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knowledge. This fault line is the ways in which temporal experienceshistory, events, development, memory, evolutionare registered in and expressed by two formal classification systems, the ICD and the INV. The crack comes when the messy flow of bodily and natural experience must be ordered against a formal, neat set of categories. We will trace this particular fault line across the two classification schemes. It is the case that all complex classification schemes have multiple sets of faults and fractures arising from similar tensions. Chapter 5 sets forth a model of the fault process as it occurs for clinical and bodily trajectories in tuberculosis. On a meta level, the system of faults and tensions forms a kind of texture of any given organizational terrain; mapping this texture is a major research challenge for the field of social informatics. |
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The International Classification of Diseases Is a Pragmatic Classification |
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To communicate information in the aggregate, we must first classify. At any time over the past 100 years one can find complaints about the Tower of Babel that afflicts the storage and communication of medical knowledge.
12 David Rothwell notes that "More than two hundred statistical systems are being used by the United States government to monitor health, occupational and environmental conditions through the country. Despite the incredible amount of information accumulated, there is no method of coordinating these data into a single coherent database, a national health information system" (1985, 169). Mark Musen complains: |
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The medical-informatics community suffers from a failure to communicate. The terms that WMR uses to describe patient findings generally are not recognized by Medline. The manner in which Iliad stores descriptions of diseases is different from that of Dxplain. Therapy plans generated by ONCOCIN are meaningless to the HELP system. . . . Each time another developer describes yet another formalism for encoding medical knowledge, the number of incompatibilities among these different systems increases exponentially. (Musen 1992, 435) |
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He points out that there is no clear relationship between "the Unified Medical Language System [UMLS] advanced by the National Library of Medicine and the Arden syntax proposed by the American Society for Testing and Materials as a standard for representing medical knowledge" (Musen 1992, 436). The ICD, he points out, originated as |
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