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Everyone loves the thrill of stumbling upon an Easter egg in their favorite video game. We get the same feeling when we discover something new about a Level Ex’er! There’s tons of hidden talent behind the scenes at Level Ex, and it’s time we share some of it with you.

We’re kicking off a new series, Minds Behind the Games, to introduce you to the unique individuals— artists, inventors, writers, researchers, and more—whose skill sets span more categories and specialties than our games. First, meet Michael Jacobs. He’s an associate product manager and patent holder!

Q: What is your role at Level Ex?

A: I’m an associate product manager. I work with our designers, developers, and business stakeholders to identify and define areas where our company can offer value to end users. I then team up with the developers to define and prioritize features and simultaneously collaborate with business stakeholders to ensure that they have the context and collateral they need to be successful.

Q: Before joining Level Ex, you worked at Medtronic. Tell us about your role there.

A: I was an engineering intern. I performed a good amount of testing validation to ensure that the fixation hooks on a leadless transcatheter pacing system called “Micra” worked the way they were supposed to. Implant fixation is generally an area of high-risk, and this device was no exception. Once implanted, the device was freely suspended inside of the heart—dangling only by the same hooks I was testing in the lab. [Wow, that sounds like an intense internship! No pressure…]

Q: What discoveries did you make while constructing, testing, and designing the cardiac pacemaker’s delivery system?

A: While building prototypes on the bench for use in piggies 🐷, I helped simplify a release mechanism method, which is used in the moment when a physician (or veterinarian) releases the pacemaker following its implantation. This eventually led to a patent filing.

Q: What is the broader impact of your discovery/invention? And why is it significant to you?

A: The design discovery was significant to me because it elegantly reduced the number of steps, variables, and operative time spent performing a cardiac procedure. Generally speaking, if there’s ever an opportunity to reduce the number of steps in surgery or eliminate unnecessary variables, it confers a safety benefit to the patient.

Q: What improvements could still be made in this area? Or what direction do you think the industry will go from here?

A: The Micra pacemaker is currently the smallest pacemaker ever implanted in a human. The thinking is that if we make the implants smaller, they’ll have fewer failure modes and cause less problems than the bulkier devices. As batteries get more efficient and compact, I’d expect even smaller implants than Micra to exist in the near future.

Q: What brought/attracted you to Level Ex?

A: As far as I can tell, there isn’t another company out there that is more committed and more immersed in meeting the needs of physicians than Level Ex. Beyond the commitment to physicians, I deeply appreciated the desire of Level Ex to leverage technology to address complex problems that haven’t been given the attention they deserve.

Michael Jacobs (top left) and other Level Ex’ers at the Pulm Ex launch party in 2018.

Q: What do you enjoy about working here?

A: The problem we’re trying to solve, and the people we’ve got here to tackle it.

Q: What do you hope to accomplish in the future with Level Ex?

A: I’d like to continue discovering ways that game design and technology can be used to solve important problems in healthcare. One doesn’t have to search too far and wide to discover that there are classes of chronic disorders that take a less than satisfactory amount of time to recognize in clinical practice. Many experiences that we’re actively developing aim to address the gaps that can lead to such diagnostic delays.

Interested in solving complex problems in healthcare? Come work with us! Check out our open positions.

I knew when I made first contact with the team at Level Ex that I had found something special.

Until now, my career has been almost entirely focused on big-budget AAA video games. Which has been great, if I’m honest. Still, all along, I have always been looking for opportunities to make a meaningful difference in the world beyond providing entertainment. Devoting time to universities, to research, to supporting independent festivals and groups striving to broaden the boundaries of what games can do… these things were always some of my favorite off-hours work.

With Level Ex I have a chance to help make a difference like that as my primary goal. I couldn’t be more excited.

Late in the interview cycle, Level Ex CEO, Sam Glassenberg, asked me—in his most direct and serious tone—why I wanted to join the company. By that time, we had already established that I am fascinated by the problem Level Ex is trying to solve, so his question wasn’t whether I was interested or not. He wanted to know what the source of my enthusiasm was.

