Evaluation and Usage Analysis of IBD Tool: A Telemonitoring

Platform for Inflammatory Bowel Disease

Caterina Lia

, Matteo Bonina

, Marco Daperno

, Valeria Figini

Flavio Martinez De Carnero

and Guido Pagana

Politecnico di Torino, Turin, Italy

Department of Gastroenterology of Mauriziano Hospital, Turin, Italy

LINKS Foundation, Turin, Italy

Keywords: Telemedicine, e-Health, Telemonitoring, Inflammatory Bowel Disease, Questionnaires.

Abstract: Telemedicine brings numerous benefits to healthcare as a support to traditional medicine. On this basis, IBD

Tool was developed. It consists of a web-app through which some of the patients suffering from Inflammatory

Bowel Disease (IBD) of the Mauriziano Hospital of Turin are followed. Thanks to IBD Tool, physicians can

follow the evolution of the disease over time, having the ability to identify periods of remission and relapse

and to reduce hospitalization’s frequency of patients. Furthermore, IBD Tool is a powerful tool also for

patients, who thanks to the web-app are always in close contact with the healthcare staff and do not feel

neglected in the months that normally elapse between a visit and the other. In this first year of use of the

platform, telemedicine has proved to be a valid support for the treatment of chronic intestinal diseases,

providing clinicians a versatile telemonitoring tool. Considering the current health situation, it is increasingly

evident that the health system cannot ignore telemedicine. In this study, we have investigated the results

collected in this first period of use of the platform, monitoring the activity state of the web-app and patients’

evaluations about the tool.

1 INTRODUCTION

The current coronavirus pandemic of 2019 has caused

a significant strain on medical center resources. Thus,

the COVID-19 pandemic has radically and rapidly

changed the way physicians deliver patient care. In

early 2020 there has been a rapid adoption of digital

tools and technologies such as telemedicine and

virtual assistance which refer to the provision of

digital or remote healthcare services using

information and communication technologies for the

treatment of patients (

Bokolo, 2020

In this scenario IBD Tool web-app was developed

and tested. The goal is to provide timely care while

minimizing the need for patients to travel to the

hospital. This study provides information on the

https://orcid.org/0000-0002-6709-6866

https://orcid.org/0000-0001-6366-9447

https://orcid.org/0000-0002-0217-6603

https://orcid.org/0000-0003-3944-1471

https://orcid.org/0000-0002-8809-6312

https://orcid.org/0000-0003-0272-3395

possible implications and potential of using virtual

assistance solutions.

IBD Tool consists of a web-app through which

some patients of the Mauriziano Hospital of Turin

suffering from Inflammatory Bowel Diseases (IBD)

are monitored. The IBDs are pathologies that

accompany patients throughout their life. Therefore,

for these patients a periodic check-up is essential to

avoid degenerations of pathology. However, the IBDs

can remain silent even for long periods of time.

Telemedicine in this field has the role of ensuring that

the patient goes to hospital only if strictly necessary.

This web-app administers specific questionnaires to

patients, focusing on the disease but also on habits

and quality of life. In this way IBD Tool monitors the

overall health of patients and provides them with an

186

Lia, C., Bonina, M., Daperno, M., Figini, V., Martinez De Carnero, F. and Pagana, G.

Evaluation and Usage Analysis of IBD Tool: A Telemonitoring Platform for Inﬂammatory Bowel Disease.

DOI: 10.5220/0010986600003188

In Proceedings of the 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2022), pages 186-195

ISBN: 978-989-758-566-1; ISSN: 2184-4984

integrated communication tool that puts them in

contact with the physicians of the Mauriziano

Hospital in Turin.

This project arises from a scientific

experimentation which is evaluating over time the

effects of telemedicine usage on patients.

IBD Tool collects questionnaires filled out by

patients since March 2020 and has evolved over time

following user requests. The platform includes

several sections: the section for receiving, sending,

and reading questionnaires for both physicians and

patients, a section with clinical data, a dedicated chat

and a dashboard to view the progress of patients

considering several parameters (which we will see

later in this paper).

