Development and feasibility of a telemonitoring tool with full integration in the electronic medical record: a proof of concept study for patients with inflammatory bowel disease in remission on biological therapy

Abstract

Objectives: Telemonitoring can be implemented to enhance disease monitoring and ultimately reduce the number of outpatient visits and associated costs. We developed an in house IBD mobile app and established a proof of concept study to demonstrate the effectiveness and accuracy of the telemonitoring tool for monitoring of disease activity.

Methods: An IBD mobile app was designed through close collaboration between the Information Technology and Gastroenterology department of University Hospitals of Leuven. The study was proposed to all patients in remission under stable biological therapy visiting the outpatient clinic. During one-year follow-up, patients completed weekly and monthly questionnaires on their mobile device or on a website. Entered data were directly sent to the electronic medical record. Predefined red flags or alerts, generated by the answers to the questionnaires, were monitored daily.

Results: The pilot study in 45 patients demonstrated accurate monitoring of disease activity with fast intervention during flares. During the 12-months follow-up period, an alert for disease activity was generated for 9 different patients out of 1296 completions of the questionnaire. Symptoms resolved spontaneously in 8 patients. One patient reported consecutive PRO-2 increase, endoscopy confirmed an IBD flare and therapy was switched. For the remaining 36 included patients, no alerts indicating disease activity increase were reported. Median compliance to all weekly and monthly questionnaires during 1 year was 52% (IQR: 24–91).

Conclusions: We developed the mynexuzhealth IBD app with full integration in the electronic medical record. The app enabled continuous remote monitoring and showed accurate detection of flares.

Keywords:

• IBD
• telemonitoring
• self-empowerment

Acknowledgments

Part of this work has been presented as a poster presentation at ECCO 2018 in Vienna.

Disclosure statement

Sofie Coenen, Egon Nijns, Ellen Weyts, Patricia Geens, and Bart Van den Bosch have no conflicts of interest.

Séverine Vermeire receives grants/research supports from MSD, Abbvie, Takeda, Janssen, Pfizer; receives honoraria or consultation fees from AbbVie, MSD, Takeda, Ferring, Genentech/Roche, Shire, Pfizer Inc, Galapagos, Mundipharma, Hospira, Celgene, Second Genome, Progenity, Lilly, Arena, Gilead and Janssen; Participation in a company sponsored speaker’s bureau: AbbVie, MSD, Takeda, Ferring, Hospira, Pfizer, Janssen, and Tillots.

Marc Ferrante receives research grant from Amgen, Biogen, Janssen, Pfizer, Takeda; receives consultancy fees from Abbvie, Boehringer-Ingelheim, Janssen, MSD, Pfizer, Sandoz, Takeda; receives speaker’s fee from Abbvie, Amgen, Biogen, Boehringer-Ingelheim, Falk, Ferring, Janssen, Lamepro, MSD, Mylan, Pfizer, Takeda.

Kris vanhaecht holds the research chair of Zorgnet Icuro and of the St Trudo Hospital and receives educational funding from the European Pathway Association.

Gert Van Assche received honoraria and/or research support to institution from Abbvie, Ferring, Takeda, Janssen, MSD, Roche, Pfizer.

Author contributions

SC: study concept and design, data acquisition, analysis and interpretation, statistical analysis, and manuscript writing; EW, PG, SV, MF, KV, and GVA: study concept and design, data interpretation, and manuscript critical revision; EN and BVdB: study concept and design, and manuscript critical revision. All the authors approved the final draft.