health gaming kapil khandelwal medical equipment and automation jan 2010

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ProductWatch

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Vol.3 No.1 October - December 2009 Rs. 150

Big on Space,the new Winger Ambulance from Tata Motors

Orchid 3000 Transport Incubator

Biphasic Defibrillator with Monitor - DEFIGARD 4000

Cover Story

Subramanian DharmarajLabindia Life Sciences

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• Monocoque Construction ensures low NVH• Low on Maintenance Costs• Can be customized to your needs

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Technological Transitionand its judicious use

Dr Shakti GuptaAIIMS Life Plus LPM-907

Cone Beam CT inDentistryan Important Tool

Robotic Surgery inUrologic Practice

... turn to Pg. 49

2 Oct-Dec 2009 � Medical Equipment & Automation

Publisher’s note

The quality of patient care is greatly infl uenced by the effi cient management and availability of accurate information. Medical informatics has originated in order to

provide better patient care, eff ective medical education and research. Radiation oncology presently deals with plenty of information including diagnosis, complex treatment planning, accurate dose calculations, and complicated treatment delivery system. Hence, a comprehensive information management scheme has become a prerequisite for the storage and retrieval of the enormous information for precise treatment in radiation oncology. Dr Abhijit Mandal, in his article on “Medical Informatics for Radiation Oncology” has stressed on diff erent aspects of role of medical informatics in radiation Oncology.

Dr Rajiv Yadav, in his article on “Robotic Surgery in Urologic Practice”, highlights the advancement of laparoscopic surgery to newer heights through the integration of computer-enhanced technology with the surgeon’s expertise, the da Vinci Surgical robotic System. Th is technology has been extensively used in Urology in the treatment of various cancers and non cancerous conditions such as prostate cancer, bladder and kidney cancer, narrowing in the urinary tract etc.

In the article “Usability of User Manuals with Medical Devices”, the author, Ganesh Bhutkar focuses on usability issues with usage and design of user manuals of medical devices. Th e author has depicted the response of the user regarding the usability issues with user manuals.

You may be surprised to know that gaming can be a health assessment device. Th ere are several diff erent online entertainment networks and technology platforms available for Health Gaming. An interesting article by Kapil Khandelwal on “Health Gaming” emphasizes the role of health gaming in assessing the health status.

Sachdev Yadav, in his article on “Pharmacy Automation: Th e Time to Automate Has Never Been Better” discusses about the need of automation, benefi ts of automated pharmacy systems and regarding facilitation of new stand-alone systems which enhances patient safety and care; the quality of life for your pharmacists and technicians and accelerates the number of prescriptions that one fi lls in a day.

Hoping this issue further enlightens our readers regarding the advancements in the fi eld of health care.

Please do send me your comments at [email protected]

Pravita IyerPublisher

To suit today’s life, newer technologies and methodologies have emerged. Technology,

globalization and the changing perception of pathology and laboratory medicine are major

trends which produce a great impact on the medical profession.

Publishers note.indd 2Publishers note.indd 2 1/16/2010 2:06:22 PM1/16/2010 2:06:22 PM

KK

Underline


Health Device

Remember PacMan? There was a time when it was the hottest game around when I was

a kid, and it got better when colour screens came around with the computer. There were actually colour dots that had to be gobbled! That was 1988. Today, games have grown from being a mere pastime. They are converging with health industry in providing solutions and engaging, entertaining, are ‘networked’, ‘electronic’ and ‘effective’ in managing consumers health conditions and outcomes. What’s more, they constitute an industry that commands respect and is often seen in awe for what it has achieved. It is estimated

that this health games segment is going to be 3 times larger than the health and wellness segment globally. Would you touch a game today that doesn’t have the best available graphics, sound and gameplay and that could also influence your health outcomes?

With the emergence of online entertainment networks, shouldn’t you also be able to play it online with your buddies? What about improvements? The publisher must release moods (with or without hot coffee!) periodically to keep the enthusiasts going… yes, gaming has become more complicated than the simple PacMan.

HealthGAMING

Can you believe that gaming can be a

health assessment device? There are

several different online entertainment networks

and technology platforms available for Health Gaming.

Numerous games can help to ascertain the

health status.

Health Gaming.indd 80Health Gaming.indd 80 1/14/2010 1:00:18 PM1/14/2010 1:00:18 PM

Health Device

81Medical Equipment & Automation � Oct-Dec 2009

This article provides more insights and details into the converging segment of gaming as a health device. The ideas here would provide cues to consumer health devices, mobile phones, game consoles, other networked device designers on what to expect from emerging healthcare consumerism in India.

