Hopefully, the days of bland patient information and mind-numbingly dull educational videos will soon be behind us. Increasingly, people are recognizing games as a way to better engage patients for educational and therapeutic purposes. These include mainstream consumer titles like the Wii Fit to specialized applications like laparoscopic surgical simulations and physical rehabilitation. In the past decade, the Robert Wood Johnson Foundation — a philanthropy whose aim is to improve healthcare — has provided grants and guidance for Games for Health and related initiatives. Their most recent competition, the Games To Generate Data Challenge, targets population health.

Litesprite (@Litespritegames) one of the competition winners, created SinaSprite, a mobile game that targets 25- to 50-year-old women with anxiety & depression. Players’ progress can be monitored & rewarded by clinicians and caregivers. The game uses cognitive behavioral therapy (CBT) principles and grant funding has been submitted for future clinical trials (view their slide deck submission at RWJF).

iMedicalApps recently interviewed Swatee Surve MBA MSME, founder and CEO of Litesprite, along with David Hazel MS, Litesprite’s technical advisor and Managing Director of the Center for Web & Data Science at the University of Washington – Tacoma.


Most healthcare apps aren’t games, so there must have been a steep learning curve. What challenges did you encounter while designing your game?

Swatee Surve: I started with the philosophy that if you want someone to get engaged,… it has to come from emotional connectivity. So I took an entertainment-driven approach. And there were several challenges we encountered. Games now are highly-engineered experiences that are audience specific. And audiences have sophisticated expectations. I needed people who understood the core components of a game and how to make these sorts of engaging experiences. So the first skillset I brought on board were game designers and other subject matter experts like Wanda Gregory who teaches game design at the University of Washington. Because we were all volunteer, we spent 4 months solely focused on game design [to determine] the role of the character,… the story arcs…[Then] we added an illustrator [to add] initial design sketches. The next challenge was then how to bring that domain expertise into addressing a healthcare issue. That is where the game designers worked closely with clinicians during the game design process.

It sounds like a big part of the challenge is knowing the existing health games market, and connecting with experts in both the psychiatric disorders and the entertainment medium.

Swatee Surve:  We started by interviewing clinicians first, documenting how they work with patients, the steps they go through during a session, and what information is important to track between sessions. We then took this information and applied it directly to our development. Our clinician, Dr. Samantha Artherholt, provided regular feedback during the design and development process on the experience. This feedback was invaluable and helped us iterate quickly. You can’t build an effective game without knowing the target audience and condition. We spent time understanding these both. From there, our development team brought their whimsy and creativity, to construct an environment of engagement and immersion.

David Hazel: We have on the advisory board, we’ve got [a person] with a background in the clinical side, we’ve got Ed Fries, co-founder of Xbox, and that covers games from the healthcare side. But what Swatee [is talking about] is getting the domain expert. …You have to have a domain expert to help talk about the depression side. Without that, the app developer might not be able to build a great game, but if you bring together a game developer and the domain expert, you have that synergy and impact. The whole tone of this conference is you can have these tools, but there has to be a sort of actionable insight that [a] provider can take. Without being able to provide some action or generate some result, you are just wasting time.

Swatee Surve: And David on our advisory board helps us understand the outcomes in the health community, so that’s the third pillar that we brought in. His team helps us with predictive analytics and tools. To David’s point, you bring the clinician expertise, the gaming expertise, but how it fits in the broader healthcare system is equally critical.


So knowing whom to call is important. Besides reaching out to experts, do you have any advice for pharmacists, physicians, nurses, and other healthcare providers who want to craft their own games?

Swatee Surve: If you’re a clinician and want to build games, it’s important that you’re playing games. By playing all different types of games you’ll develop a broad perspective that can help inspire you. Game design is a specific subject and one of my favorite books on the topic is by Jesse Schell [The Art of Game Design].

David Hazel: You have to know enough about the space to understand it; hire a competent game designer who [knows a] little bit about depression and get a clinician who knows about depression. Really, it’s about translation… we have a strong development team, a strong entrepreneur who’s making deals, good PR support, and everyone needs to know a little bit about what the rest of what everyone else is doing. You have to know enough that you’re not getting B.S.’d, but sort of trust your team and let them deliver on their expertise. You have to have a team. You can’t be that one clinician by yourself.

So no human is an island, then.

Swatee Surve: The trick is to get people equally motivated. The other thing is that if you want to get scrappy, there are schools who’ve got intern programs who have game designers. In Seattle, we have Digipen and there’s also USC (the University of Southern California), [with] two organizations who work with interns. And try to make inroads into the gaming community.  I think another part of that is…sometimes it’s hard if you’re not part of the gaming community, but you’d be surprised.

So one of the ways we connected with the gaming community was being selected to join the Washington Interactive Network’s gaming accelerator, entitled Reactor. Through Reactor we are mentored by people actively working in the gaming industry on current approaches to drive user engagement and community. We also learn from our cohort on other strategies, tools, and technologies related to game development.

Steven Chan, M.D., M.B.A., is a resident physician at the University of California, Davis Health System, researching psychiatry, telemedicine, mobile technology, & human behavior. Steve previously worked as a software and web engineer as well as creative designer at Microsoft & UC Berkeley. Visit him at www.stevenchanMD.com and @StevenChanMD.