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“You Have To Be There”
Twenty-five Years of SCAMC/AMIA Symposia

Donald A. B. Lindberg, Betsy L. Humphreys
DOI: http://dx.doi.org/10.1197/jamia.M1076 332-345 First published online: 1 July 2002


The AMIA Annual Symposium began life as the Symposium on Computer Applications in Medical Care (SCAMC) in 1977. Inaugurated as a multidisciplinary meeting with multiple sponsors, the Symposium quickly became a force in the development of the field of medical informatics. The authors summarize the 25-year history of the meeting and its proceedings, drawing on information in the printed programs and proceedings and on the personal recollections of some Symposium organizers and attendees. They also present the results of a study of the extent to which Symposium papers have been cited in the journal literature.

The Symposium, which celebrated its 25th anniversary in 2001, started as the “brainchild” of Helmuth Orthner, of George Washington University, and Abund Wist, of Virginia Commonwealth University, both Austrian-born engineers. The concept of the meeting, however, was genuinely American and new world. Orthner and Wist wanted—and created in its initial form—a meeting in which scientific but clinically significant papers were to be submitted by anyone and judged and rejected or accepted for presentation on their individual merit in a process independent of academia, government, industry, or any single scientific or professional society. Instead, individuals from many different organizations and societies would collaborate to produce a symposium that addressed their shared interest in computers and medicine.

The goal was a small meeting of perhaps 100 to 200 persons. There were to be no parallel sessions, in order to contain costs and to expose each attendee to the entire program. The papers were to be discussed and defended, or explained as needed, immediately after each presentation. Versions of the papers were to be available in print ahead of time to facilitate study by the eager and attentive coterie of engineers, scientists, and clinicians. Meals were to be provided as part of the registration, in order to eliminate distractions and enhance interaction. To achieve these objectives, Wist and Orthner enlisted the support (in dollars or in kind) of their universities, various IEEE components, other societies, and federal agencies.

The first Symposium, in 1977, transpired pretty much according to plan, with Wist as General Chair, Orthner as Chair of the Program Committee, Michael Ackerman as Exhibitions Chair, the Crystal City Twin Bridges Marriott (subsequently razed) as the site, and the IEEE as key financial backer and publisher of the Proceedings. (A listing of places, dates, key people, and features of the 25 years of Symposia appears in Table 1.) Orthner would later credit William Baker, of the Division of Research Resources, National Institutes of Health, with providing the necessary “activation energy” for the program for the first Symposium.1 Depending on whether you looked at the title on the printed program or the title on the Proceedings, the name of the meeting was either the Symposium on Computer Applications… (plural) or …Application (singular) in Medical Care. But it was clearly labeled The First Annual, indicating that there would be more to come. The meeting quickly became known as SCAMC, which made the “s” on “Applications” (or lack thereof) irrelevant anyway.

