Inflammatory bowel diseases: More patient comfort and autonomy thanks to an app

Interview with Prof. Martina Müller-Schilling, Head of Clinic and Polyclinic for Internal Medicine I, University Hospital Regensburg

10/04/2016

Chronic inflammatory bowel diseases like Crohn’s disease and ulcerative colitis increasingly develop at a younger age and affect patients for life. Regular check-ups need to occur every two to three months. Now, a specially designed app intends to provide relief.
Image: Dark haired, smiling woman in a hospital; Copyright: UKR

Prof. Martina Müller-Schilling; © UKR

In this interview with MEDICA.de, Professor Martina Müller-Schilling talks about the app that assists in monitoring inflammatory bowel diseases. Affected patients can use it to self-test, which gives them more time and autonomy. This is also intended to strengthen and improve physician-patient interaction thanks to direct data transfer.

How does the app work?

Professor Martina Müller-Schilling: The test system, on the whole, is a three-part diagnostic concept: it includes a smartphone app, an immunological test kit, and a physician portal. With the help of the immunological test kit, the calprotectin value – a biomarker to indicate intestinal inflammation- can be measured in stool samples. The result is displayed on the patient’s smartphone after approximately fifteen minutes, while the app simultaneously generates an automatic transfer to the responsible medical center. The goal is a steady and frequent monitoring of the disease to enable a quick response to an elevated level of inflammation. This ensures that the treatment can be quickly adapted accordingly.

What type of patients should use the app?

Müller-Schilling: Patients suffering from chronic inflammatory bowel diseases who are being treated in gastroenterology clinics and medical practices. They usually develop the disease at a younger age and are subsequently affected it by it for the rest of their lives. Just in Germany alone, more than 400,000 patients are affected by chronic inflammatory bowel diseases.

Which bowel diseases are specifically targeted and monitored with this app?

Müller-Schilling: Crohn’s disease and ulcerative colitis are among the chronic inflammatory bowel diseases. These diseases typically involve flare-ups and can go along with a high level of disease activity and a severe inflammation of the colon.

What are the advantages of the app?

Müller-Schilling: The advantage is that the patient is able to perform the test on his/her own at home and is more involved in the overall treatment process. We primarily expect increased autonomy and comfort for patients. But we also hope to achieve an improved physician-patient interaction thanks to better-informed patients.

How is data security ensured?

Müller-Schilling: We use a system that is equipped with state of the art technology and the highest possible level of data protection: pseudonymization. The entire electronic data transfer process occurs via a secure server. When electronic patient data is stored or transferred, the patient identity is always encrypted as a bar code or numeric code. The test system never electronically stores or transfers the patient’s personal information along with the test results. Only the treating physician knows the key and is able to link the test results to the individual patient.
Image: Front page of the medicine app. In the middle the button "Start Test", below the options "My Doctor", "History" and "News"; Copyright: Ben Pakalski / www.pakalski.de

With the app, more comfort and autonomy for the patient sould be possible; © Ben Pakalski / www.pakalski.de

How does the app impact the lives of patients?

Müller-Schilling: The first patient we involved in this has been a long-time patient of ours. He recently passed his exams and now wants to embark on a trip around the world. The app gives him this opportunity. He can be mobile and stay in touch with us at the same time and monitor his disease on his own from anywhere in the world. He would probably not dare to go on this trip without the app.
The chance to consolidate the collected data of the patient could be especially crucial in emergency situations. Unfortunately, these days it still happens that patient data is sometimes not completely available during emergencies that take place on weekends.

Who participates in this study?

Müller-Schilling: All in all, there are four target groups that will participate in this study. The first group includes patients with a recent adjustment in treatment where a steady and frequent monitoring process is required. We compare this group with a control group that is comprised of patients exhibiting no current symptoms. The third group consists of patients with an increased risk, for example, pregnant patients with chronic inflammatory bowel diseases who also require close monitoring. In the fourth group, patients with chronic inflammatory bowel diseases are surveyed with questionnaires and respective checks to determine whether the app results in more autonomy and time savings.

What is being examined and tested in the study?

Müller-Schilling: In the study, we check whether a self-testing process by patients with chronic inflammatory bowel disease allows for improved monitoring of the treatment process. At the same time, we check patient comfort in terms of autonomy and time savings and determine whether we, as doctors, respond quicker to elevated values than is the case with conventional reassessment cycles every two to three months. It is also important to test how well the app is suited to a close monitoring of patients with a high sensitivity.

In your opinion, can this app or your principle also be applied to other diseases?

Müller-Schilling: I could envision an expansion of this technology to many different areas, functions, and diseases. We need to utilize its potential to where it provides optimal benefits and gains in the lives and health of both healthy and sick people: providing information on their general health status, predisposition to diseases, prevention information, the next steps that need to be taken etc. All of this is conceivable.

What aspects can still be optimized?

Müller-Schilling: We are conducting the study to be able to answer this very question. Depending on the outcome, we can then see where there is a need for improvement. What’s important is that all health care system stakeholders – patient associations, physicians, ethicists, information scientists, lawyers, and politicians – come together to define quality criteria for these types of applications. The goal must be to create a synthesis of data, knowledge, application and data security.

Could the app establish itself for monitoring of bowel diseases in the future?

Müller-Schilling: That’s the objective of this study. We have deliberately selected a disease entity that affects young people who are faced with it for the rest of their lives. With this app, we hope to empower an autonomous patient, who is safely guided through his/her disease while still being in contact with us.
The interview was conducted by Nicole Kaufmann and translated from German by Elena O'Meara.
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