My answer then (and now) is that I have this intuition that Level Ex is designing games from the future. I want to be part of that.

His raised eyebrow indicated that he thought I was just making up pretty words. So, I elaborated.

Imagine far in the future, where the human species is 10 trillion people spread across seven planets. In that world, while there of course will still be huge, “mainstream” games that are designed for a huge audience, my expectation is that we will also be able to design games for a more and more specific type of audience. When you have that many humans, it becomes possible to design games for “2nd year college students” or “auto mechanics” or “lawyers who represent class-action groups”… because those groups will all number in the millions. I see the future of game design as including a great deal of mining very specific corners of the human experience for rich, systemic play opportunities.

Level Ex has been doing that for years: making a science out of getting to know the real-life experience of doctors and converting that experience into meaningful entertainment. I want to help map out that territory.

I’ve been at the company for only a few short weeks, and I have already had to learn more in that time than I have had to learn in my previous few years. My love of learning is being well-fed, and I’m delighted to be working with such a motivated, skilled, passionate group of human beings.

Here’s to designing the future.

Jason has led creative teams for over two decades, developing AAA video games for Ubisoft (For Honor), Activision (Call of Duty), and Electronic Arts (James Bond). At Level Ex, he employs game design methodologies, honed through extensive experience in the consumer games industry, to capture the greatest challenges of medical and surgical procedures as video game mechanics. You can follow him on LinkedIn and Twitter. If you’re interested in joining our team, we’d love to meet you! Check out our open positions.

I couldn’t be more thrilled to announce that Brainlab has successfully acquired Level Ex. Our next chapter of growth has begun—backed by a parent company that embodies Level Ex’s vision and values.

Two years ago, I visited the headquarters of Brainlab in Munich for the first time—shortly before Brainlab became one of our biggest customers. Brainlab is a 1,400-person strong medical technology company… but that descriptor doesn’t really do it justice. Brainlab is no typical medical technology company.

As a team of game developers parachuted into the healthcare industry, we at Level Ex cringe at the endless litany of examples that illustrate just how much healthcare technology lags behind video game technology—a lag usually measured in decades. Not so at Brainlab.

I have never gained more wide-eyed optimism for the future of healthcare technology than I did in the time I spent at Brainlab. I saw nothing but glorious technology, sophisticated 3D volumetric rendering, gorgeous UI and UX design, and the seamless integration of technologies like tracking, 2D imaging, 3D imaging, and AR. I witnessed firsthand why neurosurgery had developed a reputation for being one of the most technologically advanced specialties in medicine: Brainlab.

Brainlab has fiercely advanced the cutting edge of medicine for decades, building platforms that service broad ecosystems in healthcare, including leading medical device companies, life science companies, and medical societies. Its decisions are made based on what is best for the patient and the doctor. When they see a problem in healthcare, they grab their technology toolbox and they fix it. Sound familiar?

Beyond its technological prowess, Brainlab builds platforms like the Digital O.R. that integrate medical devices from across a range of manufacturers. They democratize industries and accelerate the adoption curve of new technologies in healthcare—a philosophy that overlaps heavily with Level Ex’s goals to unleash game tech and design to improve medical professionals’ skills and accelerate their adoption curve of new techniques and technologies.

With our missions so closely aligned—combined with the resources, reputation, and global network of Brainlab—Level Ex has found the ideal parent company to fuel our next stage of growth and achieve broader impact across medicine.

Because Level Ex exists at the intersection of healthcare and video games, I’d like to share what this acquisition means for both industries.

To Our Players & Partners in Healthcare

Level Ex will still operate as an independent company—with its own product roadmap. I will continue on as the CEO of Level Ex. We’ll continue to innovate in both surgical and medical gameplay without compromise. Deep in Level Ex R&D there is a pipeline of new games and features that will deliver the kinds of jaw-dropping, “I-never-even-realized-that-was-possible” experiences that we’ve become known for. And we’ll continue to accelerate delivery of solutions to new and existing customers: pharmaceutical companies, medical device companies, medical societies, government agencies, and beyond.

