Tuesday, July 10, 2012

ONC looks to grow the power of health gaming

BOSTON – At Games for Health 2012 on Thursday – amid talk of virtual worlds, avatars, Kinect sensors, biomechanics, social media crowdsourcing and exergaming – a policymaker from the Office of the National Coordinator for Health IT said that gaming is "on the radar of the federal government."

Games for Health, currently in its eighth year, is a different kind of health IT conference. Many speakers kicked off their talks with a slide showing "what I'm playing" – games that ranged from old-school Nintendo titles to mobile apps such as Words with Friends to multiplayer online games to Xbox dancing and kickboxing simulations. 

"I play a new game every day – like, as a policy," said Peter Smith, who researches immersive learning technologies at Joint ADL Co-Lab in Orlando.

Erin Poetter, from the ONC's department of Consumer e-Health/Innovations, also spends a lot of time thinking about policy.

In her presentation, "Adding Play to Our Toolbox: HHS & Games," she explained how, at ONC, "we see games a part of a larger initiative."

With their "miraculous ability to take complex data and make it actionable and meaningful," games are the perfect tool to help ONC expand its focus to engage consumers, said Poetter.

With just 10 to 20 percent of health outcomes determined by what happens in the healthcare system, it's important to do whatever's possible to improve wellness outside of the doc office walls. "Better engagement in health can make a real difference," she said. "More activated patients achieve better results."

Any tools or technology that could spur that engagement can help. Like games. "It's time that healthcare catch up with the way we live the rest of our lives," said Poetter.

Gaming is big business, after all. Really big: a projected $79 billion in revenues in 2012.

With applications affecting everything from health and wellness to rehab and physical therapy, PTSD, stroke rehabilitation, autism and more, there's no reason games shouldn't have a big role to play in health.

That's why experts from heavy hitters such as Microsoft and United Health, Yale and UPenn – designers, developers, care providers and more, from as far afield as Glasgow, Vienna and Kyushu – convened in Boston this week.

Games offer a whole lot more value beyond mere entertainment, Poetter pointed out. They can motivate people to overcome challenges; enable them to visualize change and progress; improve self-efficacy through knowledge and goal sharing and facilitate patient/provider communication and interaction.

And they can do even more than that. At Games for Health, one session explored how Xbox's Kinect could be be used not just burn calories with its virtual tennis, but be applied to gauging biomechanics and assisting with telesurgery and helping with catatonic schizophrenia. There were talks titled "Prescribing Video Games (Not Medication) for ADHD" and "Evaluating the Ergogenic Impact of Music During Exergaming When Players Are Co-Located."

It all points to an exciting future. But FDA regulations are a wild card.

As attorney James M. Flaherty of Foley Hoag LLP, said in his talk, "Games, Medical Devices and the FDA: Now, Near and Next," all video games are potentially subject to regulation by the Food and Drug Administration. "Once you start making therapeutic claims" about a product, he said, you "turn it into a medical device, just like that."

And on the FDA front, there are "a lot of unknowns" when it comes to gaming. So far, there have been no approved or cleared games with medical claims, said Flaherty. "They're not dealing with it right now," he said, but it seems likely that when they do get around to thinking of it, they will be seen through the lens of mobile medical devices.

Games are terra incognita for the FDA, Flaherty warned. And when "FDA doesn't know a particular industry or product line, they will overregulate – that's their nature."

The best way for game developers to make sure their products have the best and fastest chance to positively affect health is to "have your voice heard now, early on," he said.

In the meantime, Poetter said ONC was looking for opportunities to help, and that it wanted to hear how best to do that. Facilitate connections between gaming and research communities? Set standards for health data interoperability with technologies such as EHRs? Develop agency expertise to evaluate health games? Coordinate gaming activities across government agencies?

"Gaming is certainly on the radar of the federal government," she said. "We're looking to socialize it more broadly."

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