In considering the allocation of resources for health it is necessary to make a distinction between the provision of public and environmental health services and the provision of medical care by physicians and surgeons for those patients who seek treatment.

This study assessed the diagnostic utility of two technologies for evaluating respiratory abnormalities in sleep. We compared conventional polysomnography with a new, ambulatory microprocessor technology. Two key features of the comparison involved: (a) the use of multiple, skilled interpreters of each system; and (b) inter-rater agreement within the systems as a crucial test for the diagnostic utility of each. Results indicated that general categories of respiratory abnormalities could be judged more reliably than more specific categories, regardless of technology. For certain categories of respiratory abnormalities, however, inter-rater agreement with the newer technology was extremely low (e.g., reliability coefficients of.12,.09, and –.06). Factors contributing to these low diagnostic reliabilities are discussed. Our data indicate that any assessment of new technology cannot be made apart from the clinical judgments to be rendered with that new technology. This approach may be generalizable to the assessment of other diagnostic technologies.

In September 1986, the American College of Physicians initiated the planning phase of its Physicians Network, an effort aimed at tapping the resources of the College's membership to collect information on physician practice patterns and their relationship to the outcomes of care. Funding for the planning has been approved by the Henry J. Kaiser Family Foundation, Menlo Park, California, and will support the 15 month project.

The appearance of acquired immune deficiency syndrome (AIDS) has brought suffering and death to those who are afflicted and, at the same time, has posed daunting challenges to those who care for the sufferers, to biomedicai scientists, and to those responsible for public health and public policy. Among these challenges is the protection of the nation's blood supply from contamination by human immunodeficiency virus (HIV),1 the causative agent of AIDS. This challenge was met rapidly by the development of laboratory tests to detect the presence of antibody against the virus. The application of these tests makes it possible to determine whether the person has been infected by the virus at some time and thus to exclude persons from donating blood or to discard blood already donated. In the past 15 months, the widespread application of these tests along with self-deferral and removal of HIV-positive subjects from the pool of donors has sharply reduced the likelihood of the virus being spread by way of blood products.

This discussion of Emerging Technology focuses on technological currents in electronic technology rather than in medical technology per se. The influence of the former on the latter is not merely that medical devices have electronic parts, but that the development of new circuit technology can change radically the design, utility, and even the function of the medical devices.

Since the early days of medical computing, medical computer researchers have envisioned how computers could benefit medical research and practice and have deplored the inability of medicine to take full advantage of the computer's power. They, and others, have analyzed the causes for the medical computing “lag.” These analyses identify a wide range of difficulties that the introduction of computers into medicine faced, and continues to face.