Developing New Patient Engagement Drugs

At a 20,000 foot warehouse-style, open loft above a dance club in SOMA, San Francisco, September 28th and 29th (with the floor shaking from the beats below between 10 p.m. and 4 a.m.), over 100 innovators gathered to build new solutions to enable patient empowerment in healthcare with technology.

YetiZenThe space, a game development accelerator and co-working space called YetiZen, is normally inhabited by game designers focused “on game studio and platforms startups.”

The event, the Health 2.0 code-a-thon, was a lead-up to the main Health 2.0 Fall Conference in nearby Santa Clara that kicked off the following Monday, Sept. 30. In my last post I talked about the need for creation spaces, and the code-a-thon at YetiZen was a prime example of both real-life and virtual creation spaces coming together to develop new solutions.

Perhaps not immediately obvious, a gaming collaboration space is incredibly appropriate for a healthcare code-a-thon for a couple of reasons. First, what code-a-thon does is create a game out of innovation, and that’s a key part of why they work, people like to compete and develop mastery in a social setting. The second reason is that game designers are experts at motivating decisions and behavior. Ultimately, motivating and enabling decisions and behavior are what any healthcare program or app will need to do in a value-based care system.

If engagement is a blockbuster drug in healthcare, spaces and events like the Yetizen and the Health 2.0 code-a-thon are the research laboratories where new engagement “drugs” will be developed.

Why Code-a-Thons Work

Hackathons and code-a-thons may seem peculiar for non-hackers out there: spend your weekend in a room with a bunch of strangers, working for nothing on a project that may go nowhere. You won’t get enough sleep on any on your precious days of “rest” away from your day job, and you probably won’t be as hygienic as you might like to be by the weekend’s end (nor will any of the strangers).

Still, it may not seem that strange to see kids and young adults up playing online games until the wee hours of the morning when a new, epic game comes out.

And that, I think, is a key point. Code-a-thons are the gamification of product development, played out over a weekend by a not-so-massive, open and real-world group of people. People play, learn and get to know each other over problems that matter with a chance for recognition for their efforts, live and in person.

For sponsors, they’re often looking for validation and new ideas. Joy’s Law is the principle that “No matter who you are, most of the smartest people work for someone else,” attributed to Sun Microsystems co-founder Bill Joy. Code-a-thons are one way to inspire and even capture new ideas from some of those smart people.

Validic, a sponsor of Health 2.0, provided a single API coders could write code against to integrate data from wellness tracking tools like Fitbit or Withings. They provide resources because they want feedback from real developers so they can support their customers and ensure ease of use (reports seemed to be resoundingly positive for Validic’s ability to easily connect to a multitude of devices and sensors).

Why Code-a-Thons and Other Games Matter in Healthcare

In healthcare, there are many lessons to be learned from game designers. They are engagement experts, and they are doing the leading engagement research at the interface between humans and machines. At the end of the day, no health tools and technologies do any good if they don’t offer an opportunity for both patient and physician to engage and foster behavior change. Fitbit, Whitings and many other consumer products that measure stuff about our activity and behavior won’t last if they can’t show that they influence what people do and what decisions they make. They can’t just measure, they must influence.

All of us in healthcare need to become expert game designers, we all need to figure out how to drive engagement and influence behavior in conjunction with patient goals.

Successful games, successful engagement

At the Health 2.0 Fall Conference later in the week I had a chance to sit in on a panel on games and behavior change that really crystalized this notion. Among many great presenters, the last one was Michael Fergusson, CEO and Founder of Ayogo Games. Fergusson and his team had done research on what makes an effective, addictive game that keeps people coming back and playing. Here are their components of a great game:

  1. A compelling narrative. People get absorbed into stories, and good designers have to write good stories that pull people along. Stories that compel us to find out how it ends.
  2. Continuously providing a sense of mastery or expertise. The little bit of dopamine we get from accomplishing something is a potent motivator. These have to be metered out at levels that are neither too difficult nor too easy. We and our reward systems all enjoy a good challenge.
  3. Social influences and communications. In “Predictably Irrational,” author Dan Ariely discusses what makes email and Twitter so addictive. Part of the addiction is the slot-machine type reinforcement. We never know when something important may be coming. The other part is the social aspect. We like talking, communicating and comparing ourselves against others anywhere on the phone, on Facebook, but in games as well. Massively Multiplayer Online Role Playing Games MMORPGs are “MM” because they offer a social environment worldwide, and they are wildly successful. Close to 100 billion hours have been logged on World of Warcraft. That’s engagement.

So what makes a code-a-thon successful in terms of gaming? Let’s take a look at the narrative, mastery, and social aspects to see what works.

Let’s look at some of the skills we’ll need to understand in the context of the code-a-thon itself.

The Narrative

For successful apps, patient goals could be thought of as the narrative trajectory, with the data collected as the elements that come together to tell the story. Data, used wisely, can be a universal storyteller. It’s no wonder that UX designers often talk about the “user story.”

The tracks served as the narrative for the code-a-thon and the projects that were developed, aligning user goals and use cases and user stories. The most successful projects were those that dove into these stories:

  • Track 1: BlueButton and Patient Generated Health Data: crossing the chasm between consumer devices for wellness and the rest of the healthcare system.
  • Track 2: Exploring New Types of Data: Redesigning the Explanation of Benefits

We all care about care, but it the app also has to be something we know people will use and that will help someone’s health in one form or another.

