I averted a night in O'Hare due to hurricane Ivan, so I'm able to spend a second day here at Games for Health in Madison. The conference is getting some good press coverage, including a big half-page spread in the local paper, mention on CNN Headline news, and coverage by G4/TechTV.

You can read day 1's coverage here. Here's day 2's coverage.

Session 1: A Survey of Every Commercially Produced Health Game
Ben Sawyer, Serious Games Initiative

Sawyer's goal was to cover a broad range of representations of health and healthcare in commercial games.

Representations of healthcare in games are slim, and simple: health means lives, health meters, health packs, healers (like in RPGs), poisons, power ups, and (of course) death.

RPGS show poison, disease, potions, healers. Ultime IV allows the player to give blood to show sacrifice. Many sports games now have injuries. Grand Theft Auto has an ambulance, and also has a representation of endurance (run more, gain stamina). Team Fortress, BF1942, and America's Army have medic characters who have specific roles.

Heath is omnipresent in games, but highly abstracted. It's often linked to failure: you can't get to 110% health typically (except in Doom). The basic methodology is, when you deplete your health, your game is over. Healing is usually about finding objects or makeing a purchase only when you must... but rarely do you practice preventative treatment in games.

... doesn't this seem a lot like healthcare in the real world, asked Sawyer? It's a stat, often devoid of specific injuries or conditions, and there is usually never a procedure to fix something, other than a binary operation (get health pack, pay healer). We often lack emotion for most game characters therefore we lack passion and empathy for their conditions.

That said, many games have specific health subject matter, although there are fewer releases in recent years. Of the 50 or so Ben found, they rarely focus on people who perform healthcare. Compare that to television, in which most shows focus explicitly on people.

Sawyer then went through a number of examples of medical games: Laser Surgeon, Microsurgeon for the Intellivision / TI99. Life & Death from Software Toolworks for the PC. Epidemic, Sim Health (one of the first foundation-funded game projects). Mindwalker (recover the shards of sanity in the brain), Alphawaves (maneuver a polygon craft in the context of the human brain), Alter Ego (make a series of choices about your life and build an alternative life), Mind Mirror (designed by Timothy Leary), Epidemic (respond with nuclear strikes to control global epidemics!), Microcosm (a shooter in the body), Theme Hospital (hospital sim with some fun tongue-in-cheek elements), Robinson's Requiem (escape from an alien planet while dealing with diseases and lost limbs), Ozzy & Drix (a Midway GameBoy game, body as playground), and Legacy Interactive's healthcare simulations (Emergency Room, Combat Medic, etc.).

Sawyer argued that we can do a lot more by adding layers of detail into the healthcare in our games. Health subject matter is underweighted in the game medium compared to other media -- designers can add a few more interesting decisions to what healthcare is in games and how it functions (for example bleeding and wound care in FPS games).

Someone from the audience pointed out that some MMOG's introduce dietary conditions that affect your character's attributes and outcomes. Others pointed out that hygiene is important in The Sims -- if you don't bathe, you lose your friends. Sim City has hospitals that need to cover

Session 2: Glucoboy: Gameboy Based Diabetes Monitoring Solution
Paul Wessel, Guidance Interactive Healthcare

Wessel described Glucoboy, inspired by his son's severe diabetes. Wessel reminded us that a massive set of systems go behind health game products -- they are just a piece of a much larger system.

Wessel asked an important question: who's going to pay for this stuff? Who is your market, and what do you want to accomplish? Wessel formed Guidance Interactive Healthcare to help kids understand how to take care of health situations that they may not understand. The information is overwhelming for kids and parents alike. Like many, his son was avoiding doing his blood glucose testing -- but he always knew where his GameBoy was. Children maintain the worst levels of blood glucose control, making them perfect targets for this kind of solution.

Wessel described Glucoboy as a system for chronic disease management. Support and information are most important for long-term health improvement.

Session 3: A Series of Interactive Health Media Games
Brian Winn, Michigan State University

Winn is a part of a digital media R&D la at Michigan State. He related a project about cancer prevention and therapy, set in a theme park. Players could learn about nutrition and other plans. They are currently working on a project that explores medical communication around diabetes.

He then described Fantastic Food Challenge, a program for low-income adults to learn about nutrition. Young adults prove difficult to recruit and retain. The game based approach was a supplement to traditional instruction designed to appeal to casual players to play online. Funding of about $20k came from the USDA and MSU. The game has four smaller games, for example the Great Meal Deal, a kind of Yahtzee-like game in which you categorize food items dealt on cards.

