References on the Website
- Footnote 1: Journalist Dan Weissmann said, "If you were to design a health system that did the worst job of
serving people and immiserates people the most, you'd have a hard time coming up with something that was more effective
than what we've got.”
KHN's ‘What the Health?’: Boosting Confusion
- Footnote 2: According to the Commonwealth Fund, the US ranks dead last among developed nations on health
outcomes; last on access to care; last on administrative efficiency; and last on health equity.
Mirror, Mirror 2021: Reflecting Poorly. Health Care in the U.S. Compared to
Other High-Income Countries
- Footnote 3: According the American Journal of Public Health, healthcare is by far the leading cause of personal
bankruptcy in the United States.
Medical Bankruptcy: Still Common Despite the Affordable Care Act
- Footnote 4: Other innovators are rethinking our teetering health system.
- Footnote 5: Our health system may be broken beyond compare or repair, yet its most under-utilized,
under-performing human capital is not providers, payers, or the supply chain. It’s the embattled patients.
Warner Slack, the visionary physician who wrote that the patient is the “largest and least utilised resource in
healthcare” -- BMJ 2018;362:k3194
- Footnote 1: All ways considered, the best by far was with video games.
According to clinical research physicians with the Pediatric IBD Consortium, the lack of patient and caregiver engagement impeded patient-centered outcomes. The art and entertainment of video games were likely to counterbalance cognitive overload and dread caused by disease, whereas health information per se tended to increase it.
- Footnote 1: We are practitioners of system dynamics, a computational approach to modeling nonlinear behavior of
complex systems over time.
Our cofounder and Chief Modeling Officer, David Peterson, is the Chairman of
Ventana Systems and a pioneer of applied system dynamics. Three of our senior leaders are active members of
the System Dynamics Society.
- Footnote 2: The systems we model are determinants of health i.e. the risks, causes and consequences of
Determinants of health are a complex, nonlinear system of intersecting causal loops whose
stocks and flows change over time. Our health and healthcare simulations allow patients and other folks to
investigate and experiment with the system in order to optimize its behavior in particular scenarios.
- Footnote 3: We construct rich, mathematical models with Vensim software.
- Footnote 4: Our models power high-fidelity simulations that reframe illness as a curious puzzle that may be
seized and solved by patients and other folks.
Our scientific, evidence-based, mathematical models power
accurate, realistic simulations of causes and drivers of disease. These are two of the product types that
Humaginarium makes. A third type is video games that infuse our simulations with fantasy and address the
cravings of players for escapism.
- Footnote 5: The simulations are mediated by virtual physicians, who embody myriad human factors in our use-case
Standardized patients and now virtual patients are critically important techniques in medical
education.Virtual physicians have not existed for patient education, but are now being introduced into our
health and healthcare simulations.
- Footnote 6: Scenarios are drawn from our evidence-based patient journey maps.
journey maps are typically limited to what we call institutional determinants of health in clinical
environments. Our integrated patient journey maps include all five determinants of health for a more
authentic picture of patient experience.
- Footnote 7: the untutored and unmotivated who own the lion’s charge of health disparities and
The untutored lack science and health literacy; the unmotivated lack self-determination and
grit. Our scientific simulations provide these affordances, including to marginalized communities, and thus
attack the symbiosis of health inequities and health disparities where they are easiest to find and hardest
- Footnote 8: we create video games that render scientific simulations as adventures, role-plays, and mind-bending
Our video games are “hybrid simulations” that blend mechanics and aesthetics of
five popular video game genres: simulation, adventure, role-play, strategy, and puzzle.
- Footnote 9: together, they may improve the lives of millions.
We estimate that over 100 million American
adults, who play video games, also have at least one serious chronic illness that is poorly controlled.
- Footnote 1: medical self-efficacy
Medical self-efficacy is our term for any individual’s ability
to control and improve their health, alone and in collaboration with a care team. The pillars of medical
self-efficacy are science literacy, health literacy, and health acumen: competencies that players build in
- Footnote 2: constructive health competence
Constructive health competence is our term for any
person’s ability to apply medical self-efficacy dynamically, creatively, spontaneously, and bravely.
It is a problem-solving capacity that is key to patient empowerment.
