The E-Mail Age Implications  Key Implications to Clinical Services E-Medicine (Internet access to information, available services and referrals) and increased consumerism will change academic medical center’s traditional role in addressing health issues. User-friendly access to web-based information services will be critical to being competitive both nationally and locally. The technology to prosper in the E-Mail Age scenario will consume substantial financial resources. Society will become intolerant of existing variations of practice patterns and medical errors. This behavior will drive a focus on quality, practice guidelines and outcome measurements. The tremendous growth in E-Medicine will require time-limited credentialing/certification standards that cut across geographical boundaries. A team approach to health care delivery will evolve as the roles and responsibilities of health professionals (physicians, nurses, allied health professionals) are clarified. This will result in more cost effective, coordinated care and require interdisciplinary education and training which focuses on a seamless, satisfactory and outcomes oriented health care experience for patients. Ethical issues will increase in kind, number and complexity. Key Implications to the Community Community should be defined in its broadest sense as groups of people with common interests. Academic medical centers must recognize the strategic importance of the local, regional, state, national, international and virtual communities they will serve.   The implications to the community mission are closely tied to the other three mission areas. In the E-Mail Age, it is important that academic medical centers define their communities.  A single academic medical center may serve several different communities, depending on what the academic medical center is striving to achieve and what expectations the communities have.  Some communities may not be defined along geographic lines but could include dispersed populations that share the same interests, needs and aspirations.  The economic futures of academic medical centers and their immediate geographic communities will be interdependent. The success of academic medical centers will be dependent on how well they address the health and educational needs of all their defined communities.  This will involve innovative, sustainable partnerships with community, government and corporate entities to improve the health status of populations. Competition for external funding from private donors and foundations will become increasingly more competitive.  Funding agencies will look more than ever for collaborations and partnerships between academic medical centers and their communities in making decisions about what to fund.  Those adept at using E-technology will have an added advantage in being funded. The workforce for academic medical centers will include distance workers; e.g. employees will not be bound by geographic locations.  This may have a negative economic impact on the immediate geographic community. Close ties and affiliations with alumni and other community partners will no longer be limited to the immediate geographic region. Key Implications to Research Research databases will become increasingly large and complex, involving a wide variety of information relevant to all aspects of biomedical research.  They will include, but not be limited to, the organization and function of genomes for humans and human pathogens, protein sequence and structure-function relationships, genetic risk factors for disease, and very large patient and health outcomes databases. Research will increasingly "brand" institutions, which will identify and drive centers of clinical and educational excellence. The use of new and sophisticated electronic technology will transform communications of many types. More social and behavioral research, research on preventing disease and fostering wellness, and research on health outcomes will occur in response to patient and community demand for effective care. Increasingly sophisticated and specialized research technologies will force increased interaction of researchers at different sites.  This will force multi-center and multi-institutional research.  These types of technologies will be limited in availability. There will be an even more competitive environment for funding and sources of funding will drive the types of research.   Academic medical centers will need to shift their thinking to being more entrepreneurial.  Private business partnerships with academic medical centers and individual scientists will grow.  Individual researchers will become more and more entrepreneurial.  Expanded development of intellectual property will feed the university, industry, and the economy.  Technology transfer and issues involving conflict of interest and commitment will become increasingly more complex.   Research institutions (like UTMB) need to move to the top tier to avoid being negatively affected with respect to NIH funding. Key Implications to Education  The Internet will be a major conduit for educating health professionals.    Learning will become life long with continuing education taking on the form of mandatory competency based re-certification, as all initial certificates will be time limited. Multidisciplinary groups of faculty will be dedicated to educational design, focusing on new and innovative ways to educate the virtual student using the newest technologies and leading to a more integrated approach to health professional education.   Health professional education will become more team based and collaborative, more consumer oriented, and more focused on the maintenance of wellness, the prevention of illness, and end of life care.