The diffusion of new medical technologies will continue despite economic challenges, though prices must decline to make expensive new options like 320-slice CT and proton beam therapy more accessible. Health systems will need to find resources to finance electronic medical record implementation and new technologies while facing reimbursement cuts. Integrated delivery networks will tightly manage dollars and centralize capital equipment decision-making with key stakeholders involved. Upcoming changes to accounting standards will require operating leases to be reported as debt, increasing reported liability without changing cash flow, potentially impacting organizations with debt covenants.