Septris

Overview

Educational Technology was initially approached by a group of physicians from the departments of medicine and emergency medicine to create a game playable on mobile devices to teach and improve identification and treatment of sepsis using evidence-based management guidelines. Because 53% of gamers (as of 2014) also play on smartphones, we chose to create a mobile-accessible game using the concept of a virtual patient simulator, which became Septris.

We created Septris using JavaScript, HTML5, CSS3, and XML web technologies to ensure cross-platform compatibility and to reach as wide an audience as possible. Based on the success of Septris, a group of surgeons approached us to adapt the Septris platform—which became SICKO—to use for teaching and potentially assessing surgical decisions. 

Septris began development in September 2011 and version 1.0 was released in December 2011. A subsequent release, version 1.5 (also known as the "facelift" release), was completed and released in October 2012. The facelifted version had improved visuals and UI, and also served as the basis for Septris' sequel, "SICKO". Septris had its 3rd and final release, version 2.0, in April 2014, which brought in new features that were develped for SICKO, including a player activity tracking log that can be used for debriefing at the end of the game.

Septris is free to play, and can be accessed online here: http://med.stanford.edu/septris

Sepsis

Sepsis strikes approximately 750,000 people in the US and is responsible for more than 215,000 deaths. Mortality remains high at 25-50% at a cost of $17 billion each year. Septic states have become far too common; with unacceptable high mortality rates and lengthy hospitalizations, it is one of the most costly conditions to treat. Septris provides a practical approach to early sepsis identification and application of evidence-based management (best practice) and evidence-based guidelines. Interactive case scenarios will be used to put these principles into practice.

Septris Gameplay

The objective in Septris is to try to heal a total of 8 patients, while simultaneously treating 2 at a time. When a patient reaches the top of the screen, he or she will be discharged, and a new patient will be assigned for treatment until the player has treated all 8 patients. Without adequate treatment, patients' health will constantly drop. The patient dies if he or she reaches the bottom of the screen.

The player clicks on a patient's portrait to select the patient, which allows them to view the patient's vitals and history, and also allows the player to apply treatments and run labs for that patient. The player can also view the patient's chart, which includes lab results, any pending labs, currently applied treatments, and their durations.

Gamification

Both Septris and SICKO feature a variety of gamification concepts, such as health points, damage points, actions/abilities, score points, a high-score board, levels, and real-time interactivity. Each virtual patient in the game has dynamically changing vital signs based on a health level (health points, or "HP") and an extensive case history. Patients have a continually declining health level (damage over time, "DoT"), and players must use their diagnostics to diagnose the patients and treat them accordingly (to improve the patients’ health levels—heal over time, "HoT") before the patients die. Lab results and vital signs dynamically change depending on the patient’s HP, to give the player a realistic sense of the patient's condition.

The Virtual Attending, "Dr. Sepsis"

Throughout the game, the player will receive bonus points for performing correct actions, or lose points for performing incorrect actions. The attending, "Dr. Sepsis," will also chime in with feedback indicating why an action performed is correct or incorrect. Certain actions in the game will also trigger a mini pop quiz, which can be answered correctly for more bonus points. At the end of the game, the player can submit their score and activity log to be recorded, and Dr. Sepsis will have a different emotional expression based on a player's performance (ranging from furious to very pleased).

Septris Releases

Septris v1.0

Although the initial release of Septris featured a very basic interface, its novel game mechanics and rich content were sufficient for instructors to find it valuable as a teaching tool. Clinicians commented that they were able to make realistic clinical decisions based on the lab results and vital signs of the virtual patients in the game. The game was initially designed to be played in the portrait orientation on mobile devices, including the iPhone 3G and first iPad. 

Septris Overview Video on YouTube

Septris v1.5 (Facelift)

The project team was able to secure additional funding based on the success of the original release. The additional funding allowed the team to hire a dedicated graphic designer, which greatly improved and polished the look and feel of the game.

Septris v2.0

Version 2.0, also the final release, of Septris brought in the new UI and features from Septris' sequel, SICKO. The game interface now works best on iPad and other landscape orientation screens in order to efficiently use screen space as well as provide the user with a better experience with larger text and buttons. One of the key new features in v2.0 is the addition of an "activity log", which tracks all of a player's actions during the game and displays a summary at the end that can be used for debriefing with an instructor.

Reception

Reception to Septris was immediately positive. Septris has been featured in several internet blogs and news websites, including Stanford News Center,  iMedicalApps, the nmc Horizon Report, and more. The game was presented at several educational conferences, including the national AAMC conference and the regional WGEA/AAMC conference, where it quickly became a big hit. The game was also presented at the 2014 IMSH Serious Games and Virtual Environments Arcade where it won co-runner up (tied with SICKO) for the Best In Show award.

Since release, Septris has been accessed by over 38,000 unique users, played over 34,000 times, and completed 3,300 times (as of July 2014). Septris has been accessed at least once in 135 countries, with the average user spending at least 8 minutes on the game.

Aside from the United States, Septris has been popular in Australia, Brazil, the United Kingdom, and Canada.

The project team collaborated in 2013 and 2014 with universities in the United Kingdom and Germany on localization.

Content Expert Team

  • Lisa Shieh, MD, PhD
  • Eileen P. Pummer, MSN, RN, CPHQ
  • William Daines, MD
  • Paul M. Maggio, MD
  • Matthew Strehlow, MD
  • Irina Tokareva, BSN, MAS, CPHQ

Technical Implementation Team

  • Jamie Tsui
  • Pauline Brutlag
  • Brian Tobin
  • James Laird
  • Jonathan Tatum
  • Glenn Zephier

Funding

Septris was funded by a Continuing Medical Education (CME) Pfizer grant.

Presentations, Publications, and Press

Play Septris

Project Start Date

September 2011

Project Initial Release Date

December 2011

Project Complete Date

April 2014, Ongoing Support and Use

Quick Links