Technologies for interprofessional education: the interprofessional education-distributed "e-Classroom-of-the-Future".

Communications strategies are central to the planning and execution of interprofessional education (IPE) programs. The diversity of telecommunications-based tools and platforms available for IPE is rapidly expanding. Each tool and platform has a potentially important role to play. The selection, testing, and embedding of tools, such as social networking platforms, within education programs can be very challenging. The goal was to create, in Phoenix, a "command-and-control" video conferencing center (the T-Health Amphitheater or Telehealth Amphitheater) in which tele-consultation patients, located physically at one of the affiliated tele-clinics around the state, could be presented electronically to interprofessional teams of faculty members from the University of Arizona Colleges of Medicine, Nursing, Pharmacy, and Public Health, as well as those from the allied health colleges of other universities in Arizona, for interprofessional team training in a virtual classroom setting. The T-Health video conferencing facility was designed and built. Early assessments show that its novel learning environment is student- and faculty-friendly. T-Health Amphitheater's pair of innovative visible social networking platforms (eStacks™ and eSwaps™) may help break down some of the traditional communications barriers encountered in healthcare IPE and medical practices.

Integrating telemedicine and telehealth: putting it all together.

Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care organizations. Telemedicine programs should perform ongoing assessments of activities, ranging from service usage to quality of service assessments, to ongoing analyses of financial performance. The financial assessments should include evaluations of costs and benefits, coding issues, reimbursement, account receivables, bad debt and network utilization. Long-range strategic planning for a telemedicine and telehealth program should be carried out on an on-going basis and should include the program's governing board. This planning process should include goal setting and the periodic updating of the program's vision and mission statements. There can be additional special issues for multi-organization telemedicine and telehealth programs. For example, authority management can require the use of innovative approaches tailored to the realities of the organizational structures of the participating members. Inter-institutional relations may introduce additional issues when competing health care organizations are utilizing shared resources. Branding issues are preferably addressed during the initial planning of a multi-organizational telemedicine and telehealth program. Ideally, public policy regarding telemedicine and telehealth within a service region will complement the objectives of telemedicine and telehealth programs within that service area.

Arizona Telemedicine Program Interprofessional Learning Center: facility design and curriculum development.

The Institute for Advanced Telemedicine and Telehealth (i.e., T-Health Institute), a division of the state-wide Arizona Telemedicine Program (ATP), specializes in the creation of innovative health care education programs. This paper describes a first-of-a-kind video amphitheater specifically designed to promote communication within heterogeneous student groups training in the various health care professions. The amphitheater has an audio-video system that facilitates the assembly of ad hoc "in-the-room" electronic interdisciplinary student groups. Off-site faculty members and students can be inserted into groups by video conferencing. When fully implemented, every student will have a personal video camera trained on them, a head phone/microphone, and a personal voice channel. A command and control system will manage the video inputs of the individual participant's head-and-shoulder video images. An audio mixer will manage the separate voice channels of the individual participants and mix them into individual group-specific voice channels for use by the groups' participants. The audio-video system facilitates the easy reconfiguration of the interprofessional electronic groups, viewed on the video wall, without the individual participants in the electronic groups leaving their seats. The amphitheater will serve as a classroom as well as a unique education research laboratory.

The Arizona Telemedicine Program business model.

The Arizona Telemedicine Program (ATP) was established in 1996 when state funding was provided to implement eight telemedicine sites. Since then the ATP has expanded to connect 55 health-care organizations through a membership programme formalized through legal contracts. The ATP's membership model is based on an application service provider (ASP) concept, whereby organizations can share services at lower cost; that is, the ATP acts as a broker for services. The membership fee schedule is flexible, allowing clients to purchase only those services desired. An annual membership fee is paid by every user, based on the services requested. The membership programme income has provided a steady revenue stream for the ATP. The membership-derived revenue represented 30% of the ATP's 2.6 million dollars total income during fiscal year 2003/04.