reframing patient engagement via design and games for communities to improve health / quality of life of elder populations

1. Games and User
Interface Design:
Thinking Differently to
Affect Elderly Quality of Life
Adriana Moscatelli President, Uiidea Design
Pete Wendel User Experience Manager, Walgreens

2. today
 why games and user interfaces (ui)
 what is a game and “gamification”
 what is a user interface
 what does it mean to design games & UIs
 how can this affect quality of life
 why this matters now

3. Why games and
user interface?

4. Indeed
…but how?

5. we live our lives across
physical and digital

6. Their distinction blurs
as we experience both
at the same time…

12. Play to regain movement
after stroke (Kinect)
Source: http://www.webpronews.com/kinect-is-being-used-to-prevent-old-people-from-falling-help-stroke-patients-regain-movement-2011-12

13. …for fun (Wii games)
http://easierlivingblog.com/2012/02/16/new-exercises-help-fight-off-dementia-in-elderly/
(this game helps fight off dementia)

14. What is a game?
A game is a form of play
with goals and structure.
Maroney, Kevin (2001). My Entire Waking Life. The Games Journal. Retrieved 2008-08-17

15. Games serve multiple purposes…

16. …games have rules, goals,
uncertainty, measurable
outcomes
Done right:
fun and meaningful play
(tip: focus on play not score)

17. …games provide
social engagement, serve
as a catalyst for story
telling and learning, and
help people find joy in play

18. Games
serve several different purposes
have direct benefits on health…

19. Health benefits of Games
Provide pain relief
Increase weight loss / overall fitness
Increase self-esteem
Increase learning / cognition
Improve social interaction skills
Reduce stress and depression
Improve/help maintain vision
Delay onset of dementia
Improve recovery from stroke
Improve decision making skills
Higher measured levels of happiness / well-being
http://theweek.com/article/index/241121/7-health-benefits-of-playing-video-games

20. Health benefits of Games:
Reframes existing activities & information:
Harry was just diagnosed as being
dangerously obese, has type 2
diabetes, high blood pressure and
a possible heart condition. He was
given papers, pamphlets,
brochures, a book, web sites, new
prescriptions, and all his doctor’s
and pharmacists paperwork. He
was told he has to pay close
attention to his numbers: weight,
cholesterol, blood pressure,
glucose…

21. Health benefits of Games:
Reframes existing activites
and information:
Harry was just diagnosed as being
dangerously obese, has type 2
diabetes, high blood pressure and
a possible heart condition. He was
given papers, pamphlets,
brochures, a book, web sites, new
perscriptions, and all his doctor’s
and pharmacists paperwork. He
was told he has to pay close
attention to his numbers: weight,
cholesterol, blood pressure,
glucose…
Eating
different
Menus,
Choices
Why?
Blood
Pressure
Heart
Rate
When to
track?
Why?
Glucose
Sugar
intake
Food
choices
Change
what?
Why?
Complex
When?
Why?
Exercise
Like
what?
When?
How?
Count
calories?

22. What’s your Glucose #?
Heart rate?
Cholesterol?
Blood pressure?
Caloric intake?

23. Health benefits of Games:
Goals give meaning to my numbers
Harry was just diagnosed as
being dangerously obese, has
type 2 diabetes, high blood
pressure…
His care coach asked him what
he most enjoys doing in life.
Spending time being active
with his grandkids.
Together, they create a
gameplan to get Harry from
where he was to where he
could do more of the things
that made him happy.
Play with
G. Kids

24. Health benefits of Games:
Give numbers meaning
Play with
G. Kids
Eating
different
Brisk
walks
Heart
rate
Blood
pressure
Glucose
Tracking
Eat this
not that
Plans &
alerts to
test
Control
here =
more
play time
walking
+ HR
goal
Post
walk
measure
Better
food =
more
energy

25. How do we apply games to
increase the overall health
and well being of people?

26. Gamification. (…what?)
Gamification is: The concept of applying game-
design thinking and techniques to non-game
applications to make them more fun and engaging.

27. Gamification is not:
the simple application of adding game
mechanics (e.g. adding badges, a leaderboard
and a competition to an event).

28. Gamification is really a verb:
A form of design thinking that looks at
the entire experience of interaction
between a person and an environment or system
with the goal of shaping that experience over time
in a way to make it more fun, playful, and
memorable.

29. Gamification: an example
Problem: obesity and
diabetes are often
intertwined with many
connected places, spaces
and things. What to do?

