in what I call cognitive health and wellness.
    Where I see a big picture opportunity to use the digital tools of play to help us channel our minds in 3 ways.
    Frist, To stay sharp- with brain games such as Lumosity and Brain Resource
    Second, To stay well using meditation tools such as Headspace or breathing tools such as Heartmath
    Third, to overcome illness using smoking cessation tools such as Lit to Quit, and medication adherence tools such as Mango Health
    Think about how powerful our digital tools of play can be to help us stay sharp, stay well and overcome illness and you will understand why I am excited about a few of the upcoming and company.
  • Up and comers include:
    Headspace- Which makes meditation, easy-to-learn, fun-to-do, and relevant to your everyday life.
    Mango Health using game design to help consumers mange their health - earn points for taking medications safely and on time. Points can be redeemed by major retailers such as Target or by making charity donations
    Lark -using elements of game mechanics and automated positive coaching (with custom algorithms) to make sleep tracking more fun- and they have the world’s largest sleep database.
    Akili Interactive-combining the best in neuroscience, with the best of video games to create a new kind of personalized cognitive activation, beginning in the area of executive function
    This is exciting for two reasons:
    First, it is a real game- where you have an avatar navigating down a water world that is filled with intrigue and mystique
    Second, it uses big data analytics to give real time cognitive performance.
    This brings us closer to a future where big data and cloud solutions will enable personalized brain and overall health.
    I’ve done a lot of research in on Big Data including a paper called “Big Data in Healthcare-Hype and Hope” and a StrataRx webinar and panel presentation.
    You can find these resources and others on my blog.
  • Whether you call it gaming, design, fun if you can’t get people interested you have lost the battle.
    In every story there is a heroine, so let me tell you about one of mine.
    Leave it to Esther Dyson to give us a story that will inspire all of us to think big.
    She is not satisfied with a few corporations promoting a culture of health and wellness. She wants cities and states to compete on health and wellness.
    In her HICCUP project- Health Intervention Coordinating Council, the group is encouraging cities to create wellness competitions between themselves to prove that health will pay off financially and save the healthcare system money the long run.
    Imagine a world where using the digital tools of play and other tools in the toolkit could get people engaged worldwide in creating a culture of health and wellness for the mind, body and spirit.
    I hope that we can all work together to get more people involved (create a culture) in health and wellness for the mind, body and spirit.


  • 1. Bonnie Feldman, DDS, MBA - Business Development for Digital Health | @DrBonnie360 |
  • 2. An Emerging Ecosystem
  • 3. Common Success Factors © 2013 - All rights reserved.
  • 4. An Evolving Ecosystem
  • 5. A Swell of Employee Wellness © 2013 - All rights reserved.
  • 6. © 2013 - All rights reserved.
  • 7. Who Uses These Tools? +70% Using tools/apps for memory training Source: Park Associates © 2013 - All rights reserved.
  • 8. Chasing Cognitive Health © 2013 - All rights reserved.
  • 9. 4 Trend Setters dfsjfjs They make meditation fun, easy to learn and relevant to everyday life. Using game design to help consumers manage their health Using elements of game mechanics and automated positive coaching Combining best in neuroscience with best in video games Earn points for taking meds safely and on time Have world’s largest sleep database Creating a new kind of cognitive activation © 2013 - All rights reserved.
  • 10. © 2013 - All rights reserved.
  • 11. © 2013 - All rights reserved.
  • 12. © 2013 - All rights reserved.
