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Discussing Games for Health and Serious Games with Ben Sawyer

Games for Health LogoThe Games for Health Initiative and its annual Conference have been a driving force in promoting the use of video games in healthcare for half a decade. The organization has proven to be an invaluable asset to game developers and health industry researchers, allowing them to pool their knowledge, skills and resources. Game Forward had the opportunity to speak with Ben Sawyer, founder of the Games for Health Initiative, about the future of video games in healthcare.

The 2009 Games for Health Conference, which took place in Boston, MA, on June 11 and 12, was a genuine success. The event was practically sold out, with nearly 400 hundred participants attending over the two days. The event was an opportunity for many researchers to present their work to date and create new partnerships in developing promising new health tools. Read More...

“The amount of research-oriented content that was provided and the amount of community that emerged and the overall buzz that it generated, I think it was good,” said Sawyer in a phone interview. “We clearly saw people talking about collaborating and all of our goals in general were met.”

The organization was created in early 2004 after Ben Sawyer, working on the Serious Games Initiative, noticed the strong potential of medically-oriented games; a field which he felt could use a little more direction in order to grow.

“We were seeing some really cool things people were doing with health. One of them was a lot of this sort of virtual reality (VR) phobia stuff that existed where they were taking game engines and that was fascinating to me,” explained Sawyer. “It just didn’t seem like we were in an area of serious games that was going to get to its highest potential without further organizing and help.”

“There were already lots of educators meetings, there already are lots of military people meeting and there were lots of corporate learning people meeting about games, there weren’t a lot of health people meeting. There were some people meeting in the area of VR health, but they were mostly concerned with certain specific types of psychology or certain types of surgery training, because of the roots of the matter. And a lot them, while interested in game engines, were not very savvy about games themselves.”

“So it just seemed like the right area and I personally said that when something is that different it just caught my attention. And so we had some money available in our (Robert Wood Johnson Foundation) grant to explore some of these areas with deeper dives and so I said let’s do something on health.” And so, soon afterwards, the first Games for Health Conference was reality.

While each conference is an opportunity for researchers to share their work with others in the field, the impact of every event is sometimes only noticeable further down the road. “The real proof in the putting sometimes comes as long as two years later, when you find out that some project got started because two people met for the first time at our Conference,” explains Sawyer.

When asked about some of the most innovative new developments in healthcare games, Sawyer replied that in his eyes physical rehabilitation games had impressed him. “I saw a real emergence in physical therapy. I really think there is a much broader community looking at physical therapy and rehabilitation opportunities with games than before.”

But what the organization would like to see more of are games actively tackling nutrition, an area which has yet to be effectively addressed. “I haven’t really seen very good work in the area of nutrition. And if you look at the obesity epidemic, there is research that shows you can’t just exercise the population out of it, you have to change eating habits. (…) I would love to see a batch of really good games that help people rethink calories, rethink content of food,” said Sawyer.

During its off season, the Games for Health Initiative is hard at work reviewing literature demonstrating the advantages of healthcare games. While the organization used to compile examples of such games, they have recently realigned their attention on cataloguing others’ research in the field.

“Right now we sort of stopped doing (the cataloguing of games used in healthcare) for a little bit. What became a larger issue is what do we want to catalogue. Right now, there’s probably anywhere from 30 to 40 decent examples of research work or published games that seem to have some level (of success)… Other groups have catalogued as many as 400,” explains Sawyer. “One of the things that we’ve also been reticent to do is to put out a list past what we provide to people when they ask for examples because we start to get worried that it might imply some level of endorsement.”

Though the Initiative is prepared to endorse products that have proven their effectiveness, it prefers basing this decision on academic findings. “We endorse things where we can point to other people’s endorsement, like Dance Dance Revolution (DDR), here’s research or here is West Virginia’s use of DDR. I’m more concerned about that than whether someone has built a specific game about cooking, unless I can show that that game has been used in a way that clearly seems to work.”

In the meantime, another similar initiative, also sponsored by the Robert Wood Johnson Foundation, is promoting research aimed at determining some of the attributes of successful healthcare games. Health Games Research is investigating how individuals respond to games, in order to develop highly effective and beneficial ways to design and use games to improve health.

Health Games Research “was based after the first two years of our project. (The Foundation) really realized that the amount of evidence-based research needed to be higher, so if they’re going to invest more money besides with us, what else could they do to make a difference in ten years. So they decided, with input from ourselves and others, that launching some more research projects would be useful,” explains Sawyer.

