Eighteen years ago we stated our business purpose: the transformation of medicine through communication. We hoped that could happen through conferences, presented papers, and the intellectual camaraderie of such symposia. The transformation is far from complete and has much more to do with what transpires outside of conferences than at the meetings themselves, but we have been privileged to witness significant stages of the metamorphosis.

The first ambulatory surgery facilities were developed in the late ‘70s and within ten years, nearly half of all surgical procedures were done outside the hospital. While payers saved billions of dollars, many hospitals were forced to close their doors. Further advances in radiologic technology took diagnosis and treatment to another level--often into ambulatory care facilities-- and struck another blow to hospitals. The healthcare (r)Evolution accelerated in the early ‘80s with the advent of outpatient care. Later, combining advances in treatment with advances in information technology, the healthcare (r)Evolution raced forward. Now, with the advent of telemedicine in the ‘90s, the healthcare (r)Evolution is irrevocable. From electronic patient records to electronic representations of the patient, computers now play an integral role in every aspect of health care. Very soon, health care services will be home-delivered, creating even more healthcare industry economic chaos. And this is good, because the graying global population will require more healthcare services, but behemoth institutions won't effectively deliver them. Ideally, we'll have virtual health care providers and hospitals will become conference facilities.

When, a quarter century ago, Buckminster Fuller conceptualized a global energy grid, it was almost coincident with the World Health Organization's declared goal of Healthcare for All by the Year 2000. That may not happen in the next three years, but it's on the horizon, and access to electrical power is the critical partner. Advances in diagnosis and treatment and the advent of information technology, intersected with telecommunications, are creating the global transformation of medicine through communication. We humbly suggest that conferences may have had some small thing to do with this (r)Evolution. One such conference is Medicine Meets Virtual Reality, where the cutting edge is honed. Many ideas, outrageous when first presented at the 1992 conference, are now realized daily in clinical practice; tools exhibited at this year's meeting were then only graphics on a screen. Techniques and technologies being developed by a small group of committed individuals are (r)Evolutionizing healthcare. And this year, at the 5th MMVR conference, we saw real movement and change: even in the age of telecommunication and virtual presence, conferences are a great opportunity to document progress.

As the MMVR conference organizers, we sincerely thank all of you who share our purpose by sharing your work and your selves.