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reimbursement, in cost assessments, and in the allocation of expensive equipment on the basis of diagnostic need. Issues of social justice and policy are very deeply embedded in all these question of due process (Gerson and Star 1986). |
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The ICD is one of the earliest modern attempts to collect global information across a number of federated suborganizations and feeder sources. Like state censuses and many forms of business and governmental statistical data collection efforts, it is protean in its effects on knowledge in both the private and public sectors. People use the ICD and its knowledge in a myriad of ways, including developing diagnosis-related groups (DRGs),
21 electronic medical records, assessing equipment and personnel needs, and reporting vital statistics. These in turn have a profound impact on health care costs and business policies (see Geist and Hardesty 1992 for a discussion of this in the American case). |
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The ICD and similar categorizing schemes are examples of the practical and theoretical difficulties and challenges inherent in modeling large-scale knowledge work and collaboration. They are also good examples of how management and decision-making tools become part and parcel of organizational structure. In recent years, burgeoning interest has risen in joining management information systems (including complex modeling), social history of statistics and classification, sociology of technology, and studies of infrastructural development (Hughes 1987, Boltanski and Thévenot 1991, Desrosières 1988 and 1993, Yates and Orlikowski 1992, Star 1995c, 1991b). |
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As noted, the ICD is about 100 years old and revised nearly every ten years since the end of the nineteenth century. It is distributed as a book, or as a component of medical record-keeping software, to public health offices, hospitals, insurance companies, health accountancy firms, and bureaus of vital statistics throughout the world. It contains numbers that correspond to causes of death or illness of the sort discussed in chapter 2, and algorithms for arriving at those numbers in complex cases involving more than one disease or cause. In a sense, the ICD is the backbone of a sophisticated, very large computer-supported cooperative work (CSCW) system as well as a form of large-scale organizational memory. It is also a decision-making tool for all sorts of policymakers. On the basis of data collected using the ICD system, decisions are made about allocation of resources, whether and how to control epidemics or endemic illnesses, and whether there are |
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