Ayogo is building an adherence game for big pharma

By: Jonah Comstock | Jun 27, 2013        

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Ayogo's Diabestes app for college students.

Health gaming company Ayogo’s CEO Michael Fergusson hinted at this week’s Games for Health event in Boston that the company is working on a new game for a major pharmaceutical company, although he wasn’t able to reveal any details.

“I sure would like to show you this game but I didn’t get clearance to show it. We’re working with one of the five largest pharmaceutical companies in the world to build a game for people with Type 2 diabetes.”

Ayogo has previously worked with Sanofi, Merck, Novartis, Pfizer and Boehringer Ingelheim, according to Fergusson’s presentation and the company’s website.  Fergusson said they’re working on a diabetes application for adults.

“It is a social game designed to be played as a kind of ARG, partly online and partly mobile. It integrates a broad prescription compliance program along with a diet and exercise program,” Fergusson said during the Q&A. “It’s probably the most beautiful thing we’ve ever done.”

“ARG” stands for alternate reality game, which is a game with a narrative that somehow incorporates’ players’ real-life surroundings. ARGs usually involve engaging participants over multiple media.

At the conference, Fergusson spoke about some of Ayogo’s past ventures including kid’s diabetes game Monster Manor, which he also spoke about at December’s mHealth Summit.

He also mentioned that the company is using the Metria patch — a version of BodyMedia’s VUE patch, developed by Avery Dennison — in a health game the company is piloting at British Columbia Children’s Hospital. The game uses Ayogo’s game economy to promote activity among children.

This is not the first time Ayogo has used patch technology in a health game. Back in 2011, Fast Company wrote about a joint project between Ayogo and the Center for Body Computing called I Heart Jellyfish which used a heart-rate monitoring patch.

Fergusson also spoke about Ayogo’s peer-to-peer diabetes adherence support network for college students called Diabesties. Previously based on manual input of blood glucose readings, Fergusson shared that the forthcoming version will incorporate a Bluetooth glucometer.

“We know that at 16, a Type 1 diabetic is typically very adherent. And then when they go away to college, they’re not very adherent at all. Why is that? Well, there’s a number of obvious reasons. You leave all of your routines on which you built your good habits behind, your pediatric endocrinologist is back in your hometown, and your new roommate thinks pizza’s a vegetable.”

Fergusson said that college students don’t play games nearly so much as they message one another, and that instant messaging is a form of play for college students. The platform involves pairing off two college students with diabetes, one more adherent than the other. Fergusson found that students are more likely to check their glucose right after receiving a message.

With all of their products, the company tracks adherence data against game performance. Fergusson said this has led to some interesting insights. For instance, when people elect to challenge their friends to an activity, they are twice as likely to complete that activity themselves. Even more interestingly, the receiver of the challenge is three times as likely to complete the activity.

“Our interpretation was that people who received challenges — even if they never respond to them — were the most engaged people of all,” he said.


Games for Health attendees share engagement strategies

By: Aditi Pai | Jun 26, 2013        

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ZombiesRunOn the sidelines of the Games for Health event in Boston this week, Dr. Mark Sivak, assistant academic specialist at Northeastern University, explained to MobiHealthNews that the conversation around health games has evolved from one focused on novelty to one more concerned with outcomes.

“What we’re staring to get into now on the research level is that previously people would ask, ‘Okay, prove to us you can make a health game, or an educational game, any kind of game with impact,’ and the answer has been yeah, we can do that,” Sivak said. “All the researchers have been trying to just make these kinds of games. Now we are at the second stage, now we are proving efficacy.”

One panel discussion at the event focused on engagement strategies and breaking through the barrier between the mobile device’s screen and healthy actions the player can take in their “real” life.

Panelist Doris Rusch, an assistant professor at DePaul University, suggested one possibly effective gaming tactic was “poking as punishment”.

“You try to avoid the pokes,” she said. “[In other words] force intrinsic motivation to check-in or do something before the tool yells at you.”

Rusch’s suggestion, which other panelists built on, is an example of a passive game, one played in the background while the user goes about their daily lives. That’s different from, for example, an active game played by swiping at cartoon fruit on an iPad screen.

