Health Care Is Better as a Game

Kim BellardSo many counter-intuitive findings recently.  For example, a new study claims 7 of the 10 most profitable hospitals in the country are "non-profit."  Let me say that again, most profitable hospitals in the country are usually nonprofit.  Or, despite the drive to improve surgical quality by limiting surgeries at low volume hospitals, it appears that the relationship between volume and patient outcomes is not as clear as had been thought, once "more advanced statistical modeling" is used to analyze the data.  Wait, what?

Either one of these would be a good topic to write about, and many others have done so already (e.g., KHN and Modern Healthcare, respectively).  Instead, I'll talk about something equally counter-intuitive but more fun: how important games might be for health care.

Let's start with what's going on with tuberculous.  About one-third of the world's population is infected with TB (many of whom don't know it).  It is one of the leading infectious disease killers.  Surprisingly, though, it is not particularly easy to diagnose, and researchers at Stanford think a video game could help with that.

The game is Eterna Medicine.  The first version of Eterna was released five years ago, and it allows anyone to try to design bio-molecules.  Seriously.   Apparently learning to fold RNA molecules can be fun, a real-life kind of puzzle, Something like 100,000 players have tried it so far.  As one of them, Jeff Anderson-Lee, told NPR: "You can start out not knowing any of the science.  You start to get a sense for what things go together to make an RNA design fold the way you want.  While you're doing that, you're gaining points and rising in rank."

Fun or not, it has proved to be meaningful.  In February, Mr. Anderson-Lee and fellow gamers used their Eterna learnings to publish an article (check it out: "Principles for Predicting RNA Secondary Structural Design Difficulty") in Journal of Molecular Biology, an eminently legitimate, peer-reviewed scientific journal.  It is believed to be the first such "citizen scientist" publication, although it probably will not be the last.

As Peter Venkman might say, "no studying."

With Eterna Medicine, the goal is to try to figure out what particular configuration of RNA designs is most likely to mark the presence of TB.  Players "vote" on designs, and the winning designs will actually get synthesized to see if they work.  If they do, testing for TB could become as easy as using a home pregnancy test.

The Wall Street Journal profiled not just Eterna but also several other game approaches to health care research.  These include:

If people got bored with those, there are games that allow users to play with quantum physics.   They've published too.  
I wrote about the use of games in health care a couple years ago, and it has continued to fascinate me.  After all, some 155 million Americans admit to playing video games, spending some $23b annually.  It is particularly common among -- but not unique to -- younger people.  Health care experts have seen ways to utilize games or gaming principles in health education, motivating better health habits, even training of medical professionals.  
I got a little more interested when Microsoft bought the popular game Minecraft for $2.5b in 2014.  I got even more interested when they announced they were expanding into education with Minecraft Education Edition.  As the announcement said: "We've seen that Minecraft transcends the differences in teaching and learning styles and education systems around the world.  It's an open space where people can come together and build a lesson around nearly everything."  The Education Edition is now in beta and will be released for free in an early access program this summer.  
And I got really interested after reading Isaac Kohane's great post What Minecraft can teach the health care system.  Dr. Kohane reports watching with awe as a group of 11 year-old children worked together in the game to get through the complex virtual environment-- and managed to have fun doing so.  As he says, "It was a remarkable demonstration of using technology to coordinate teams in complex tasks without prior training."   
He goes on to note, perhaps superfluously, "I can tell you with assurance that the use of team technology in the American health care system lags decades behind the seamless coordination that Minecraft players take for granted."
Dr. Kohane sees three substantial (but not insurmountable) obstacles to changing that:
  • Unique systems: Health care thinks it is so unique that its systems need to be, making them "less secure, less versatile, and more expensive than they have to be."
  • Billing gets in the way: this needs no explanation, but I'll say it anyway.  Our system is  more about making sure providers get paid than on achieving better patient outcomes or experiences.
  • Clinicians only: Patients have not historically been involved in the decision-making, so no wonder communication flows are at best siloed.
He is optimistic that -- if we can overcome "institutional inertia -- "there will be no reason that a patient's history, diagnoses, and next steps can't be presented in a way that makes as much sense to adults as Minecraft intuitively does to 11-year-olds." 
I love his optimism, but that's a powerfully big "if" he qualifies with. 
By far the most viewed post I've written was one I did a couple years ago on Twitch, the hugely popular online service that doesn't even let people play games, just watch others play them.  I'm old enough that I rarely play video games but young enough to at least understand the appeal, but Twitch confirmed for me that there are younger generations that see them in entirely different ways than us older generations do.   My conclusion is that if the health care system doesn't recognize and adapt to gaming's technology and its users' preferences, it is going to become obsolete.  
Perhaps I'll go try to fold some RNA sequences...
Health Care Is Better as a Game was authored by Kim Bellard and first published in his blog, From a Different Perspective.... It is reprinted by Open Health News with permission from the author. The original post can be found here.