Digestive Diseases and Sciences

, Volume 54, Issue 11, pp 2463–2472 | Cite as

Home Telemanagement for Patients with Ulcerative Colitis (UC HAT)

  • Raymond K. CrossEmail author
  • Nadia Cheevers
  • Joseph Finkelstein
Original Article


Effective therapies exist to treat ulcerative colitis (UC); nonadherence, inadequate monitoring, and side-effects result in suboptimal outcomes. Novel methods for monitoring are needed. Our objectives were to assess acceptance of home automated telemanagement in ulcerative colitis (UC HAT). The UC HAT system consists of a laptop connected to a scale, a decision support server, and a web-based clinician portal. The UC HAT system facilitates self-care in UC patients by monitoring patient symptoms, side-effects, and adherence, and helping patients in following their individualized treatment plans. Ten adult patients with UC were trained to use UC HAT. Attitudinal surveys and qualitative interviews were performed. The results showed that all patients reported that use of the computer was not complicated. 90% reported that the symptom diary and side-effect questions were not difficult. All patients reported that the training was adequate and 70% reported that testing took little time. Seventy percent would feel safer using the system, and 90% would agree to use UC HAT in the future. Patients felt UC HAT would keep the patient and provider up to date on changes in symptoms. Self-testing appeared to make patients accountable for managing the disease. It was discussed that improved monitoring is needed for UC. Patients with UC can be easily trained to use HAT, and patient acceptance of the UC HAT system is high. Home automated telemanagement has potential to improve clinical outcomes and patient satisfaction in UC.


Inflammatory bowel disease Ulcerative colitis Monitoring Telemedicine Telemanagement 



This study was supported by research funds from the Broad Medical Research Program (IBD-0190). The authors would like to thank Jean-Pierre Raufman, MD for his advice and comments for this project and Kathryn Lambert, BA, Allison Steele, RN, MSN, CRNP, and Paul Stozhkov, MA for help in implementation of the study protocol. The authors would also like to thank James Lewis, MD, David Binion, MD, and Miguel Regueiro, MD for their advice in creating the UC symptom diary.


