Bioscape Digital has partnered with ER Express and the National Association of Chronic Disease Directors to develop an educational gaming platform called "Defeating Diabolical Diabetes" to be deployed via tablets and kiosks in emergency rooms and clinics. The game aims to educate patients about diabetes in an engaging way while also collecting health data. If selected for the RWJF Games Challenge, Bioscape will pilot the game in several locations and use the data and feedback to improve health literacy and patient outcomes.

1. Defeating Diabetes
Bioscape Digital’s proposal for
RWJF Games Challenge Phase1
Friday, February 22, 2013
Summary:
With over 136 million Emergency Room (ER) visits annually in the United States1, there is little doubt that our country’s ER
system is stretched to its breaking point. As a direct result, wait times continue to increase and patient satisfaction plummets.
However, where there is a problem, there is also an opportunity.
Bioscape Digital (Bioscape) has partnered with ER Express (https://www.erexpress.com/) and the National Association of
Chronic Disease Directors (NACDD) (https://www.chronicdisease.org) to deliver a platform for patient education via tablets
and interactive kiosks in ER waiting rooms, health clinics and other treatment facilities. The Bioscape platform delivers
easily digestible modules of information, empowering patients to engage in their own health.
By activating2 or engaging with these patients, Bioscape enables patients to take a stake in their own health. As multiple
studies over the years have indicated, engaged patients decrease system wide costs frequently associated with preventable
chronic diseases. Furthermore, engagement directly correlates with the ability to increase patient satisfaction and decrease
instances of re-admittance; both measures critical for reimbursement in the future.
Bioscape’s platform utilizes a mixture of tools such as interactive quizzes, educational modules, and 3D games delivered via
tablet and kiosk to deliver easily understandable health information that can empower the patient.
Working together in partnership, Bioscape, ER Express and NACDD are better educating patients, and for the Robert Wood
Johnson Foundation Aligning Forces for Quality (AF4Q) Initiative will work together to develop a gaming application to
capture vast quantities of data, provide actionable insight into reason for visit by location, common misconceptions by
population and other key demographics.
About Bioscape Digital:
Bioscape developed and manages a proprietary platform that leverages the power of customizable 3D graphics to educate
patients about their health. Bioscape illustrates complex medical concepts, such as heart disease, through easy-to-
understand, interactive modules. By partnering with hospitals, clinics, doctors, medical schools and the government,
Bioscope is positioned to transform the future of patient education.
About ER Express:
Headquartered in Atlanta, GA, ER Express is a privately held company that allows patients to compare nearby hospitals and
bypass a hospital's ER waiting room through an online reservation system.
ER Express was founded by an emergency medicine group to provide patients with an alternative to the crowded ER waiting
room. With ER Express, patients simply enter their zip code and a preferred radius and are given a list of nearby hospitals. If a
hospital is affiliated with ER Express, the patient can view real time appointment times and then reserve their place in line.
About the National Association of Chronic Disease Directors:
The National Association of Chronic Disease Directors is a non-profit Public Health organization committed to serve the
chronic disease program directors of each state and U.S. jurisdiction. Founded in 1988, NACDD connects more than 3,000
chronic disease practitioners to advocate for preventive policies and programs, encourage knowledge sharing and develop
partnerships for health promotion. Since its founding, NACDD has been a national leader in mobilizing efforts to reduce
chronic diseases and their associated risk factors through state and community-based prevention strategies.
Bioscape Digital: RWJF Games Challenge Phase1 1

2. Software Description:
Bioscape’s platform is device and location agnostic. Initially, the solution will be delivered via secured tablets and touch
screen kiosks in ER waiting and exam rooms. In developing for the AF4Q Initiative, the software will offer access to short
Learning Modules, Interactive Trivia and our Defeating Diabolical Diabetes educational game.
Wire Frame
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3. System Components
Learning Modules
Bioscape has developed learning modules aimed to deliver quick hitting information that allows a patient to grasp
important health topics. This information is delivered through a combination of audio, visual and interactive tools. Initial
topics to be delivered include Cholesterol, Diabetes, Kidney Disease and Hypertension.
