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The Gamification of Healthcare: Emergence of the Digital Practitioner?
Eli G. Phillips Jr, PharmD, JD; Chadi Nabhan, MD, MBA; and Bruce A. Feinberg, DO
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Mary E. Reed, DrPH
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The Gamification of Healthcare: Emergence of the Digital Practitioner?

Eli G. Phillips Jr, PharmD, JD; Chadi Nabhan, MD, MBA; and Bruce A. Feinberg, DO
Gamification in healthcare is gaining momentum, with attempts to apply gaming principles to improve patient clinical outcomes. This trend establishes the need for a “digital practitioner” who channels these games, monitors progress, and selects the most appropriate ones for a given patient.
Clinical Assessment

In applying a medical device approach to gamified apps, patient safety concerns resulting from mechanical malfunction and design flaws must be considered. From a mechanical perspective, software technology developers and the smartphone manufacturers who enable their deployment are readily able to construct designs that lack defects. However, the problematic abuse of smartphone apps has been well described, including instances in which patients can experience symptoms that mirror addiction, such as excessive use and separation anxiety.9 The DSM-5 has even proposed diagnostic criteria for “internet gaming disorder.”9 Is it too far-fetched to imagine a gamified weight-loss app that gives rise to eating disorders? Although gamification in healthcare has the potential to modify behaviors, participating in gaming is innately a behavior that may result in unintended consequences. Given concerns both real and imagined, it does not seem unreasonable for gamified health apps to undergo an assessment of efficacy and safety before being released to the public.

Practitioner Interventions

The role of practitioners in the era of gamification has not been well established, but clinical practice guidelines for game selection may be on the horizon. Noncompliance with and nonadherence to prescribed medical treatments are problems that seem well suited to alternative motivational strategies. Conceptually, a variety of disease states could be avoided or their progression substantially halted by more rational patient behavior, which might similarly be positively influenced through game application. Clinical examples include diet and exercise in patients with cardiac disease, smoking cessation in patients with chronic obstructive pulmonary disease, and lifestyle modification in patients with type 2 diabetes. Given that these chronic diseases have significant management costs, it would seem appropriate that physicians monitor the gamified apps in such clinical scenarios. The clinical spectrum of gamification in medicine may not be limited to motivating patients; rather, healthcare providers themselves may benefit from their use as process improvement and interventional research tools.

The Path Forward

As gamification and software platforms become more accepted, it is possible that the need arises for the new world of the “digital practitioner”: one who specializes in healthcare apps, accepts referrals from other practitioners, identifies the best programs to meet individual patient needs, and consults to assess whether game applications might improve clinical outcomes. Getting to this point will require new assessment tools validated via real-world evidence and comparative effectiveness research. Just as patients vary in their responses to medications, it is reasonable to assume that some patients will benefit more from one game over another. A 2-way gaming interface could permit the digital practitioner to monitor the progress of the patient, address any deficiencies that might be noted, and adjust the game accordingly. Noted deficiencies could include lack of adherence to the program, skipping levels, and successes or failures in maintaining targets.

Technological advancement in healthcare is in an explosive growth phase, and there is likely a role for gamification as a next approach to modify behavior. As gamified applications for healthcare increase, the best way to protect patients is with a combination of provider and regulatory interventions.

Author Affiliations: Cardinal Health Specialty Solutions, Cardinal Health (EGP, CN, BAF), Dublin, OH.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (EGP, CN, BAF); acquisition of data (EGP, CN, BAF); analysis and interpretation of data (EGP, CN, BAF); drafting of the manuscript (EGP, CN, BAF); critical revision of the manuscript for important intellectual content (EGP, CN, BAF); and administrative, technical, or logistic support (EGP, CN, BAF).

Address Correspondence to: Eli G. Phillips Jr, PharmD, JD, Cardinal Health Specialty Solutions, 7000 Cardinal Pl, Dublin, OH 43017. Email: eli.phillipsjr@cardinalhealth.com.
REFERENCES

1. Volpp KG, Asch DA, Galvin R, Loewenstein G. Redesigning employee health incentives—lessons from behavioral economics. N Engl J Med. 2011;365(5):388-390. doi: 10.1056/NEJMp1105966.

2. Thaler RH. Nudge, not sludge. Science. 2018;361(6401):431. doi: 10.1126/science.aau9241.

3. Takahashi D. Candy Crush Saga: 2.73 billion downloads in five years and still counting. VentureBeat website. venturebeat.com/2017/11/17/candy-crush-saga-2-73-billion-downloads-in-five-years-and-still-counting. Published November 17, 2017. Accessed October 2, 2018.

4. Kawachi I. It’s all in the game—the uses of gamification to motivate behavior change. JAMA Intern Med. 2017;177(11):1593-1594. doi: 10.1001/jamainternmed.2017.4798.

5. Von Bargen T, Zientz C, Haux R. Gamification for mHealth: a review of playful mobile healthcare. Stud Health Technol Inform. 2014;202:225-228. doi: 10.3233/978-1-61499-423-7-225.

6. Sardi L, Idri A, Fernández-Alemán JL. A systematic review of gamification in e-health. J Biomed Inform. 2017;71:31-48. doi: 10.1016/j.jbi.2017.05.011.

7. Changes to existing medical software policies resulting from section 3060 of the 21st Century Cures Act: draft guidance for industry and Food and Drug Administration staff. FDA website. www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM587820.pdf. Published December 8, 2017. Accessed August 23, 2018.

8. Digital health innovation action plan. FDA website. www.fda.gov/downloads/MedicalDevices/DigitalHealth/UCM568735.pdf. Published 2017. Accessed October 4, 2018.

9. Panova T, Carbonell X. Is smartphone addiction really an addiction? J Behav Addict. 2018;7(2):252-259. doi: 10.1556/2006.7.2018.49.
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