Panelist Ben Sawyer, event chair and co-founder of games consulting firm Digital Mill, agreed with Rusch that getting people to play a game passively might be a good strategy for healthy games, but designers don’t completely understand how to pull that off yet. Keep reading>>

Oregon health company to launch depression tracker with Fitbit integration

By: Jonah Comstock | Jun 26, 2013        

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MoodhackerMichael Mulvihill, CEO of ORCAS, announced that the company will be launching a new, clinically tested iOS app for depression self-management next month.

ORCAS, which originally stood for Oregon Center for Applied Science, was founded in 1989 as a research organization looking into ways people could use technology to improve their own health. The organization has been developing a number of mobile health apps and other interventions with funding from the National Institutes of Health. But with Mulvihill as CEO, the company is transitioning from a government-funded research group to a commercial company, offering their clinically validated apps as B2B products for employers.

“We’ve been very fortunate over the years to secure very significant funding thougth NIH,” Mulvihill said, “but my mission as CEO of the company is to turn us more toward the market in the business-to-business opportunity. We really want to create a sustainable business model. And we’re looking at very large channel partners who will actually distribute our product. So we’ll continue to do research and trials, but have the majority be market-oriented.

ORCAS is developing or clinically testing a number of apps — educational health games for children, a game to help children and parents talk about sex and puberty (Betwixt), and a game under development to help adults deal with ADD (Special Agent 24/7). But the focus of the company’s soon-to-be released MoodHacker app is depression, which Mulvihill said is especially problematic because it’s so frequently comorbid with conditions that many mobile health developers are focusing on, like diabetes.

“When you have co-morbidity of stress, depression, or anxiety along with chronic conditions or other lifestyle factors, both conditions are worse,” he said. “The vast majority of our patients have co-morbid stress and anxiety. In a sense, we have a huge healthcare crisis and these co-morbid issues sit right in the middle.”

The app takes a self-management approach to depression management. Users can track their mood on the app along with other factors like food and activity, to educate themselves about what things correlate to different moods. The app responds to the data with analysis and videos about depression. (Some of those can be found on ORCAS’ website here.) Mulvihill said the app can also connect to a Fitbit to automatically report activity data to the dashboard.

“The intelligence that is created by understanding my activity patterns, my sleep patterns, and how they’re effecting the mood puts the person in charge and knowledgeable about what works for them. Ultimately I think that will provide greater autonomy for the individual.”

Mulvihill said the clinical trial results for MoodHacker are promising: use of the app lead to a decrease in depression symptoms, an increase in behavioral activation, and an increase in worker productivity.

The app has been in beta and version two will launch next month. Mulvihill said the company has several commercial launches planned in the next three to six months, and some clinical trials concluding in the next two months.

Health games still waiting for a runaway hit

By: Jonah Comstock | Jun 26, 2013        

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Ben Sawyer games for health 2013This year marks the ninth Games For Health conference, an event which has long paid particular attention to mobile health gaming. But Ben Sawyer, the event’s organizer and arguably the biggest name in health gaming, says the mobile health gaming industry is “still in pre-season.”

“The software’s evolving, but no one seems to be running away with anything,” Sawyer said in the opening address of the conference. “There’s no amazing, super-amazing mobile health game that is just the beacon upon which to foster activity.”

But Sawyer believes a number of trends in mobile and gaming are leading the nascent health gaming industry to that point. One of the biggest, he said, is the ascendancy of tablets, particularly as they displace not the smartphone, but the PC. This shift necessitates a distinction between mobile gaming — which integrates mobility as part of the gaming experience — and games which happen to be run from a tablet.

“From a health standpoint, and looking at experimentation and innovation we still need to be thinking about what is different about adding a device that can sense movement, that can sense light, that is always with you, that also has a camera,” he said. “As tablets become such a focus it’s more about replacing a desktop experience, and less about the accelerometers, the sensors. Both of those things will take place, but I hope this community will keep experimenting about what happens when this thing leaves this place, with you. Not just so you can play Civilization on a park bench.”

Sawyer pointed to the action and consolidation in the activity tracker space as a major trend in health gaming, citing Jawbone’s recent acquisitions of BodyMedia, Massive Health, and Visere.

