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Page 148 Table 4.1 Some conflicting needs of ICD users Information needs Problems International Public Health Data Collection precision; thorough coverage by case; timeliness; consistency religious and cultural customs; incompatible medical systems ownership and administration of data; different granularity needs of users Government legality; vital statistics for planning matching legal and medical categories; crimes unreported for various reasons Doctors, epidemiologists, and statisticians diagnostic; preventative; predictive statistical vs. clinical approaches different hierarchies of multiple causes; early detection vs. clear clinical case Industrial targeting special groups; industrial pathogens; drug impacts and indications different aggregations of data; shifting market needs the matrix shown in table 4.1 summarizes what should be obvious: something has to give. The list cannot be homogeneous, neutral, and appeal simultaneously to all parties. This is always the case for tools and objects that inhabit a number of different social worlds (Star and Griesemer 1989, Star 1989b). King and Star (1990) have examined this problem for the decision-making process in organizations and its implications for designing organizational-level decision support. Policy Inscribed into the ICD The discussion now turns to the solutions to the problems of multiple membership and thus heterogeneous definitions and goals that have been explored through the ICD's history. A number of very bright people have long been working on the difficulties posed by the ICD that we adumbrate above. This section inventories working solutions to the above problems at the level of the negotiations about the design
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