IBD Tool was developed with the aim of making

the application easy to use for both clinicians and

patients.

Physicians recruited volunteer during the first

follow-up visit after the start of the platform testing

phase. The patients who joined the trial signed an

informed agreement, and they were then registered by

the physicians on the web-app. Among the patients

who joined the trial, not all had the same type of

access to the platform. The 50% were randomly

referred to telemedicine care and the remaining 50%

to standard care. It is a compromise between ethical

aspects (to not deprive the patient of a potentially

useful tool especially in the pandemic period) and the

need to have a control sample. The difference

between patients in telemedicine and those in

standard care is the administration frequency of

questionnaires, which are more frequent in the first

group.

In a year and a half of use, physicians have always

been able to give direct feedback to improve the web-

app. In this study, we investigate patient feedback to

assess whether the objectives of simplicity of use

have been achieved and possibly accept proposals for

changes to improve it. Main focus is the use of the

web-app among patients-users, their involvement,

and their activity rate with respect to the application.

2 METHODS

2.1 Questionnaires

The monitoring function of IBD Tool is based on

questionnaires. IBD Tool automatically administers

specific questionnaires to patients based on their

category. Presence of a new questionnaire is notified

by mail and by the platform through the notification

section. When a user-patient is registered on the

platform by the clinician, he is automatically and

randomly assigned to a specific treatment category,

STANDARD or TELEMEDICINE, which identifies

two different levels of remote assistance.

The differences between the two categories are:

▪ The administration frequency of questionnaires:

patients in “TELEMEDICINE” category fill out

questionnaires more intensively than patients in

“STANDARD” category.

▪ The type of sent questionnaires: patients in

“TELEMEDICINE” category fill out more

types of questionnaires than patients in

“STANDARD” category.

The IBD Tool’s questionnaires assess various life

aspects. Monthly questionnaires are:

▪ HBI (Harvey Bradshaw Index): it consists of 5

questions, and it is used only for Crohn’s

patients (Harvey, 1980). It evaluates the

patient’s well-being, abdominal pain, the

number of liquid or soft bowel movements, the

presence of abdominal mass and the presence of

complications. It is sometimes compiled by

clinicians to compare the results with patient

scores.

▪ SCCAI (Simple Clinical Colitis Activity Index):

it is used only for ulcerative colitis patients, and

it is composed by 13 questions that refer to the

symptoms of the last week, to bowel

movements, episodes of fecal incontinence,

blood in the stool, joint pain, erythema and any

infections (Bennebroek Evertsz’, 2013). It is

sometimes compiled by clinicians to compare

the results with patient scores.

▪ MIAH (Monitor IBD at Home): it is constructed

in both a version for patients with Crohn’s

disease (MIAH-CD) and for patients with

ulcerative colitis (MIAH-UC), with respectively

6 and 5 questions (de Jong, 2018).

▪ IBD-DISK (Inflammatory Bowel Disease -

Disability Index disk form): it was validated

starting from a previous questionnaire (the IBD-

DI: Inflammatory-Bowel-Disease Disability

Index) with some modifications; it is based on

10 items, about abdominal pain, regulating

defecation, education and work, sleep, energy,

emotions, body image, sexual functions, and

joint pain (Gosh et al., 2017).

3-Monthly Questionnaire are:

▪ PRISM (Pictorial Representation of Illness and

Self Measure): it is not made up of questions,

but of two circles, one represents the disease, the

other represents the patient; the user must

indicate, by moving the circles, how much he

Evaluation and Usage Analysis of IBD Tool: A Telemonitoring Platform for Inﬂammatory Bowel Disease

187

suffers due to his illness. The final score is

returned in terms of distance (Gosh et al., 2020).

It is sometimes compiled by clinicians to

compare the results with patient scores.

