Towards a Fortnite Healthcare System or how Gen X and Millenials will demand Gamification in Medicine

Kim BellardThe World Health Organization (WHO) just included "gaming disorder" as a new mental health condition, listing it is its 11th edition of the International Classification of Diseases. My first reaction was, oh, good, now I have a good excuse to write about Fortnite.

A year ago I hadn't even heard of Fortnite. That's no surprise, because few had; it wasn't officially released until July 2017, and even then the free, most popular version -- Fortnite Battle Royale -- wasn't released until last September. It was an immediate sensation, with over a million players within the first month. It has been smashing numbers ever since.

For example, it has had as many as 3 million concurrent users, as many as 40 million players every month, and as many as 125 million total players. Not only that, they're smashing records for people logging on to simply watch others play it, such as on Twitch or on YouTube. People watch some 25 million hours of it on YouTube alone. It accounts for a third of all streaming video views.

And it is not even on Android yet. It was released on iOS just in March and launched on Switch last week.

Oh, and get this: even though the most popular version is free, the game is generating in excess of $125 million a month, mostly from in-game purchases. They are preparing for a 2018-2019 "Fortnite World Cup," with $100 million in prizes. $100 million. For a "free" game.

In the words of Buffalo Springfield:

There's something happening here
But what it is ain't exactly clear

Let's back up. What is Fortnite, and how is the Battle Royale version different? Both games are basically about survival, trying to fight off "zombie-like monsters." In Battle Royale, you and 99 other co-players fight to see who can be the last to survive, in a "Hunger Games" type scenario. Although there is plenty of killing in both games, the violence is generally considered more "cartoonish" than gory, as in many other shooter games.

What makes the Fornite games more interesting, and which has caused them to be described as different permutations of "Minecraft meets ____", is that there is an emphasis on building -- in this case, forts, traps, fortifications, and weapons. Ingenuity and planning are as important as quick reactions or shooting skills. As is probably already clear to any gamer, I am not a video games person. Aside from an inexplicable and short-lived "Angry Birds" fascination a few years ago, I don't play and haven't played video games. But, as the above illustrates, just because I don't participate in a trend doesn't mean I can't see one.

The Greatest Generation was a movie generation. They went to the movies in record numbers, and movies helped set as much as reflecting cultural norms. My generation, Baby Boomers, are a television generation. We grew up with it, watched as much of it as we could, even when there were only 3 or 4 channels to choose from, and even when those choices might have offered shows like My Mother the Car or The Beverly Hillbillies.

You could make an argument that post-Baby Boomer generations -- Gen X or Millennials -- are Internet generations, but you could make an equally compelling argument that they are video game generations, especially since the latter preceded the former (think Nintendo, Sega, and Atari, or Space Invaders.).

The Greatest Generation's idea of the healthcare system came from those movies. Dr. Kildare or Dr. Gillespie were the models: all-knowing, never to be questioned (and, of course, white men). They couldn't always cure you, but they always had great sympathy and your best interests at heart. True to our TV bias, Baby Boomers' model physician is probably closer to Hawkeye Pierce -- still all-knowing and good-hearted but more irreverent. We still didn't question much, but as the "cool," young generation, we demanded anything and everything that might help us stay young -- knee replacements, face-lifts, and, of course, plenty of pills.

Gen X/Millennials' model physician? They don't have one; they're too busy building forts and fighting off zombie-like monsters. Besides, they always get another life.

Unfortunately, our healthcare system is based too much around its biggest current users -- the Greatest Generation. Don't ask questions, don't expect too much, don't trust technology too much, and go to the hospital when you're sick. Be good patients; be patient.

I'm convinced the only reason hospitals have moved to private rooms is because Baby Boomers started having babies of our own. Don't believe it? See what happens when we start going to nursing homes.

If you tell a Gen X or a Millennial that the healthcare system still uses faxes, its technology often can't share data, that you can't usually schedule appointments online and that even doing video-visits remains a novelty, well, they'll probably shake their head in disbelief and unpause their high def, interactive video game.

The healthcare system is starting to design for the Baby Boomers -- in-office wifi, patient portals, electronic records, those private hospital rooms, etc. -- but its feet remain firmly planted in the past, in Dr. Kildare days. By the time it has fully caught up to what Baby Boomers want and expect, we'll mostly be dead and those Gen X and Millennials will be wondering what kind of bad video game they've found themselves stuck in.

The future of the healthcare system is going to be participatory, cooperative, interactive, iterative, online, rewarding, challenging but fun. In other words, more like a video game. To the Greatest Generation and to many Baby Boomers, that sounds like a warning; to everyone else, it sounds like a hope.

In the rest of the economy, technological adoption is rising faster than ever. Consumers expect the latest iPhone, the newest technology, the fastest option. Healthcare can't say that. Patients who expect to listen to Dr. Kildare or even Dr.Pierce have been willing to tolerate that, but the video game generations will not be.

It takes healthcare a long time to change, but it better start preparing for its Fortnite future right now. Whatever that means.