MORE THAN A GAME?
Digital Healthcare and Healthy Living 2030 Task Force
The Disruptive Growth of Digital Health
1
Dedicated to: PROFESSOR PATRICK JOHNSTON former Vice-Chancellor, Queen’s University Belfast and original Chair of the Task Force
Digital Healthcare and Healthy Living 2030 Task Force
FOREWORD
The health sector faces a daunting digital challenge. Technology has the potential to reinvent how care is delivered, however, it can be hugely disruptive and there are significant challenges with its implementation. We are chairing a Task Force for the National Centre for Universities and Business reviewing the implementation challenges for digital healthcare. This, our first report, focuses on the therapeutic benefits of serious gaming for mental healthcare of adolescents. These approaches show significant benefits, but also point to fundamental issues in funding, culture, implementation and regulation. It will feed into our final recommendations. We are grateful to all Task Force members and others for their commitment to this project.
JOHN JEANS Chairman, EM Imaging; Chairman, UK Biocentre; Non-Executive Director, ProMetic Pharma SMT Ltd.; Adviser to the Prime Minister, Medical Technologies
BEVERLEY BRYANT Chief Operating Officer at System C and Graphnet Care Alliance; Former Director of Digital Transformation, NHS Digital, NHS England
PROFESSOR SIR LESZEK BORYSIEWICZ Chairman, Cancer Research UK; former Vice-Chancellor of the University of Cambridge
DAVID DOCHERTY Chief Executive, NCUB
NASHITA PATEL Project and Research Manager, NCUB
With thanks to Jo Pisani (Chair, PwC), Alex Barclay (Big Radical and XDs), Isabel del Arbol Stewart, Shakira Malkani and Rachel Miller.
Foreword
03
CONCLUSIONS
01.
02.
‘Serious games’, are designed for a primary purpose other than entertainment, add additional benefits to traditional treatment methods for depression among young people and can improve self-management to encourage behavior change.1 As a large percentage of young people experience significant anxiety in accessing mental health services, the use of digital games if correctly used can improve patient outcomes.
Digital therapies have demonstrated significant clinical benefit within trial settings across several specialities in healthcare. Deployment of such therapies across the NHS may provide an approach in optimising clinical effectiveness and achieving cost reductions.
03.
There are significant market opportunities for healthcare and tech firms in the UK, but global competition is moving at greater speed than UK firms.
04.
The UK is number two in the world for university research in the use of digital games for mental health, but there is much more to be done to understand the mechanisms of effective therapeutic gaming.
05.
There is a serious digital therapy skills gap in the NHS that will undermine the delivery of its 2021 targets for mental health care.
RECOMMENDATIONS
01.
02.
03.
04
Serious gaming and interactive therapy models must be integrated into the training and development for the next generation of mental health specialists and healthcare professionals. The developer community should be engaged on the development of modules and curricula to ensure that this training is adapted to the current pace of innovation in gaming and to encourage disruptive innovation ideas from the NHS workforce.
The Department of Health, NHS, and Innovate UK should work with interactive media trade associations to establish a standing network of therapeutic specialists and commercial developers. This will provide advice on the rapid implementation of technology within clinical practice, whilst ensuring patient safety at all times. The development of guidelines in collaboration with the National Institute of Clinical Excellence will aid implementation, whilst ensuring regulation of the industry.
UK Research and Innovation (UKRI) should fund a multi-disciplinary research programme on serious games for mental healthcare. This will provide an incentive to improve technological innovation, increase capabilities within industry in line with the UK Government’s Green Paper on “Building our Industrial Strategy” and gaining greater insight in patient and carer voices.
Foreword
INTRODUCTION
THE DISRUPTIVE GROWTH OF DIGITAL HEALTH
Digital Healthcare and Healthy Living 2030 Task Force
“Digital health is the convergence of the digital and genomic revolutions with health, healthcare, living and society. As we are seeing and experiencing, digital health is empowering us to better track, manage, and improve our own and our family’s health, live better, more productive lives, and improve society. It’s also helping to reduce inefficiencies in healthcare delivery, improve access, reduce costs, increase quality, and make medicine more personalised and precise.” Paul Sonnier, Author and Founder of the Digital Health LinkedIn network 2
06
The Disruptive Growth of Digital Health
Digital technology is transformative and disruptive. Entire sectors are being born and centuries-old skills are becoming redundant, some at bewildering speeds. The health sector is being reshaped by the same forces, pressures and opportunities driving the fourth industrial revolution, namely automation, big-data, machine learning, always-on connectivity, customisation, and user-experience.