▪ PHQ9 (Patient Health Questionnaire 9 items): it

is used for the diagnosis of depression

consisting of two questions, the first of which

evaluates the symptoms of depression

(Kroenke, 2001).

▪ IPAQ-SF (International Physical Activity

Questionnaire - Short Form): it is aimed at

measuring the amount and type of physical

activity performed in the last seven days (Craig

CL, 2003).

▪ WPAI (Work Productivity and Activity Index):

it is used to assess the impact of the disease, both

Crohn’s disease and ulcerative colitis, on work

and daily activities (Reilly MC, 1993).

▪ IBDQ (Inflammatory Bowel Disease

Questionnaire): it is for quality of life

assessment. Its composition consists of 32

questions, which take into consideration

different fields about social life, emotional

health, and symptoms (Hlavaty, 2006)

(Ciccocioppo

, R., 2011).

▪ MMAS8 (Morisky Medication Scale 8 items): it

is based on 8 questions that assess adherence to

therapy. The questions relate to times when a

patient forgets to take the tablet or stops taking

it because it is believed to be ineffective or

causes discomfort (Hu W, 2020).

▪ TSQM (Treatment Satisfaction Questionnaire

for Medication): it is used to assess the level of

satisfaction or dissatisfaction with the drug that

the patient is taking. In particular, the

effectiveness, the side effects, the use of the

drug, its planning and the convenience or

inconvenience of taking it are evaluated

(Vermersch, P., 2017).

6-monthly Questionnaire are:

▪ EQ5D5L (European Quality version 5D - 5

Levels): it is about the measurement of the

quality of life, work, personal care, physical and

psychological health, usual activities, pain, and

discomfort (Herdman, 2011).

▪ PSQI (Pittsburgh Sleep Quality Index): it is for

the evaluation of sleep in the last month, with

questions regarding the time a person fell asleep,

the time taken to fall asleep, the wake-up time in

the morning, the total hours of sleep, the general

sleep quality, how many times a person wakes

up during sleep, whether a person has been

taking sleep medications, etc. (Curcio, 2012).

Patients in “standard of care” category only compile:

HBI, IBD-DISK, MIAH-CD if they suffer of Crohn’s

disease, PATIENT-SCCAI, IBD-DISK and MIAH-

UC if they suffer of ulcerative colitis, IBD-DISK if

the pathology is undefined; the administration

frequency is of three months.

Patients in “telemedicine” compile all the

questionnaires with their regular administration

frequency.

2.2 Platform Structure

The web-app was built by using different

technologies. IBD Tool comprises two parts: the

frontend and the backend. The frontend is the user

interface of the platform, and it is the visible part of

it, which can be reached from every browser.

The used framework is Angular, an open-source

framework for the creation of single page client

applications, based on Typescript, an object-oriented

programming language, CSS (Cascading Style

Sheet), and HTML (HyperText Markup Language).

Furthermore, Angular is a tool for developing multi-

platform applications. Through some toolkits, it is

possible to develop responsive applications.

To implement the backend, Java programming

language is chosen. This language is an object-

oriented programming language, and it can be used

on Spring Boot, one of the frameworks for creating

web applications based on microservices. The IBD

Tool backend is organized following the multitier

architecture, which matches perfectly with the

instruments made available by Spring. Specifically,

IBD Tool is a 4-tier architecture, and these layers are:

▪ Presentation Layer

▪ Service Layer

▪ Data Domain Layer

▪ Data Access Layer

Communication between frontend and backend is

done by the HTTP (HyperText Transfer Protocol).

For all the features, IBD Tool can be defined as a

REST (Representational State Transfer) architecture,

completely compatible with the HTTP (Figure 1).

Security issues were considered by guaranteeing

the access to the platform by username and password

and checking the role of the user who logs into the

application. Furthermore, Spring Security and use of

a JWT (Json-Web Token) permit an additional

security level.

All data is saved in some collections of a

MongoDB cluster, specifically created for IBD Tool.