Brainlab is leading the digital transformation of medicine, starting with a near-term future where new technologies and data sources are seamlessly integrated into the digital operating room. In a world where the operating room and patient are digitized, Level Ex will provide the onramp through game technology and design, enabling doctors to develop their skills and confidence on new devices and techniques in a video game, before they enter the OR or clinic to diagnose and treat live patients. Brainlab will also continue to use Level Ex to expand its reach, leveraging our game technology and design to help surgeons better visualize patient data and understand the applications of new Brainlab technologies.

To Our Peers in the Video Game Industry

In the games business, we pride ourselves on the rapid expansion of our medium: growth driven by profound creativity and cutting-edge technology. Only a handful of top video game studios have accomplished the industry’s apex achievement: bringing games to new audiences through the creation of an entirely new game genre. That’s what we’ve achieved at Level Ex with medical video games.

In our industry’s 40-year history, acquisition of a genre leader by a major company from outside of the current confines of the games industry has always marked a turning point. The first games-studio acquisitions by the major tech companies (Microsoft/Google/Amazon), the leading Hollywood studios (Disney/Warner Bros), and the top media companies have heralded new eras in gaming and proven the relevance of our field.

The acquisition of Level Ex by Brainlab marks the first acquisition of a video game company by a major international healthcare company. Last week, we also witnessed the FDA’s approval of the first prescription video game. Both of these milestones are the first of many. The crucial role of video games in healthcare is no longer theory—it’s very, very real.

Thank you to the Brainlab team, and extra thanks to Level Ex employees for helping us achieve all that we have in the past four years. What a rewarding, fun journey it has been—from building a medical training game as a favor to my dad, to becoming a vibrant 105-person company with Fortune 100 healthcare clients and using our games to address critical problems in healthcare like COVID-19, to preparing future astronauts for medical emergencies with NASA/TRISH. As I reflect on our accomplishments and growth, culminating in this acquisition, I relive the same enthusiasm I felt at Brainlab so many months ago: I have never been more excited about the future of healthcare.

“How soon can you launch this game?! We need this! We need this now!”
—Pulm Ex Playtester, Pulmonologist

Over the last five years, we have seen a range of reactions during our hundreds of physician playtests, but nothing like this. COVID-19 has amplified gaps in physician education that have been made acute by this crisis—specifically the need for instantly accessible, effective training. Physicians in our network shared:

• “We are facing a new disease on a global scale, and there is still so much more we need to learn and share to understand what the best care looks like.”
• “Things are continually changing in COVID-19, so it’s difficult to keep on top of things in communities not linked to academic centers.”
• “COVID-19 has been a game changer to medicine, and information is rapidly changing.”

In addition to understanding ever-evolving data about the disease, physicians across specialties were being summoned to assist in an “all hands on deck” crisis. As our CEO, Sam Glassenberg, explained, “Medical residents and retired physicians are serving on the front lines, and medical professionals from tangential medical specialties are being thrust into roles they weren’t prepared for. Demand is unprecedented for a tool that allows medical professionals to exercise their sometimes rusty (or non-existent) skills in areas like airway management, intubation, diagnosis, or ventilator management.”

With hundreds of pages of medical resources to read, and training centers being closed, how could we help physicians develop a real mental model to manage COVID-19? How could we help them to be most effective on patient #1 instead of patient #101? Coming from the world of video games, we believe that the best way to learn, retain, and develop skills, is through play.

Our mission since day one has been to advance the practice of medicine through play: That means using video games to accelerate the adoption curve for new medical techniques, guidelines, and technological advancements. And with our mobile platform, we are able to release critical content immediately, keeping medical professionals current. This mission and work made us uniquely qualified to address the pandemic where it mattered most—at the front lines.

Therefore, we began creating game levels that would help medical professionals—regardless of their experience or expertise level—learn best practices and guidelines around COVID-19 as quickly and efficiently as possible.