major business opportunities for healthcare and tech companies in the UK. Deloitte forecast the global healthcare market at $8.7 trillion by 2020, primarily driven up by work-force costs, changing patient expectations, increased life expectancy and improved treatment options. Within the UK, total healthcare expenditure was £185 billion in 2015 approximately 10% of GDP - and this is expected to continue to increase.3 There are of course, multiple entry points into this challenge, including the use of big data, artificial intelligence, genomics, social media, sensors and wearables, serious games and information technology such as electronic patient records. (Figure 1).
The National Centre for Universities and Business (NCUB) established a Task Force to review and make recommendations on the ways in which government, employers, businesses and universities can integrate and collaborate to maximise the benefit to the UK in this emerging digital health ecosystem. The NHS has recognised the potential by investing £100m to establish centres of global digital excellence, and there are
FIGURE 1
The Task Force focused initially on mental health, particularly among young people, not only to gain insight into this growing epidemic, but also to establish a broader understanding of the innovation and skills challenges of implementing new digital technologies.
£100M
THE DIGITAL HEALTH LANDSCAPE
NHS INVESTMENT IN CENTRES OF GLOBAL DIGITAL EXCELLENCE 3 mHEALTH
DIGITAL HEALTH
HEALTH AND WELLNESS APPS
GAMIFICATION
BY 2020, DELOITTE FORECAST THE HEALTHCARE MARKET TO BE VALUED AT
HEALTH 2.0 / SOCIAL MEDIA EHEALTH
SENSORS AND WEARABLES QUANTIFIED SELF
HEALTH IT EHR/EMR
INTEROPERABILITY
TELEHEALTH / CONNECTED HEALTH
MEDICAL IMAGING
ARTIFICIAL INTELLIGENCE AND PREDICTIVE ANALYTICS
$8.7TN
3
BIG DATA
PERSONAL GENOMICS
TOTAL UK HEALTHCARE EXPENDITURE IN 2015
£185BN
3
Figure adapted from http://clients.bellman.co.uk/Nuviun/index.html
The Disruptive Growth of Digital Health
07
MENTAL HEALTH IN CHILDREN AND YOUNG ADULTS
Digital Healthcare and Healthy Living 2030 Task Force
Current population data estimates suggest that one in ten children aged between five and sixteen years have a diagnosable mental health condition, including depression. Digital prevention and treatment of such conditions will ultimately be wide-ranging,4 but to shed light on their potential we explored the therapeutic role of ‘serious games’, which have a predefined educational, social, or medical purpose (Figure 2).
FIGURE 2
RELATION OF SERIOUS GAMES AND LEARNING
ENTERTAINMENT EDUCATION GAME-BASED LEARNING
DIGITAL GAME-BASED LEARNING TECHNOLOGYENHANCED LEARNING
SERIOUS GAMES
EDUTAINMENT
Figure adapted from Breuer et al; Journal for computer. 2010;4:7-24
50%
OF ALL MENTAL HEALTH CONDITIONS HAVE BEEN ESTABLISHED BY THE AGE OF 14 YEARS
BY THE AGE OF 24 YEARS THIS INCREASES TO
75% Mental Health in Children and Young Adults
Depression is characterised by extended periods of low mood, disturbance in memory, changes in appetite, isolation, lack of motivation and sleep disturbance.5 It is also linked with the development of high blood pressure, cardiovascular disease and stroke as well as range of other physical illnesses; further complicating management of the disorder. Recurrent depression can affect a person’s ability to perform at school or in the workplace, ultimately resulting in significant working days lost.6 Evidence suggests that 50% of all mental health conditions have been established by the age of 14 years, increasing to 75% by the age of 24.7 The UK’s Department of Health claims that mental health cost the country £105 billion a year and accounted for approximately 23% of total NHS activity.8 Of the estimated 1.7 million people in contact with mental health services at the end of March 2017, 21.2% were aged under 19 years. Yet, it is estimated that 75% of such children and young adults receive no treatment due to the short supply of trained mental health practitioners and associated stigma of the disorder.9,10 The scale of the problem is enormous and continues to escalate rapidly, therefore identifying even marginal treatments, early intervention and prevention gains could lead to significant wins for patients, the healthcare systems and ultimately the UK economy.
