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The characteristics of health data are diverse and vary by discipline. Health data can be viewed from three perspectives. They can be examined at a basic level of different variable types and database constructions. At an intermediate level, the way data are structured in a facility is a model of how an organization works. A computerized information system is a model of how work is performed. An understanding of facility data architecture and data structure is essential for adapting both manual and computerized systems to the rapid changes occurring in health care today. Lastly from the highest-level perspective, for communication and exchange of health data to be possible across all components of the health care delivery system, standards for data must be adopted by all institutions and individuals involved in the development of health data information systems. To expedite such exchange, the American Medical Informatics Association (AMIA) has recommended standards for patient, provider, and site-of-care identifiers; computerized message exchanges; and medical record content and structure. AMIA has also recommended the use of the universal medical language system as the basis for future developments in a universal medical language.

Ragins and Sundstrom suggest three major conclusions based on power and gender differences within organizations. The first is that power develops or detracts as individuals progress along their career track. HIM professionals who accept the challenges that changing roles bring can also develop a new sensitivity to the value of power as a tool. They can use their negotiating skills to avoid being placed in work roles that result in a decrease in power. The second difference between men and women within organizations is that obstacles often impede women's career paths more than men's. Perceptions by women and men of a woman as homemaker and mother create serious conflicts when jobs are demanding and time intensive. Lastly, Ragins and Sundstrom suggest that career progression is influenced by both intrinsic factors (personal and professional) and extrinsic factors (organizational and interpersonal). The interaction between these factors is often driven by gender differences allowing men to progress and succeed, whereas women remain beneath the glass ceiling. HIM professionals, like other women health professionals, are graduating from advanced programs in health care and business administration at a greater rate than ever before in the history of this country. Not all these graduates will be able to acquire top-level administrative positions in the traditional health care institutions (e.g., hospitals). Therefore, if they wish to advance, they may have to move to nontraditional work settings. This is especially true for HIM professionals. The expanding computerized environment in traditional and nontraditional health care settings presents great potential for the development of new roles and responsibilities that have not been identified as male roles. HIM professionals and women in other health care professions who aspire to advance to upper administrative positions in traditional and nontraditional settings must be willing to take the risks inherent in assuming these changing roles and responsibilities. Successful women leaders in upper administrative positions recognize and take opportunities when they are offered and are not reluctant to assume more responsibilities and power in an organization. Lastly, if women are to move through the glass ceiling, health care institutions must become sensitized to the factors that prevent women's advancement and facilitate entry-level opportunities for women in administration. Continuing education and opportunities for mentoring and networking, combined with flexibility in work structures, will promote the integration of women at high administrative levels in health care, not only within their own professions, but in corporate health care as well.

To verify and elucidate the results of a previous study that documented four-fold variations in small area admission rates for diabetes mellitus in Washington state, the authors examined the hospital records of a sample of diabetes discharges from hospitals in high-, medium-, and low-rate counties. Hospitals in high-rate counties were generally smaller than those in medium- and low-rate counties and admitted a greater proportion of patients with mild illness. Also, physicians in hospitals in high-rate counties tended to be less vigorous in the diagnosis and treatment of diabetes. Variations in admission rates were not explained by coding errors or by differences in selected sociodemographic characteristics of admitted patients. The authors conclude that small area variations in hospitalization rates for diabetes were related to clinical differences in admission criteria and may also reflect differences in the medical management of hospitalized patients.

A statewide stratified, random sample of diabetes-related hospital discharges for Medicare and Medicaid recipients was reviewed to assess principal diagnosis coding validity. After reabstracting, only 60 percent of the sample were found to be unequivocally correct. In another 23 percent, the correct principal diagnosis could not be determined with certainty. Furthermore, ten percent of the cases where diabetes mellitus was coded as another diagnosis were ambiguous as to whether diabetes actually was the principal diagnosis. The potential impacts of these ambiguities on measures of admission rates, average length of stay, and hospital payment are examined.