After attending and covering 20 annual HIMSS Conferences (every year since 1991, with the exception of 1996), I guess I can now officially join the ranks of the “grizzled veterans.” And as an official “grizzly,” I can say that the atmosphere, the overall “gestalt” of the HIMSS Conference has evolved considerably over that time.

Of course, the conference is much larger, on several fronts—in terms of the number of educational sessions, number of vendor booths, size of vendor booths, and of course, attendance. This year’s 31,000-plus broke a record, pushed up presumably by all the activity surrounding HITECH/meaningful use and federal healthcare reform. But the conference has also evolved in terms of its “feel,” and it’s hard to think of a conference that has had a greater sense of urgency and relevance than this one.

And that sense of urgency cuts two ways. On the one hand, going all the way back to the early 1990s, I remember years when everything seemed rather hazy, and the horizon appeared vague and clouded. Back then, most software vendors, particularly on the clinical side, were hawking offerings that were closed and heavily proprietary, with terrible (if any) interoperability, clunky user interfaces, and very uncertain benefits. Fortunately, both the core technologies of EMR products and the strategies behind them have improved considerably, and we’ve witnessed a very iterative (if long!) process of evolution in the past 20 years, in which vendors have sought and received input from those healthcare IT leaders and clinician end-users the vendors needed to hear from in order to build useful products that worked.

Indeed, the industry has evolved forward tremendously in general since then, of course. Twenty years ago, the first IT directors were being promoted to CIO titles, and few outside “cognoscenti” circles had even heard of CMIOs. On the non-clinical side, too, it’s taken years for healthcare IT leader and end-user concerns to really filter down to profoundly influence the development of the software products the industry has needed and still needs.

At the same time, healthcare IT leaders themselves have been evolving forward, as the parameters of the current landscape have come more clearly into view, and as their own professional horizons have broadened.

And then came the HITECH Act in February 2009, as part of the overall federal stimulus act (ARRA); and comprehensive federal healthcare reform in March 2010. Taken together, there is no question that these two pieces of legislation are already reshaping the healthcare industry more broadly, and the healthcare information technology sector more specifically. At long last, there is an extremely clear overall federal policy thrust, with countless imperatives undergirding that thrust. And that sense of overall direction has certainly invigorated and focused the activities at the HIMSS Conference this year.

At the same time, part of the sense of urgency this year also comes out of the numerous areas of confusion in the HITECH Act in particular, around some of the requirements of meaningful use. I wrote in a post last Wednesday about what I called the emerging “umbrella/modular” confusion—meaning, the lack of clarity over applying for meaningful use if a hospital organization is running any niche applications from vendors other than its core-clinical vendor. As I wrote last week, if industry luminaries (and recent or current CHIME CIOs of the Year, no less) like Chuck Christian and David Muntz are uncertain as to what ONC wants hospitals to do, then how can anyone else be clear?

So one of the elements that was evident this year was a nervous sense of urgency, a sense that CIOs and other healthcare IT leaders could inadvertently make missteps, based on unclear direction from ONC or CMS, that could cost them valuable time and financial and human resources, at a time when they are working intensively and with all their expertise engaged, to meet meaningful use and at the same time move towards the new, post-healthcare reform healthcare that is looming just over the immediate horizon.

So it’s hard not to invoke the opening sentence of Charles Dickens’ A Tale of Two Cities, “It was the best of times, it was the worst of times…” Certainly, I’ve never seen the wonderful professionals in our industry work harder or with more concentration and resolve, than they are right now; and equally certainly, I’ve never seen a time when the stakes were higher or the challenges more intense. It will be fascinating to attend HIMSS in 2012 and see what progress will have been made, and where patient care organizations find themselves, a year from now. Along the way, we at Healthcare Informatics will of course remain committed to providing our readers with the latest information, insights, analysis, and perspectives, through editorial of the highest possible quality, to help our readers make it successfully to HIMSS12 and beyond.