The Evolution of a Health Information Brokering Service in the Province of British Columbia
Bibliographic record
Abstract
ElectronicHealthcare Vol.2 No.2>2003 The Provincial Health Services Authority (PHSA) is implementing a health information brokering service in the province of British Columbia. This brokering service (called the Clinical Broker) is based upon the experienced gained by the B.C. Cancer Agency (BCCA) in the creation of its Electronic Health Record (EHR) for cancer care. The brokering service will initially focus on an operational need for information exchange between healthcare providers. Over time, it will be extended to include more complex healthcare services, such as results query, appointment booking and clinical decision support. Given the results achieved at the BCCA, the brokering service is expected to more than pay for itself in operational savings. It will also result in improved care and reduced clinical risk by accelerating the delivery of clinical information. As a byproduct, a unique data resource for the development of a provincial EHR is being created at no additional cost. Extensive experience is also being gained on the development of interfaces to clinical information systems, clinical information workflow, and on the value of data standards for clinical information exchange. This paper will examine the circumstances leading to the development of the Clinical Broker, and the opportunities that it will create in British Columbia. The story begins at the BCCA. THE B.C. CANCER AGENCY AND THE CANCER AGENCY INFORMATION SYSTEM The BCCA operates a cancer care program for the population of British Columbia. The management of information on cancer patients begins with the B.C. Cancer Registry, where, by law, all patients with a positive pathology of cancer must be registered. Approximately 60% of these patients will eventually be referred to the BCCA for treatment. Within the BCCA, care is primarily delivered through four comprehensive cancer centres, where the patients are primarily seen as outpatients. Information on all cancer patients in the province is maintained in the Cancer Agency chart. As with other types of chronic disease, the chart is longitudinal rather than encounterbased. More than 60% of the pages in a cancer chart originate from outside the BCCA. Information is gathered and retained from diagnosis to death, and sometimes beyond, for research. The BCCA currently has more than 450,000 charts, of which more than 100,000 are active. These paper-based charts represent a very significant information management challenge. In the fall of 1992, the BCCA began planning to build a new cancer treatment facility in the Fraser Valley. The existing information systems were dated and not capable of expanding to include the new centre. The market was examined for vendor solutions, but none were found . Electronic Health Records
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.010 | 0.002 |
| Scholarly communication | 0.008 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".