View this table:
Table 1

Locations, Dates, Key People, and Features of the Symposia

Date/LocationProgram ChairGeneral Chair/SCAMC/AMIA President; Arrangements Chair/Executive DirectorPlenary Speaker(s)Program Features IntroducedNo. of Parallel Sessions ProgramNo. of Tutorials Listed in ProgramNo. of Exhibits Listed in Program
1977 Oct 3–5 Washington DC area (Twin Bridges Marriott, Crystal City)F. Helmuth Orthner, PhD, George Washington University (GWU)Abund O. Wist, PhD, Virginia Commonwealth University General Chair; N/ATurner E. Hasty, PhD, Texas Instruments; William Yamamoto, MD, GWU; Banquet speaker: Carl Hammer, Sperry UnivacInvited papers, contributed papers, CE credit11Not in program
1978 Nov 5–9 Washington DC (Sheraton Inn, Silver Spring)F. Helmuth Orthner, PhDAbund O. Wist, PhD, General Chair; N/ACesar Caceres, MD. Clinical Systems Assoc. Banquet speaker: Lawrence Weed, MD, University of VermontPanels, workshops, postersPosters parallel to papers210
1979 Oct 14–17 Washington DC (Sheraton Inn, Silver Spring)Rosalie Dunn, PhD, National Center for Health StatisticsAbund O. Wist, PhD, General Chair; N/AJoshua Lederberg, PhD, Rockefeller University (Nobel Laureate, genetics)Evening sessions45Not in program
1980 Nov 2–5 Washington DC (Washington Hilton)Joseph T. O'Neill, National Center for Health Services ResearchHarry E. Emlet, Jr, PhD, General Chair; Thomas E. Piemme, MD, GWU, Arrangements ChairJack D. Myers, MD, University of PittsburghSCAMC, Inc. becomes primary sponsor; demonstrations; job exchange6612
1981 Nov 1–4 Washington DC (Sheraton Washington)Henry G. Heffernan, SJ, MUMPS users groupThomas E. Piemme, MD, General Chair; Greg P. Thomas, PA-C, GWU, Arrangements ChairJames H. Sammons, MD, AMA; plenary panel: Eugene A. Stead, MD, Bernard W. Bise, MD, Charles S. Mirabile, Jr, MD, Donald R. Studney, MD, Ephraim R. McLean, PhD, Alan Taylor, Ian E. Bush, PhD, Jack D. Myers, MDOutside referees for contributed papers, student paper competition, software exchange76Not in program
1982 Oct 30–Nov 2 Washington DC (Sheraton Washington)Bruce I. Blum, Johns Hopkins UniversityThomas E. Piemme, MD, General Chair and Executive Director; Greg P. Thomas, MPH, Arrangements ChairAlan Cormack, PhD, Tufts University (Nobel Laureate, computed tomography); plenary panel: Donald A.B. Lindberg, MD, G. Octo Barnett, MD, Homer Warner, MD, PhD, Raymond E. Lenhard, Jr, MD, Clement J. McDonald, MD813Not in program
1983 Oct 23–26 Baltimore (Convention Center)Ruth E. Dayhoff, MD, Georgetown UniversityHenry G. Heffernan, SJ, President and General Chairman; Thomas E. Piemme, MD, Executive Director, SCAMC, Inc.; Gail Mutnick, Symposium Coordinator, Greg P. Thomas, MPH, Arrangements ChairRobert S. Ledley, DDS, Georgetown University; plenary panel: Ted Kehl, PhD, Paul C. Lauterbur, PhD, James A. Reggia, MD, PhD, G. Octo Barnett, MD, Donald W. Simborg, MD, Thomas M. KuriharaRoundtable discussions, site visit102377
1984 Nov 4–7 Washington DC (Washington Hilton)Gerald S. Cohen, National Center for Health Services ResearchWilliam R. Felts, MD, President and General Chairman; Thomas E. Piemme, MD, Executive Director, SCAMC, Inc.; Gail Mutnick, Symposium Coordinator, Greg P. Thomas, MPH, Arrangements ChairDavid Pearce Snyder, editor, Futurist Magazine; plenary panel: Duncan Newhauser, PhD, Edwin Tuller, George L. Collins, MD, Commodore Grace Murray Hopper82378
1985 Nov 10–13 Baltimore (Convention Center)Michael J. Ackerman, PhD, Naval Medical Research InstituteRudolf G. Bickel, MD, President and General Chairman; Thomas E. Piemme, MD, Executive Director, SCAMC, Inc.; Gail Mutnick, Symposium Coordinator; Greg P. Thomas, MPH, Arrangements ChairCharles A. Csuri, Cranston/ Csuri Productions and Ohio State University; John E. McNamara, Stratus Compure, Inc.; Adam Osbore, Paperback Software International82366
1986 Oct 5–6 Washington DC (Sheraton Washington)Helmuth F. Orthner, PhD, William R. Baker, PhD, co-chairsGerald S. Cohen, President; Thomas E. Piemme, MD, Executive Director; SCAMC, Inc.; Gail Mutnick, Symposium Coordinator; Greg P. Thomas, MPH, Arrangements ChairWilliam S. Yamamoto, MD, Georgetown University; Peter L. Reichertz, MD, University of HannoverSpecial format: 1 day of tutorials, 1 day of invited sessions preceding MEDINFO826N/A
1987 Nov 1–4 Washington, DC (Sheraton Washington)William W. Stead, MD, Duke UniversityDaniel K. Harris, President, Thomas E. Piemme, MD, Executive Director, SCAMC, Inc.; Gail Mutnick, Symposium Coordinator; Greg P. Thomas, MPH, Arrangements ChairDonald E. Melnick, MD, National Board of Medical Examiners; Ronald W. Nugent, Nebraska Videodisc Design/Production Group; Robert Hecht-Neilsen, Hecht-Neilsen Neurocomputer Corp.; James B. Wyngaarden, MD, Director, National Institutes of HealthMeet the Experts92456
1988 Nov 6–9 Washington, DC (Sheraton Washington)Robert A. Greenes, MD, PhD, Brigham & Women's Hospital, Harvard UniversityEdward S. Shortliffe, MD, PhD, President; Thomas E. Piemme, MD, Executive Director; Diane Taub, Symposium Coordinator; Greg P. Thomas, MPH, Arrangements ChairTed Nelson, Project Xanadu; Lee Bryan, Vortech Data; Daniel R. Masys, MD, Lister Hill Center, NLM,ACMI Distinguished Lecture; first appearance of Capitol Steps at reception102464
1989 Nov 5–9 Washington DC (Sheraton Washington)Lawrence C. Kingsland, III, PhD, Lister Hill Center, NLMEdward S. Shortliffe, MD, PhD, President; Thomas E. Piemme, MD, Executive Director; Diane Taub, Symposium Coordinator; Greg P. Thomas, MPH, Arrangements ChairDonald A.B. Lindberg, MD, NLM; Edward S. Shortliffe, MD, PhD, Stanford University112757
1990 Nov 4–7 Washington DC (Sheraton Washington)Randolph A. Miller, MD, University of PittsburghDonald A.B. Lindberg, MD, President, AMIA; Thomas E. Piemme, MD, Executive Director; Joanne Doyle, Symposium CoordinatorBetsy L. Humphreys, MLS, NLM; Clement J. McDonald, MD, Regenstrief Institute; plenary panel: Don E. Detmer, MD, Daniel R. Masys, MD, Robert A. Greenes, MD, PhD, Paul Clayton, PhDAMIA becomes sponsor, AMIA membership meeting102468
1991 Nov 17–20 Washington DC (Sheraton Washington)Paul Clayton, PhD, Columbia-Presbyterian Medical CenterDonald A.B. Lindberg, MD, President; Gail E. Mutnick, MBA, Executive DirectorDavid Eddy, MD, PhD, Duke University; John M. Eisenberg, MD, University of Pennsylvania112656
1992 Nov 11–12 Baltimore, Maryland (Convention Center)Mark E. Frisse, MD, Washington University, St. LouisClement J. McDonald, MD, President; Gail E. Mutnick, MBA, Executive DirectorEsther Dyson, Editor and Publisher, Release 1.0, President, Edventure Holdings92473
1993 Oct 30–Nov 3 Washington DC (Sheraton Washington)Charles Safran, MD, MS, Beth Israel Hospital, Harvard UniversityClement J. McDonald, MD, President; Gail E. Mutnick, MBA, Executive DirectorFrancois Gremy, MD, Université de MontpelierACMI Debate93266
1994 Nov 5–9 Washington DC (Sheraton Washington)Judy Ozbolt, PhD, RN, University of VirginiaRandolph A. Miller, MD, President; Gail E. Mutnick, MBA, Executive DirectorKathryn Hannah, PhD, University of Calgary; C. Everett Koop, MD, ScD, former Surgeon General93283*
1995 Oct 28–Nov 1 New Orleans (Hilton Riverside)Reed M. Gardner, PhD, University of UtahRandolph A. Miller, MD, President; Jeanne Nevin, Acting Executive Director; Vernell Henry, Meetings ManagerBrent C. James, MD, Intermountain Health Care; Michael J. Ackerman, PhD, NLMElectronic message center124868*
1996 Oct 26–30 Washington DC (Sheraton Washington)James J. Cimino, MD, Columbia UniversityReed M. Gardner, PhD, President; Jeanne Nevin, MBA, Executive Director; Vernell Henry, Meetings ManagerTim Wild, Tandem Computers115070
1997 Oct 26–30 Nashville, Tennessee (Opryland)Daniel R. Masys, MD, University of California, San DiegoReed M.Gardner, PhD, President; Dennis Reynolds, Executive Director; Amanda Rushing, Meetings ManagerJay Sanders, MD, The Global Telemedicine GroupProceedings also on CD-ROM104157
1998 Nov 7–11 Orlando, Florida (Lake Buena Vista)Christopher Chute, MD, PhD, Mayo FoundationPaul Clayton, PhD, President; Dennis Reynolds, Executive Director; Dasha Cohen, Meetings ManagerTim Berners-Lee, World Wide Web Consortium104042
1999 Nov 6–10 Washington DC (Marriott Wardman Park)Nancy C. Lorenzi, PhDPaul Clayton, PhD, President; Dennis Reynolds, Executive Director; Dasha Cohen, Meetings ManagerPeter G.W. Keen, Keen Innovations124534
2000 Nov 4–8 Los Angeles, California (Westin)J. Marc Overhage, MD, PhD, Regenstrief InstitutePatricia Flatley Brennan, PhD, RN; Dennis Reynolds, Executive Director; Dasha Cohen, Meetings ManagerMichael L. Millenson, law firm of William M. Mercer104037
2001 Nov 3–7 Washington DC (Marriott Wardman Park)Suzanne Bakken, RN, DNSc, Columbia UniversityPatricia Flatley Brennan, PhD, RN; Dennis Reynolds, Executive Director; Dasha Cohen, Meetings ManagerTom Ferguson, MD, Susannah Fox, Lee Rainie, Pew Internet and American Life Project114523