They are currently working on an assessment proposal to study the effects of the game.

Winn recommended integrating learning into the gameplay, purusing strong collaboration with the healthcare experts, and using an iterative development model. He also recommended to plan assessment from the beginning.

Session 4: Personal Investigator: A Game Tool for Psychological Interaction
Mark Matthews & David Coyle, MediaLab Europe

Matthews and Coyle's group at the European arm of MIT MediaLab presented a project they developed for interventions in adolescent psychotherapy. The game provides an interface for adolescents to tell a personal story. It specifically targets depression, anxiety, and social skills problems. It is intended to be a tool to aid therapeutic conversations.

The researchers felt that a game would increase the facility for adolescents to engage with therapists, to reduce the stigma associated with therapy, and to reduce the sensation that the therapist is an authority figure to be defied.

Games provide safe spaces, a shield from the trauma of the real world experience and the real world itself. Adolescents are also resistant to typical forms of therapy, and they enjoy games, making games an ideal choice for such usage. They developed a computer aided model for therapeutic intervention. Previous work in this area includes the use of COTS games (Super Mario Bros), custom games, story systems, conversational agents, role-playing games, and identity construction environments.

In designing the game, they focused first on the ethical issues of established therapeutic models. Focusing on a solution focused therapy model, they concentrated on goal oriented, future-focused solutions. The game genre they chose was role-playing (because they are character based), the subject field a detective story. In the game, the player is a trainee detective who has to find the solution to a personal problem, striving to graduate as a master detective. The Detective Academy principal (not called a therapist) sets the goal for the game (a therapeutic goal). The player visits five areas and finds clues to understand the solutions for their problem.

In practice, the game has taken 3 - 4 sessions (1 hour each) to complete the game. The therapist and the client work together in the game, and the therapist can provide answers or questions.

Results of the initial sessions are pending, based on post-trial questionnaires and interviews.

Session 5: Game Platforms for Deployable Medical Training
Russell Schilling, Office of Naval Research

Commander Schilling begain working on perceptual data and games in the late 80s. Since 1999 he has worked in the Naval Postgraduate School, where he contributed to the sound design for America's Army, and learned the game to conduct research on emotion and learning.

Schilling is interested in emotion as an enhancement of learning and memory. In a study, his students created an environment in America's Army and asked to memorize objects in buildings. In a control group, the groups wandered aimlessly; the other group had to fight their way from building to building. Schilling demonstrated that the memory and emotion circuitries are connected, and the players who had to fight their way to the buildings remembered the objects inside better. As part of that process, sound design is a crucial component. Simulations, argued Schilling, argued that simulations are unnatural or "Frankensteinian."

Schilling described several lessons from his experiences.

Know exactly what you want to train
Don't assume that the customer knows, and be prepared to deconstruct each task. Training has to precede production, not follow it.

Storytelling is a crucial part of good simulation
But, a poor story is worse than no story. A game can indeed be a worse experience than a brochure.

A simulation built on a game engine is not a game
It's not the technology, it's the experience. You need play and fun to make it a game.

A product designed on a game engine by an engineer is usually indistinguishable from a traditional VR product
You need artists, writers, and other "long-haired folk."

Games can be "tweaked" between entertainment and learning
But this takes more effort and pre-planning.

You need a balance point to make the customer and the developer happy
There is a different mentality in military/government and game development

Schilling is now working in casualty prevention, where he is interested in eye protection, driving damage control, and similar projects. In this context, he is looking at neurological damage, musculoskeletal injury, training aids for medics and first responders, and prediction of heat casualties. In this arena, he is working on bringing game-based approaches to these problems. They have started a project on the America's Army engine to teach bleeding wounds. Another takes on warfighter mental health, a VR psychological tool.

Other research plans include developing therapy strategies for early intervention and, possibly diagnosis, and as a systematic approach to training with low-cost game-based systems to get these tools deployed widely and quickly. Finally, he projects a need for PTSD experts to assess the tools on an ongoing basis.

Schilling also outlined an example for agent-based training to help understand best practices for controlling common outbreaks in an enclosed environment (like a naval ship).

Session 6: Health Emergency Simulation
Doug Whatley, BreakAway Games

Whatley demonstrated Emergency Room Challenge, a prototype for a forthcoming product for emergency room response training.

Note: I had to leave before Doug Whatley's presentation. I'll leave the placeholder here in case I can get notes from another attendee.