title: EHealth Technologies in Inflammatory Bowel Disease: A Systematic Review.
abstract: OBJECTIVE
  Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care.
  
  
  METHODS
  Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters.
  
  
  RESULTS
  Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [(n = 1) 18 days vs 77 days, p < 0.001]; disease activity (n = 2); short-term medication adherence (n = 3); quality of life (n = 4); IBD knowledge (n = 2); healthcare costs (n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms (n = 1), and; facilitating the remote management of up to 20% of an IBD cohort (n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost-benefit analyses.
  
  
  CONCLUSIONS
  EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.
authors.affiliation: Department of Gastroenterology, The Austin Hospital, Melbourne Australia Department of Medicine, University of Melbourne, Austin Academic Centre, Melbourne, Australia.
authors.forename: Belinda D
authors.initials: BD
authors.lastname: Jackson
authors.affiliation: Health and Biomedical Informatics Centre (HABIC), University of Melbourne, Melbourne, Australia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gray
authors.affiliation: Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia Department of Mental Health, St Vincent's Hospital, Melbourne, Australia Department of Psychiatry, The University of Melbourne, Melbourne, Australia Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Knowles
authors.affiliation: Department of Gastroenterology, The Austin Hospital, Melbourne Australia Department of Medicine, University of Melbourne, Austin Academic Centre, Melbourne, Australia ppdecruz@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: De Cruz
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D005060:Europe; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics / Q000628:therapy*; D020407:Internet; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D012648:Self Care; D017216:Telemedicine / Q000191:economics / Q000379:methods* / Q000592:standards; D014481:United States
keywords: EHealth; inflammatory bowel disease; remote consultation; self-management; telemedicine