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HeartSaver: Experimenting with News Games to Tell a Story

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HeartSaver, ProPublica's entry into the April 2013 GEN hack day, lets players steer New York City heart attack victims to the closest hospitals.

This past weekend, a team from ProPublica competed in the GEN Editors’ Lab New York hack day, with the theme “Newsgaming.” We learned how to use game mechanics to create an interactive experience that went beyond badges and reputation systems to explore a complex accountability story in fun and engaging way. Seriously, our game is really fun.

Here’s what we learned (and produced!) in two days.

The game, HeartSaver, aims to help players explore access to good emergency care in New York City, where nearly half a million people suffer from heart disease. We wondered: does everyone have access to high-quality care? What happens if I have a heart attack at work? At home? We invited players to explore this question by challenging them a mission: Save as many heart attack victims as possible.

A player’s score depends on how quickly they can get heart attack victims to the best available hospital. For victims, survival often hinges on how quickly they can get to the emergency room, with odds decreasing 7-10 percent every minute before defibrillation, according to the American Heart Association. And on arrival, quality of care plays an important part. We turned these factors into variables in the game. Players can explore how access to good emergency care works. The faster a player routes victims to quality care, the more lives they save. The more lives they save, the higher their score. How many lives do you think you could save? Play the game and find out.

News Games Tell a Story

While playing the game, players are telling themselves the story we want them to tell. It becomes clear very quickly which areas have fewer hospitals with emergency departments. When an icon representing a victim lands in Woodhaven, Cypress Hills or Whitestone, Queens, the closest hospital suddenly seems very far away. Having players experience the anxiety of seeing a victim with no hospitals nearby gives them an intuitive and memorable understanding of how the lack of emergency care affects neighborhoods -- much more so than they’d get from an article or an interactive map.

As the difficulty of HeartSaver increases, players are faced with two important and emotional decisions.

First, if a victim appears close to a hospital with a below average heart-care rating, does the player risk a longer transportation time to bring the victim to a better hospital? The precious seconds players take to decide affect the victim’s survival rate.

Second, as the number of victims increase, it becomes difficult to prioritize them. Should a player triage victims based on which ones needed help first, or focus on helping those already close to a hospital?

Forcing players to make these decisions lets them actually experience the complexity and difficult decisions in the real system.

Using Real-ish Data in a Game

HeartSaver relies on three key data points: The time elapsed since each victim’s 911 call (how long it takes the player to drop the victim icon onto a hospital), the time it would take to transport the victim from their location to that hospital in the real world, and that hospital’s relative quality of care.

In the game, a minute is compressed into a second. For every second that passes as the victim awaits help, survival odds decrease 10 percent.  For every second of game time spent driving, survival odds decrease by .58 percent. Since we couldn’t find solid data connecting minutes of ambulance travel time with survival odds, the game uses the lowest rate we could find.  We calculate the survival rate once the victim arrives at the hospital using that hospital’s mortality rate. If you’re a researcher and can help us answer this question more rigorously, let us know.

We calculate transport time from a victim’s location to the hospital the player drops them onto by passing addresses and coordinates to the Google Directions API, which returns the estimated driving time.

We also use Medicare’s risk-adjusted 30 day heart attack mortality rates to factor hospital performance. In the game, a victim’s post-travel survival chances are multiplied by Medicare’s survival rate for heart attack victims at that hospital. Finally, there’s an element of randomness applied after all of these factors are combined.

Here’s the full formula for how we calculate survival chances:

Some important caveats: We don’t know if a hospital's mortality rate factors out things like response time and travel distance. Also, in the real world, there isn't just one ambulance dispatcher for the city, and you'll almost definitely end up at the nearest hospital to your current location. Finally, the American Heart Association statisitc we use refers to sudden cardiac arrests, which is different from heart attacks, though a heart attack can also lead to sudden cardiac arrest. Read more about that here. This is a two-day hackathon project meant to explore how news games work, and not the results of months of rigorous research, so take things with a grain of salt (actually, you should probably go easy on the salt).

In order to make sure that every “patient” landed in one of the New York City boroughs, and not, say, in the water or New Jersey, we used geographic shapefiles from the NYC Department of City Planning.

News Games vs. Interactive Graphics

We could have made a great interactive graphic on heart disease and emergency care in New York, plotting hospital locations and quality of care ratings relative to reader locations. But that’s not a game.

On the first day of the hackathon, Columbia Journalism School professor Susan McGregor spoke to the teams about game design, and three of the criteria really stood out to us.

  1. Games have an objective: Some games like Minecraft can pull off being a sandbox, which is basically an open-ended game where players can do anything they want, without any goals. But for most games, the objective is what makes it fun, because people enjoy the feeling that comes with overcoming challenges.
  2. Result of the game is unknown: Players don’t know ahead of time how the game will end, and more importantly, players can take actions that impact the outcome. The game isn’t passive, instead it actively engages the player in a series of decisions and actions toward a final goal.
  3. Creating the feeling of “together, apart”: A great game allows players to feel a sense of community, even though they are sitting with their own devices, looking at their own screen. Think of the success of massive multiplayer online games (or MMOs), such as the World of Warcraft. Our goals for HeartSaver were much more scaled back, but we wanted to create a “together-apart” feeling by giving players statistics on how their score compared with others who played.

If you’re interested in learning more about news games, Sisi also gave a lightning talk on how to make them at the NICAR 2013 conference.

Next Steps

Because this was a two day hackathon project, we were pretty constrained as to what we were able to accomplish. If we had more time, we would have been much more rigorous with the data, and added more opportunities for players to see access to high-quality care near them.

Also, we would’ve allowed players to input their own addresses for work and home (or link up their Foursquare account to detect popular locations) to see how far their nearest hospital was. Then, we would’ve encouraged them to share and check hospital distances for family and friends. Once we’ve got readers’ attention with the game, we would have loved to show them an immersive interactive graphic to show how quality of care in the city affects them personally.

We want to thank the Global Editors’ Network for such a great event, as you can tell, we’re pretty excited about what news games can do. If you haven’t already, check out HeartSaver, which is currently still a prototype, and make sure to play the all the other games that came out of the hackathon!

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