09
FIGURE 3
THE MULTIDISCIPLINARY MENTAL HEALTH TEAM Clinical psychologist Community mental health promotion
Rehabilitation and residential services
Crisis resolution team
Occupational therapist
Psychiatric nurses
P AT I E N T
General practitioner
Current clinical guidelines for the management of depression recommend psychological treatments, interpersonal psychotherapy and the use of antidepressant medications used individually or in combination. This is delivered by a multidisciplinary team in both primary and secondary care settings (Figure 3).11 Cognitive Behavioural Therapy (CBT) is considered the ‘gold-standard’ treatment for the management of depression.12 However, despite the documented effectiveness of CBT, it remains underutilised due to poor implementation and dissemination amongst healthcare professionals.13 The identification of digital tools to aid the delivery of established, cost-effective treatments methods has the potential to add value not only for the patient but also the healthcare system. However, our wide consultations show that there is insufficient interaction between the developer community, the extensive multidisciplinary teams treating a patient and lack of a shared understanding of current treatment options and methods of resource allocation within the healthcare system. We recommend a structured and permanent network should be established and maintained by the NHS. This will provide deep research and clinical insight, identify potential gaps in the market and facilitate education and training of digital health technologies within mental health services, to aid implementation and increase uptake. The NHS has begun the journey, but other specialists must be mobilised:
10
Psychiatrist
Early intervention service
“By 2020/21, there will be significant expansion in access to high-quality mental health care for children and young people. At least 70,000 additional children and young people each year will receive evidence based treatment, representing an increase in access to NHS funded community services to meet the needs of at least 35% of those with a diagnosable mental health conditions.”14
As part of this initiative, the health service is reviewing technology-enabled therapies, including the use of gaming: “…there will be a critical focus on developing frameworks for regulation of digitally-enabled mental health services. This will support the evaluation and endorsement of digital tools to support evidence based mental health care, understanding and promoting the digital literacy and participation of those using mental health services, and setting standards for sharing electronic health records and data. This approach will allow safe and effective implementation across all mental health pathways.”15
Alongside these benefits to the health service, there are major market opportunities for UK firms.
Mental Health in Children and Young Adults
DIGITAL GAMING AND MENTAL HEALTH
Digital Healthcare and Healthy Living 2030 Task Force
Digital gaming generated £4.66 billion in revenues in the UK alone, and this will grow as mobile technologies become more sophisticated and other affordable next generation hardware is deployed.16 The serious games market is forecast to penetrate most industry sectors, to be worth $5.5bn by 2020, and grow at a compound rate of over 16%.17 The average Generation Xer will probably have played 10,000 hours of game time by the age of twenty,18 and like all new electronic media, this has been the subject of widespread social and academic concern. Games have
been linked with increased unemployment among young men, aggression, anti-social behaviour and suicide. Academic research has, of course, explored these challenges, but there is a growing literature on the benefits of ‘serious games’. Mental health was the focus of up to a third of disease-specific apps in 2015, and researchers have explored their therapeutic and other successes.19 It is a truism that every field requires more research, but this is certainly true for this growing field. Elsevier a member of the Task Force, was delighted to offer a review of academic outputs - including original research, meta-analysis and conference proceedings - on the use of digital games for mental health. This showed significant and encouraging growth, and that the UK is among the leading research communities.
ACADEMIC PUBLICATIONS REVIEWING THE USE OF DIGITAL GAMES FOR MENTAL HEALTH BY YEAR
FIGURE 4
611
455 386 264 186
40
1995
71
78
84
1997
1999
2001
104
2003
2005
Three independent meta-analyses supported the notion that serious games produced for psychotherapeutic purpose, as well as commercial games can provide a positive impact when used as an adjunct to traditional therapy methods. They can increase motivation, attention, knowledge, physical activity and emotional expression, and within randomised controlled trials, significant reductions were noted in disruptive behaviour, depressive and anxiety symptoms.20 Psychoeducation and training, virtual reality exposure therapy, exercise, and entertainment provide support to differing population cohorts.
