Alissa Walsh

Research interest: Digital health, Remote monitoring of chronic disease

Alissa Walsh is a Consultant Gastroenterologist at the Translational Gastroenterology Unit in Oxford. After completing her formal gastroenterology training in Australia, Dr Walsh undertook a Clinical Fellowship in Inflammatory Bowel Diseases within the Oxford University Hospitals NHS Trust (2007-2008) and thereafter a National Health Medical Research Council fellowship in Australia (2009-2011). Dr Walsh spent six years as a Consultant Gastroenterologist at St Vincent’s Hospital in Sydney, Australia before returning to Oxford where she has completed a DPhil in clinical medicine from the University of Oxford.  Dr Walsh’s research interests include electronic remote monitoring in chronic disease, IBD activity indices, prevention of opportunistic infections in immunocompromised patients, and the role of faecal transplantation in ulcerative colitis. Dr Walsh is a founder and director of Crohn’s Colitis Cure, an Australian charity supporting IBD medical research. 

The TrueColours Inflammatory Bowel Disease (IBD) project was established in 2016 in Oxford. TrueColours-IBD is a comprehensive real-time web-based programme that provides remote self-monitoring for patients through validated questionnaires relating to disease activity (sent by email either daily or weekly), quality of life (fortnightly), and outcomes (every 3 months). Responses are plotted on a red/amber/green graph to monitor both symptoms and quality of life, which provides immediate visual feedback to both patients and clinicians.

The Covid-19 pandemic has brought remote, digital monitoring of patients with IBD into its own. It has been used in three ways:

1. Clinicians undertaking telephone clinics log into the TrueColours website  (https://ouh.truecolours.nhs.uk/ibd/en/) which enables the clinician to review the graph both before and during the consultation, since this displays a summary of current symptoms and disease course
2. The TrueColours team are identifying all patients with clinic appointments in the month ahead who are not already using TrueColours and contact them by telephone to enrol them
3. TrueColours-IBD includes a calculator that predicts the likelihood of treatment escalation or intervention at a consultation, based on responses. This was about to be tested in a randomised controlled trial, Project RAINBOW (MREC 20/SC/0101, CPMS Portfolio 43751). RAINBOW is on hold, so the team are vetting all IBD appointments through ePR and their TrueColours record. Patients with  good symptom control and quality of life (likelihood of treatment escalation of <10%) are being offered the opportunity of extending their clinic review by up to 12 months, with safety netting advice and access to the IBD advice line should it be necessary

Impact to date (1 May 20)

• Every clinician doing an IBD telephone clinic now uses TrueColours-IBD (usage prior to pandemic 6/14)
• Enrolment increased from 1104 (1 Mar 20) to 1281 (29 Apr 20)   
• 70/365 appointments extended (19%)

Future plans

In the ‘new normal’, Project RAINBOW will be implemented with pharmacoeconomic analysis supported by the BRC. The landscape will, however, have changed forever and it is inconceivable that clinic follow up for patients with IBD will be 100% face-to-face, as it was until just 6 weeks ago.  TrueColours-IBD will act as the pilot for real-time remote digital monitoring of patients with chronic disease for OUHFT. Recruitment will continue in order that most patients with IBD who have blood, tissue, or other samples collected in the GI cohort will have a contemporaneous record of disease activity and quality of life from validated indices available to researchers, as well  as ICHOM patient-reported outcome measurements (https://www.ichom.org/portfolio/inflammatory-bowel-disease/)