Learning Modules screens
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4. Interactive Trivia
For AF4Q, in combination with ER Express and NACDD, Bioscape will develop an Interactive Trivia platform functioning as a
two-way communication tool. Not only does the trivia system deliver information in a fun and interactive manner, it also is
able to collect critical data. Included in the data generated might be indications of critical misunderstandings about
common health issues. Aligning Forces data will be incorporated into the trivia game, educating the population on common
health misconceptions and ultimately driving higher rates of compliance through patient engagement.
Trivia quiz screens
Trivia quiz screens
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5. Interactive Game Concept: Smash n’ Crash! Defeating Diabolical Diabetes
Bioscape’s Smash n’ Crash: Defeating Diabolical Diabetes is a game aimed to be fun, interactive and informative. With 25
million diabetics in America and another 75 million defined as pre-diabetic3 it is critical to educate the population on the
risks associated with this disease.
Game Overview
Diabolical Diabetes is an evil spirit who thrives on making people sick. The more people he makes sick with diabetes, the
bigger and more powerful and ugly he becomes. Diabolical Diabetes is trying to control the world and bring about the Age
of Darkness (blindness).
Your mission is to infiltrate the Diabetes Domain, battle the Diabetes Sugar Monsters and defeat Diabolical’s evil plans!
Diabolical is cranky and powerful- he has an endless supply of sweet henchman - but you are not without defense. Your
weapon to fight Diabolical armies of darkness is the Clean Plate. As you infiltrate the Diabetes compound, you learn the
true power of your weapon and how to wield it. You’ll discover more tools secrets about Diabetes and armed with
knowledge of healthy nutrition, you can fight your way inside. Sling your plates to fight the monsters! Wreak havoc inside
the Diabetes Domain with satisfying smashing delight!
Game Highlights: Interaction methods
• Touch-tapping: to rotate your view, to access/use/examine items, to utilize
• Touch-hold: for navigation through 3D environments
• Swipe/slash/flick: plate slinging!
• 3D environments and physics: more bouncing plate smashing action!
Game Play:
There are 5-6 main Chapters, each with substages. Player must explore each stage and find the best foods that will allow
them to continue their quest and simultaneously avoid the sugar monsters and other food booby traps which are laid by
the Diabolical.
Each stage holds a unique challenge or type of game play, incorporating various interaction methodologies as well as
delivering important take-away messages about healthy eating/living habits to avoid the onset of diabetes.
Look and Feel
The game will be presented in 3D toon-shaded environments ranging in scope complexity and size depending on type of
level. A combination of 3D environment hints and 2D overlays will comprise the user interface.
Game Mechanics: combination of several mechanics
• Explore & discover: getting around and finding what you need
• Observe and maintain personal health status: You’ll have energy, glucose and fat levels to watch and maintain.
Glucose and fat levels can have both short-term and long-term effects on the players’ ability. It will be possible to get
through many levels riding the edge of high glucose by just eating the junk food, but before the end the cumulative
effect will bring about a diabetic condition in yourself and if good habits are not quickly reinstated, you’ll suffer the
real effects of retinopathy, diabetic coma - hyperglycemic hyperosmolar nonketotic syndrome, possible death.
• Collect objects: good food items (gain points), you’ll need food for energy to get around
• Avoid objects avoidance: bad food items (lose points), these will give you energy, but also jump up your glucose and fat
levels, also subtract points and will contribute to possible diabetic condition in yourself later on! Also you’ll need to avoid
the sugary sweet henchman and angry monsters- if they catch you they can trigger a potentially fatal sugar spike.
• Take trivia/factoid challenges: pieces of information will be delivered in small bites, they will often factor into game play
• Solve puzzles: incorporation of facts and info into simple puzzles to unlock areas and levels
• Evaluate/sort objects: make judgment calls on what kinds of foods to take
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6. Game Chapters and Storyline (Diabetes Domain, the factory and stronghold of Diabolical Diabetes)
• Intro Levels, The Convenience Store, the tunnels; first levels will be part introduction to story and part tutorial on how to
navigate, what to look for, what to avoid, how to fling plates (with some practice sessions), how to succeed in the game.
• The Grounds, the Maze, the Greenhouse: learning more about what goes into good food choices.
• The Pantry: learning the Plate Method, meal planning recommended by the diabetes.org
• The Banquet Hall dinner event: the Diabolical is hosting a big dinner; he plans to feed his guests a dinner to make their
pancreas’ cringe- you must foil the plot- snatch the menu before it gets picked up by the cook and switch out the
menu for healthier selections; the save the dinner guests from certain pancreatic crises!
