My article on healthcare gaming in India Kapil Khandelwal QuoteUnquote with KK www.kapilkhandelwal.com

1. Vol.3 No.1 October - December 2009 Rs. 150
Cover Story
Electromyography
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Wheelchairs
and its judicious use
Cone Beam CT in
Dentistry
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Robotic Surgery in
Urologic Practice
Interview
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With l Interviews l Hospital Updates l Product Updates & more

2. Publisher’s note
To suit today’s life, newer technologies and
methodologies have emerged. Technology,
globalization and the changing perception of
pathology and laboratory medicine are major
trends which produce a great impact on the
medical profession.
T he quality of patient care is greatly influenced by the efficient management and
availability of accurate information. Medical informatics has originated in order to
provide better patient care, effective medical education and research. Radiation oncology
presently deals with plenty of information including diagnosis, complex treatment
planning, accurate dose calculations, and complicated treatment delivery system. Hence, a
comprehensive information management scheme has become a prerequisite for the storage
and retrieval of the enormous information for precise treatment in radiation oncology.
Dr Abhijit Mandal, in his article on “Medical Informatics for Radiation Oncology” has
stressed on different aspects of role of medical informatics in radiation Oncology.
Dr Rajiv Yadav, in his article on “Robotic Surgery in Urologic Practice”, highlights the
advancement of laparoscopic surgery to newer heights through the integration of
computer-enhanced technology with the surgeon’s expertise, the da Vinci Surgical robotic
System. This technology has been extensively used in Urology in the treatment of various
cancers and non cancerous conditions such as prostate cancer, bladder and kidney cancer,
narrowing in the urinary tract etc.
In the article “Usability of User Manuals with Medical Devices”, the author, Ganesh Bhutkar
focuses on usability issues with usage and design of user manuals of medical devices.
The author has depicted the response of the user regarding the usability issues with user
manuals.
You may be surprised to know that gaming can be a health assessment device. There
are several different online entertainment networks and technology platforms available
for Health Gaming. An interesting article by Kapil Khandelwal on “Health Gaming”
emphasizes the role of health gaming in assessing the health status.
Sachdev Yadav, in his article on “Pharmacy Automation: The Time to Automate Has Never
Been Better” discusses about the need of automation, benefits of automated pharmacy
systems and regarding facilitation of new stand-alone systems which enhances patient
safety and care; the quality of life for your pharmacists and technicians and accelerates the
number of prescriptions that one fills in a day.
Hoping this issue further enlightens our readers regarding the advancements in the field
of health care.
Please do send me your comments at pravita@charypublications.in
Pravita Iyer
Publisher
2 Oct-Dec 2009 Medical Equipment & Automation

3. Health Device
Health
GAMING
emember PacMan? that this health games segment
Can you believe that
gaming can be a
R There was a time when
it was the hottest game
around when I was
a kid, and it got better when
colour screens came around
is going to be 3 times larger
than the health and wellness
segment globally. Would
you touch a game today that
doesn’t have the best available
health assessment with the computer. There were graphics, sound and gameplay
device? There are actually colour dots that had and that could also influence
several different online to be gobbled! That was 1988. your health outcomes?
Today, games have grown from
entertainment networks being a mere pastime. They With the emergence of
and technology are converging with health online entertainment networks,
industry in providing solutions shouldn’t you also be able to
platforms available and engaging, entertaining, play it online with your buddies?
for Health Gaming. are ‘networked’, ‘electronic’ What about improvements?
Numerous games can and ‘effective’ in managing The publisher must release
consumers health conditions moods (with or without hot
help to ascertain the and outcomes. What’s more, coffee!) periodically to keep
health status. they constitute an industry the enthusiasts going… yes,
that commands respect and is gaming has become more
often seen in awe for what it complicated than the simple
has achieved. It is estimated PacMan.
80 Oct-Dec 2009 Medical Equipment & Automation