In his opening remarks as General Chair, Wist expressed the hope—soon to be realized—that “this forum will provide the basis for symposia of a more expanded nature in the future.”2 Orthner's opening statement included a less accurate prediction: “In a few years, I think that industrial support will reach a level whereby even a practicing physician can implement his own information system.”3 Regular registration for the 3-day meeting cost $65; the one 6-hour tutorial, “Introduction to Computer Technology,” cost $60; and continuing education credit was awarded by George Washington University. About 250 people attended the meeting, 67 papers were presented, and the scientific expectations were met.

The Symposium Takes off and Takes Shape

SCAMC was an idea whose time had come. People working on the application of computers to medicine and health clearly wanted and needed a regular meeting. Federal funding agencies were interested in having the results of the research they were supporting disseminated in public scientific sessions.* The annual SCAMC meeting quickly became “a gathering of the tribes” for widely distributed U.S. groups working in medical informatics. Although the meeting was initiated and organized by persons in the Washington, DC area, the range of topics addressed and the stature and geographic distribution of the invited speakers was national—even international—from the outset (see Table 1).

There have been some excellent opening sessions over the years, but the Symposium's keynote speech has often been a hair-raising event for the organizers. Many program chairs would agree that selecting, recruiting, or even listening to keynote speakers was the most nerve-wracking aspect of their jobs. On one occasion, the SCAMC treasurer refused to pay the speaker the full honorarium because the talk was a fraction of the length agreed upon. In another memorable instance, Clem McDonald took on the assignment of impersonating a plenary speaker who was a last minute no-show.

The Symposium grew rapidly during its first decade, assuming roughly its current form and dimensions by 1983 (see Table 1). As the number of submissions increased, the dreaded parallel session immediately appeared. Thus, by the second SCAMC in 1978, poster sessions (which would appear intermittently in the future) were already parallel to the paper sessions. By the third SCAMC in 1979, there were four parallel tracks. By 1982, there were eight tracks. The number has fluctuated between 8 and 12 since that time. The number of tutorials continued to grow in the 1980s and 1990s, as it became clear that they were extremely popular and more than self-supporting. Over the past 5 years, the number of tutorials has fluctuated between 40 and 45.

At the first meeting in 1977, all regular sessions were devoted to invited and contributed papers. Other types of sessions appeared quickly. By 1981, when the Student Paper Competition debuted, all the major program elements, including panel sessions and demonstrations, were in place, although some features were added later, including site visits, Meet the Experts, the American College of Medical Informatics (ACMI) Distinguished Lecture, the ACMI debate, various paper and poster awards, and the AMIA business meeting.

