Future of Health IT: Trends and Scenarios

The unexpected convergence of gaming and enterprise IT

I have been reading articles on the state of the art in computer gaming technologies from the August issue of the Communications of the ACM. One in particular, Scaling in Games and Virtual Worlds by Jim Waldo, describes the (up to now) unique characteristics of computer gaming from a scalability perspective, which to my surprise began to resonate with my vision of the future of enterprise IT, particularly healthcare enterprise IT and health informatics.

At the risk of plagiarizing, I'm going to reproduce the entire introduction, which is a very small part of the whole article, and is aimed at enticing you to subscribe to the magazine (by joining ACM) or pay for the article. Here goes:

I used to be like you.

I used to be a systems programmer, working on infrastructure used by banks, telecom companies, and other engineers. I worked on operating systems. I worked on distributed middleware. I worked on programming languages. I wrote tools. I did all of the things that hardcore systems programmers do.

And I knew the rules. I knew that throughput was the real test of scaling. I knew that data had to be kept consistent and durable, and that relational databases are the way to ensure atomicity, and that loss of information is never an option. I knew that clients were getting thinner as the layers of servers increased, and that the best client would be one that contained the least amount of state and allowed the important computations to go on inside the computing cloud. I knew that support for legacy code is vital to the adoption of any new technology, and that most legacy code has yet to be written.

But two years ago my world changed. I was asked to take on the technical architect position on Project Darkstar, a distributed infrastructure targeted to the massive-multiplayer online game and virtual-world market. At first, it seemed like a familiar system. The goal was to scale flexibly by enabling the dynamic addition (or subtraction) of machines to match load. There was a persistence layer and a communication layer. We also wanted to make the programming model as simple as possible, while enabling the system to use all the power of the new generations of multicore chips that Sun (and others) were producing. These were all problems that I had encountered before, so how hard could these particular versions of the problems for this particular market be? I agreed to spend a couple of months on the project, cleaning up the architecture and making sure it was on the right track while I thought about new research topics that I might want to tackle.

The three months have turned into two years (and counting). I've found lots of new research challenges, but they all have to do with finding ways to make the environment for online games and virtual worlds scale. In the process, I have been introduced to a different world of computing, with different problems, different assumptions, and a different environment. At times I feel like an anthropologist who has discovered a new civilization. I'm still learning about the culture and practice of games, and it is a different world.

The next section is entitled "Everything You Know Is Wrong" - and from a computer science perspective it is true, with respect to gaming now and healthcare enterprise IT as it will soon be. Let's explore why.

This Is Not A Game: Alternate Reality Gaming and its potential for learning

Long-time readers will recall my interest in storytelling as a medium for therapy and clinical research, beginning in early 2006 with a post on Carolyn Watters' work with child cancer patients, and continuing with others, including one on Atari pioneer game designer Chris Crawford's StoryTron platform.  (You can find the whole collection of FutureHIT posts tagged 'storytelling' here.)

Last week I wrote about a CACM article on the emerging discipline of alternate reality gaming. following up on that, I found an article in the FutureLab site by Tash Lee entitled This Is Not A Game: Alternate Reality Gaming and This Is Not A Game: Alternate Reality Gaming and its potential for learning. It's not part of the latest ARG buzz: it was published in July 2006. 

Here's a taste:

It is the job of the game designers, or 'Puppet Masters', to weave the narrative through the different media to create a cohesive story for players. However, it is the players that drive the game forward, through the solving of puzzles closely connected to the plot. Generally puzzles are too complex to be solved alone, and so games are played with the support of an online community that works collaboratively to speculate, share expertise and overcome hurdles.

