BALTIMORE — Telemedicine is advancing rapidly from the "show me" stage to the "help me" phase, judging by the activity and attendee makeup of this year's American Telemedicine Association convention.

Compared with, say, five years ago, stories coming from both educational presentations and in many of the 525 exhibitor booths are about "not just doing a pilot project, not just the results of a demonstration, but this is a change in the way the health system is doing business," said Jonathan Linkous, the only CEO in the trade group's 21-year existence. "It is a permanent change in the way that health care is delivered."

Attendance this year hit 5,000, a step or so above the 4,400 last year, but the story was in who were there rather than how many. Some health care delivery systems took booth space, but, said Linkous, "Every one of the large systems is here. They may not always be present on the floor, but they're all here at the conference, because they're all moving into [telemedicine]. I've had a dozen meetings in the last couple of days with health systems. They're all asking the same questions, they're all doing the same thing."

Talking about operational efficiencies is "so much of a marked change over talking about whether you can do this technology," he said. "What's important now is, how do we deal with a huge patient load of 5,000, 10,000 patients who are having monitoring because of some chronic failure?"

The telemedicine industry now has to rise to the occasion, and it may have its hands full. "This show is bigger, and there's a lot more product that we're starting to see out there, but I really do believe that we're in that high-school experimental phase, getting to know ourselves," said Kent Dicks, CEO of Alere Connected Health, Scottsdale, Ariz. "I think we are moving from PowerPoints to production," which is what he said the industry had been doing for years while figuring out a clear role. But he adds, "It is an industry that's still trying to find its way."

The use of devices such as those for monitoring patients in their homes is set to change drastically, said John Bojanowski, president of Honeywell HomMed, Brookfield, Wis. Historically, monitoring base stations and metrics devices were plugged into a wall jack, placed in homes for homebound, really sick patients. New pressures coming to bear on hospitals to mind a chronically ill, at-risk population will greatly expand the profile of who should get a new style of mobile home monitoring, he said. Moving from a fragile to active population, mobility becomes important. For example, a patient can go somewhere else for a week and take it all with, which encourages an active role in health.