The 1986 SCAMC meeting was unique: a special one-day session of invited papers, primarily by persons who had also presented at the first Symposium, followed by the International Medical Informatics Association's MedInfo '86, hosted by the “U.S. Council for MEDINFO '86,” a precurser of AMIA.

In remarks that opened the 1987 Symposium, General Chairman Daniel Harris said that reading the Proceedings was not enough—“you have to be there.”4 Harris was referring to the importance of informal conversations and meetings, which on occasion led to important research or system development projects. His statement also applies to the main substance of the meeting, however. For most of the Symposium's 25 years, a third or more of the program sessions have been demonstrations, workshops, and panels that are not reflected in the Proceedings. Before the Internet and the Web, demonstrations at SCAMC were the only practical way for many people to see the latest applications developed at key medical informatics centers in the United States. Live demonstrations were extremely popular among attendees, and the Symposium did far more than most other meetings to support them properly. Nonetheless, in the days before laptops and inexpensive display devices, a demonstration could be a logistical nightmare for the presenters. Some demonstrations gave a view of brand-new technologies or applications. Others showed off new features in major production systems, including costar, the VA System, HELP, The Medical Record (TMR), AI/Rheum, Grateful Med, and the Regenstrief Medical Record. This last probably has been demonstrated at more years of the Symposium than any other system.

Panels have served a variety of purposes, beyond the obvious one of allowing for up-to-the-minute reports. For example, in 1978, the first year that panels appeared on the program, one such session was devoted to “Economics of Computers in Private Medical Practice,” with both U.S. and Canadian perspectives presented. Recently, there have been popular recurring panels on such topics as “Implementing Computerized Patient Record Systems: How to Succeed, How to Fail, and How to Know What Happened.” A panel chaired by Don Detmer in 1991 discussed the Institute of Medicine's study on the Computer-based Patient Record. There have been several subsequent panels reporting on other major Institute of Medicine or Association of American Medical College (AAMC) studies relevant to medical informatics. Panels are often used to present current information on standards developments, laws and regulations, and other public policy issues relevant to informatics. Recent topics have included HIPAA, HL7, and the Telecommunications Act of 1996. Panels tend to be popular, probably because of the currency of the topics, the stature of some of the speakers, and the opportunity for audience participation, and possibly because they are not reflected in the Proceedings.

Managing the Symposium

Considerable credit for the early expansion of SCAMC and its transition to a professionally managed meeting belongs to Thomas E. Piemme, a faculty member and Assistant Dean at the George Washington University School of Medicine. Piemme became involved when planning for the Third Symposium was well under way, and immediately introduced the first of his memorable principles: “Advertise and They Will Come.” There was no money for marketing the Third Symposium, because proceeds from the first two had all been returned to sponsoring organizations, principally the IEEE. Piemme contrived an advance of $40,000 from George Washington University to buy mailing lists and to pay for a printing and mailing campaign for the Third SCAMC. The result was an increase in attendance from probably about 500 in 1978 to 1,000 in 1979. Attendance far exceeded the available space at the Sheraton Inn in Silver Spring, the venue for both the second and third meetings, and a mad scramble for hotel rooms elsewhere in the vicinity ensued.

The success of the Third Symposium led to the decision to move the meeting to a much larger facility, the Washington Hilton, the following year. It also prompted the creation of a new not-for-profit corporation, SCAMC, Inc., for the fourth meeting in November 1980. This transition was necessary simply to have legitimate means to carry forward funds collected from attendees at each meeting, so that they could be used for organizing and publicizing the next one. The legal creation of the corporation as a not-for-profit 501(3)c corporation and the hiring of staff went relatively smoothly.

In 1981, SCAMC moved to the then Sheraton Washington Hotel, now the Marriott Wardman Park. To date, 13 of the 25 meetings have been held in that location. Also in 1981, Piemme recruited Greg Thomas, a physician's assistant and a recent graduate of the meetings management curriculum at the University of Texas, to serve as Arrangements Manager for the Symposium, a job he performed very ably and with requisite good humor for the next 10 years. Gail Mutnick joined Piemme's team as Symposium Coordinator from 1983 to 1987 and returned in 1991 to serve as AMIA's first Executive Director.

Social events at SCAMC meetings changed over the years in response to the behavior of the attendees. By 1979, free lunches and dinner were dropped simply because so many paid-for meals went unclaimed. About this time, Piemme enunciated his second resounding principle for managing SCAMC: “Do It Right, or Don't Do It.” When applied to the thentraditional SCAMC evening cocktail reception, this involved the mathematical model of one bar per 50 attendees, more if the attendees were surgeons or pathologists, less if psychiatrists.

The bar-to-attendee model worked reasonably well until SCAMC 1985, in Baltimore. On this occasion, the SCAMC Board had to recognize that a shift had occurred in the make up and habits of the attendees. This was because it took only 20 minutes—the initial 20 minutes—of the opening cocktail party to completely obliterate 14,000 hot hors d'oeuvres. In fact, the Piemme damage control team had to start closing bars and start opening cookie boxes. This was the beginning of the end of the SCAMC cocktail party and the beginning of the beginning of the SCAMC dessert evening.

The dessert reception has often been either an Election night party or a Halloween party, depending on the date of the meeting. One of the most memorable Halloween celebrations was in New Orleans in 1995, the first time the Symposium left the Washington–Baltimore area. Obviously, the most memorable election night party occurred in 2000, in Los Angeles, as it became clear that the result of the Presidential race would not be known for some time. To date, the Symposium has been held outside the Washington–Baltimore area four times; in each case attendance was down about 200 from the typical Washington experience.