Creating COVID-19 Game Levels

In early March 2020, little was known about COVID-19, and resources on best practices for emergency care were scarce. Our team started with the only information available—guidelines from the Italian Anesthesia Society, where the pandemic had struck sooner. We then sought out additional guidelines from the Centers for Disease Control and Prevention, the World Health Organization, the American Society of Anesthesiologists, and other reputable sources, along with insights from physicians on the front lines of the pandemic to inform game content.

COVID-19 level development kicked into high gear when we received an educational grant from the Johnson & Johnson Institute, as well as a grant from The Translational Research Institute for Space Health (TRISH), a research partner for NASA. We were able to build levels across three games—Pulm Ex, Airway Ex, and Cardio Ex—that provide real-time feedback and scores based on how well players’ actions adhere to guidelines, allowing healthcare providers to “practice high-stakes decisions in a simulated environment” (Dinesh Kurian, MD, Anesthesiologist) and “learn and reinforce key concepts of diagnosing and treating COVID-19” (Jeremy B. Richards, MD, Pulmonologist).

Watch these levels come to life in Sam Glassenberg’s demo during the 2020 Social Innovation Summit.

Pulm Ex COVID-19 Unit

In Pulm Ex’s COVID-19 Diagnosis Unit, players ask questions and run tests based on a virtual patient’s chief complaint, then try to determine a correct diagnosis of COVID-19 or a mimicking disease. COVID-19 presents with a wide range of symptoms, and certain respiratory illnesses present similarly to COVID-19 but are treated very differently. By solving these inductive reasoning puzzles, medical professionals can hone diagnostic and emergency decision-making skills.

Airway Ex COVID-19 Unit

Airway Ex’s COVID-19 Safe Airway Management Unit is a decision-making strategy game that presents virtual intubation scenarios that require players to make clinical decisions about the compromised airways of COVID-19 patients. With each choice, the game explains and reinforces best practices that minimize the risk of spreading the disease. Each clinical decision impacts players’ score—choices like which devices and techniques to use in what order. Scoring is based on patient outcomes and COVID-19 safety, and after each level players can evaluate the decisions they made and internalize best practices. An added level of challenge comes from the fact that COVID-19 guidelines differ from processes typically followed during patient airway management. Jacqueline M. Morano, MD, revered anesthesiologist and academic clarified that Airway Ex’s COVID-19 levels are a “helpful reminder of what changes are occurring in the airway algorithm, as this is very different from our normal routine.”

Cardio Ex COVID-19 Unit

As the pandemic spread, we began to observe that COVID-19 can manifest with cardiac complications. In Cardio Ex’s COVID-19 Unit, players recognize and treat those manifestations of COVID-19 and explore comorbidities. They can test their ability to differentiate between COVID-19 induced cardiac complications and similar disease presentations as well as treat patients with a previous diagnosis of COVID-19 related cardiovascular conditions.

From In-Game to the World: COVID-19 Levels in Action

As the COVID-19 crisis unfolded around us, we committed as many resources as possible to support our players and get them the information they needed—and it worked.

“The content developed by Level Ex has the potential to assist individuals during potentially very dangerous episodes of care. The content has the ability to help elucidate different circumstances that will inevitably arise in real life situations. With the assistance of the Level Ex created [games], one may be able to avoid potential pitfalls that can have dangerous consequences for both the patient and provider.”

—Nishant Shah, MD, Medical Director, Illinois Sports Medicine and Orthopedic Surgery Center, Partner, Midwest Anesthesiology Partners, Advocate Lutheran General Hospital

We have always seen our games as playing a vital role in fixing systemic problems in healthcare; little did we know that we could help combat one of the most daunting medical emergencies of our lifetimes.

To learn more and download the games for free, visit our COVID-19 page.

Further reading:

“New mobile games aim to help medical professionals treat coronavirus” by The Washington Post

“Level Ex upgrades surgery games to virtually train doctors to treat COVID-19” by VentureBeat