Apps for tracking behavior, sharing information with providers, and making smart insurance decisions were well framed by the opening of the health insurance exchanges last week, where thousands if not millions of people were making those exact same decisions. Solutions for helping consumer make decisions on the insurance exchanges were key themes of the Health 2.0 Conference, so we know that these are important problems to solve for important reasons.

Progressive Mastery

Validic is working to develop a type of progressive mastery of its products that will, in turn, create more customers.

Meanwhile, in developing new products and getting feedback from others throughout the week, those who participate in the code-a-thon benefit from progressive mastery, with winning being the ultimate prize.

Patients, too, will benefit from progressive mastery. Diabetes is a long slog of intermittent fear and loathing of the disease. Progressive mastery could help many types of chronic disease patients begin to feel they are the masters rather than the servants of their illness.

According to Game Designer Jane McGonigal in her great book Reality is Broken, “Satisfying work always starts with two things: a clear goal and actionable next steps toward achieving that call.” McGonigal goes on to say that “Having a clear goal motivates us to act: we know what we’re supposed to do.” (This sounds a lot like what BJ Fogg calls “motivation and ability”.)

Knowing what to do next is key for every patient out there that is constantly Googling or looking to online advice and communities looking for answers. Health care applications that can turn hard, confusing slogs into satisfying work will do well.

Social Interaction

Meeting and working with others might be a greater prize than than any reward money. There’s a reason it’s a code-a-thon and not a developer challenge, the goal is to work with and near your competition, to learn from them and to learn what it’s like to work together and share new ideas and abilities.

Meeting great people that share your passions and have real influence helps as well.

For this event, Health 2.0 did a great job of bringing out influencers. There was a treasure-trove of renowned experts in healthcare and innovation to do judging, including:

  • Rebecca Mitchell Coelius, MD, Medical Officer for Innovation, HHS
  • Lenny Lesser, MD, Assistant Research Professor, Palo Alto Medical Foundation
  • James Gilbert, Director, Platform and Application Development, Optum Cloud Services at UnitedHealth Group
  • Zac Jiwa, Innovation Fellow, Department of Health and Human Services
  • Stacey Chang, Director, Healthcare, IDEO
  • Ward Detwiler, Project Manager, Henry Ford Innovation Institute
  • Drew Schiller, Chief Technology Officer, Validic
  • Jean-Luc Neptune, MD, Senior Vice President, Health 2.0

As I wrote in my last post, communities form when sharing and trust are enabled around shared resources, and prize money is perhaps one potentially shared resource that brings people to the competition. It’s not necessarily enough to compensate a team of six to win $3,000 for a weekend’s worth of their time, but it’s enough to make it interesting. Over $10,000 in prizes was offered over the tracks supported by sponsors the ONC and Optum.

Perhaps the greatest prize and motivation was for the winning team to present their project to a large audience. Team Edge Interns got the chance to present in front of a thousand or more at the Health 2.0 Fall Conference.

Congrats to them on an app to help psychology patients with “Mind Mentor.” It was truly inspiring, and for a “behavioral app” to screen for disorders, then give patients a nice visual for symptoms, a physician dashboard, and integration with Validic-integrated devices like Fitbit and Withings to track what works for them. I am betting we may see a lot more of this. This was a behavioral app, I might add, that incorporated narrative, mastery and social communication for behavior change.

Here’s a video created by the winning team about their experience:

So, putting on a code-a-thon, like a good app, requires a bit of gamification and good design, using narrative, mastery, and communication. Money doesn’t hurt, but it’s more about the experience. We can learn a lot from game design, particularly healthcare and patient engagement.

Code-a-thons and shared creative spaces may be the basic research labs of consumer engagement “drugs.” It would be great to match them with the burgeoning health and wellness communities to get a better handle on the dose-response of engagement pills. We at VivaPhi will continue to explore the intersection of games, networks, communities, creation spaces and health care.  We strongly believe this this is the new way to do basic science in health care.

If you’re interested in this topic, I highly recommend game designer Jane McGonnigal’s book “Reality is Broken” as well as “Total Engagement” by Byron Reeves and J. Leighton Reed. Great books if you want to learn how to build engaging experiences for patients, customers or just about anyone.

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Leonard is Principal and Co-Founder at VivaPhi, an agency that solves multi-disciplinary business problems involving data science, software, biomedical science, behavioral science, health care, product design, community development, marketing, consumer engagement and organizational design. He has been quoted in Forbes and other top-tier publications for thought leadership on patient and consumer engagement. In addition to his role at VivaPhi, he is Chair of the Marketing and Communications Group for the Collaborative Health Consortium. Prior to VivaPhi he held the position of Vice President of Operations at Capitis Healthcare International as well as executive positions with several startups. He started his career as a software requirements analyst on Qwest Communication’s highest priority IT project while earning a triad of advanced degrees from the University of Colorado. These included an MBA, a Master’s of Science in Information Systems and a Master’s in Biomedical Sciences (Thesis on System Dynamics in Parkinson’s Disease). Leonard earned a Bachelor’s in Zoology from Miami University in Oxford, Ohio. He’s interested in how systems evolve, and how to help them evolve, in a variety of unique contexts. Connect with Leonard: @leonardkish, LinkedIn and Google+

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