Werbach says that paying people to get healthy may be effective, but only to a point. “Tangible rewards are potentially very effective, but also potentially very dangerous,” he says. “If it signals that this is really not about improving your life, but this is about getting some financial payment, then people will tend to only do the thing to the extent that they get the payment. The totality of the game experience must be sufficiently engaging.”
Protecting patient privacy
Any company that applies gamification to healthcare faces the added challenge of protecting patient privacy. Insurers, hospitals and other health providers are bound by the Health Insurance Portability and Accountability Act (HIPAA), which requires them to conceal personal health information related to all patients in their care.
But the rules for technology startups and other companies that don’t provide direct patient care are considerably fuzzier, says Andrea Matwyshyn, professor of legal studies and business ethics at Wharton. “These kinds of innovative health gamification ventures are primarily governed by contract law and not existing privacy law,” Matwyshyn says. “So a host of problems arise because of the way that digital contracts in particular have developed.”
For example, when consumers sign up for most health apps or web programs, they are generally asked to agree to a lengthy contract, which they may not bother to read, particularly if it is written in a very small font and they are viewing it on a cell phone. “We know that the reality is the consumers don’t read these contracts, or they do, but they have tremendous difficulty understanding them because they’re written by lawyers for lawyers,” Matwyshyn says.
Some consumers have complained that health-app companies release too much information about their personal habits. For example, Fitbit came under fire in 2011 when the sexual habits of several hundred of its customers started showing up in Google search results. The company had been making all of the physical activities of its members public to encourage exercise and competitive interactions. After the outcry, Fitbit flipped the default setting for its members’ activities from public to private.
Matwyshyn suggests that most technology startups working in health care need to place more emphasis on privacy concerns. “The legal consequences of losing consumer data are not aggressive enough to encourage companies to plan optimal levels of data security budgeting into their bottom lines,” she says.
“In that sense, you have internal culture wars between the data security champions and the bean counters, who are more concerned with quickly visible profits quarter to quarter. Yet it does have real ramifications when a company is perceived by its consumers to have behaved in a way that violates their trust. The risk is that consumers will leave you.” Matwyshyn says there’s an “active debate” in the legal community about how best to tighten up the laws governing tech startups working in the health arena.
In the meantime, startups and established healthcare players alike continue to add elements to their games that will improve their stickiness. Most recently, health-related games have taken on more of a social feel, with features that allow users to challenge other users to fitness or weight-loss contests, for example, and to announce their results on Facebook and Twitter.
“Community and social experiences are very commonly connected to games. We want to play with and against others, and to share that experience with others,” Werbach says. “So having a social dimension is typically a significant and valuable part of gamification.”
But adding that social element isn’t enough, Werbach warns. “As with everything else, it has to be done effectively. It’s not enough to say, ‘Do you want to announce to your Facebook friends that you hit this milestone in a game?’ It has to be a real community.”