“You see Jawbone looking across at Fitbit, looking across at Nike, looking at other sensor startups and saying ‘We’ve got to start moving and making investments.’ So you’re now starting to see acquisitions and roll-ups in terms of trying to build a bigger war chest,” he said.

But Sawyer also pointed out that both Apple and Android are making major changes that could be beneficial for those building health apps. Apple’s iOS7 operating system will change the protocol for background applications, including the accelerometer, making it easier for built-in activity trackers to run on an Apple device without using too much power. Apple is also making moves toward gaming with its announcement of a made-for-iOS certification program for peripherals, which include joysticks and game controllers.

While Apple is moving toward becoming a gaming company, Google announced a new protocol for Google Play games that will allow users to save games and achievements in the cloud and open them up on another device — even an iOS device. This could make Android an even more attractive platform for health game developers.

Sawyer said one of the most promising shifts within the health gaming community was a shift away from a rhetoric he sees as unproductive — the distinction between gamification, where apps incorporate game mechanics like scores and leveling without a true game structure, and “true games.”

“Real consumers and real producers weren’t going to spend the time on that culture war among game designers, but instead they just pick and choose the things that work for them. And there were benefits of design practices coming out of each end of the spectrum. What was nice to see as I started talking to more companies throughout the year is I saw less people trying to get caught up in whether they were one in the same and more people doing a little bit of both and seeing what consumers like and what they don’t like. So it seems like things have died down a little bit in terms of the war.”

In terms of the “beacon” health gaming is still awaiting, Sawyer conceded that the closest contender is Six to Start’s “Zombies, Run!” which is scheduled to make a big news announcement at the conference tomorrow.

Final days of waiting for FDA mobile medical app guidance?

By: Brian Dolan | Jun 25, 2013        

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Brian Dolan, Editor, MobiHealthNewsIn the next few days — after two years of waiting — the FDA will publish its final guidelines for mobile medical apps. That was the plan, anyway.

News of the imminent publication of the guidelines prompted the Bipartisan Policy Center to make moves to put pressure on HHS to stop it. Last week the group got 129 companies and associations to sign a letter that urges the administration to hold off on publishing the FDA’s final guidelines on mobile medical apps until an ONC workgroup focused on developing a risk-based framework for health IT regulations finishes its work.

The formation of this workgroup was not mandated by the FDASIA legislation that passed last year. As MobiHealthNews reported at the time of the law’s passage last July, the House and Senate agreed to keep an amendment that calls for the Secretary of HHS to work with the FDA, ONC and FCC to develop a report to be delivered to Congress within 18 months that includes “a strategy for coordinating the regulation of health information technology in order to avoid regulatory duplication” and “recommendations on an appropriate regulatory framework for health information technology, including a risk-based framework.” Language that originally required the FDA to wait until this report was completed was removed so that the final guidelines could be published when ready. The law also left it up to the Secretary of HHS to decide whether she should form a committee of outside stakeholder to help inform the required report. That’s why HHS decided to form the FDASIA workgroup.

Now, on the eve of the FDA’s publication of the final guidelines, the Bipartisan Policy Center and companies that include McKesson, Microsoft, Oracle, athenahealth, Epocrates, Siemens, UnitedHealth Group, Teladoc, the Silicon Valley Chapter of Health 2.0 and StartUp Health have asked HHS to delay the FDA’s final guidelines on mobile medical apps until the workgroup finishes. Currently the FDASIA workgroup’s recommendations are not likely to be finished until after the deadline that the agency (kind of) promised Congress — the end of its fiscal year in September. (CORRECTION: The list above incorrectly included Verizon as a signatory of the BPC letter. Verizon did not sign the BPC letter.)

Meanwhile, the mHealth Regulatory Coalition, which includes about 20 companies that represent many of the pioneers of mobile health — WellDoc, AgaMatrix, GreatCall and more — has sent its own letter to HHS urging it to let the FDA publish its guidelines without haste. Here’s how the MRC’s letter concludes:

“The Secretary’s objectives are different from the FDA regulatory framework on mobile medical apps. The Secretary is charged with making broad policy recommendations on a comprehensive strategy for all Health IT. FDA’s guidance, on the other hand, is focused on providing specific details of whether different mobile medical apps will be regulated or not – this is the level of regulatory detail app developers need now.”