“The first portfolio of research projects started last year and new portfolio research projects will be announced this year. The first portfolio will finish by the end of this year, the rest are staggered. As they finish, they’ll start sharing information through our Conference, through other means and the goal is that out of 20-25 projects funded some decent amount of them provide some ideas as to where things should go and what kind of psychologies and design practices elicit better responses. The ideas hopefully go into the next generation of games.”

While research demonstrating the power of games in the healthcare field is one step to ensuring greater legitimacy, other important changes are required to increase their use. Policy makers have a significant role to play in this process, but so do video game companies and the media.

“I’ve met with staff on Capitol Hill and if you were to show them someone playing a physical therapy game built with video game technology and you can show that patient getting better and you can eventually, not right this moment, but you can start to show adherence and compliance, that can eventually lead to lower costs, they have no problem understanding that. A lot of these staffers are our age and they get it,” emphasized Sawyer.

“You could start to get into issues of regulation as it relates to what things are medical devices and what aren’t (…) but honestly, that’s going to take some time. And then there are issues of reimbursement policy, in terms of the way health providers reimburse and what they reimburse for,” Sawyer points out. “And now we’re in the midst of major policy reform in the United States, likely that there is going to be some sort of health insurance plan passed through Congress and that may change all of these projections.”

For some of these innovative projects to take shape, investments are mandatory. “There are so many hurdles in all of this that it makes it hard for investment to happen. At the same time, there’s lots of great investment in exergaming because the path to the customer is really clear, no one’s in the way, someone walks in and buys it. The problem is that the health impact is not as measured. The health impact is a fraction of what the sales impact is.”

But in order to assist healthcare games in becoming validated tools, the most important step is ensuring public opinion is on their side. That is where media organizations and events like the Games for Health Conference come into play, by helping promote and shed light on examples of success.

“One of the things that we learned early on is to collect stories. People remember stories,” said Sawyer. “And while stories are sometimes counterintuitive (to scientific evidence) they tend to be the kinds of things that have an impact on people, that get them to understand it emotionally where they can then move forward with a more rational mind toward these types of things.”

“I am always enthused when I hear about a kid who’s played Re-Mission and says ‘this really did help me, it motivated me more, it made me realize more what I was facing as a cancer patient.’ Or when I read a story about a kid who came to our Conference a couple of years ago and he was clearly the profile of person they were able to reach in West Virginia through exergaming to finally start participating in gym class more aggressively. That to me speaks in ways that make it possible for people who don’t understand the personification of this to understand it. And I think what everyone can do is to look for these types of positive stories and collect them and repeat them.”

As the Conference organizers continue to forge ahead in their promotion of healthcare games, Ben Sawyer is hoping to bring further improvements to the event. The wheels are already in motion in preparation of next year’s edition of the Games for Health Conference.

“I tend to be one of those people who sort of nit-picks, so I’ve got a long laundry list of things I want to improve. A lot of them are more operationally oriented,” explains Sawyer. “A lot of it has to do with just improvement of content and looking to make the content reviews be even better than they were.”

As in its first years, the Conference will continue to promote partnerships and hopes to attract new players. “We’re looking to figure out ways to help certain specific communities network more. I think also we’re trying to figure out how to bring in more potential customers so that the economic activity attached to the Conference—at and post—goes up.”

“What we know that we want to improve the most next year would be the exhibit area, that was an area, we felt, that could have done better,” Sawyer believes. “I’d like to see of all a little bit more of a trade show atmosphere, in the sense that there are vendors getting economic activity, there are exhibits to see, above and beyond just going through the content.” But in the current economic times, Sawyer explains that there is a challenge in convincing exhibitors to invest the funds to get involved.

When Ben Sawyer is not busy working on Games for Health, he spends his time working on projects through his company. “Digitalmill is basically a corporate entity through which I do my work, along with people who help me. The short story is we spend 50 percent of our time on these outward facing community type projects, and then we spent the other 50 percent of our time working with customers who want to build projects.”

Through Digitalmill, Sawyer and his partners have built games for Cisco, hospitality companies, DARPA, as well as for other foundations working on educational games projects. “I spend about half of my time doing general consulting on video games and then the other half doing actual game design. I actually just finished a game design last week, that’s now going into production. It’s probably my first real health-oriented project.”

In the medium to long term, Sawyer has modest ambitions for Games for Health. “My hopes are to see the Conference rise to 500 or so attendees. If it gets more, I think that it’s because there’s been some breakthroughs and other types of things happening, more healthcare establishment coming in.”

Regardless, the organization and its Conference remain symbols of innovation and will continue to be a focal point for the promising healthcare advancements of tomorrow.