The majority of health-care workers have direct contact and interaction with IBD patients. Other physicians, such as pathologists and radiologists, make patient assessments by sharing the results of diagnostic testing. A myriad of cross-disciplinary information is required to care for IBD patients, especially those whose disease has followed a complicated course. Guidance and expert opinions from outside institutions are often sought either by phone consultation between the treating and consulting physician or by having the patient physically travel to another medical center for care. Each type of outside consultation has its drawbacks, whether it is due to insufficient information for giving advice via the phone or the substantial time demands and financial expenses of travel, as well as minimal out-of-network insurance coverage for many patients.

Physicians who practice at academic centers routinely share information about a given IBD patient through direct consultation and patient evaluation. Within an institution, more generalized education about specific IBD-related illnesses and their complications is considered and frequently debated at weekly grand round sessions. On a larger scale, gastroenterologists attend regional and national conferences to present their data and explore new insights about IBD. Although these meetings are a great source of information for IBD specialists, their infrequency significantly restricts their ability to a superior means of interacting with peers at outside institutions. The teleconference, specifically the videoconference, may provide a way to diminish the prevailing limitations of distance consultation and infrequent educational meetings.

The purpose of telemedicine is to communicate electronically to exchange medical information between separate sites to improve the clinical health status of one or more patients. Telemedicine has grown to comprise a great range of information and telecommunication methods [8]. Teleconferencing has become very popular among physicians and other researchers because of the ability to include multiple team members in a discussion. Teleconference has long been favored in surgical morbidity and mortality sessions because it allows satellite academic campuses to be included in patient presentation and dialogue [9].

The early form of teleconferencing was typically limited to voice only conversations. Although the cost is fairly low, drawbacks of audio only teleconferencing include the lack of preparation or attentiveness of certain members of the call, particularly those who are less involved in the case discussion. Additionally, some members of the teleconference are not able to participate in each session, due to clinical duties or scheduling conflicts. Teleconferences involving large groups of participants make it difficult to identify some speakers or to be cognizant of who is speaking. Finally, audio teleconferences do not allow for the presentation of physical findings or imaging studies.

The transmission of images in conjunction with telephone discussion dates back to the 1930s, when the invention of the television led to the establishment of analog videophone communication [10]. In this era, for instance, the German post office network connected Berlin with other German cities using coaxial cables [11]. Today, videoconferencing is becoming such a common means of interinstitutional communication that some people hypothesize that travel may soon be unnecessary [12]. Videoconferencing encompasses live audio and video streaming.

In the treatment of IBD patients, this form of live and active communication embodies a successful implementation of a telemedicine system. Videoconferencing allows a slide show to be presented to multidisciplinary physicians and physician trainees, highlighting the most salient features of the patient’s clinical course. Relevant photos demonstrating imaging and endoscopic studies, displaying skin or stoma lesions, or describing assessments of other extraintestinal disease manifestations are often shown to the group. Videoconference participants view the presentation in real time and are able to provide valuable interpretation and feedback about key issues in each case.

We recently established a formal, multi-institutional IBD videoconference that geographically links discrete medical institutions and physicians by using interactive live video streaming [13]. The idea for this conference came from gastroenterologist Miguel D. Regueiro, M.D. and surgeon Andrew Watson, M.D. MLitt, who both practice at the University of Pittsburgh Medical Center. For several years prior to the development of the videoconference, there had been a weekly “in person” multidisciplinary conference that included the pediatric gastroenterologists. When the pediatric hospital of Pittsburgh relocated several miles from the adult hospital, the challenge arose of linking to the pediatricians. This continuing medical education (CME)-accredited IBD case conference has expanded nationally and is now known as The inflammatory bowel disease live interinstitutional and interdisciplinary videoconference education (IBD LIVE). IBD LIVE brings together clinicians from a variety of disciplines to discuss challenging IBD patients where management decisions could benefit from outside consultation and discussion. Each quarter, selected cases from the IBD LIVE series are published in the journal Inflammatory Bowel Diseases. The conference was developed and has grown exponentially over the course of 4 years. We believe that IBD LIVE is the first IBD videoconference of its kind and we will describe various important aspects of this program in subsequent sections.

The core technology used in a videoconferencing system is digital compression of audio and video streams in real time. Certain equipment is needed to conduct a successful videoconference, including a digital network (Internet Protocol [IP] or Integrated Services Digital Network [ISDN]), video input (camera or webcam), video output (computer monitor, projector, or television), audio input (microphone), audio output (system speakers), means of data transfer (local area network [LAN] or the Internet), and a computer that initiates and maintains data linkage via the network, unites all of the components, and performs the compressing and decompressing of data.