Different Online Entertainment Networks and Technology Platforms for Health Gaming

In India, most consumers still play games online or download games from the web. Mobile phone games, is the fastest growing segment as the number of mobile subscribers are soon going to cross over half billion although from a very small base.

With the 3G introduction in India, entertainment networking platform is likely to experience even accelerated growth as wireless internet access on mobile phones devices becomes more common, combined with ever-faster download speeds. CD and other desktop computer-based and games console such as Sony Playstation, Microsoft Xbox, and Nintendo Wii make up the rest of the market. We are seeing games on special devices such as Apple Ipod Nano, exergaming equipment and cable set-top boxes in the market. These product segments are still very small and insignificant in size when compared to the mobile phone game segment.

Different Games for Health Status

There is growing evidence of clinical effectiveness of health games for managing conditions like cancer, diabetics, asthma, cystic fibrosis, among others.

As clinical evidence of the impact of gaming on health conditions is gaining ground, there are newer categories of games and content being produced for different health status as is summarised in the diagram. In India, we are still waiting for content these segments with local relevance to be produced. However the potential for each of the segments is immense.

• Exergames: These are games that require physical activity. They include games that motivate exercise through game-play and virtual coaching, such as Nintendo s Wii and Wii Fit for home use. Recently, Nike and Apple iPod have collaborated to create a

solution that combines a Nike shoe wirelessly connected to an iPod Nano with an application designed to log, monitor and manage a user’s running activities. These are now linked to the social media and online

entertainment networks where over 1 million users are tracking, challenging each other and improving health outcomes using these devices.

• Brain Fitness Games: These are games that help exercise and improve various cognitive functions including attention, memory, visual/spatial processing, auditory processes and language, motor coordination and executive functions like planning and problem solving. Soduko and other such games fall into this category.

• Healthy Eating Games: We are a fairly diverse population with food

Fig.1



Health Devicehabits and customs. The knowledge of regional diets and nutrition and behaviors to modify diet, nutrition and weight management is fairly limited. However there are games which are targeted at this segment to help them make smart nutritional choices. These games are typically offered online for free and are sponsored by health care companies, government agencies or consumer product good companies who are trying to promote their products in association with healthy eating.

• Condition Management Games: Several acute and chronic disease conditions are being targeted after clinical research to provide educational information about the condition and treatment methods to improve adherence to doctor’s treatment plan through the games. In the USA, most of these games are being developed by health insurance payers, NGOs or from government grants.

• Professional Training Games: As game technology is becoming more and more realistic, these are being applied for training healthcare professionals to focus on decision-making and risk mitigation. Many soldiers, pilots, doctors and nurses, surgeons are now being provided with gaming simulations as part of their professional training. An example of a virtual reality game can

be used to train surgeons, allowing them to practice on virtual body tissue and get the same feedback they would experience in performing a real operation. In the US, Nobel Biocare, a dental implant company, has provided $65 million in

grant money to the Medical College of Georgia to develop training games and simulations for classrooms and clinics around the world.

• Therapy Games: As our research and understanding of the health outcomes through games is increasing, there are newer games that are helping patients to combat pain, deal with physical and mental trauma and create a positive image in dealing with conditions like cancer, etc in India.

In the future as the social media and entertainment networking converges with

the gaming industry, newer gadgets and games segments are expected to emerge.

Different Models of Health Gaming and Health 2.0 and Entertainment Networking Platform Technologies

Search engines, wikis, blogs, video, RSS feeds and online communities are empowering, engaging and educating healthcare consumers and providers. The emerging Health 2.0 web technologies that use social media software and its ability to promote collaboration between patients, their caregivers, doctors and other stakeholders in health are converging with the health games. The emerging health gaming entertainment networking platform has multiple stakeholders who would like to monetise the out of pocket consumer spend in India.

Top down the model would look as follows: It is still early

Fig.2


Health Device

83Medical Equipment & Automation � Oct-Dec 2009

to provide a measurable impact for any of the emerging business models in this sector. However for the health games to gain widespread adoption with providers and carriers, clinical research will need to demonstrate significant improvements in health promotion and cost reduction relative to existing solutions.

While several dozen research studies are currently underway in the US leadership from the RWJF, Cornell University, UC San Diego School of Medicine, University of Florida, University of Washington School of Medicine, Baylor College of Medicine, among others. In India, industry bodies like Nasscom, etc is still to wake up to the potential that emerging and fast converging sector offers.

Directions for the Future Health Gaming Models of Business in India

While the sector is emerging and has potential, there are several key issues that need to be addressed as part of the emerging business models in India. • Who will dominate?