30. Start by:
Place people &
problems at center
& work solutions
from here
Needed Results:
new ideas,
collaborations &
solutions created with
the communities
they serve…

32. Value created with diverse audiences

33. Co-creation key to sustainable ideas

34. Fitwits: game as learning hybrid

35. touchpoints: things people use

36. Touchpoint Design =
User Interface Design
via Mirriam-Webster Dictionary
…what?

37. What is a User Interface?
Definition of
GRAPHICAL USER INTERFACE:
a computer program designed to allow a
computer user to interact easily with the
computer typically by making choices from
menus or groups of icons
Definition of INTERFACE
1: a surface forming a common boundary of two bodies, spaces, or phases
<an oil-water interface>
2 a : the place at which independent and often unrelated systems meet and act
on or communicate with each other<the man-machine interface>
b : the means by which interaction or communication is achieved at an interface
http://www.merriam-webster.com/dictionary/interface

38. This is a User Interface

39. This is a User Interface

40. This is a User Interface

41. This is a User Interface

42. This is a User Interface

43. This is a User Interface
Open a
window
Use a map

44. User Interface:
biggest impact?
It’s actually not the things
themselves, nor the interactions
with those things…

45. User Interfaces connect us to
services through things.
Biggest impact:
Products, places, & spaces are
gateways to services.

46. products = connection point to a set of services

47. ‘everyware’:
Becoming connected through devices to
communities of people and services…

48. ‘everyware’ User Interface
Shifts where/how we create value in healthcare and
business models with connected systems:

49. Implications:
How does this affect us?

50. Metaphors change for how we relate
to each other, the services we use,
and the places and spaces we
inhabit; our perspective shifts…
physical & digital

51. We make/use them……
They make/use us via our behavior, time,
language, metaphors, tools…
Implications: tools / touchpoints

52. Implications: new approaches needed

53. how design of games and user
interfaces can affect quality of life:
Services are intangible and unfold
through time
Products and things in our environment are
now interconnected services
Designers, such as game and interaction
designers, see and think differently about
services, making them tangible:
• Create maps to see services as wholes
• Create systems which evolve over time
Connect & empower

54. Designing with
(connected) games and
UI’s in mind helps to
move the focus from
point of service to
patient engagement…

55. Why this matters
Healthcare is broken. “Healthcare is broken. ... We have set up a delivery
system that is fragmented, unsafe, not patient-
centered, full of waste, and unreliable. Despite the
best efforts of the workforce, we built it wrong. It
isn't built for modern times." *
* Dr. Donald Berwick (who oversaw Medicare & Medicaid) as quoted by Richard Anderson at
http://riander.blogspot.com/
* from Health Services Research publications by Judith Hibbard, et al. such as http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC1955271/
We need results that help people
(we vs. me / with vs. for)
Results show improved behaviors follow on increased
activation** (a measure of engagement)

56. Why this matters now:
Patient Engagement:
We can’t “motivate behavior change”—instead, we
facilitate behavior change.
** from Dr BJ Fogg, Director of Persuasive Tech Lab at Stanford University, as presented at
Healthcare Experience Design conference on March 27, 2012

57. Why this matters now:
Engagement with what?
With one’s self, first and foremost
Healthcare systems need
to treat the whole self,
across all life contexts
We have to reach and engage people wherever they are, whenever they act
Digital channels are
key cost-effective
modern ways to
extend the reach of
care delivery systems

58. Why this matters now:
New business models being explored and encouraged
by government regulation
Moving from fee-for-(face-to-face)-service to fee for
quality-outcomes demands greater efficiency at scale *
* Value Based Purchasing incentive payments and HCAHPS scores
http://www.betterpatientengagement.com/2012/07/15/patient-experience-vs-patient-engagement/
** Noreen Clark, director of the Center for Managing Chronic Disease at the University of Michigan, as
quoted in “The Simple Idea That Is Transforming Health Care”
http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html
“Quality of life happens to be the element that is most
import in motivating people to deal with an illness." **
ROI > ROB
to get this you need
return on behavior

59. business models
must evolve from
systems of records
and transactions to
systems of
engagement
Why this matters now:
http://www.dachisgroup.com/2011/06/movingbeyond-
systems-of-record-to-systems-of-engagement/

60. Walgreens example system of
engagement (a start):
Steps with Balance Rewards
(was Walk with Walgreens)
• Earn rewards for healthy behaviors
• Set goals and track progress
• Share and collaborate with others in
local community
Over 420K members in 5 months
Goals set: 560k
Miles (walk/run) logged: 18 M
2-3% of all Walgreens.com traffic
~20% using digital health devices to
autosend their steps / activity info
Currently: 1.3M+ members
60% engagement rate
20+% autolog via digital devices
2nd most freq used mobile feature
3-5% of all Walgreens site traffic
…spend more time/$ than our
highest-value customer segments

61. Now: think different
Ecosystems: connect services through things
Ethics: no such thing a neutral design
Empowerment & Engagement: with people
Visible things + Invisible ‘everyware’

62. Result: improve quality of life
Use This Recipe:
Empower people and communities
with tools they can use to co-create
solutions together
Take a wholistic view across time
and touchpoints
Start with people and problems
at the center and work outwards

63. Harry: What if…
…Harry could be helped even
more effectively by engaging
the people and places within
his community?
…Harry had an opportunity to
learn from and with others
who’ve walked in his shoes?
…Harry wasn’t the only one at
risk? Perhaps his 8 year old
grandaughter is?
…then how would Harry feel
about the people and places in
his community?

64. What better time than now?
Your call to action:
start creating
engagement ecosystems
What better place than here?