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188

Figure 1: Web-Platform Architecture. the Figure Shows

How the Web-Client and the Web-Server Interact through

the HTTP.

2.2.1 Supporting Instruments for

Development

Some other tools are used to support the development

and the release of the web-app. GitHub is used to host

all the code of the backend and the frontend,

facilitating updates, and merging code’s procedures.

Heroku is used as a server service, where the backend

is hosted and directly linked to the GitHub code.

Firebase Hosting is used to host the frontend of the

web-app, while Firebase Cloud Messaging is used to

manage the real-time communication. IBD Tool also

relies on a Gmail account to send emails to users.

2.3 Validation’s Instruments for the

Platform

To assess the web-platform’s efficiency, a new

satisfaction questionnaire was created by consulting

widespread questionnaires for the evaluation of

telemedicine services, as TUQ (Telehealth Usability

Questionnaire) (Parmanto, 2016) and TSQ

(Telemedicine Satisfaction Questionnaire) (Yip,

2003).

This new questionnaire is composed of 10

questions about the quality of care provided, the ease

of use and learnability, the satisfaction and future use,

and the interaction quality. Last question is an empty

box where users can give their suggestions. This

questionnaire is administered only to patients. Each

answer can be in a range of 1-10, where 1 means “not-

at-all” and 10 “very much”. The structure of the

questionnaire is in Table 1.

Table 1: Satisfaction Questionnaire for IBD Tool.

Qualit

of care

rovide

I think that IBD Tool improved the quality of service

offered b

Mauriziano Hos

ital of Turin

I think the service I obtained was better thanks to IBD

Tool

Thanks to IBD Tool, I felt more followed between a visit

and anothe

Satisfaction and future use

I will continue to use IBD Tool in the future

I am satisfied of the quality of service offered by IBD

Tool

Ease of use and learnabilit

I need assistance to use IBD Tool

IBD Tool is eas

and intuitive to use

Usefulness

I think IBD Tool lets me go to the hospital only when

strictly necessary

Interaction

ualit

IBD Tool made the communication with Mauriziano

Hospital’s clinicians faste

Suggestion box

Blank

(

To fill

)

2.4 Analysis Method

All information about patients registered on the

platform are saved in different collections of a

MongoDB cluster, specifically created for IBD Tool.

In order to communicate with MongoDB, the

repository support offered by Spring is used, making

this communication much easier than traditional

implementations.

2.4.1 User Activity Analysis

In the ‘user’ collection of MongoDB cluster, there is

a record for each enrolled patient containing clinical

variables such as, pathology, presence or absence of

previous surgery, sex, type of active therapy, age etc.

Evaluation and Usage Analysis of IBD Tool: A Telemonitoring Platform for Inﬂammatory Bowel Disease

189

A “lastLogin” field indicates the timestamp of the

user's last login.

This configuration allows division of patients into

different subgroups with the aim of analysing whether

the use of the platform was influenced by certain

characteristics, such as patient age or the duration of

the disease. Patients are divided in the following

subgroups:

▪ Category: Telemedicine or Standard of care

▪ Pathology: Crohn disease, Ulcerative colitis or

other

▪ Sex: Men or Women

▪ Age – Age at diagnosis: Four different ranges

(0-20, 20-40, 40-60, 60 or more years)

▪ Pathology duration: Four different ranges (0-10,

10-20, 20-30, 30 or more years)

▪ Active therapy: 5ASA-OS, TOPICA, GCS-OS,

IMM., BIO

▪ Presence of previous surgery

For each of the subgroups, activity and inactivity rate

of patients are calculated, considering:

activity rate =

    

    

(1)

inactivity rate =

    

    

(2)

Being inactive has a different meaning if users are in

“telemedicine” or “standard of care” category. When

a user of category “telemedicine” is inactive he/she

has not accessed the platform for 4 months or more.