12
206
2007
2009
2011
2013
2015
“Evidence from neuropsychological research further suggests the therapeutic value of game-based digital interventions in depression therapy, finding that positive game-playing experiences trigger the release of hormones such as endorphins and striatal dopamine.”21
Digital Gaming and Mental Health
FIGURE 5
ACADEMIC PUBLICATIONS REVIEWING THE USE OF DIGITAL GAMES FOR MENTAL HEALTH BY COUNTRY AND TERRITORY
1770
538 172
ND
211
221
242
254
269
IT
FR
ES
CH
AU
317
320
DE
CA
UK
US
Many within the research community are aware of the need to call for faster iterations, rapid testing, non-traditional collaborations, and user-centred approaches to achieve significant mental health benefits. They recognise that:
It is crucial, that ‘serious games’ should be as compelling as commercial games, and not just as a therapeutic tool. The Grand Theft Auto franchise invested $266m in its latest release, and even relatively simple games like Angry Birds can cost approximately $100k to build, and are constantly updated and revised. A game that stands still, is a game that won’t be played for very long. This is a crucial lesson for therapeutic gaming within mental health. Pricing and business models remain a challenge for wide-spread uptake within healthcare markets.
Fast iterations based on research on the immersive quality of the user experience, will allow others to build and deploy. However, traditional randomised controlled trials take approximately seven years, which militates against fast iteration and implementation.22 If the UK healthcare system is to move seriously into this therapeutic approach, it must explore alternative methods to traditional randomised controlled trials, for example utilising the concept of ‘substantial equivalence’ currently used for medical devices in the US FDA processes.23
Success will only flow from strong collaborations across sectors, disciplines in healthcare, information technology and data science. The UK’s research councils have a range of research programmes focused on depression, and the Elsevier study shows that the UK is third in terms of output, but further multi-disciplinary studies must be undertaken to dissect the mechanics of how serious games work. Future research should also include independent trials and direct comparisons of game-based and non-game-based options for varied user groups.24 All research must systematically involve the game developer community, and universities can play a significant convening role in enabling this.
Digital Gaming and Mental Health
13
10.4%
88.0%
11.5 %
90.0%
OF PATIENTS WERE AWARE OF SERIOUS GAMING
OF CLINICAL PSYCHOLOGISTS WERE AWARE OF SERIOUS GAMING
Even if all the above can be achieved, there are significant barriers to scaling up and creating value. These include keeping up with technology, potential harm to the patient-healthcare professional relationship, and patients accessing inappropriate or harmful games through the open market. To ensure that games are accessed and utilised in an ethical and regulated manner, as with all healthcare interventions, policy makers need to address potential changes in guideline content together with confidentiality of records.25 There are further issues in educating parents, patients and therapists about the benefits. A recent survey showed that only 10.4% of patients and 11.5% of clinical psychologists were aware of serious gaming. However, 88% of patients and 90% of mental health care professionals could envisage therapeutic use and benefit.26 As expected, experienced gamers are more likely to consider this treatment to be valid and therapists who play computer and video games see fewer therapeutic disadvantages. Healthcare professionals envisaged significant benefits for the management of anxiety, affective, impulse control and adjustment disorders in young adults (for example, the use of games with young adults was deemed the most appropriate by 91.8% of healthcare professionals).
OF PATIENTS COULD ENVISAGE THERAPEUTIC USE AND BENEFIT 25
OF MENTAL HEALTHCARE PROFESSIONALS COULD ENVISAGE THERAPEUTIC USE AND BENEFIT 25
A group of healthcare professionals concluded their review of gaming:
“With smart devices that are carried with us, using the internet, email, social media, we are able to gather and disseminate information in ways that were less time-consuming, more interesting and more readily available. With advanced graphic and audio-visual performance, we are able to create virtual multisensory worlds in order to expose clients to important stimuli in a safe manner without limiting ourselves to physics or logistics of the real world. The use of electronic games may allow us to engage our clients in a way that is not only more appealing to many clients, especially children and adolescents, but also with demonstrated efficacy.� 26
To explore this proposition in a practical way, the Task Force worked with Big Radical, a product development studio, and the Experience Design Group (The XDs) on a fast-iteration, rapid Design Jam to explore various potential products to increase mental well-being amongst adolescents and young people.
14
Digital Gaming and Mental Health
DESIGN JAM:
ITERATING SOLUTIONS
The two-day workshop brought together User Experience (UX) and software developers, data scientists, strategists, psychologists, clinical psychiatrists, businesses and academics. The average age was around twenty-five, which meant that they were close in experience and understanding to the group we were targeting. The teams formulated their hypotheses, tested initial ideas and turned these into stories and early prototypes which would turn into full business plans and prototypes to be judged against competing teams.27 Criteria for success included the use of different types of digital platforms, innovation, investment opportunities, sound business models and outcomes for those suffering from depression. The winner was Altru - an app that captures mood and works by providing incentive to someone to nudge and hang-out with their friends to start conversations they wouldn’t have otherwise had.
