Although not routinely applied to chronic gastrointestinal illnesses such as UC, telemedicine has been applied to chronic conditions similar to UC, and patients’ acceptance of telemedicine systems is high [20–26]. IBD shares many similarities to these other chronic illnesses in that patients have long-term symptoms, experience frequent recurrence of symptoms, and require ongoing medical therapy to control symptoms and prevent relapses. A home telemanagement system similar to that described below was well accepted by patients with asthma [21], resulted in greater adherence with self-action plans [27], improved quality of life and patient knowledge, and decreased urgent care visits [28]. In a follow-up study by Finkelstein et al, significant improvements were noted in asthma symptoms, self-administered spirometry, adherence to action plans, and decreased use of quick-relief inhalers [28]. Likewise, a large randomized trial from a different center demonstrated that Internet-based monitoring reduced asthma symptoms and improved lung function and quality of life compared to specialist or general practitioner monitoring [29]. In diabetes, several studies demonstrated reduced glycosylated hemoglobin with the use of telemedicine [30–35]. Telemedicine was shown to improve quality of life and to decrease hospitalizations and length of stay, emergency room visits, and office visits [36, 37]. Moreover, even studies that showed no improvement in glycosylated hemoglobin showed that telemedicine results in equivalent outcomes with decreased clinical visits [38]. A recent systematic review summarizes the effect of telemedicine interventions in patients with diabetes. Overall, telemedicine interventions decrease glycosylated hemoglobin and complications of disease [39]. In congestive heart failure, telemedicine improved clinical outcomes and quality of life [40, 41]. Further, telemedicine interventions decreased utilization of health-care resources [40, 42]. Roth and colleagues showed that telemedicine decreased hospitalizations by 66 %, and Benatar et al. demonstrated decreased hospitalization costs in the telemedicine group [40, 42].

Pilot testing of telemedicine in IBD has demonstrated that it is feasible to use and that patient acceptance is excellent [43–45]. One pilot study assessed the acceptance of a home telemanagement system for IBD (IBD HAT) in ten patients with IBD. IBD HAT was comprised of three components: a patient home unit, a decision support server, and a web-based clinician portal. The patient home unit included an electronic weight scale connected to a laptop computer via a serial port for self-testing [44].

The laptop computer contained a symptom diary, side effect inventory, adherence check, and assessment of body weight. Patients answered questions directly using the laptop; weight was assessed after audio prompts from the laptop. Individualized patient data was entered into the secure web portal; information collected included contact information, medication prescriptions, IBD HAT testing schedules, and disease history. Clinicians used the web portal to customize medication and side effect profiles for each patient. Furthermore, a clinical alert system was customized for each patient based on responses to the symptom diary, medication side effect questions, self-reported adherence, and body weight. Figure 31.2 demonstrates the flow of data communication in this telemedicine system. Once self-testing was completed, patients received an IBD-related educational prompt in the format of a “tip of the day”; the following week, patients were asked a question about the tip. Patients could not advance in the educational curriculum unless they answered the question correctly. The results of self-testing were submitted telephonically and were available for review immediately thereafter on the secure web server [44].

IBD HAT was tested on ten adult patients with IBD. Participants underwent a single 45-min training session during which they were taught how to use the equipment. They then completed self-testing without supervision. All participants reported that self-testing was not complicated and that the symptom diary and side effect questions were easy to answer. Participants felt that self-testing took very little time and that they could adhere to self-testing at least three times per week. Most patients thought IBD HAT would make them feel safer, and 80 % would agree to use the system in the future [44].

Based on the positive pretesting results, a 6-month open-label trial to assess the feasibility and patient acceptance of IBD HAT in patients with IBD was performed. Thirty-four patients were enrolled. Each participant received an initial 45-min instruction session at their home during which they were taught how to operate the equipment. After this initial training session, the participants were asked to complete weekly self-testing sessions over a 6-month period. During the study period, participants continued to receive standard IBD care in addition to the weekly HAT sessions. Twenty-five participants successfully completed the 6-month study. Fifteen participants had CD, nine had UC, and one had indeterminate colitis. Over the study period, 89 % of participants were adherent with weekly self-testing. Attitudes toward IBD HAT were also very good; 95 % of participants said that self-testing was not complicated. Ninety percent of patients reported that use of the weight scale was not difficult, and 100 % reported use of the computer was not difficult. Similarly, 90 % reported that answering the symptom diary and medication side effect questions were not difficult. Participants reported that self-testing took very little time and did not interrupt their usual activities. Seventy percent of patients felt safer using the system. Mean self-reported adherence with IBD medications was 90 % throughout the study. Clinical disease activity, disease-specific quality of life, and patient knowledge improved after using IBD HAT for 6 months compared to baseline [45].