Storytelling is human nature, so the genre naturally has a number of antecedents; however, the birth of ARG as we know it is widely considered to have been in 2001, with the launch of an online 'wild goose chase' to promote Spielburg's film AI. It started with a credit in its marketing material for 'Sentient Machine Therapist' Jeanine Salla, alongside the actor's names. This anomaly tapped into people's natural curiosity and when they Googled 'Salla' they found her profile at 'Bangalore World University' where she worked - in the year 2142. From here there were countless links to other websites all set in 2142 - all convincing and seemingly 'real'. Those who had fallen down the proverbial 'rabbit hole' were rewarded with the discovery of an elaborate real-time story about a murdered man in which they were now active participants.

Tash is interested in the potential of ARG as a learning medium:

Alternate Reality Gaming: Can we apply the Swarms paradigm to translational medicine?

I haven't written about serious games in quite a while, but that doesn't mean the topic hasn't been on my mind in the interim. The Feb 2008 ACM Communications issue has a cover article entitled "Alternate Reality Gaming", by Jeff Kim of UWash, Jon Allen of UCSF, and Elan Lee, creative director of two of the pioneering ARGs - The Beast and I Love Bees.

As far as I could recall, I had never heard of the concept (but then I'm pushing 60, so who knows what I knew two weeks ago), but googling ARGs led me to a post in Christy Dena's blog, which pointed me to Jane McGonigal's blog, where she was celebrating her recently being featured in the Harvard Business Review's annual "Top 20 Breakthrough Ideas" List.

Jane knows whereof she speaks, it seems - according to the article by Kim et al, she played the "community lead" role in the ILB game, which sounds like it basically meant being in-world (the virtual world) 24/7/365, observing events and making sure the game reacted in timely and innovative ways.

Here's a key excerpt from Jane's HBR article:

In the coming decade, many businesses will achieve their greatest breakthroughs by playing games—specifically, alternate reality games, or ARGs. Custom-designed ARGs will enable companies to build powerful collaboration networks, discover solutions to specific business problems, forecast opportunities, and innovate more reliably and quickly.

Why? ARGs train people in hard-to-master skills that make collaboration more productive and satisfying. Playing an ARG teaches 10 collective-intelligence competencies. These include cooperation radar, a knack for identifying the very best collaborators for a given task, and protovation, the ability to rapidly prototype and test experimental solutions. Using these skills, players amplify and augment one another’s knowledge, talents, and capabilities. Because ARGs draw on the same collective-intelligence infrastructure that employees use for “official” business, games will map directly to a familiar reality—no translation required.

As these competencies mature within a business, ARGs will provide a truly stimulating framework for doing everyday work. Few meetings are as engaging as an ARG, whose emerging narrative evokes players’ shared sense of urgency and whose puzzles and clues deepen their curiosity. The structure for collaboration is clear, with players rallying around explicit goals and continually sharing theories, tactics, and results. Playing also generates compelling momentum: The puppet master monitors and rewards participants’ efforts, and times the release of new challenges so that players experience multiple cycles of success.

OK, so business will soon be a lot more fun than it was during the first 35,000 years since the last Ice Age. What does this portend for translational research. Quite possibly, it's big news.

[SERIOUS GAMES] Video Games Conquer Another World: Retirees

The New York Times has an article about the rapid rise in senior citizens in the gaming world population: Video Games Conquer Another World: Retirees. I laughed a lot while reading it, but the implications are serious - and a lot more positive than I expected when I first saw the headline.

Second Life : Rogue Server Goes Open Source

This isn't absolutely new and fresh, in fact it's sooooo last month ago, but I just noticed it. Here's the scoop from 3pointD.com: Rogue Second Life Server Goes Open Source.

While Prokofy Neva, Tony Walsh and others wonder what will happen to Second Life real estate investments once it’s possible to run your own open-source server (i.e., create your own virtual land), someone has gone ahead and done just that. This thread over at the libsecondlife forums describes a Second Life server built by a user, a single sim that can be accessed using the standard client software. As near as I can figure, the server was built by examining the client code (and/or reverse-engineering it) along with the information that is passed between client and server in order to get an idea of what the server code would need to look like. What’s more, an early version of the server code has already been made available as an open-source project. While this doesn’t mean that people can immediately set about creating the distributed metaverse that 3pointD often likes to contemplate (questions such as where everyone’s assets would reside in such a place remain to be answered), it is a step toward a virtual world, solar system, galaxy or universe free from centralized corporate control, one that looks more like the World Wide Web of individually controlled sites than it does a contiguous grid such as exists in Second Life.