When a user of the category “standard of care” is

inactive he/she has not accessed the platform for 7

months or more. Furthermore, users who are

classified as “unlogged in” are those who did not log

in the platform after at least 2 weeks from the

registration phase.

2.4.2 Questionnaires Filling Frequency

Analysis

All the compiled questionnaires are saved into a

‘questionnaire’ collection of MongoDB cluster. Each

record contains the answers given by the patient, final

score, and type of questionnaire.

Mean number of compiled questionnaires per

patient is calculated with the aim of analysing user

activity, considering:

mean per user =

  

  

(3)

This number is calculated for each type of

questionnaire. Furthermore, questionnaires are

addressed to different patients, based on category

and/or pathology.

Regarding the satisfaction questionnaire, it was

created following the template of the clinical

questionnaires. To warn all the users of the platform,

a new section was added to the user "personal page"

and an email was sent to each patient with the link to

the questionnaire.

3 RESULTS AND DISCUSSION

3.1 Results

From the analysis of how many users are active or

inactive, referring to the access and the utilization of

the platform, it was found that among a total number

of patients of 677, 86,9% logged in the platform at

least once, while the 13,1 % did not. Among users

who logged in at least once, the 73,6% are active, so

they constantly access the platform, compile

questionnaires and/or write some chat messages to the

clinician, while the 13,3% are inactive (Figure 2).

Figure 2: Distribution of the 677 registered users in logged

and unlogged in. Logged in users are divided into active and

inactive. Only active users are those who regularly use the

web-platform.

Analysis of registered users reveals that there are 677

global users (constantly increasing), who can be

differently distributed depending on variables of

interest (category, age, sex, pathology, pathology

duration, etc.). The balance between telemedicine and

standard of care users is about equal, as well as among

users suffering from Crohn's disease (CD) and

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190

ulcerative colitis (UC), while there is a small

percentage of patients (1,6%) whose disease is still

unclassified (IBD-U). In the web-platform male and

female are balanced. Most of the recruited users

belong to the age groups 20-40 and 40-60, followed

by the age group 60+ and only lastly by the age group

0-20. This is because pediatric users have never been

foreseen until now. In these data, pathologies are

mostly diagnosed in the age range of 20-40 (52,9%),

followed by 0-20 (23,5%), 40-60 (20,5%), and 60+

(2,2%). Then, pathology duration in this population

of users is mostly about 0-20 years (40,8%), followed

by 20-40 (30,4%), 40-60 (19,6%) and 60+ (8,3%).

Furthermore, in the field of ongoing therapies, the

most frequent therapy is the 5-ASA-OS because

52,9% of users are undergoing this therapy and some

of them in combination with another. The second

most frequent therapy is biologic, which involves

38,7% of users. All this information is reported in

Table 2.

Table 2: Distribution of registered users by category,

disease, sex, age, age at diagnosis, pathology duration,

ongoing therapy, and previous surgery. For both age at

diagnosis and pathology duration, there is information on

671 instead of 677 people because for 6 patients there are

not information about these fields.

Users Total

Global 677

Category Total

Telemedicine 338 49,9%

Standar

339 50,1%

Disease Total

CD 354 52,3%

UC 312 46,1%

IBD-U 11 1,6%

Sex Total

Men 333 49,2%

Women 336 49,6%

Missing 8 1,2%

Age Total

0-20 years 13 1,9%

20-40 years 265 39,1%

40-60 years 284 41,9%

60+ years 115 17,0%

Age at diagnosis Total

0-20 years 159 23,5%

20-40 years 358 52,9%

40-60 years 139 20,5%

60+ years 15 2,2%

Pathology

duration

Total

0-20 years 276 40,8%

10-20 years 206 30,4%

20-30 years 133 19,6%

30+ years 56 8,3%

Ongoing therapy Total

5-ASA-OS 358 52,9%

TOPIC 71 10,5%

GCS-OS 79 11,7%

IMM. 37 5,5%

BIO. 262 38,7%

Previous surgery Total

Yes 266 39,3%

No 411 60,7%

Distribution of logged in users (both active and

inactive) is analysed by considering different sub-

groups (category, sex, pathology, age, pathology

duration, ongoing therapy, age at diagnosis, and

previous surgeries) (Figure 3).