4. Health Device
This article provides more Different Games for Health solution that combines
insights and details into Status a Nike shoe wirelessly
the converging segment of connected to an iPod Nano
gaming as a health device. There is growing evidence of with an application designed
The ideas here would provide clinical effectiveness of health to log, monitor and manage
cues to consumer health games for managing conditions a user’s running activities.
devices, mobile phones, game like cancer, diabetics, asthma, These are now linked to
consoles, other networked cystic fibrosis, among others. the social media and online
device designers on what
to expect from emerging
healthcare consumerism in
India.
Different Online
Entertainment Networks
and Technology
Platforms for Health
Gaming
In India, most consumers still
play games online or download
games from the web. Mobile
phone games, is the fastest
growing segment as the
number of mobile subscribers
are soon going to cross over
half billion although from a Fig.1
very small base.
As clinical evidence of the entertainment networks
With the 3G introduction impact of gaming on health where over 1 million users
in India, entertainment conditions is gaining ground, are tracking, challenging
networking platform is likely to there are newer categories each other and improving
experience even accelerated of games and content being health outcomes using
growth as wireless internet produced for different health these devices.
access on mobile phones status as is summarised in
devices becomes more the diagram. In India, we are • Brain Fitness Games: These
common, combined with ever- still waiting for content these are games that help exercise
faster download speeds. CD segments with local relevance and improve various
and other desktop computer- to be produced. However cognitive functions including
based and games console the potential for each of the attention, memory, visual/
such as Sony Playstation, segments is immense. spatial processing, auditory
Microsoft Xbox, and Nintendo processes and language,
Wii make up the rest of the • Exergames: These are motor coordination and
market. We are seeing games games that require physical executive functions like
on special devices such as activity. They include games planning and problem
Apple Ipod Nano, exergaming that motivate exercise solving. Soduko and other
equipment and cable set-top through game-play and such games fall into this
boxes in the market. These virtual coaching, such as category.
product segments are still Nintendo s Wii and Wii Fit
very small and insignificant for home use. Recently, • Healthy Eating Games:
in size when compared to the Nike and Apple iPod have We are a fairly diverse
mobile phone game segment. collaborated to create a population with food
Medical Equipment & Automation Oct-Dec 2009 81

5. Health Device
habits and customs. The be used to train surgeons, the gaming industry, newer
knowledge of regional diets allowing them to practice gadgets and games segments
and nutrition and behaviors on virtual body tissue and are expected to emerge.
to modify diet, nutrition and get the same feedback
weight management is fairly they would experience in Different Models of Health
limited. However there are performing a real operation. Gaming and Health
games which are targeted In the US, Nobel Biocare, 2.0 and Entertainment
at this segment to help a dental implant company, Networking Platform
them make smart nutritional has provided $65 million in Technologies
choices. These games are
typically offered online for
free and are sponsored by
health care companies,
government agencies or
consumer product good
companies who are trying
to promote their products
in association with healthy
eating.
• Condition Management
Games: Several acute and
chronic disease conditions
are being targeted after
clinical research to provide
educational information
about the condition and
treatment methods to Fig.2
improve adherence to
doctor’s treatment plan grant money to the Medical Search engines, wikis,
through the games. In the College of Georgia to blogs, video, RSS feeds
USA, most of these games develop training games and and online communities
are being developed by simulations for classrooms are empowering, engaging
health insurance payers, and clinics around the world. and educating healthcare
NGOs or from government consumers and providers.
grants. The emerging Health 2.0 web
• Therapy Games: As technologies that use social
• Professional Training our research and media software and its ability to
Games: As game technology understanding of the promote collaboration between
is becoming more and health outcomes through patients, their caregivers,
more realistic, these are games is increasing, there doctors and other stakeholders
being applied for training are newer games that are in health are converging with
healthcare professionals to helping patients to combat the health games. The emerging
focus on decision-making pain, deal with physical health gaming entertainment
and risk mitigation. Many and mental trauma and networking platform has
soldiers, pilots, doctors create a positive image in multiple stakeholders who
and nurses, surgeons are dealing with conditions like would like to monetise the out
now being provided with cancer, etc in India. of pocket consumer spend in
gaming simulations as India.
part of their professional In the future as the social
training. An example of a media and entertainment Top down the model would
virtual reality game can networking converges with look as follows: It is still early
82 Oct-Dec 2009 Medical Equipment & Automation