This is more like civilization springing up in South America the same time as in ancient Sumeria, but the potential is there: once they "discover" each other, their economies and societies can intermingle. Evangelical warrior/explorers take note.

A more fun (and realistic) intermingling would occur if World of Warcraft were to suddenly open up a Stargate-like portal into Second Life. Would SL's warriors turn out to be girlie-men, or would they successfully defend us? If so, would that change their status in SL society from annoying griefers to warlords over all? Maybe I'd better create a second avatar and learn more about Gor... ;-)

Second Life: the next paradigm for Computer Supported Cooperative Work (CSCW)?

Last week I wrote in my First Annual Chinese New Year Technology Predictions post that "Serious Games, especially 3D Virtual Worlds, will start being taken seriously by mainstream academic health researchers." This prediction is my small contribution to the storm of controversy around Second Life. When I made the prediction I hadn't yet seen a post in the blog of Irving Wladawsky-Berger (hereinafter W-B) entitled  A Dialogue on Virtual Worlds, in which he contrasts his view with that of perhaps the three most prominent voices in the Second life debate, Clay Shirky of NYU and Beth Coleman and Henry Jenkins of MIT's Comparative Media Studies program.

W-B's post reports on the point of view he expressed at a panel on Transforming Healthcare, Education and Business through Virtual Worlds at the Westport (CT) Public Library. (Sounds like a great public library, by the way!) W-B's point of view is unlike either of the two most prevalent views in the technology predictions space, which I referred to in my Predictions post as the enterprise prognosticators and the gadget geeks.  As an IBM executive it can be argued that his viewpoint is closest to the enterprise prognosticators, but as chief of IBM Research he takes a longer, wider, and deeper view than that expressed in the business mainstream.  I watch his blog closely because he is in a position to see further down the road than most IT mavens. 

Clay, Beth, and Henry's viewpoints, while strongly divergent with each other and to some degree with W-B's and my own, are of similar quality to that of W-B's in my estimation. Clay in particular is prominent in the health IT arena, most recently as chair of the Technical Subcommittee of the Markle Foundation's Connecting For Health initiative.
 

Many are trying to figure out whether [virtual worlds and Second Life in particular] are serious subjects that go beyond games and entertainment.  Some of us believe that this is the natural evolution of the Internet and World Wide Web, and therefore worthy of the considerable attention being increasingly devoted to it by the technical and business communities, as well as by the media.  Others, however, feel that this is all the marketing hype of a hungry IT industry looking for its Next Big Thing.  Perhaps the biggest skeptic about the future of virtual worlds and Second Life is Clay Shirky, a consultant, writer and teacher who is Adjunct Professor at NYU's Interactive Telecommunications Program.

He, Beth Coleman and Henry Jenkins have started a very interesting dialogue on virtual worlds and Second Life through their respective blogs.  Henry Jenkins is Professor of Literature at MIT, where Beth Coleman is Assistant Professor of Writing and New Media.  They are both also on the faculty of MIT's Comparative Media Studies program.  Here are Henry's, Beth's and Clay's blog entries to kick off their discussion.  I would like to contribute to this civilized exchange by explaining my own point of view on the subject, which I come to from a somewhat different angle than Clay, Beth and Henry. 

First Annual Chinese New Year Predictions

Making my technology predictions during the Chinese New Year celebration seems like it will be a lot easier than joining the crowd at the Western calendar's equivalent.  Not only is there less competition, but I have the benefit of reading everybody else's before I do mine.

I find, though, that I have a distinctly different point of view (POV) than most prognosticators.  There are two varieties that seem to predominate.