The Symposium has been likened to a three-ring circus, and it has always had multiple ringmasters. A Program Chair has always been responsible for the intellectual content of the meeting, and the roster of those who have held this position reflects the multidisciplinary nature of medical informatics (Table 1). In the years preceding the formation of AMIA, a General Chair or President of the SCAMC Board oversaw the fiscal arrangements for the meeting. After the first few meetings, the Executive Director of SCAMC, Inc. and then of AMIA had overall responsibility for meeting arrangements. Individuals variously titled Arrangements Chair, Symposium Coordinator, Meetings Manager, and such have actually made the physical arrangements and provided administrative and logistical support to the Program Chair.

Everyone who has served in any of these roles has interesting tales to tell. One executive director, for example, shared news of an early telephone call to his office. His staff had mailed out many copies of the Advance Program, hoping to entice yet more interested new attendees. Imagine his bewilderment when a caller asked if he could return his Advance Program and get one for beginners. Then there was the time a program chair found himself frantically following garbage trucks around town because his entire pile of original, only-copy, accepted SCAMC manuscripts had been removed overnight from his office and taken to the trash dump. Happily, the papers were recovered—and happily, very few people knew of this near miss. One recurring game, which no one ever wins, is guessing which sessions should be assigned large meeting rooms and which sessions should get small rooms.

While SCAMC, Inc. was formed without much serious fuss and feathers, the creation of AMIA was preceded by unmistakable fireworks. The founding of AMIA involved the legal union or merger of the American Association for Medical Systems and Informatics, SCAMC, and ACMI. (The former head librarian of the National Library of Medicine, Lois Ann Colaianni, used to refer to them as “Flopsy, Mopsy, and Cottontail.” Quite irreverent, but at least she was laughing.) The people who finally voted through the merger, and signed the papers that created AMIA, were not laughing. In fact, many of them were upset and angry. Mentions were made of Benedict Arnold and Aaron Burr. No actual demands for a duel were issued, but more than one dear and well-respected professional friend did march out of the last meeting of the SCAMC Board, never to reappear at a future AMIA meeting.

Among the divisive issues of the day was at least one clearly legitimate difference of opinion. Orthner and others originally imagined the strength of SCAMC as its position as a neutral meeting ground for papers from members of many professional societies. They believed in SCAMC's being sponsored (even originally financially sponsored) by numerous groups, such as IEEE, the ACM, the Computer Society, and various federal agencies, including NLM. By 1980, SCAMC was sponsored (quite a weak bonding) by 15 societies and 4 IEEE units. Later, there were as many as 70 sponsoring organizations. Thus, SCAMC had no individual members and was promoted as not being in competition with the professional societies.

Ultimately, most of the SCAMC Board members persuaded themselves that many persons wanted to belong to some kind of American professional group in support of medical informatics. Hence, AMIA was created as a membership society and became the sponsor of the Symposium.

The Proceedings as a Reflection of Work in Medical Informatics

As previously mentioned, for most of the history of the Symposium, the published proceedings have reflected less than 70 percent of the content of the meeting. Nonetheless, the Proceedings are an important publication vehicle for those who work in medical informatics, and they have often been viewed, with good reason, as an indicator of trends in the field. In the preface to the proceedings of the Second Symposium, in 1978, Wist noted that the program committee had originally intended to focus entirely on topics that were not covered the previous year.5 This plan was abandoned because of the number of excellent submissions received on topics already addressed in 1977, thus setting a pattern of broad subject coverage that has endured to this day.

The Proceedings have formed all or part of the source data for a number of studies of research and publication trends in medical informatics. As of 1984, NLM found that about 20 percent of the documents cited in the medical informatics literature were papers published in proceedings. Interestingly, the percentage of citations to proceedings was higher in journal articles than in SCAMC papers.6 In 1987, Stead concluded that the field of medical informatics was concentrating its work in too narrow a range of topics and was missing out on some good opportunities for additional multidisciplinary research.7 Safran and co-authors found that, between 1977 and 1993, the quality of medical informatics papers had improved, as evidenced by inclusion of evaluative data and references to previous work.8 Corn determined that, as of 1998, about 60 percent of the informatics papers published in the Proceedings were receiving some support from U.S. funders. Papers in JAMIA had even higher funding rates. The NLM was the most frequently cited donor by a large margin.9

To assist with our study of the Symposium, a searchable database of citations to papers in the first 24 Proceedings was created by downloading the citations from medline, inspec, or inspel using the Procite software. The NLM began indexing the Proceedings in medline in 1991, but previous years had been indexed in engineering indexes, reflecting the Symposium's early association with the IEEE. For some years, citations to descriptions of demonstrations and posters are present and for some years they are not. The resulting database contains 4,592 citations, most with abstracts. We did not do a cross-check with the actual proceedings to verify completeness.

Web of Science was then searched to find the number of times Proceedings' papers had been cited in the journals covered by Science Citation Index and Social Science Citation Index. If more than one citation was found in Web of Science as of June 2001, the number of times the paper had been cited was added to the database. There are many potentially interesting ways to analyze the database, and it is available to others to explore. We used it to look at when certain topics first appeared in Symposium papers, as well as to identify Symposium papers that have been highly cited in the journal literature.

