We were going to use a fiberoptic land line to handle the video transmission, but there was a nursing strike the week before the conference, and the cable installers wouldn't cross the picket line. So we brought in a truck with a dish and bounced the session off a bird to the hotel."

That's right: A truck with a dish bounced a session off a bird. A dish is a satellite transmission device. A bird is a satellite. If you think the high-tech folks who offer videoconferencing services to meeting planners speak another language, you're right.

At this stage in its development, the videoconference is not a gimmick, but a tool: It can put medical experts from anywhere in the world in front of your meeting's audience. Similarly, it can add to your meeting's audience by making it possible for those who won't or can't travel to participate in a meaningful way. While the cost of presenting a live, interactive, remote medical procedure to a large audience in an auditorium is not inconsiderable-if you aren't prepared to budget as much as $50,000, you probably can't do it, say industry experts-it is a proven attendance-builder.

Won't videoconferences cannibalize small meetings? Not nearly as much as the World Wide Web will, says Greg Talley, president of Talley Management Group, a leading medical association management firm. "High-tech for us involves the business of moving meeting planning along. The biggest impact for us is that what used to be taken care of face-to-face at airport meetings can now be done by phone and modem. It's having, and will have, a tremendous impact on program committee meetings."

In fact, it's the smaller medical societies that are being most aggressive about moving into videoconferencing, according to James Daggett, a Chicago-based meetings consultant. "They can move faster because they don't have the conservative infrastructure, so to speak, of large

associations."

What's What In High-Tech Meetings What's the difference between a video-conference and a virtual conference? What, pray tell, is a telebridge? What is a public room, and why would a medical meeting planner want to use it? For answers to these and other questions, here are some vignettes from the high-tech meeting revolution:

DOWNLOAD I: Of Birds, Dishes, and Telebridges: Q&A with Paul Lynch Paul Lynch, of Lynch Communications, has been in the videoconferencing business for 16 years-about as long as there has been a videoconferencing business. This Argentine native's media production company specializes in audio, visual, and live-event programming for medical education and healthcare communications.

Q: What are the most important things you need to focus on when you are going to put on an educational videoconference for a medical association or hospital?

A: First is place and time: Make it convenient for attendees to get away from busy schedules. Choose venues near the medical center or a central location where many attendees work. If folks are flying in, consider a property near the airport. Take into account the hour of the day. In the east, after business hours may be a good time. Remember that a broadcast originating on the east coast may be too early for the west. Remember, too, that it is possible to delay (rebroadcast) transmissions to accommodate those in other time zones. Check well ahead of time that you're not competing with another related event for the same time slot.

Q: As the degree of technological sophistication increases, doesn't the likelihood of system failure increase? What do you do about this?

A: I like to have a back-up satellite. One downlink (satellite dish) is enough. It should arrive on site early, to confirm that a signal is being received properly.

If your program includes prerecorded material and a question-and-answer session, a good way to insure meetings return on investment is to ship a videotape containing these segments to each downlink site. Ask the on-property audiovisual manager to set up a videotape player. If a problem should occur during transmission, your attendees can at least view the "meat" of your message.

Q: What is the actual series of links, from video camera at site of origination to screen at remote site? How-if at all-do these links differ with satellite transmission as opposed to telephone lines?

A: The series goes like this: Cameras to video switcher (control room). If your origination point (the place you're transmitting from) has an uplink (transmission dish) then it would go right up to the bird (communications satellite). If not, the signal is handed off to a local facility (called a telebridge) that does have an uplink, sometimes via microwave.

From the bird, it is beamed down to the dishes that are parked outside the reception locations, or to the downlink site (hotel or convention center) dish, if it has one. From there, it's cable to the video projector in the meeting room and onto the screen.

Q: Are there particular things to look for in a hotel ballroom or conference room that will make it a satisfactory site for video?

A: Stay away from ballrooms with mirrors, tile, glass, or other reflective surfaces. Rugs and curtains are usually helpful. Avoid oversize spaces which can give a cavernous, impersonal feeling to the event. The room should have the ability to be darkened easily during daylight.

If you're making use of your own dish (as opposed to the property's built-in dish), the room should be physically accessible via cables from the satellite transmission truck parked outside. Preliminary site inspections will be necessary for properties that are not on your broadcast service provider's list of preapproved or "preferred" sites. By the way, it is not unusual for parking permits to be required, especially in crowded downtown streets.

Q: We have been told that picture quality is important for some kinds of medical videoconferences. For example, when a surgeon is demonstrating how to cut into a knee, attendees want to be confident that what they are looking at on screen is a very close approximation of what is actually happening. How would a medical conference planner address this issue? Are there minimum standards planners should be aware of in terms of scans per second, number of pixels, etc.?

A: For the best picture quality, use full-motion video (30 frames per second). That is the same broadcast standard that television uses. K-band is the technical term. Less detail will cost less and offer a strobe-like, jerky image.

For broadcasts which require the protection of their content, there's an optional feature called "encryption," a scrambling of the signal which allows only authorized downlinks to decode and receive.