Second Life Herald: Interview With the Agoraphobic: Fighting the Fear in Second Life

This is just a brief note to point out this interesting post about a novel application of virtual reality to healthcare in the Second Life Herald: Interview With the Agoraphobic: Fighting the Fear in Second Life.  It's apparent that healthcare IT is evolving in ways few of us could have imagined even a decade ago. It's a testimony to the power of the Web as a social interaction medium.

Meet Roberto, quite an eye-catching avatar who is one of the more interesting characters that can be found frequenting random areas of the Second Life world that we explore from day to day. Above Roberto's head is a floating, spinning, square picture of his real-life self. This floating image of himself is something he calls a "tip hat", where people can pay a small donation to receive a party hat, and witness Roberto doing a dance in return for their kindness. Some of the contributions Roberto receives go toward the cause of making his avatar look as much as possible like his real self.

This, however, raises a few questions: Isn't there an easier way to raise the money? Why is it so important for him to look like his real-life image? And what's his motivation for setting out on such a time-consuming and ultimately unrewarding task? The answer is simple: Agoraphobia.

Serious Games Source: 'Persuasive Games: Wii’s Revolution is in the Past'

I try to pay a lot of attention to human-computer interface (HCI) advances, in part because it is a passion, and in part because it is the area in which I am earning a Master's at the University of Michigan School of Information.  I also have a strong interest in the concept of "serious games", which are games that serve a serious purpose such as helping children with cancer deal with the pain and fear they experiences. My first post on the subject of serious games was put up over a year ago, describing the work of Carolyn Watters of Dalhousie University.

In spite of all this interest, I was blind-sided by a new development in the area of gaming hardware.  Most computer game interfaces are implemented using either primitive keyboard commands or a cryptic piece of hardware that can only be understood by someone with a lot of time and energy to put into learning it.

It was exciting to learn from the e-zine Serious Games Source of the haptic-input interfaces that come with the new Wii game platform from Nintendo. Haptic interfaces are related to the sense of touch; a true haptic interface offers full-duplex touch communication, exerting forces that affect the user's sense of touch in addition to accepting touch input. The Wii controllers are not true haptic devices since they work in only one direction, but they are a major advance over traditional game control input modalities. Per Nintendo:

Sporting the size of a traditional remote control, the wireless Wii Remote is a multifunctional device that is limited only by the game designer's imagination. In a tennis game, it serves as your racket you swing with your arm. In a driving game, it serves as your steering wheel. For first-person shooters, the Wii Remote acts as your weapon that you point at an enemy. The list of potential uses goes on and on.

In addition to its pointing and motion-sensing abilities, the Wii Remote also includes a speaker, rumble feature and expansion port for additional input devices, such as the Nunchuk.

They have a cute video ad on YouTube that gives a better idea of what all this means.

The Serious Games Source article was entitled Persuasive Games: Wii’s Revolution is in the Past.  It described in brief the applicability to healthcare:

In terms of applicability to serious games, the games for health community will no doubt see the immediate opportunities for the Wii. Physical interfaces like Dance Dance Revolution have proven effective in exercise and weight loss regimens, and the wiimote extends active play to many more genres of games, and therefore to more varieties of players. Aside from exercise games, the wiimote’s application in serious games is more limited. There is nothing wrong with using physical interfaces in serious games, but the feature does not directly help developers model things like disease or organizational politics or leadership or nonviolent conflict, examples of the problems serious games address.

Sounds to me like the possibilities are, if not endless, at least manifold. A major step forward in HCI.

QUICKIE: Irving Wladawsky-Berger, An Unusual Meeting

Further validation on Second Life as a business tool: Irving Wladawsky-Berger describes an international business meeting conducted in Second Life last month. 2500 people gathered in the SL metaverse, with First Life locations from Beijing to Tampa, FL. Check it out: An Unusual Meeting.

Oh my. I feel the onset of the symptoms of "Conversion Flu." I may be coming down with it soon, in spite of everything I said in my "Real Is Beautiful" post and other diatribes I've written about the dangers Virtual Reality presents.