Some of the recent trends in our field include an increased emphasis on patient-centered systems, public health applications, work at the intersection of health services research and medical informatics, bioinformatics, and public policy issues, including health data privacy. Somewhat to our surprise, these and most of the major topic areas that have ever appeared in the Proceedings are evident in some form in the first 6 years of the Symposium (Table 2). The participation of Warner Slack on the 1978 program committee may explain why patient-centered computing made such an early appearance in the Symposium. Billing systems were discussed in the first few years, but that topic disappeared quickly.

View this table:
Table 2

Years When Selected Topics and Terms First Appeared in the Proceedings

1977Medical record systems
Expert systems
Automated instrumentation
1978Natural language processing
Patient-centered systems
Medical genetics
1980Public health
Health services research
1981Nursing informatics
1982Library systems
1986Regulation of medical software
1988Molecular biology
1993World Wide Web

Judging from the Proceedings alone, it would appear that the Symposium narrowed its focus, emphasizing clinical systems and knowledge representation and vocabulary issues, in the mid to late 80s, and then broadened out again in the mid 90s. Of course, topics covered in panels and tutorials generally make the subject coverage of any Symposium broader than that of the Proceedings alone, but our analysis confirms the narrowing of interests that Stead noted in 1987.7 There are many plausible explanations for this shift, including the development of new associations and meetings that siphoned off some of the groups represented more heavily in the early years and changes in funding levels and priorities at various federal agencies, including NLM.

The term “medline” was first mentioned in the Proceedings about 12 years after its first appearance in the journal literature. Perhaps interest in IAIMS finally brought it into the Symposium's fold. In contrast, the Unified Medical Language System (UMLS) appeared in the SCAMC proceedings several years before it was discussed in the journal literature.

There was an effort to introduce computational molecular biology or what we would now call bioinformatics into the Symposium beginning in 1988, when the National Center for Biotechnology Information was established at NLM. At that time, the Symposium was not successful in attracting many submissions or attendees in this area, and the attempt was abandoned after a few years. AMIA now has a genomics working group, and more recent attempts to include aspects of bioinformatics have achieved some success, as the program for the 2002 meeting illustrates. The Internet and the World Wide Web arrived in the Proceedings at roughly the same time they hit the medical journal literature. This holds true for many new technologies introduced during the 25-year history of the Symposium.

By 1982, the Proceedings had settled on the one-volume format, with most papers limited to a maximum of five pages. A lack of page limits was one of the major reasons that the 1980 Proceedings was the longest ever—nearly 2,000 pages in three volumes. The 1980 Proceedings also included papers from the 12th annual conference of the Society for Advanced Medical Systems, the first and last time papers from another meeting were included. The three-volume Proceedings was expensive to produce and not at all popular with those who had to carry it home. It is probably not a coincidence that 1981 was the first year that contributions were selected on the basis of full papers (rather than abstracts) and that peer reviewers from outside the program committee were enlisted to help winnow the increasing number of submissions to the Symposium.

Bibliographic Characteristics and Citation Patterns of the Proceedings

The Symposium has not been a model of bibliographic clarity—but it is probably no worse than many symposium proceedings of equal longevity. It has had four different “official” titles—and the acronym SCAMC is not one of them (Table 3). In 1981, the “s” was finally added to “Applications” in the name of the Symposium that appeared on the Proceedings volumes. In 1994, the Proceedings became the Symposium Supplement of JAMIA, but the name of the Symposium did not change. In 1997, the meeting became the AMIA Fall Symposium. This was the same year that Program Chair Daniel Masys inaugurated the CD-ROM version, which included supplemental content not found in the printed volume. In 1998, the title became the AMIA Annual Symposium. Perhaps 2002 will be the year that the Proceedings are deposited in PubMed Central.

View this table:
Table 3

Official Titles of the Symposium Proceedings

1977–1979Proceedings—Annual Symposium on Computer Application in Medical Care
1980–1996Proceedings—Annual Symposium on Computer Applications in Medical Care (Journal of the American Medical Informatics Association. Symposium Supplement, from 1994)
1997Proceedings—AMIA Annual Fall Symposium
From 1998Proceedings—AMIA Annual Symposium

There is no way to determine how many ways the Symposium has been cited by authors over the years. The Web of Science has more than 200 different abbreviations for the Proceedings, most apparently devised during data entry (Table 4). To obtain some notion of the impact of the Symposium on the journal literature, we searched all the Web of Science abbreviations we could find and added up the numbers of citations to the same papers that appeared under each abbreviation, making adjustments for errors in years, pagination, and authors' names and referring to the actual Proceedings volumes when necessary.

View this table:
Table 4

Partial List of Abbreviations of the Proceedings Found in Web of Science (as of June 2001)

▪    [1…19] SCAMC▪    P S Comput Appl Med
▪    [1st…19th]▪    P S Computer Applica
   Ann S Comp Appl▪    S Comp Appl Med Car
   P Ann S Comp Ap▪    S Computer Applicati
   P Ann S Comp App▪    SCAMC …
   P S Comp Appl M▪    AMIA…
   P SCAMC …▪    JAMIA S S
   P Ann SCAMC▪    P [1996 …2000]
▪    P [1…21] Ann S Comp Appl   S Am Med Inf
▪ P [1…21] S Comp Appl Med   Am Med Inf As
▪    P [1…21] SCAM…   Am Fall S
▪    P Ann S Comp App Med   AMIA Fall S
▪    P Ann S Comp Appl Me   AMIA Fall S P
▪    P Ann S Comput Appl   Fall AMIA
▪    P Ann S Computer App▪    P Am Med Inf Ass Ann
▪    P S Comp App Med Car▪    P AMIA
▪    P S Comp Appl Med Ca▪    S Am Med Inf Ass
▪    P S Comp Appl Med Car

Table 5 summarizes what was found. The data have some limitations. They only include citations that appeared in the journals scanned by Science Citation Index and Social Citation Index and that are therefore present in Web of Science. Since the universe of journals scanned has undergone significant expansion over the last 25 years, the year-to-year comparability of the data is suspect. Major informatics journals such as Methods of Information in Medicine and Computers and Biomedical Research were among the journals scanned throughout the whole period, however.