  • 13. +1.310.666.5312 Bonnie Feldman DDS, MBA Business Development for Digital Health @DrBonnie360
  • 14. Sources • Ellen Martin • Lumosity • Finn, M., & McDonald, S. (2010). Improvement in Sustained visual attention following Cognitive Training in a sample of older people with Mild Cognitive Impairment. Presented at the Australian Association of Gerontology Conference, Brisbane, Australia. • Gyurak, A., Ayduk, O., & Gross, J. B. (2010). Training executive functions: emotion regulation and affective consequences. Presented at the Determinants of Executive Function and Dysfunction Conference, Boulder, CO. • Hardy, J. & Scanlon, M. (2010). Analysis of cognitive performance in worldwide sample of over 200,000 people reveals new distinctions in age-related cognitive decline. Presented at the Society for Neuroscience Conference, San Diego, CA. • Hardy, J. L., Drescher, D., Sarkar, K., Kellett, G., & Scanlon, M. (2011). Enhancing visual attention and working memory with a web-based cognitive training program. Mensa Research Journal, 42(2), 13–20. • Kesler, S., Lacayo, N., & Booil, J. (2011). A pilot study of an online cognitive rehabilitation program for executive function skills in children with cancer-related brain injury. Brain Injury, 24(1), 101–112. • Kesler, S., SM Hosseini, C. Heckler, M. Janelsins, O. Palesh, K. Mustian, and G. Morrow. "Cognitive Training for Improving Executive Function in Chemotherapy - Treated Breast Cancer Survivors." National Center for Biotechnology Information. U.S. National Library of Medicine, 3 May 2013. Web. 30 May 2013. © 2013 - All rights reserved.
  • 15. Sources • Omada • "Diabetes Prevention Program (DPP)." National Diabetes Information Clearinghouse. US Department of Health and Human Services, n.d. Web. 30 May 2013. • Shape Up • Leahey, Tricia M., Melissa M. Crane, Angela Marinilli Pinto, Brad Weinberg, Rajiv Kumar, and Rena R. Wing. "Effect of Teammates on Changes in Physical Activity in a Statewide Campaign." National Institute of Health. Preventative Medicine, July 2010. Web. 30 May 2013. • Leahey, Tricia M., Rajiv Kumar, Brad M. Weinberg, and Rena R. Wing. "Teammates and Social Influence Affect Weight Loss Outcomes in a Team-Based Weight Loss Competition." Articles: Behaviour and Psychology. Nature Publishing Group, Jan. 2012. Web. 30 May 2013. • Wing, Rena R., Angela Marinilli Pinto, Melissa M. Crane, Rajiv Kumar, and Brad M. Weinberg. "A Statewide Intervention Reduces BMI in Adults: Shape Up Rhode Island Results." National Center for Biotechnology Information. U.S. National Library of Medicine, May 2009. Web. 30 May 2013. • Wing, Rena R., Melissa M. Crane, J. Graham Thomas, Rajiv Kumar, and Brad Weinberg. "Improving Weight Loss Outcomes of Community Interventions by Incorporating Behavioral Strategies." American Public Health Association -. N.p., 15 Mar. 2010. Web. 30 May 2013. © 2013 - All rights reserved.
  • 16. Sources • • • • • "mHealth Mobile technology poised to enable a new era in health care." E&Y 1 (2012): n. pag. E&Y. Web. 15 Nov. 2013. Stuart, Phil . "Why games should matter in the Health sector." Preloaded. N.p., 1 Oct. 2013. Web. 15 Nov. 2013. http :// Buffer. Kish, Leonard. "The Noise of mHealth: What WebMD’s Acquisition of Avado May Signal." HL7 Standards. N.p., 31 Oct. 2013. Web. 15 Nov. 2013. http ://!. "Clinical Management Apps: Creating Partnerships Between Providers and Patients." The Commonwealth Fund 30 (2013): 1-10. Print. Dan Ariely. (2009, May). Are we in control of our own decisions. dan_ariely_asks_are_we_in_control_of_our_own_decisions.html © 2013 - All rights reserved.
  • 17. Sources • • Bernstein , Carole. "How to Get People to LIve Healthier." UPHS. N.p., n.d. Web. 15 Nov. 2013. summer_2013_healthier.pdf. Dan Pink. (2010, April). Drive: The surprising truth about what motivates us. © 2013 - All rights reserved.