Digital Gaming and Mental Health
“To make use of serious games but also more widely technology, we need to break out of our professional silos and work with multidisciplinary teams. I’d love to have a UX designer and a coder on my team so we can work in a much more agile way about deploying technology and I think seeing that in action at the design jam reinforces that belief.”
James Woollard, clinical child and adolescence psychiatrist advising the project.
15
DIGITAL SKILLS AND CAPACITY BUILDING A GROWING GAP
Digital Healthcare and Healthy Living 2030 Task Force
We have established a clinical and systematic need, a strengthening research base, and a large potential market. But there remains perhaps the most significant challenge of all – the training and education of healthcare professionals to take advantage of new interactive technologies. To deliver its mental health targets for 2021, the NHS must train a large number of psychiatrists, psychologists and nurses. Furthermore, GPs and community healthcare workers are often the ‘gatekeepers’ for accessing secondary care. If the gains outlined here are to be realised, then Health Education England should enable the development of customised programs on digital therapies for all healthcare professionals at both undergraduate and postgraduate levels. But there is a bigger challenge for the skills base, one that is shared by all professions.
Digital Skills and Capacity Building - a Growing Gap
New specialisms must be developed, funded and validated for digital healthcare professionals who understand and can build on the key components of success, such as coding, app development and data analytics. The skills acquired are potentially transferable to all specialities of allied health professionals, not just mental health. Further research to assess the needs of front line staff is essential to tailor educational programmes to ensure its effectiveness at the pace of technological advances. There are already serious games courses and hubs in UK universities, including Coventry, Southampton, Northampton, and the Glasgow School of Art who provide modules on the use of ‘serious gaming’ for educational purposes. But if the UK is to take a leading role in helping to treat depression and other mental illnesses through gaming and interactive solutions, then universities must develop more multidisciplinary courses and opportunities for students, including more collaborative courses with UK pharmaceutical, health, gaming and technology companies.
17
CASE STUDIES
Digital Healthcare and Healthy Living 2030 Task Force
SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts) is a video game utilising a 3D interface similar to that in World of Warcraft, developed by academics at the University of New Zealand, to improve access to health services. The aim of SPARX is to reduce depressive and anxiety symptoms in children and adolescents to similar levels or below what is currently achieved by clinical management. The game utilises cognitive behavioural therapy (CBT) methodologies to assist the player/ patient to develop techniques to reduce symptoms and prevent relapses. A multi-centre randomised controlled trial reported in the British Medical Journal found significant improvements in depressive symptoms together with higher remission rates (measured up to 3 months following completion of the study) associated with the utilisation of SPARX as a treatment modality, in comparison to current clinical management (for example the use of face-toface counselling). Use of the program also resulted in significant reductions in symptoms of anxiety, hopelessness and an improvement in quality of life.
“Remissions rates were significantly higher in the SPARX arm (n=31, 43.7%) than in the treatment arm as usual arm (n=19, 26.4%) (difference 17.3%, …, p=0.030).”
The use of a SPARX as a management of depression, was shown to result in similar rates of patient satisfaction in comparison to normal clinical care. Despite similar
Case Studies
satisfaction rates, 80.5% of participants would recommend this method of treatment to their friends, significantly higher than that associated with standard clinical guidelines. Satisfaction rates were significantly higher amongst users of SPARX as participants “…could do it at school or in a clinic”, “…learn things by myself or at my own pace” and “…made especially for young people”. Through an interactive three-dimensional fantasy environment, SPARX utilises a first-person instruction where the player interacts with them as their ‘guide’ throughout the game. The ‘guide’ places the game into context and provides methods of education to allow implementation of CBT techniques including relaxation, breathing techniques, avoidance of negative thoughts and methods of thinking constructively. Furthermore, the game has capabilities to assess the player’s mood as well as monitor responses to challenging scenarios in real life. Although the market has seen numerous serious games in recent years, SPARX is unique as it provides an engaging method of management of depressive and anxiety associated symptoms without arousing feelings of guilt, shame or requirement for oral medication in comparison to other gaming methods. In view of the significant clinical effectiveness of the serious game, SPARX is now backed by LinkedWellness; a commercial tech start-up to aid implementation within clinical practice globally. At present, the serious game is a standalone version but further work is currently being undertaken to develop a clinically validated symptom assessment tool that has the potential to prospectively diagnose patients with mild or moderate depression, providing a method to monitor symptoms throughout the use of the game. Evidence consistently demonstrated a shortage of skilled mental health workers therefore prescribing online therapy by clinicians and allied mental health professionals may provide an alternative method to improve access to health care. The use of serious games within targeted populations, particularly those with chronic co-morbidities, may provide an alternative method to engage and improve adherence in young people.