View this table:
Table 5

Number of Proceedings Articles with Two or More Citations in Web of Science, as of June 2001

1977–1981 22 3 0 0 0
1982–1986 3311 4 1 0
1992–199635411331 9 1
1997–2000 94 9 1 1 1

Very recently, citations from all the Proceedings papers published since 1994 have been entered into Web of Science. The data shown here were obtained in June 2001 and reflect only the number of times Symposium papers were cited in the journal literature, not the citations to Symposium papers that appeared in the Proceedings itself. Also, there is no way to verify that every abbreviation of the title of the Proceedings used in Web of Science was found. For both of these reasons, the data presented are an understatement.

Two or more citations were found for 17 percent of the papers represented in the database we created. Only 13 papers were cited more than 20 times, and only 31 papers were cited more than 15 times. As Figure 1 shows, a sharp increase in the number of papers cited two or more times began in the late 1980s, before NLM started indexing the Proceedings of the Symposium in medline in 1991. It is too soon to know whether the decline after 1994 is real (perhaps caused by the introduction of JAMIA) or just a normal delay in the citation of papers published in recent years. Certainly the delay factor is affecting the numbers for 1998 through 2000.

Table 6 lists the most-cited papers for each five-year period as of June 2001, with the number of citations. Although the year 1993 has the largest number of papers cited more than once, the majority of the most highly cited papers were published between 1987 and 1991.

View this table:
Table 6

Most-cited Proceedings Paper in Each Five-year Period

5-Year PeriodPaperNo. of Citations
1977–1981Carson, Cheng, Phelps. BLD: a software system for physiological data handling and model analysis, 1981 8
1982–1986Robb, Heffernan, Camp, Hanson. Workstation for interactive display and quantitative analysis of 3-D and 4-D biomedical images, 198617
1987–1991Humphreys, Lindberg. Building the Unified Medical Language System, 198962
1992–1996Campbell K, Weickert, Fagan, Musen. A computer-based tool for generation of progress notes, 199323
1997–2000Spackman, Campbell, Cote. Snomed RT: a reference terminology for health care, 199720

Table 7 includes abbreviated citations to the 31 papers that were cited more than 15 times, in descending order by the number of citations and then by the last name of the first author. Eleven of the 13 papers cited more than 20 times were published between 1987 and 1991. Of the 31 papers cited more than 15 times, 20 appeared during those 5 years. Not surprisingly most of the highly cited papers describe tools and methods that appeared in the Proceedings before they appeared in the journal literature. This is true of the several UMLS papers and also of those dealing with the Arden Syntax and snomed.

View this table:
Table 7

Papers Cited More Than 15 Times

No. of CitationsPaper
62Humphreys, Lindberg. Building the Unified Medical Language System, 1989
48Cimino, Hripcsak, Johnson, Clayton. Designing an introspective, multipurpose, controlled medical vocabulary, 1989
45Hripcsak, Clayton, Pryor, Haug, Wigertz, Van der Lei. The Arden Syntax, 1990
40Lindberg, Humphreys. The UMLS Knowledge Sources: tools for building better user interfaces, 1990
27McCray, Hole. The scope and structure of the first version of the UMLS semantic network, 1990
24Warner, Haug, Bouhaddou, Lincoln, et. al. ILIAD as an expert consultant to teach differential diagnosis, 1988
24Hripcsak, Cimino, Johnson, Clayton. The Columbia-Presbyterian Medical Center decision-support system as a model for implementing the Arden syntax, 1991
24Bernauer. Conceptual graphs as an operational model for descriptive findings, 1991
23Sumner, Nease, Littenberg. U-titer: a utility assessment tool, 1991
23Campbell, Weickert, Fagan, Musen. A computer-based tool for generation of progress notes, 1993
20Tuttle, Sherertz, Erlbaum, Olson, Nelson. Implementing Meta-1: the first version of the UMLS Metatheaurus, 1989
20Spackman, Campbell, Cote. SNOMED RT: a reference terminology for health care, 1997
20Centor, Keightley, Gerald. Receiver operating characteristics (ROC) curve area analysis using the ROC ANALYZER, 1989.
19McCray. UMLS Semantic Network, 1989.
19Forsythe. Using ethnography to build a working system: rethinking basic design assumptions, 1992.
19Bell, Greenes, Doubilet. Form-based clinical input from a structure vocabulary: initial application in ultrasound reporting, 1991.
18Johnston, Friedman, Cimino, Clark, Hripcsak, Clayton. Conceptual data model for a central patient database, 1991.
18Clayton, Pryor, Wigertz, Hripcsak. Issues and structures for sharing medical knowledge among decision-making systems: the 1989 Arden Homestead Retreat, 1989.
18Campbell, Musen. Representation of clinical data using SNOMED III and conceptual graphs, 1992.
17Wyatt, Spiegelhalter. Field trials of medical decision-aids: potential problems and solutions, 1992.
17Robb, Heffernan, Camp, Hanson. Workstation for interactive display and quantitative analysis of 3-D and 4-D biomedical images, 1986.
17McCray, Srinivasan, Browne. Lexical methods for managing variation in biomedical terminologies, 1994.
17Forsythe, Buchanan. Broadening our approach to evaluating medical information systems, 1991.
17Brinkley, Prothero, Prothero, Rosse. Framework for the design of knowledge-based systems in structural biology, 1989.
17Barr, Komorowski, Pattison-Gordon, Greenes. Conceptual modeling for the Unified Medical Language System, 1988.
16Gustafson, Hawkins, Boberg, Bricker, Pingree, Chan. The use and impact of a computer-based support system for people living with AIDS, 1994.
15Rector, Nowlan, Kay. Unifying medical information using an architecture based on descriptions, 1990.
15Heckerman, Horvitz, Nathwani. Update on the Pathfinder project, 1989.
15Evans, Classen, Stevens, Pestonik, Gardner, Lloyd, Burke. Using a hospital information system to assess the effects of adverse drug events, 1993.
15Das, Tu, Purcell, Musen. An extended SQL for temporal data management in clinical decision-support systems, 1992.
15Austin, Balas, Mitchell, Ewigman. Effect of physician reminders on preventive care: meta-analysis of randomized clinical trials, 1994.

