a complete evaluation of a technology are not available. This finding may serve as an impetus to initiate research to supply the missing information. Similarly, an assessment may lead to changes in practice norms when it yields a conclusion that differs from common clinical behavior.
Yet efficient use of resources for technology assessment requires a systematic priority-setting process. In the legislation establishing AHCPR, the IOM was asked to develop a process and criteria for setting priorities for health care technology assessment and reassessment to assist OHTA in its expanded role within that agency. The establishment of AHCPR itself can be seen as recognition of the need to look systematically at the value of health care services in improving health. This kind of assessment uses measures of effectiveness as a means of better understanding the appropriate use of new and established technologies; the expansion of the role of OHTA to develop a comprehensive process to guide this work is consistent with that goal. Such a process should also be of value to other organizations that, notwithstanding their different goals, must develop priorities for the use of limited assessment resources.
The committee described several examples of priority setting from a number of different organizations or groups: (1) the Health Care Financing Administration; (2) a research-intensive pharmaceutical company; (3) the Clinical Efficacy and Assessment Program of the American College of Physicians and the Diagnostic and Therapeutic Technology Assessment Program of the American Medical Association; (4) the priority-setting process used by the IOM's Council on Health Care Technology in its 1990 pilot study; (5) the Food and Drug Administration; two examples of quantitative models of priority setting—(6) David Eddy's Technology Assessment Priority-Setting System and (7) the Phelps and Parente model; and (8) the process developed under the Oregon Basic Health Services Act to set priorities for Medicaid spending.
The committee drew on these examples to derive a set of principles for developing a process for OHTA to use in setting priorities. Although individual assessment organizations may have various goals in assessment, the public as a whole has an interest in the effects and use of medical technologies. Public agencies need a comprehensive, proactive process of public input to ensure that the technology assessment provides the greatest gain to the health of the public. In addition, priority setting must be accountable to the public. It cannot be private, implicit, or internal to the organization, and it must include a process that is open, fair, and credible to discriminate among the array of possible technologies that it might assess or reassess.