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I~ r] ~ ~ th Council on Health Care Technology wihiam N. Hubbard, Ir. The Council on Health Care Technology was established within the National Academy of Sciences and Be Institute of Medicine in 1986. The council is responding to selected problems that are related to technol- ogy in heath care: Improving the availability and interpretation of information al- ready in the literature on technology assessments. Improving methodologies mat are used for health technology assessments and the selection of appropriate mesons. Improving professional and public understanding of how the outcomes of using specific technologies affect We benefits of health care. Improving the efficiency of technology assessment by develop- ing a more systematic procedure for establishing national priori- ties of technologies to be assessed and fostering their execution. . Many interested parties are concerned with the assessment of health care technology. The perspective from which He council proceeds is that me uniquely valid outcome marker is the weR-being of the individ- ual patient. We do not, therefore, orient our concerns specifically to entitlements or reimbursement patterns or organizational issues or even technical safety and efficacy; rather, we orient our own concerns toward demonstrations of the relationship of an intervention to the well-being of the patient. With these interests in mind, we have instituted this series of public discussions He Health Care Technology Forum Series. The theme Hat ties the initial meetings of the series together is the issue of 1

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2 WILLIAM N. HUBBARD, JR. quality in health care as it relates to assessment of the use of technology and as it is defined by demonstrations of individual patient benefits. The first forum of the series emphasized what may be obvious but certainly has not been clearly pursued in practice the indivisibility of evaluations of effectiveness and quality. These tend to be two different communities of investigators. The interdependence of these two descriptors of technol- ogy assessment was the focus of the first meeting held in May 1987. The problem of appropriateness of use of an interventions by the health professional in the patient's course comes down to selecting and adapting that intervention to the individuality of the patient. This is particularly pertinent, as we see technology becoming more and more autonomous, under pressure to be more generally effective and its use being cost controlled. As we observe the operation of technology in care of the elderly the focus of this forum it becomes obvious that the overarching prin- ciple of an interventions being individualized has a particular poignancy when technology confronts the elderly. It is that confrontation and the efforts that are appropriate and necessary in order to individualize inter- vention that we win focus on today.