To provide some context, Table 8 shows the most highly cited paper in JAMIA and the most highly cited paper in the field of medical informatics as a whole (the latter according to ISI, which produces the citation indexes), with the number of citations each had in June 2001. It is interesting to note that as of early January 2002, Web of Science identifies 158 citations for the most highly cited paper, 21 more than were present in June 2001. The additional ones came from the SCAMC and AMIA Symposium volumes whose citations were added to Web of Science after June. It is likely that the addition of citations from the Symposium Proceedings has increased the citation counts for many Symposium papers as well.

View this table:
Table 8

Related Web of Science Data, June 2001

PaperNo. of Citations
Most highly cited article in JAMIA:Cimino J, Clayton, Hripcsak, Johnson. Knowledge-based approaches to the maintenance of a large controlled medical terminology. 98
J Am Med Inform Assoc. 1994;1(1)
Most highly cited article in the field of medical informatics*:Lindberg, Humphreys, McCray. The Unified Medical Language System.137
Methods Inf Med 1993;32(4)
  • * Per ISI.

Impact of the Symposium

Although citation data show that the Proceedings have had a noticeable effect on the informatics research and development reported in scientific journals, the most significant impact of the Symposium was to foster development of the multidisciplinary field of medical informatics in the United States. The Symposium was a major factor in the establishment of AMIA, and it has been a powerful tool for recruiting people to the field. From its beginning, the Symposium has attracted people from different disciplines who have a common interest in the use of computers to improve health and advance biomedical science. The Proceedings document that many people who first came to the Symposium as students went on to become productive researchers, informatics faculty, and developers or managers of major information systems.

As background for this paper, we solicited reminiscences of the Symposium from ACMI members and other colleagues. The majority of the comments had a common theme, whether the respondents were physicians, nurses, computer scientists, or from another discipline. People recalled receiving inspiration, attention, and encouragement from the leaders in the field and from others who were presenting cutting edge work at the meeting: I attended my first SCAMC in 1980 and saw dozens of very bright, articulate, and passionate presenters. I remember thinking “I want to be like them some day.” A very powerful impression.—John Glaser, PhD, Sep 24, 2001

My first SCAMC was 1987. At that time I was a doctoral student. … I remember being introduced to the gurus in nursing informatics. I was quite impressed! Carole Gassert, PhD, Sep 20, 2001

Others commented that the Symposium felt different from other professional meetings they attended—the people were friendlier and more supportive of those just getting interested in the field.

Two stories illustrate the special character of the Symposium. In 1983, Rob McClure attended his first SCAMC: The year before, as a second-year [medical] student, I had organized a “network” of mostly students interested in the use of computers in medicine and was publishing a newsletter. I showed up at the meeting, looking to find like-minded folks, with a stack of … newsletters and the new Tandy TRS model 100 “portable” computer I was taking on rotations as a third-year. Since both students and portable computers were a rare sighting, I got a lot of attention. … I particularly remember Octo [Barnett] seeking me out to play with “that little computer” and discussing how students might use it. Larry Weed, Clem [McDonald], Bob Greenes, and others were excited about the level of interest I had found in the students.—Robert Mcclure, MD, Sep 24, 2001

In 1992, Randy Barrows, then a postdoc fellow at Columbia, was assigned the task of session chair. Taking his duty seriously, he read all the papers in advance so that he could ask an intelligent question if none was forthcoming from the audience. During the session, one of the speakers was extremely nervous—so nervous, in fact, that he fainted. Randy, being an ER doc, recognized the signs in time and was able to catch the poor fellow before he hit the floor. He was revived and escorted out by his friends. … Randy then proceeded to give the rest of the presentation.—James J. Cimino, MD, Sep 20, 2001

For the past 25 years, you did “have to be there” to experience the Symposium's special combination of high tech and high touch. If AMIA members can continue to demonstrate this to an increasingly diverse group of newcomers, the Symposium's future should be as bright as its past.


The authors thank Catherine Selden for creating the database of Proceedings citations, and Tonya Truesdale and Sean McDonald for assistance in editing it. They also thank Helly Orthner, Tom Piemme, Mike Ackerman, the AMIA office, and others who provided information, documents, and pictures related to the history of the Symposium.


  • * Agencies that gave early support to the application of computers in medicine included the Division of Research Resources, National Institutes of Health, the National Center for Health Services Research and Development, the Bureau of Health Manpower, and the National Library of Medicine.


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