The difference in the involvement in the

application is analysed in terms of activity rate and

inactivity rate between each sub-group

(telemedicine/standard of care, men/women, etc)

(Figure 4).

Figure 3: Active and inactive patient percentage divided by sub-groups. Each single graph is referred to a different patient

distribution: category, pathology, sex, ongoing therapy, previous surgery, pathology duration, age at diagnosis, and age. Each

percentage.

Evaluation and Usage Analysis of IBD Tool: A Telemonitoring Platform for Inﬂammatory Bowel Disease

191

Figure 4: Activity and inactivity rate in each sub-group. Each single graph is referred to a different patient distribution:

category, pathology, sex, ongoing therapy, previous surgery, pathology duration, age at diagnosis, and age. The figure shows

high activity.

For each sub-group the number of users is different,

except for category and sex, in which there is a major

balance (Table 2). Considering the category, 50% of

users belong to the “telemedicine” program (338

users) and 50% belong to the “standard of care”

program (339 users). Active telemedicine users are

41,7%, while inactive are 9,0%; active standard of

care users are 43,0%, while inactive are 6,3% (Figure

3). The inactivity rate of telemedicine users is 0,2

against the 0,1 of standard of care users (Figure 4).

Considering pathology and sex, the balance between

active and inactive users is quite the same. Although

the percentage of active Crohn’s disease users is

43,0% against the 40,1% of ulcerative colitis, the total

number of Crohn’s users (354) is higher than those

who suffer from ulcerative colitis (312) (Figure 3).

Considering sex, the activity rate of men is 0,8, for

women is 0,8 (Figure 4). Considering age groups, it

can be observed that they all have a similar degree of

participation in the platform and the activity rate is in

the range 0,8-0,9 for each group (Figure 4). Same can

be said if the population is divided by pathology

duration (activity range: 0,8-0,9) and age at diagnosis

(activity range: 0,8-0.9) (Figure 4).

Furthermore, those who have had surgery

(activity rate of 0,9) have a degree of involvement in

the application quite higher to those who have not had

any (activity rate of 0,8) (Figure 4). Considering the

ongoing therapy, each group has an activity rate in the

range of 0,7-0,9 (Figure 4).

The activity of users was also taken into

consideration in terms of compiled questionnaires

(Table 3). Clinician’s questionnaires have a mean per

user higher because all the patients are followed by 3

physician users.

Table 3: Compiled questionnaires and corresponding mean

per users. Red part of the table indicates monthly

questionnaires; light yellow part of the table scheduled 3-

monthly questionnaires (except for PRISM which has been

compiled also during the face-to-face visit with physicians);

light blue part of the table indicates 6-monthly

questionnaires; grey part represents satisfaction

questionnaire; white represents questionnaires compiled by

physicians.

Questionnaire Number

Mean per user

HBI 1764 5

PATIENT-SSCAI 1586 5,1

IBD-DIS

3068 9,5

MIAH-CD 1626 4,6

MIAH-UC 1420 4,6

PATIENT-SSCAI 1586 5,1

MMAS8 507 1,5

PHQ9 552 1,6

IBDQ 395 1,2

IPAQ-SF 529 1,6

PRISM 1165 3,4

TSQM 475 1,4

WPAI 484 1,4

PSQI 226 0,7

EQ5D5L 238 0,7

SATISFACTION 285 0,4

CLINICAL-HBI 561 187

CLINICAL-SCCAI 510 170

CLINICAL-PRISM 1071 357

Total 16439

The last analysis section is about the user

valuation of the web-platform through the satisfaction

questionnaire. In the following analysis, only

questionnaires completed within 5 days of

publication and notification of the satisfaction

questionnaire were considered. 285 over 677 users

compiled the questionnaire, and they were mostly

active users (only 2 over 285 inactive users compiled

the questionnaire). IBD Tool obtained a global mean

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192

score of 7,4 over 10 in “quality of care provided”, 8,1

over 10 in “satisfaction and future use”, 8,5 over 10

on “ease of use and learnability”, 6,4 over 10 in

“usefulness”, and 6,9 over 10 in “interaction quality”

(Table 4).