• The Kitchen retreat: Diabolical’s minions trap you in the kitchen after the menu switch- good thing you have access to
plenty of plates! This is timed free-for-all battle against waves of sugary minions.
• The Warehouse, the basement/dungeon/prison/animal testing: learn about the A1c.
• The 2nd Floor, the Additives Lab: learn the dangers of mysterious additives, an insidious plot of the Diabolical
• The Control Tower (Diabolical’s Lair- Boss level!)
The Conclusion
The Control Tower is the seat of power for Diabolical- this is the Boss Level!
You’ll need to use all the knowledge you have gained throughout the course of the game to defeat Diabetes (and quite a
few plates). The successful players will ultimately discover the biggest, darkest secret: Diabolical is the way he is because
he is sick and miserable. He has diabetes! He doesn’t know much about his condition; only resents the notion of not having
sweets; he forces his dark and sinister desires on everyone else because he doesn’t know how he can improve his life.
In order to win, the player must use their knowledge (and plates) to teach Diabolical that there is hope and he can feel
better and have a better life- Redeem/reform the Diabolical! You are a plate-slingin’ super health hero!
The Sequels
Even though you MAY have reformed the Diabolical; he has after all spent most of his life recruiting and training millions of
minions who are already out in the world, spreading the disease.... They must be stopped! The next series of plate-slash-
crashing adventures addresses the best ways to manage diabetes, once you are diagnosed.
Game screens
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7. Data Generation Description
Bioscape’s platform enables the real-time generation of data. This data can be segmented into three classes:
1. User Data: Bioscape’s platform allows for easy collection of demographic and disease state data in an anonymous
format that is both statistically significant and actionable.
2. Trivia data: Bioscape’s Interactive Trivia will allow a unique understanding of population trends as they relate to
baseline understanding of health issues. For example, if a certain city or location demonstrates a significantly higher
rate of incorrect answers within a specific topic, this becomes actionable intelligence.
Such conclusions can be provided to both national and state level public health officials for discussion. Further, active
locations can compare outcomes to baseline Aligning Forces Data. Finally, if a population is more knowledgeable
about a topic, then a provider will be more likely to be engaged by the patient on the topic.
3. Usage Data: Bioscape’s platform enables the collection of usage data which can quickly enhance understanding as to
which topics are most relevant to the patient population.
Demographic data screen Trivia quiz screen
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8. Community Deployment Approach
Initial deployments will be focused on Emergency Rooms throughout the country. Access to these locations will be
generated as a direct result of ER Express’ relationships with multiple providers. Additionally, NACDD has significant
experience working to deliver education to underserved populations (i.e. public health clinics), which will prove extremely
valuable during the deployment phase.
After initial trials prove successful, there are numerous opportunities to deploy content across multiple locations. NACDD
has expressed a willingness to partner to solve the logistics of a larger distribution.
Should Bioscape win the challenge, $12,000 of the winnings will be dedicated to hardware investment (Hardware estimated
to cost $400 per unit). Additionally, there will be an opportunity to subsidize the platform costs through integrated
marketing opportunity and incorporating other hardware providers such as Samsung and Qualcomm Incorporated into the
project (both have already expressed interest in providing hardware solutions).
Bioscape, thanks to ER Express, has secured multiple locations for initial beta deployments.
Conclusion
Bioscape, in partnership with ER Express and NACDD is in a position to deliver a platform that advances health literacy,
enables the collection of valuable insight and initiates the activation of patients. This patient activation is critical to the
success of the healthcare ecosystem in the 21st century.
The AF4Q grant will allow Bioscape to focus on health literacy in a manner that would otherwise be impossible.
With our partners, we will:
1. Launch the educational platform into trials
2. Generate vital population data
3. Create a “buzz” through word of mouth
This interactive platform will be a launching pad to engage the entire population about their healthcare. With better
education comes better health.
Appendix
1. 136.1 M ER visits annually. National Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary
Tables, tables 1, 4, 14, 24 Adobe PDF file [PDF - 481 KB]
2. Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and
Consumers. Judith H Hibbard, Jean Stockard, Eldon R Mahoney, and Martin Tusler
3. National Diabetes Education Program, http://ndep.nih.gov/am-i-at-risk/DiabetesIsPreventable.aspx
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