Table 1.

Essential Issues and Considerations Relating to Establishment of Integrative Medicine Centers

Essential Issues	Key Considerations	Implications
I. Decisions regarding settings and populations
Organization and setting	Physical vs. virtual entity Located within main hospital, satellite clinic, or separate from both Outpatient vs inpatient care, or both	Perceived legitimacy/credibility and institutional commitment Ease and access to referrals and patient populations
Principal population	Broad vs. focused principal populations, including clinical conditions (all vs. specialty) and ages (adult only vs. inclusion of children)	Degree of population focus impacts specificity of team training, potential for condition-specific research, referral stream, and breadth of prospective patient base
Nature of clinical services provided	Primary care vs. consultative services vs. both	Affects all core decisions related to settings, populations, team, and organizational, staffing, administrative and financial issues If provide both, offers fully integrative patient care but potentially competes with other primary care clinics
II. Decisions regarding composition, recruitment, and training of multi-disciplinary team
Selection of CAM practices and specific providers	Choice of modalities to match targeted clinical conditions Rules for qualifications and competencies for CAM providers (including state privileges, national certifications, licensure, etc)	Must take into consideration specific hospital guidelines for credentialing Ability to work across medical cultures Ability to work both as an independent provider of a specific discipline as well as a member of an interdisciplinary team
Original team training	Duration, intensity, and content of trans-professional training activities (e.g. one single vs. extended program, experiential vs. didactic teaching) Nature and philosophy of team communications (e.g. referrals, shared decision making, use of electronic medical records, etc)	Financial resources and clinician time to make training sessions feasible
Ongoing training of clinicians/team	Content (clinical topics and case reviews, administrative issues), format, level of requirement, and frequency	Good for integrating of new team members Opportunity for CME credits Increased costs if not billable by team members
III. Decisions regarding role of research and educational initiatives
Scope of research activities	Involvement in clinical services only vs. additional participation in research activities (e.g. health services, comparative effectiveness, efficacy, or basic research)	Initial establishment of research infrastructure requires individuals with research expertise and separate funding Successful research program could impact academic credibility, financial sustainability of clinic, and continuing evidence-based education of clinicians
Scope of educational activities	Nature of target audience (team members, other clinicians or employees within institution, trainees or fellows, patients and families, outside health professionals, or public)	Impacts visibility for referrals, credibility regarding evidence-base for IM, training of next generation of providers Programs can be structured as “service” or investment with goal of marketing, or potential for fee revenue generators
IV. Decisions regarding organizational, administrative and financial issues
Reporting structure	Separate entity vs. entity within a department or patient care line	Implications for financial, organizational and legal responsibility for oversight and sustainability; authority, independence, billing opportunities and constraints; and intra-organizational coordination
Medical records	Independent or shared electronic medical record system with parent institution Input of notes by conventional providers only or all IM team providers	Opportunities for communication within and between conventional and IM providers. Requirement of development of shared medical lexicon and training in use of EMR system
Herbs and supplements	Recommendation, prescription and sale of herbal products and supplements	Existence of sufficient evidence for patient recommendation and/or approval for inclusion in hospital formulary Potential for real or perceived conflict of interest on part of health care providers for direct sales Potential for revenue stream for clinic
Scope of practice	Degree of limitations with procedures or techniques set by either licensed CAM professional groups or individual institutions	Guidelines may allow selective practices (e.g. no chiropractic cervical manipulation without written consent)
Nature of CAM provider employment status	CAM providers as independent contractors vs. hospital employees	Implications in a number of areas, including nature of payment and overhead, liability, access to electronic medical records, and professional practice obligations
Initial business plan and model for sustainability	Deliverables and timelines for review by stakeholders Acceptance of third-party coverage vs concierge practice and/or hybrid models Need for ongoing philanthropic contributions and/or institutional subsidization	Recognition of value-added and definition of “success” to the institution