19
Pesky gNATs is a 3D computer game, devised for the management of low mood and anxiety in young people aged between 9-12 years, delivered by the therapist during the course of their regular therapy session. The game provides a psychometric assessment of symptoms and delivers a cognitive behavioural therapy (CBT) based intervention teaching self-regulation techniques. Pesky gNATs assists management for anxiety and low mood utilising a three-pronged digital approach; a. www.peskygnats.com website provides therapists with virtual training b. A computer game administered by a therapist during a one-to-one consultation allows the delivery of an evidence based intervention c. Smart-phone app allows remote access to material learnt during consultations at home, school and/or in the community
At present, young people experience significant anxiety in accessing mental health services due to a skilled worker shortage and limited adherence to evidencebased clinical interventions. It is also well recognised that development differences between adolescents and adults has the potential to result in a difficulty to grasp abstract concepts associated with CBT, due to their stage in cognitive development. Therefore Pesky gNATs was devised to provide a method of improving access and engagement to mental health services for young people.
20
“Pesky gNATs was designed to increase adherence to the evidence based principles of cognitive behavioural therapy.”
The game is set on a distant tropical island, where patients progressively learn to trap gNATS (i.e. observe and challenge their negative thoughts) and locate gNAT hives, to undertake hive splatting (identifying and challenging negative core beliefs). Each level of the game introduces a single CBT concept including thoughts, feelings and behaviours, cognitive monitoring, cognitive re-structuring, negative core belief identification, negative core belief re-appraisal and relapse prevention. As the young adult progresses through the game, they have an opportunity to acquire relaxation and mindfulness through methods focused specifically for children aged between 9-12 years. Furthermore, study participants reported higher levels of satisfaction with the game and thought it an acceptable method for the delivery of such interventions. Playing the game together with a therapist was necessary for many of the participants. The involvement of a professional aid is likely to result in improved patient outcomes.
“Put my mind at rest about the thoughts, that it’s OK to have negative thoughts” “Always hated therapy but this would be my style of doing it” “Was good doing it on a computer- don’t like talking much, it was back-up if you didn’t want to talk, you could look at the computer”
Case Studies
CONCLUSIONS Despite the market potential, therapeutic, public health system benefits and consumer demand, ‘serious games’ as a toolkit for the management of depression particularly in young people, is in its infancy. The Task Force strongly recommends tailored research into user needs is undertaken by the relevant research councils to ensure a structured development forum is established, bringing together the NHS, Department of Health, regulatory bodies and game trade associations. This would be expected to make recommendations on incentives, including tax breaks, regulatory processes and innovation funding, to further develop the serious games market for healthcare. We anticipate the NHS will deliver on its promise to set standards and guidance on the implementation of digital technology throughout the NHS. The NHS quietly launched an app store in April 2017, however only one app is currently approved for use. To aid implementation and allow transformation of the health service within a digital era, further work is essential to provide confidence to developers, healthcare professionals and patients of the market. Finally, universities, the NHS and training bodies should review and make recommendations on ways in which all healthcare professions, including psychologists, doctors and nurses are trained and revalidated on new forms of technology within healthcare. The Local Education and Training Boards in England and the Deaneries in the devolved administrations, which are responsible for the training and education of doctors and nurses, must integrate best practice modules and test for knowledge of serious gaming throughout their careers.