Table 4: Average score resulting from the analysis of the

285 satisfaction questionnaires.

Quality of care provided Mean

score

I think that IBD Tool improved the quality of

service offered by Mauriziano Hospital of

Turin

7,5

I think the service I obtained was better

thanks to IBD Tool

7,1

Thanks to IBD Tool, I felt more followed

etween a visit and anothe

7,6

Satisfaction and future use

I will continue to use IBD Tool in the future 8,4

I am satisfied of the quality of service

offered by IBD Tool

7,8

Ease of use and learnabilit

I need assistance to use IBD Tool 1,7

IBD Tool is eas

and intuitive to use 8,7

Usefulness

I think IBD Tool lets me go to the hospital

onl

when strictl

necessar

6,4

Interaction

ualit

IBD Tool made the communication with

Mauriziano Hos

ital’s clinicians faste

6,9

estion box

Blank

(

To fill

)

3.2 Discussion

Rate of users who constantly access and use the

platform is high, the 73,6%. Users who are classified

as “unlogged in” are those who have been registered

by the physician, but have never accessed the web-

app. These users declared interest on the

telemonitoring program, but never joined the service.

Active users compile with diligence all the

received questionnaires; the different values of

compiled questionnaires per patient are since not all

the questionnaires are administered to the patients

with the same frequency. Questionnaires like HBI,

Patient-SCCAI, MIAH-UC, MIAH-CD and IBD-

DISK are administered monthly to telemedicine users

and, consequently, the number of compiled

questionnaires of this type is higher. The number of

questionnaires like PRISM, HBI, Patient-SCCAI or

clinical ones is higher because they are compiled even

at the time of the visit.

Evaluation results on satisfaction questionnaire

show that most of analysis fields obtained good

marks. Critical issues came from limitations of

hospital face-to-face visits. Most of users think that

IBD Tool is easy to use, intuitive and that there is no

need of help for using it and answering to

questionnaires. Most of them will continue to use IBD

Tool in the future. Generally, satisfaction is good

among active users.

4 CONCLUSIONS

Potential of this web-app is manifold, both in the

short term and in the long term. In the short term, it

has a direct effect on patients, allowing them to feel

followed and accompanied by physicians even at a

distance. This allows the consequent monitoring and

prevention of the disease degeneration.

In the long term, the development of a machine

learning algorithm is planned. The goal is to process

the collected data, to assess the risk of degeneration

considering combinations of variables present in the

questionnaires.

Patient point of view should be highlighted.

Therefore, they were provided with a satisfaction

questionnaire. This questionnaire allows the

evaluation of the application on the patient side. One

of the goals was to facilitate all-ages patients to easily

utilize the application.

In this questionnaire the possibility to add any

suggestions was given. From the analysis of all the

suggestions, it emerged that a considerable number of

patients would like a notes section at the end of the

questionnaires to be able to argue their answers when

multiple choices are not enough.

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Another emerging need concerns having a patient

section where it is possible to have information about

the disease using graphs that summarize the course of

the pathology to have a greater awareness of their

state of health.

Results of the analysis on the activity and on the

use of IBD Tool have shown a great involvement.

Patients constantly compile questionnaires, contact

the clinicians through the platform for any kind of

technical or medical problem. Also, clinicians

constantly use the web-platform and take into

consideration the questionnaire scores to make their

clinical evaluations.

The results of this study encourage us to improve

the platform and service by trying to consider patient

suggestions.

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