Although games for health constitute a significant step forward in improving the lives and well-being of a huge swathe of the population, gamification is not enough. Technology from video games can and should be leveraged in the wider health care industry to help specific people get better in specific ways; but it’s just one piece of the health care improvement puzzle.
Reflexion Health is a leader in what I’ve termed "health care through game tech" and we’re significantly different from the more familiar notion of “games for health.” How do I know? Well, I’m a lead engineer on a team that develops VERA™, Reflexion Health’s patient-facing telerehabilitation solution. This application uses motion tracking technology and is developed in Unity, a leading video game engine that I used frequently when I worked for a video game studio making traditional console and mobile games. When I started at Reflexion Health, I assumed I’d be helping to gamify physical rehabilitation. But I’ve slowly come to understand the important differences between “games for health” and what we do.
Games For Health
There are lots of offerings on the market that make getting healthy more fun. These cover a broad continuum, from games that augment your daily run by imagining that you’re running away from zombies, to full-on exercise systems that combine flight sims in VR with a workout routine. For my money, the most successful game for health in the medium’s young history is actually the ‘stealth health’ Pokemon Go, an application whose immense popularity and setting in the real world meant that millions of people walked further–sometimes much further–than they otherwise would have.
Reflexion Health appreciates the many benefits offered by games for health. But our approach is different. Our challenges are more diverse and broader than those encountered in the general games industry, which is one reason that doing this work is so appealing from an engineering perspective. What follow are a few of the most significant differences between VERA and games for health.
We’re Making Digital Medicine
I think it’s helpful to think about Reflexion Health’s work as being similar to pharmacists’: both are helping translate clinicians’ prescriptions into real-world therapeutic benefits. It is the careful attention of this translation from idealized prescription into realized and measurable benefit that marks one difference between Reflexion Health and games for health.
Video game makers generally want the maximum number of people possible to play and enjoy their game, while pharmacists work carefully to assure maximum benefit of prescribed therapy to a targeted population. One of the major differences, then, between games for health and Reflexion Health’s work, is that our technology is tailored for a targeted population. Our platform specifically incorporates engagement from highly-trained physical therapists and features an intuitive patient user interface that maximizes ease-of-use.
Additionally, as VERA helps patients recover function over time, it is essential to encourage, measure, and report patient engagement and objective performance of their progress. This focus on developing an ongoing relationship with specific patients, along with the framework it requires and the metrics it produces, are major differences from broadly-released, “fire-and-forget” games for health.
This Medicine Requires Hardware
Another difference between “game for health” and healthcare through game tech is the fact that VERA requires hardware for our software to run on. Because VERA is not meant for broad release, we customize who receives our software and what they’re getting, far more so than the maker of a game for health. It’s an amazing opportunity to build precisely the hardware that VERA needs and that best serves the patient, but it represents a whole slate of challenges that software-only applications don’t have to worry about. We need to employ experts in both computer performance and industrial design to make a platform that runs our app, is accessible, and is easy to use and understand.
For Everyone Who Uses It, It Has To Work
There are two challenges baked into this fairly straightforward statement and they’re both noteworthy. The first challenge concerns the assurance that the application works for injured patients; regardless of the state of their home, any assistive equipment they’re using, their comfort with technology, etc. Making a complex application accessible through these constraints is difficult but rewarding. In addition to making sure that nothing is broken in the patient experience, we also need to convince regulators that use of our application meets acceptable risk-tolerance for use in the target population. (We’ve been successful in this: VERA is an FDA-cleared medical device.) This regulation is completely appropriate, and I’m glad it’s there, but it requires more care and a higher bar to cross than a game for health.
We Need to Satisfy More than One Target Audience
Through most of this, I’ve focused on the difficulties of getting our app to satisfy patients. And it’s true - without satisfying patients we wouldn’t have a product. But it’s just as important to satisfy the clinicians who are helping those patients: our clinician-facing software needs to be clear, fast, and easy to use, or else clinicians won’t use it.
It’s also extremely important to satisfy those who are actually paying for our product. In order for VERA to deliver its full potential, it needs to clearly deliver value to the patient, provider and the payor. Dealing with all of these different perspectives adds yet another layer of complexity to our offering, as compared to a game for health.
Technology we’ve borrowed from video games has made our work on VERA possible. The joint tracking we leverage from motion tracking software and the game engine we’ve built our application upon were both requirements for us getting off the ground. But we’re achieving very different goals from a game for health, and consequently our application doesn’t look or feel very much like a game.
Although my initial assumptions about my job were wrong, the challenges I’m helping to overcome are so interesting and so varied that I’m much more satisfied making health care through game tech. More importantly, I know my team’s work is and will make a huge difference in the lives of patients around the world.
By Mark Barrett, Lead Software Engineer at Reflexion Health
Mark Barrett is the lead software engineer for Reflexion Health’s patient-facing Unity application. Prior to his work for Reflexion, he worked for an indie video game studio in New Zealand. He loves talking about source control solutions, working with the talented people at Reflexion Health, and his five-month-old daughter Tess.