  1. 1.
    Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126(6):1504–1517. doi: 10.1053/j.gastro.2004.01.063.CrossRefPubMedGoogle Scholar
  2. 2.
    Faubion WA Jr, Loftus EV Jr, Harmsen WS, et al. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121(2):255–260. doi: 10.1053/gast.2001.26279.CrossRefPubMedGoogle Scholar
  3. 3.
    Irvine EJ. Quality of life in inflammatory bowel disease and other chronic diseases. Scand J Gastroenterol Suppl. 1996;221:26–28. doi: 10.3109/00365529609095550.CrossRefPubMedGoogle Scholar
  4. 4.
    Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992;14(4):309–317.PubMedGoogle Scholar
  5. 5.
    Kane SV, Cohen RD, Aikens JE, et al. Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol. 2001;96(10):2929–2933. doi: 10.1111/j.1572-0241.2001.04683.x.CrossRefPubMedGoogle Scholar
  6. 6.
    Kane S, Huo D, Aikens J, et al. Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis. Am J Med. 2003;114(1):39–43.CrossRefPubMedGoogle Scholar
  7. 7.
    Navarro F, Hanauer SB. Treatment of inflammatory bowel disease: safety and tolerability issues. Am J Gastroenterol. 2003;98(12):S18–S23. doi: 10.1016/j.amjgastroenterol.2003.11.001.CrossRefPubMedGoogle Scholar
  8. 8.
    Kane S, Dang J. Medication taking behavior in a gastroenterology clinic: a disconnect between patient behavior and physician knowledge. Gastroenterology. 2004;126(4):A605.Google Scholar
  9. 9.
    Cross RK, Wilson KT, Binion DG. Polypharmacy and Crohn’s disease. Aliment Pharmacol Ther. 2005;21(10):1211–1216. doi: 10.1111/j.1365-2036.2005.02429.x.CrossRefPubMedGoogle Scholar
  10. 10.
    Cross RK, Lapshin O, Finkelstein J. Patient subjective assessment of drug side effects in inflammatory bowel disease. J Clin Gastroenterol. 2008;42:244–251.PubMedGoogle Scholar
  11. 11.
    Robinson A, Thompson DG, Wilkin D, et al. Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial. Lancet. 2001;358(9286):976–981. doi: 10.1016/S0140-6736(01)06105-0.CrossRefPubMedGoogle Scholar
  12. 12.
    Kennedy AP, Nelson E, Reeves D, et al. A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease. Gut. 2004;53(11):1639–1645. doi: 10.1136/gut.2003.034256.CrossRefPubMedGoogle Scholar
  13. 13.
    Finkelstein J, Khare R, Vora D. Home Automated Telemanagement (HAT) system to facilitate self care of patients with chronic diseases. J Syst Cybern Inform. 2003;1(3):78–82.Google Scholar
  14. 14.
    Finkelstein J, O’Connor G, Friedman RH. Development and implementation of the home asthma telemonitoring (HAT) system to facilitate asthma self-care. Stud Health Technol Inform. 2001;84(Pt 1):810–814.PubMedGoogle Scholar
  15. 15.
    Finkelstein J, Hripcsak G. Monitoring of Asthma Severity in Patients’ Homes Using Wireless Technology. San Jose, CA: Spring Congress of the American Medical Informatics Association; 1997.Google Scholar
  16. 16.
    Finkelstein J, Hripcsak G, Cabrera M. Telematic system for monitoring of asthma severity in patients’ homes. Stud Health Technol Inform. 1998;58(pt 1):272–276.Google Scholar
  17. 17.
    Finkelstein J, Arora M, Joshi A. Home automated telemanagement in hypertension. In: Proc. of the 17th IEEE Symposium on Computer-Based Medical Systems 2004. Bethesda, MD; 2004:452–459.Google Scholar
  18. 18.
    Finkelstein J, Khare R, Vora D, et al. Design and implementation of home automated telemanagement in chronic obstructive pulmonary disease. Proc. of the 16th IEEE Symposium on Computer-Based Medical Systems. New York, NY; 2003:207–212.Google Scholar
  19. 19.
    Cross RK, Arora M, Finkelstein J. Acceptance of telemanagement is high in patients with inflammatory bowel disease. J Clin Gastroenterol. 2006;40(3):200–208. doi: 10.1097/00004836-200603000-00006.CrossRefPubMedGoogle Scholar
  20. 20.
    Castro HK, Cross RK, Finkelstein J. Using a Home Automated Telemanagement (HAT) system: experiences and perceptions of patients with inflammatory bowel disease. AMIA Annu Symp Proc. 2006:872.Google Scholar
  21. 21.
    Cross RK, Finkelstein J. Feasibility and acceptance of a home telemanagement system in patients with inflammatory bowel disease: a 6-month pilot study. Dig Dis Sci. 2007;52(2):357–364. doi: 10.1007/s10620-006-9523-4.CrossRefPubMedGoogle Scholar
  22. 22.
    Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–6. doi: 10.3109/00365528909091339. Discussion 16–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Straus A. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. New York: Wiley; 1984.Google Scholar
  24. 24.
    Straus A. Qualitative Analysis for Social Scientists. New York: Cambridge University Press; 1987.Google Scholar
  25. 25.
    Ritchie J, Spencer L. Analyzing Qualitative Data. London: Routledge; 1996.Google Scholar
  26. 26.
    Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. BMJ. 1955;2:1041–1048.CrossRefPubMedGoogle Scholar
  27. 27.
    Seo M, Okada M, Yao T, et al. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol. 1992;87(8):971–976.PubMedGoogle Scholar
  28. 28.
    Walmsley RS, Ayres RC, Pounder RE, et al. A simple clinical colitis activity index. Gut. 1998;43(1):29–32.PubMedCrossRefGoogle Scholar
  29. 29.
    Powell-Tuck J, Day DW, Buckell NA, et al. Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis. Dig Dis Sci. 1982;27(6):533–537. doi: 10.1007/BF01296733.CrossRefPubMedGoogle Scholar