The video projector is also important in delivering a quality picture. Use a high end unit, especially if your program includes not just video but also data (charts, tables, number displays). The Sony 1271 is an industry standard and can accommodate up to about 150 to 200 attendees in classroom seating.

Q: Are there issues to consider regard-

ing bringing a video camera into a sterile environment? Also, if attendees are going to be able to ask questions of the attending physician, what protocol would you

recommend?

A: Video equipment and operators have to take special precautions in a sterile environment. Usually one camera person and one additional operator (for cables, audio, etc.) are sufficient. All equipment must be treated. Make sure you have clearance in writing with the head nurse or person in charge.

Q: What else should meeting planners ask about when they are getting ready to put together a videoconference?

A: Add 30 minutes of transmission time prior to broadcast for downlinks to confirm a clean signal. Have a clear set of objectives for the videoconference, then find a supplier that will help you meet those objectives. As you alluded to earlier with your question about system failures, there are many details that go into the making of a videoconference, and many different suppliers involved in this type of project. If something goes wrong it can be hard to know who to hold accountable. I recommend using project producer-one who will be responsible for all technical aspects of your broadcast.

DOWNLOAD II: At The HII Virtual Conference "Welcome and thank you for participating in HII '96-The Emerging Health Information Infrastructure: Enabling The Vision Conference. At this 'first of its kind' conference, sponsored by the Friends of the National Library of Medicine, we will broadly examine opportunities and impediments toward making the health information highway a reality."

So went the first of dozens of e-mail messages constituting the virtual part of the Health Information Infrastructure conference, which also was going on for real at the Georgetown University Conference Center in Washington, DC, from April 15 to 18.

Attending a conference by e-mail has some of the same qualities of actually attending a meeting, but mostly it doesn't. The part that is the same is that in between downloads of large files containing the text of speeches come short e-mail messages from other virtual participants, introducing themselves. They include a PhD candidate from Sri Lanka studying health policy at the University of Ontario, a blood pathologist from Thousand Oaks, CA, and the network coordinator for the Rural Health Training Unit based in Townsville, in North Queensland, Australia. A fellow virtual participant can send e-mail greetings back, and establish a relationship of a sort.

The part that is not the same is that one of the downloaded files is a speech that begins: "Introductory Video [Begins with computer animated video of various medical information technologies. Continues with animations of carrier proteins, DNA replication, embryonic development, HIV infection.]" The message goes on to apologize for a technical glitch in the program. There are no pictures in any of the transmissions.

On the other hand, registering for the conference gets you full, editable texts of all the major papers-immediately. This must be of sufficient benefit for many virtual attendees, because the organizers are bullish on the idea.

"We have found virtual conferences to be a great way to reach people who cannot attend our meetings, plus a new way to diversify nondues income," says Keith Krueger, executive director of the Friends of the National Library of Medicine and president of NonProfit Management Associates, an association management firm. "In the future, I envision more virtual conferences that are not connected to an on-site conference."

DOWNLOAD lII: The ASCRS Film Festival David Karcher is the kind of medical conference organizer the technologically challenged can relate to: "My main concern with videoconferencing is that when the on-button is hit, everything works," says Karcher, executive director of the American Society of Cataract and Refractive Surgery (ASCRS), Arlington, VA. "What goes on in between is far beyond me."

A major medical device firm sponsors an annual videoconference at the ASCRS's annual meeting, featuring a famous eye surgeon who happens to be based in Calgary, Alberta. Videoconferencing brings him to the meeting while allowing him to work in the familiar confines of his local operating theater.

"They beam his live surgery for about two hours to our audience of 250 eye surgeons. The reaction is very, very positive," says Karcher.

Interaction Is The Key "Interaction is the key to all of this," he adds. "We have four microphones set up so attendees can ask questions of the surgeon as the procedure goes on. We always have a moderator, but he's there just to identify the questioner-we prefer a more freewheeling approach to questions.

The surgeon must not just demonstrate techniques but must also be a good teacher and communicator. We've been fortunate to have quite a few members with those qualifications."

Live surgical procedures via video have proved to be an attendance-builder at the annual meeting, says Karcher, but he adds that his group has always had a proclivity toward video.

"Our members were probably the first to get heavily involved in videotaping their surgical procedures. The vast majority tape every procedure they do, for medical and legal reasons. When we realized there was a great library of recorded procedures out there, we began to run a festival of eye surgery videos." At first, the idea was taken lightly by attendees, according to Karcher. But then, people got serious, and the event took off.

"We have 167 submissions this year. It's become a big event," he says. "The ceremony itself is just like the Academy Awards, and we give out statues ('The Eye-Scor') to winners."

While the film festival is shown on a large video projection screen, it is also shown on smaller monitors that provide more detailed images. "These are microsurgical procedures, and the attendees need a high-definition image to get a good look," says Karcher. "We set the rooms for 100 theater-style, and typically use six monitors plus the big-screen monitor. Attendees are usually paying the most attention to the small screen."