To date, the game console players such as Sony, Nintendo, Microsoft have been the only companies in the health game market that have been clear winners, commercially speaking. However they have only about penetrated the high end urban segment in India. We have a huge latent mobile phone consumer population with smart mobile phone that could well turn in to a gaming

console. Who will change this? Where will the value be created and captured in the next generation of the health games market in India on the 3G enabled mobile phones? Like mobile telephony radically transformed the voice communications market in India and demonstrated a business model for replication in other emerging markets, do we expect to see start-up ventures as we did for the ICT sector? Will this be part of the health ICT or health or entertainment networking sector? If so, which product categories are the most attractive in the near-term?

• What are the market

participants likely to do? With over 1 percent of India’s

GDP being spent out of pocket by the consumers on health, games, mobiles, mobile and internet connectivity, cable TV subscription, what strategies can we expect from the 3000 odd large players with regards to segment? Will Apple, Nokia, Sony, Microsoft and others follow Nintendo’s lead in India? If so, will they enter the Indian market with innovative products at attractive prices? What are the opportunities and risks to these companies in integrating healthy messages into games which have been traditionally about pure entertainment? Are carriers like Airtel, Vodaphone, Reliance, Tata throw their might with value added services in the face of declining ARPU or would the entertainment giants like Zee, Sun, Tata Sky want to win their cable audience over with value added service in the consumer drawing room?

• What solutions would be best for the mass markets and niche segments? Are video games the right

approach to addressing youth wellness, obesity and sedentary lifestyles? While games like the Ninetendo Wii are healthier than video games, do these games really approach the health benefits of actual sports and outdoor recreation? How supportive will the Indian medical fraternity be with the emerging clinical research to endorse this segment?

• How do we enable the industry in India to be globally competitive? India demonstrated its might

of a globally competitive ICT industry. Some of the issues to be addressed are:

Large talent supply: The local industry is facing

is the severe shortage of trained manpower. Nasscom has projected that there will be a requirement of close to over 10,000 engineers and product developers for export and domestic market in the medium term.

Localization of games/content:

In order to better address the gaming needs of the target audience the games, consoles, phones, devices need to be customised for local market needs and clinically proven. Though most of the development work is being done for overseas market, however, in future the focus would shift to the domestic market.



Health DeviceCurrently several Indian

companies are start ing to focus on customizing content for the Indian market using local themes, icons & games. I t would also include spicing-up the avai lable international content/ idea to appeal to a larger audience. However, we have great Oscar famous ‘Lagaan’ historical content and mythological and poli t ical icons that can be monetised for mass markets.

Main Stream Advert is ing and Right Messaging

To bui ld demand, main s t ream adver t is ing may be requi red for the mass markets . However issues around heal th such as how should heal th l i teracy and support be best de l ivered in v ideo games? In what s i tuat ions should heal th messages be over t and pr imary? In what s i tuat ions should heal th messages be s tea l th? In what s i tuat ions should a game not conta in any heal th message, but ra ther be used as incent ive for heal thy behaviour such as test ing b lood g lucose leve ls or exerc is ing? What can we learn f rom internat ional markets and the growing ev idence and exper ience base?

Enabling payment mechanisms

Recognizing that the low penetrat ion of credit cards & debit cards can be a potential bott leneck, can products and service providers partner with mobile phone service providers to take an init iat ive in enabling onl ine payment though their platforms.

This is al l the more important because the core gaming segment users do not want to use their cards. One of the init iat ives being experimented with is pre-paid gaming cards with mobile phone pre-paid charge. These cards would enable both subscript ions for the gaming service and purchase game add-ons.

How wil l healthcare services and other product companies partner in this sector?

The health insurance sector wil l have to eventual ly come out with dif ferentiated products for dif ferent segments of Indian populat ion are l ikely to adopt health gaming into their toolkit of patient education and marketing support.

Some of the healthcare services would need to plan to integrate health game capabilities into their corporate wellness and disease management solutions. It would be relevant to demonstrate in terms of clinical effectiveness and user experience to become an integral element of wellness

and patient care support regime.

On the other hand, pharma, devices, health foods and nutrition and other products companies would like to develop viable direct-to-consumer business models for monetizing games that assist with everything from product usage to disease management. Are in-game advertising or sponsorship models plausible for these product companies? Can health games attain the scale and installed user base to attract significant advertising and sponsorship money from these companies in India?

It is still early days for our PacMan avatar in India to turn into a health, entertainment platform for the masses to manage their health outcomes positively! �

Kapil Khandelwal is an independent board member on several healthcare and ICT organisations and a leading healthcare and information communication technology (ICT) expert in Asia Pacific and Emerging Markets.

Kapil Khandelwal