I was surprised to find that health academy StartUp Health was on the list of companies in favor of delaying FDA final guidance for mobile medical apps. I asked Unity Stoakes, StartUp Health co-founder and president why they signed the BPC’s letter.

“We want to make sure that there is sufficient time to develop guidelines and a process that is entrepreneur friendly so that we don’t inadvertently slow the pace of innovation or discourage progress. It’s essential that patient safety comes first, but a process for oversight doesn’t stifle innovation. We look forward to continuing to work with the Administration as well as Congress to ensure that health IT is regulated in a way that achieves the goals of improving the quality, safety and cost-effectiveness of care.”

If the FDA doesn’t publish its final guidelines in the next week or so, it is likely the BPC coalition convinced HHS to intervene and regulatory clarity for mobile health will continue to be left in the lurch.

Keas raises $8M, partners with Fitbit for gamified employee wellness

By: Jonah Comstock | Jun 25, 2013        

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KeasKeas, the corporate wellness platform founded by Google Health vet Adam Bosworth in 2009, has announced an $8 million investment round, new customers and partners. The round was led by existing partners Atlantic Ventures and Ignition Partners. Keas hasn’t raised money since the end of 2011, when it raised $6.5 million. Total funding for the company now stands at $25.5 million.

The current incarnation of Keas — an employer-facing gamified social network that also incorporates data from connected devices — is similar to other device-connected employee health platforms that have made big announcements this month: Aetna CarePass and Jiff Healthcare’s new venture. Keas announced a partnership with Fitbit that will allow users to automatically import Fitbit stats into the Keas network to share, track, or compete. The company has previously announced partnerships with BodyMedia and Runkeeper, and CEO Josh Stevens told MobiHealthNews recently that partnerships with Jawbone and Nike are in the works.

Keas is also announcing new partnerships with health coaching platforms GAIN Fitness and meQuilibrium as well as LabCorp, a provider of medical laboratory tests, biometrics and health assessments.

Keas has pivoted several times since its initial inception, going from a “Mint.com for health” to more of a “Facebook for health.” Stevens, who took over the company in February, discussed some of those shifts with MobiHealthNews.

“The company’s been through three iterations. The first iteration was five years ago, and Adam Bosworth really created a hardcore health plan protocol based on your biometrics. You’d go to Quest Diagnostics, get your blood drawn and a whitepaper would come back and say ‘here’s what you should do’. It was technically accurate, but very boring,” he said. “That went into a pivot into Keas 2.0, a social game. We dumped the data overboard, made it all self-reported, and made it more like the Facebook-Zynga experience. … With that one, the usage was very high, but the hard health data and getting to a return on investment was missing. We went back to the first version and brought back just enough data to make it relevant for the ROI, but not so much data that you’re overwhelmed.”

Keas has a number of corporate customers using their wellness platform. Pandora, Valeant Pharmaceuticals and KLA-Tencor were just announced as clients, and the company had previously announced Pfizer, The Cheesecake Factory, Living Social, Reed Elsevier (owner of Lexis Nexis) and defense contractor BAE Systems.

Stevens said the money is being used to meet what he’s saying is an increased market demand caused by provisions of the affordable care act that are just kicking in. In addition, the company intends to branch out into other “human capital management” areas besides just employee healthcare. These could include training and compliance, open enrollment, and benefit selection.

Stevens echoed his competitors in speaking about the need to get self-tracking data out of silos to really make it useful and actionable.

“You have to give choice to the consumer so whatever they’re using can be incorporated,” he told MobiHealthNews. “All this data is in seven different places and it’s really hard for the consumer to bring that together and benchmark to see where they are, and see how that value actually helped. The value add of Keas is that we bring all that together.”

Stevens believes what sets Keas apart from other employee wellness platforms is guaranteed engagement — the company claims its users check in to the platform 10 times per month — and the social aspect. Employees on the network can compete in team health challenges for rewards such as a reduction of their deductible.

“Your team is made up of your colleagues and your family — we cover dependents for free,” he said. “The user sets goals individually that they can report in on every day or their wearable computer can update. You can participate individually or on a team to win prizes. When you’re on a team you’re eligible for greater prizes. This is by design, because people on teams are more likely to participate.”