Conclusions
Digital Healthcare and Healthy Living 2030 Task Force
21
TASK FORCE STEERING COMMITTEE
22
NAME
COMPANY
Jo Pisani
Chair, PwC
Sandy Johnston
PwC
Lim Chea
PwC
Paul Evangalou
PwC
Alex Barclay
Big Radical/XDs
Kieran Waelen
Big Radical
Professor James Bown
Abertay
Professor Andrew Chitty
Arts and Humanities Research Council
Professor Phil Evans
University of Surrey
Dr Morag Foreman
Wellcome Trust
Hazel Harper
Innovate UK
Karen Livingstone
Eastern Academic Health Network
John Loder
Nesta
Ivan Phelan
Sheffield Halam
Steve Price
Tenshi
Paul Thomas
Microsoft
Daniel Wood
UK Interactive Environment
Kristina Barger
The Experience Design Group (XDs)
Phil Breedon
Nottingham Trent University
Duncan Brown
Shift Design
Serena Connor
Tenshi
Michael Craven
University of Nottingham/Mindtech
Scott Ewings
Big Radical
Maxine Mackintosh
Health Tech Women/University College London
Chris Sawyer
Innovate UK
Patrick Smith
Kings College London
Seb Tucknott
IBDrelief and Brightside
John Wilderspin
Wilderspin Consulting
James Woollard
NHS England
Aimie Chapple
Accenture
Professor Adam Gazzaley
NeuroSpace
Chris Hollis
University of Nottingham/Mindtech
Chris Emerson
Intel
Neil Dawson
Anna Freud Centre
Task Force Steering Committee
FOOTNOTES Wantland DJ et al. The effectiveness of web-based vs. non-web-based interventions: A meta-analysis of behavioural change outcomes. Journal of Medical Internet Research 2016;6:1-13
1
http://storyofdigitalhealth.com/definition/
2
www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2017-health-care-outlookinfographic.pdf
3
www.mentalhealth.org.uk/statistics/mental-health-statistics-children-and-young-people
4
www.who.int/classifications/icd/en/bluebook.pdf
5
www.hse.gov.uk/statistics/causdis/stress/stress.pdf
6
www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
7
www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf
8
Hollis C et al. Annual research review: Digital health interventions for children and young people with mental health problems a systematic review and meta-review The journal of Child Psychiatry 2017; 58:474-503
9
Davies S. Annual report of the chief medical officer 2013, public mental health priorities: Investing in the evidence. Department of Health, UK 2017
10
www.nice.org.uk/guidance/cg90
11
National Institute of Clinical Excellence. Depression in adults: recognition and management. Clinical guideline CG90; www.nice.org.uk/guidance/cg90/chapter/1-Guidance#care-of-all-people-with-depression
12
Beck AT. How an anomalous finding led to a new system of psychotherapy. Nature Medicine 2006;12:1139-1141
13
www.england.nhs.uk/wp-content/uploads/2016/07/fyfv-mh.pdf
14
See also: http://mindtech.org.uk/projects/71-digital-mental-health-tools-evaluation-criteria-technology-theme.html
15
https://ukie.org.uk/research
16
https://seriousgamesmarket.blogspot.co.uk/2015/05/serious-games-market-expected-to-grow.html
17
www.newstatesman.com/culture/2014/08/i-ve-probably-played-over-10000-hours-video-games-i-could-be-concert-pianist-now
18
Johnson D et al. Gamification for health and wellbeing: A systematic review of literature. Internet interventions 2016;6:89-106
19
Lynn Horne-Moyer H et al. The use of electronic games in therapy: a review with clinical implications. Current Psychiatry Reports 2014;16:520
20
Li J et al. Game based digital interventions for depression therapy: a systematic review and meta-analysis. Cyberpsychology Behaviour Society Network 2014;17:519-27
21
Hollis C et al. Annual research review: Digital health interventions for children and young people with mental health problems- a systematic review and meta-review. The Journal of Child Psychology and Psychiatry 2017;58:474-503
22
www.fda.gov/medicaldevices/deviceregulationandguidance/howtomarketyourdevice/premarketsubmissions/ premarketnotification510k/#se
23
Fleming TM et al. Serious games and gamification for mental health: Current status and promising directions. Frontiers Psychiatry 2016;7:215
24
Barrett MS et al. Computers and psychotherapy: are we out of a job? Psychotherapy 2014;51:220-223
25
Eichenberg C et al. Acceptance of serious games in psychotherapy: an inquiry into the stance of therapists and patients. Telemedicine J E Health 2016;22:945-951
26
https://vimeo.com/224029711 A video of the two days.
27
Footnotes
23
WORKING TOGETHER FOR GROWTH AND PROSPERITY
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