6. Health Device
to provide a measurable console. Who will change • What solutions would be
impact for any of the emerging this? Where will the value best for the mass markets
business models in this sector. be created and captured in and niche segments?
However for the health games the next generation of the Are video games the right
to gain widespread adoption health games market in India approach to addressing youth
with providers and carriers, on the 3G enabled mobile wellness, obesity and sedentary
clinical research will need phones? Like mobile telephony lifestyles? While games like the
to demonstrate significant radically transformed the voice Ninetendo Wii are healthier
improvements in health communications market in India than video games, do these
promotion and cost reduction and demonstrated a business games really approach the
relative to existing solutions. model for replication in other health benefits of actual sports
emerging markets, do we and outdoor recreation? How
While several dozen research expect to see start-up ventures supportive will the Indian
studies are currently underway as we did for the ICT sector? medical fraternity be with the
in the US leadership from the Will this be part of the health emerging clinical research to
RWJF, Cornell University, UC ICT or health or entertainment endorse this segment?
San Diego School of Medicine, networking sector? If so, which
University of Florida, University product categories are the • How do we enable the
of Washington School of most attractive in the near- industry in India to be
Medicine, Baylor College of term? globally competitive?
Medicine, among others. In India demonstrated its might
India, industry bodies like • What are the market of a globally competitive ICT
Nasscom, etc is still to wake up participants likely to do? industry. Some of the issues to
to the potential that emerging With over 1 percent of India’s be addressed are:
and fast converging sector GDP being spent out of pocket
offers. by the consumers on health, Large talent supply:
games, mobiles, mobile and The local industry is facing
Directions for the Future internet connectivity, cable TV is the severe shortage of
Health Gaming Models subscription, what strategies trained manpower. Nasscom
of Business in India can we expect from the 3000 has projected that there will be
odd large players with regards a requirement of close to over
While the sector is emerging to segment? Will Apple, Nokia, 10,000 engineers and product
and has potential, there are Sony, Microsoft and others developers for export and
several key issues that need follow Nintendo’s lead in India? domestic market in the medium
to be addressed as part of the If so, will they enter the Indian term.
emerging business models in market with innovative products
India. at attractive prices? What are Localization of games/
• Who will dominate? the opportunities and risks to content:
To date, the game console these companies in integrating In order to better address
players such as Sony, Nintendo, healthy messages into games the gaming needs of the
Microsoft have been the which have been traditionally target audience the games,
only companies in the health about pure entertainment? Are consoles, phones, devices
game market that have been carriers like Airtel, Vodaphone, need to be customised for local
clear winners, commercially Reliance, Tata throw their might market needs and clinically
speaking. However they have with value added services in proven. Though most of the
only about penetrated the high the face of declining ARPU or development work is being
end urban segment in India. would the entertainment giants done for overseas market,
We have a huge latent mobile like Zee, Sun, Tata Sky want to however, in future the focus
phone consumer population win their cable audience over would shift to the domestic
with smart mobile phone that with value added service in the market.
could well turn in to a gaming consumer drawing room?
Medical Equipment & Automation Oct-Dec 2009 83

7. Health Device
Currently several Indian This is all the more and patient care support
companies are starting to important because the core regime.
focus on customizing content gaming segment users do
for the Indian market using not want to use their cards. On the other hand, pharma,
local themes, icons & games. One of the initiatives being devices, health foods and
It would also include spicing- experimented with is pre- nutrition and other products
up the available international paid gaming cards with companies would like to
content/ idea to appeal to a mobile phone pre-paid develop viable direct-to-
larger audience. However, charge. These cards would consumer business models for
we have great Oscar famous enable both subscriptions monetizing games that assist
‘Lagaan’ historical content for the gaming service and with everything from product
and mythological and purchase game add-ons. usage to disease management.
political icons that can be Are in-game advertising or
monetised for mass markets. How will healthcare sponsorship models plausible
services and other product for these product companies?
Main Stream Advertising companies partner in this Can health games attain the
and Right Messaging sector? scale and installed user base
To b u i l d d e m a n d , m a i n to attract significant advertising
stream advertising may The health insurance and sponsorship money from
be required for the mass sector will have to these companies in India?
markets. However issues eventually come out with
around health such as how differentiated products for It is still early days for our
should health literacy and different segments of Indian PacMan avatar in India to turn
support be best delivered population are likely to adopt into a health, entertainment
in video games? In what health gaming into their platform for the masses to
situations should health toolkit of patient education manage their health outcomes
messages be overt and and marketing support. positively!
primary? In what situations
should health messages be Some of the healthcare
stealth? In what situations services would need to
should a game not contain plan to integrate health
any health message, but game capabilities into
rather be used as incentive their corporate wellness
for healthy behaviour such and disease management
as testing blood glucose solutions. It would be relevant
levels or exercising? to demonstrate in terms of
What can we learn from clinical effectiveness and
international markets and user experience to become an
the growing evidence and integral element of wellness
experience base?
Enabling payment
mechanisms Kapil Khandelwal is an independent board member on several
Recognizing that the low healthcare and ICT organisations and a leading healthcare and
information communication technology (ICT) expert in Asia
penetration of credit cards &
Pacific and Emerging Markets.
debit cards can be a potential
bottleneck, can products and
service providers partner
with mobile phone service
providers to take an initiative Kapil Khandelwal
in enabling online payment
though their platforms.
84 Oct-Dec 2009 Medical Equipment & Automation