- Footnote 3: science literacy in tandem with health literacy
the CDC, “Personal health literacy is the degree to which individuals have the ability to
find, understand, and use information and services to inform health-related decisions and actions for
themselves and others.” According to the The OECD PISA Framework (2015), science literacy is "the ability to
engage with science-related issues, and with the ideas of science, as a reflective citizen." Though it is
impossible to make informed health-related decisions without understanding the science that justifies them,
it is a fact that science and health literacy are never paired, as we have paired them, in a unified
construct of medical self-efficacy. The apparent reason: science is hard. We make it fun.
- Footnote 4: patient competency model
According to SHRM, “A competency model refers to a collection
of competencies that are needed for effective job performance.” Avoiding, preventing, and mitigating
chronic illness amounts to a full-time, self-employed job for millions of people, but no competency model
exists for it. As though patients do not require competence to achieve their health outcomes. This of course
is nonsense, and we are correcting it with the dynamic concept of constructive health competence.
- Footnote 5: patient-centered outcomes
Patient-centered outcomes are usually assumed to be the sole
responsibility of healthcare providers. In our simulations, they are the fruits of collaboration between
providers and patients, with patients exercising considerable thought leadership.
- Footnote 6: virtual physicians
Our invention of virtual physicians is conceptually and functionally
analogous to extant virtual patients.
- Footnote 7: healthcare simulation for patient skills development
The well established industry of medical and
healthcare simulation provides services to providers only, for their training and development. It
does not address the needs of patients.
- Footnote 8: mathematical modeling of to power health and healthcare simulations
models of determinants of health are not unprecedented. Scientists have modeled somatic and social
determinants of health for medical and industrial applications. What is unprecedented in our work is
mathematical modeling of determinants of health for the general population.
- Footnote 9: video games to engage folks with determinants of their health
Our video games are not
educational or “serious”; nor are them gamification. They are art and entertainment that engage
consumers with subject matter for the purpose of amusing them. The subject matter happens to be determinants
of their health, but that is not intrinsically fun or even interesting to most people. Mechanics and
- Footnote 10: transform healthcare, health education, and health promotion
Our simulations enhance
patient experience and outcomes (healthcare); how well patients understand determinants of their health
(health education); and the degree to which patients control and improve a chronic illness (health
promotion). This triple play is transformative.
- Footnote 11: increase the size and scope of the video game industry
At present, despite the gargantuan
size of the video game industry, not a single AAA game concerns itself with personal or public health; or
for that matter edifies players about any aspects of life. Popular video games are pure fantasy and
escapism. We do not undercut fantasy and escapism, but we make them more personally meaningful.
- Footnote 1: people facing serious chronic disease. That’s well over half the US population.
According to the CDC, six in 10 adults in the US have a least one chronic disease;
four in 10 have more than one. Chronic diseases are the leading causes of death and disability and the
leading drivers of the nation’s $3.8 trillion in annual health care costs.
- Footnote 1: The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) say
health promotion is a process of enabling people to increase control over, and to improve, their
World Health Organization and Centers for Disease Control and Prevention
- Footnote 2: We see health promotion as a call for patient empowerment, though others may believe it’s a
way to improve healthcare.
High-level definitions of health promotion allow for both interpretations;
the latter is preferred by stakeholders in health systems that assume responsibility for health outcomes.
Unfortunately, those health systems are failing across every dimension except for revenue generation. We
believe that the only health promotion that matters is the kind that empowers individuals to take better
care of themselves.
- Footnote 3: US health system is ineffective and unlikely to change until its financial incentives change; that
is, not soon.
Mirror, Mirror 2021: Reflecting Poorly. Health Care in the U.S. Compared
to Other High-Income Countries
- Footnote 4: we view empowerment as a cognitive more than a behavioral intervention.
the unusual position that patients are not stupid; that they want to understand and solve problems; moreover
that they resist solutions that they don’t understand. We offer ways for them to figure things out, on
their own terms, as a prerequisite for taking action. This contrasts with digital health technology that
eclipses cognitive problem-solving and decision-making with conditioned behavioral response.
- Footnote 5: Ground zero for empowerment is learning, not nudging.
We believe nudge theory is a
high-falutin reframing of the commercial truism: “don’t make me think.”
- Footnote 6: resistance to learning that is too strong to overcome.
“The expression learning
resistance … refers to situations in which one or more individuals directly or indirectly,
consciously or unconsciously reject any engagement in a learning possibility.” Illeris K. (2012)
Learning Resistance. In: Seel N.M. (eds) Encyclopedia of the Sciences of Learning. Springer,
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