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or other of the ICD. As one article put it: ''We are often reminded that medical knowledge has grown to the point where we require the assistance of computers to manage it. One response has been the construction of controlled vocabularies to facilitate this process. We are now at the point where the vocabularies themselves have reached unmanageable proportions and must again call on computers for help" (Cimono et al. 1989, 517). The call now is for a unified medical language system (UMLS) that will provide for automatic, flexible communication among all authorized controlled medical vocabularies. Embedded within the UMLS will be the ICD. Embedded in the ICD will be flexible classifications that will, in principle, allow a reconfiguration of past records. And surrounding all of it are secondary and tertiary analysis and fiduciary industries that audit, monitor, and collect revenues based on their expertise in analyzing the intertwined category schemes. Figure 3.2, for example, advertises a firm with precisely this mission. Readers will recognize herein a familiar chapter in the history of expert systems, with the emphasis moving from faith in a unitary vision of the world as modeled in symbolic artificial intelligence to the management of multiplicity and pragmatic circumstances. By concentrating on the ICD and information technology, we are able to see a new kind of "open past." Rather than searching for disease precedents described before about the internal history of medicine, we may also find them in the history of information technology. |
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As such, this open past is shared by a number of different disciplines and professions. Note though, as David Levy (1994) points out more generally, that the move to computerization may lead in some senses to less flexibility and local variability than in the past. Jucovy (1982, 467) states that in the medical field, "computers will probably firm up lexical use in much the same way as printing served to fix the spelling of words a few centuries ago." The reconfigurable past of the ideal database meets the installed inertia of the standardized basesthus the old dialectic is transferred to a new medium. |
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A key outcome of the work of information scientists of all kinds is the design and implementation of information infrastructures. In looking at the case of the development of the ICD, a fundamental figure-ground problem emerges in the analysis of such infrastructures. In particular, the medical classification system that underlies a large part |
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