  30. 30.
    Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625–1629.PubMedGoogle Scholar
  31. 31.
    Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet. 1980;1(8167):514. doi: 10.1016/S0140-6736(80)92767-1.CrossRefPubMedGoogle Scholar
  32. 32.
    Irvine EJ, Zhou Q, Thompson AK. The short inflammatory bowel disease questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol. 1996;91(8):1571–1578.PubMedGoogle Scholar
  33. 33.
    Farzanfar R, Finkelstein J, Friedman RH. Testing the usability of two automated home-based patient management systems. J Med Syst. 2004;28(2):143–153. doi: 10.1023/B:JOMS.0000023297.50379.3c.CrossRefPubMedGoogle Scholar
  34. 34.
    Finkelstein J, Hripcsak G, Cabrera MR. Patients’ acceptance of Internet-based home asthma telemonitoring. Proc AMIA Symp. 1998:336–340.Google Scholar
  35. 35.
    Finkelstein J, Feldman J, Safi C, et al. The feasibility and patient acceptance of computer-assisted asthma education in Emergency Department setting. In: Proc. of the Academic Emergency Medicine 2003 Annual Meeting; Academic Emergency Medicine; 2003:505.Google Scholar
  36. 36.
    Finkelstein J, Cabrera MR, Hripcsak G. Internet-based home asthma telemonitoring: can patients handle the technology? Chest. 2000;117(1):148–155. doi: 10.1378/chest.117.1.148.CrossRefPubMedGoogle Scholar
  37. 37.
    Finkelstein J, Khare R, Ansell J. Feasibility and patient’s acceptance of home automated telemanagement of oral anticoagulation therapy. AMIA Annu Symp Proc. 2003;230:4.Google Scholar
  38. 38.
    Finkelstein J, Friedman RH. Potential role of telecommunication technologies in the management of chronic health conditions. Dis Manag Health Outcomes. 2000;8(2):57–63. doi: 10.2165/00115677-200008020-00001.CrossRefGoogle Scholar
  39. 39.
    Joshi A, Amelung P, Arora M, et al. Clinical impact of home automated telemanagement in asthma. AMIA Annu Symp Proc. 2005:1000.Google Scholar
  40. 40.
    Rasmussen LM, Phanareth K, Nolte H, et al. Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. J Allergy Clin Immunol. 2005;115(6):1137–1142. doi: 10.1016/j.jaci.2005.03.030.CrossRefPubMedGoogle Scholar
  41. 41.
    Hee-Sung K. Impact of Web-based nurse’s education on glycosylated haemoglobin in type 2 diabetic patients. J Clin Nurs. 2007;16(7):1361–1366. doi: 10.1111/j.1365-2702.2007.01506.x.CrossRefPubMedGoogle Scholar
  42. 42.
    Montori VM, Helgemoe PK, Guyatt GH, et al. Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis. Diabetes Care. 2004;27(5):1088–1094. doi: 10.2337/diacare.27.5.1088.CrossRefPubMedGoogle Scholar
  43. 43.
    Shea S, Weinstock RS, Starren J, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus. J Am Med Inform Assoc. 2006;13(1):40–51. doi: 10.1197/jamia.M1917.CrossRefPubMedGoogle Scholar
  44. 44.
    Dang S, Ma F, Nedd N, et al. Care coordination and telemedicine improves glycaemic control in ethnically diverse veterans with diabetes. J Telemed Telecare. 2007;13(5):263–267. doi: 10.1258/135763307781458958.CrossRefPubMedGoogle Scholar
  45. 45.
    Barnett TE, Chumbler NR, Vogel WB, et al. The effectiveness of a care coordination home telehealth program for veterans with diabetes mellitus: a 2-year follow-up. Am J Manag Care. 2006;12(8):467–474.PubMedGoogle Scholar
  46. 46.
    Chumbler NR, Neugaard B, Kobb R, et al. Evaluation of a care coordination/home-telehealth program for veterans with diabetes: health services utilization and health-related quality of life. Eval Health Prof. 2005;28(4):464–478. doi: 10.1177/0163278705281079.CrossRefPubMedGoogle Scholar
  47. 47.
    Howells L, Wilson AC, Skinner TC, et al. A randomized control trial of the effect of negotiated telephone support on glycaemic control in young people with Type 1 diabetes. Diabet Med. 2002;19(8):643–648. doi: 10.1046/j.1464-5491.2002.00791.x.CrossRefPubMedGoogle Scholar
  48. 48.
    Jaana M, Pare G. Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract. 2007;13(2):242–253. doi: 10.1111/j.1365-2753.2006.00686.x.CrossRefPubMedGoogle Scholar
  49. 49.
    Roth A, Kajiloti I, Elkayam I, et al. Telecardiology for patients with chronic heart failure: the ‘SHL’ experience in Israel. Int J Cardiol. 2004;97(1):49–55. doi: 10.1016/j.ijcard.2003.07.030.CrossRefPubMedGoogle Scholar
  50. 50.
    Schofield RS, Kline SE, Schmalfuss CM, et al. Early outcomes of a care coordination-enhanced telehome care program for elderly veterans with chronic heart failure. Telemed J E Health. 2005;11(1):20–27. doi: 10.1089/tmj.2005.11.20.CrossRefPubMedGoogle Scholar
  51. 51.
    Benatar D, Bondmass M, Ghitelman J, et al. Outcomes of chronic heart failure. Arch Intern Med. 2003;163(3):347–352. doi: 10.1001/archinte.163.3.347.CrossRefPubMedGoogle Scholar
  52. 52.
    Lichtenstein GR, Abreu MT, Cohen R, et al. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006;130(3):940–987. doi: 10.1053/j.gastro.2006.01.048.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Raymond K. Cross
    • 1
    • 2
    Email author
  • Nadia Cheevers
    • 2
  • Joseph Finkelstein
    • 1
    • 3
  1. 1.Veterans AffairsMaryland Heath Care SystemBaltimoreUSA
  2. 2.Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Chronic Disease Informatics ProgramJohns Hopkins University School of MedicineBaltimoreUSA

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