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Magnetic resonance imaging (MRI) continues to expand in influence as a diagnostic tool, with the number of units installed in the United States growing rapidly, according to an AHA technology assessment report. Technology assessment is being used more and more in decision making regarding the use of MRI and other diagnostic technologies. Two perspectives on the phenomenon are explored.

The implicit promise of technology assessment is that if you look hard enough, you'll find the best new drug or device--before the competition does. But health care providers may forget to exercise a powerful option: just saying 'no'. So says Alan Weinstein, president, Premier Hospital Alliance, Inc., Westchester, IL.

Each of the major decision areas that is covered in this article is multi-dimensional in nature, and each could be developed into a lengthy and meaningful discussion. However, the basic purpose of this article has been to suggest a framework for evaluating and making decisions that are associated with planning prepared food systems. We have attempted to underscore the importance of making basic procedural and conceptual decisions related to prepared food systems before deciding the subcomponents of each decision area. Perhaps the most important element of the decision-making process is a thorough understanding of the interrelationships between each of the five major decision areas. This understanding, when it is combined with the suggested decision framework, should contribute to a well-planned, smoothly operating prepared food system.

The acquisition of capital equipment is considerably more involved than the purchase of supply items. Because of the long life of capital equipment, errors in judgment at the time of acquisition can haunt a purchasing manager for years. But if he exercises good judgment and does not lose sight of the particular needs of his hospital, capital equipment can be acquired in a manner that will be in the continuing best interests of the hospital.

Equipping a new hospital involves quickly shifting and sometimes overlapping phases. Consequently, considerable coordination is required among the hospital administration, user departments, purchasing department, suppliers, architect, builder, trade unions, and other involved parties. Detailed procedures such as those described in this article can help to efficiently organize this effort and protect the hospital's interests regarding the costs, specifications, acceptability, and safety of the equipment that is acquired and installed.

Purchasing committees are essential to effective materials procurement and management. These committees perform not only initial evaluation of materials and supplies but also ongoing reevaluation. Thus, they help to ensure that the hospital obtains and maintains appropriate quality, quantities, and cost effectiveness in its purchases and its inventory.

When determining a method of procurement, the purchasing manager must remember his goals. Whether it be by bidding, negotiating, or open-ended contracts, the method chosen is a means of obtaining savings for the hospital and, ultimately, for the patient.