 
Hello. I'm Dr. Jon Perlin Chief
Medical Officer and President of
Clinical Services at HCA
healthcare. Welcome to A
Physicians Lens, a series of
periodic conversations with our
physician and clinical community
on topics of general clinical
interest to the HCA healthcare
family. Joined today by Dr.
Edmund Jackson, our Chief Data
Scientist, and Chief Data
Officer. Our topic today is data
science, particularly as it's
applied to Covid. So Edmund
Jackson, uh, as we say in the
South, you're not from around
here, quick introduction on your
background. Well, thank you, Dr.
Perlin. Uh, yes, you can tell
from my accent, I'm from further
South, very, very far South,
South Africa. In fact, I like to
joke that I'm more southern than
all of y'all put together. Um,
but anyway, it's a delight to be
here. Thank you for the
opportunity to talk about data
and analytics and data science.
So you carry two titles, Chief
Data Officer, and Chief Data
Scientist. What do those mean?
What do you do? So the two
relate to data. Chief data
officer relates to creating the
foundations of data that are
necessary for appropriate and
high end analytics and chief
data scientist is to lead those
analysts data scientists who are
using the data to create output.
So it's ready to put the two
things together to create good
data and then to use it well.
One of the blessings, the
privileges of scale is the
ability to, as we say, learn at
speed, we've created a learning
health system out of our
information architecture, which
means that every piece of data
that's created in the act of
clinical care it's collected
into a data warehouse that can
be channeled back for improving
quality. One of the best
examples of that is one, that
we've worked together a good bit
on that spot, sepsis prediction
and optimization of therapy in
the aggregate, it saved 8,000
lives and a particular
congratulations Edmond spot just
recently was recognized with the
John  M. Meisenberg award
quality award for innovation.
Well, thank you, Dr. Perlin
that's that, that project is the
reason I joined HCA. The reason
I stay at HCA and, you know, I
want to thank you for the
leadership behind that for year
after year to back it up. Both
of us really thank our clinical
colleagues for making this, um,
for making this work. And what's
really gratifying to us is that,
uh, for those of us who hunted
and packed, uh, through the
electronic health record, uh,
we've heard back that it's not
the routine decision support,
but things like spot quote,
unquote, that make using the
electronic health record
worthwhile. One of the things
you've stressed, Edmund is the
spot is not just a program for
sepsis, but it demonstrates a
platform. And you've been
working on another platform
called Nate, tell us a little
bit about Nate and then let's
dovetail into how that applies
to our care of patients with
coronavirus. Sure. So, so Nate
is the son of spot in order to
create spot, we have to create a
data platform with our IT
colleagues that span the entire
nation and put all of our data
together, made it usable and
accessible in real time. And so
once we worked on spot for
awhile, the question then became
what next. And so we've created
a platform, Nate, that's very,
uh, plastic configurable, usable
by any user to create different
sorts of realtime products. And
there's been a Cambrian
explosion in the number of
things that are now available on
Nate. So in particular, I think
we could talk about the Coronate
because that's that's top of
mind right now. Yeah. A really
bad pun coro Nate, get it. I
can't help myself. I'm a father
of two and I like a dad joke. So
coronate is a platform that
spans all of our facilities and
gives real time information on
the COVID population.
Specifically in the early days,
it was around who were persons
of interest who had a positive
test. Now it's, who's recovered.
Where are they? When are the
labs taken the full picture at a
hospital level, rolling all the
way up and it's available to any
member of the HCA community. So
I, I
personally, I got a copy of that
on my smartphone and it's really
terrific, but it allows you to
see how patients are cohorted,
what the patient load is and
what, where do you see that
going?
Uh, everywhere, everywhere. So
the, the idea is that it's a
platform on which multiple
products can be built and after
Coronate, and we've already
started working on a product
with case management called, uh,
tempo, and that's, uh, uh, an
idea of vision of product that
came out of the central West
Texas division, tremendous
leadership there. And we've been
able to work with them now to
scale it across the entire
nation. And it allows for very,
very rapid barrier rounds. We're
now talking about safety rounds,
we're talking about, um,
throughput optimization and the
sky's the limit.
Yeah, well, this is really
exciting. If spot is directed
directly at clinical care, then
Nate and Coronate helps us
manage patient throughput and
obviously tremendously important
than the, in the era of COVID,
as we want to cohort patients
with COVID, um, knowing that a
positive means positive a
negative, not necessarily that,
but, um, to the extent that we
know those COVID patients when
isolate them, because that gives
us the opportunity to really
resume business. We know that so
many of our physician clinical
colleagues have been struggling
during this period of less
normal activity. It's really
quite remarkable, but our
ability to, to load balance
allows us not only to care
responsibly for COVID patients,
but to care responsibly for all
patients. And that's pretty
exciting. Uh, one of the things
that we, uh, hope we're not
excited by is that we hope the
activity is quiescent, uh,
across the summer. Um, some of
us worried about, uh,
recrudescence in the fall, uh,
Edmond, um, you've been doing a
lot of work on COVID
projections. Talk a little bit
about your work on COVID
projections and let's dovetail
to some of the work on community
COVID projections. So,
absolutely.
Well, thank you sir. The, the
projection of COVID was probably
the hardest thing I've ever
tried to do and failed pretty
hard at it as well. So in the
early days we were dealing with
something we'd never seen
before, and there was no data.
And so we only had theory to
rely upon it turned out that
theory was perhaps, you know, a
little bit aggressive in its
approach. And it was a wonderful
example of HCA coming together
because, you know, I created
some projections and very
quickly the feedback came, these
are not realistic. We're not
seeing that in our hospitals.
And so very rapidly given the
privilege of our scale, we were
able to bind that with real data
and come up with what we call
the San Jose model, because we
were experiencing, uh, the
COVID, uh, primarily on the
coast in the beginning.
And San Jose was one of the
first facilities to, to actually
experience it. And we were able
to take the experience there,
generalize it and apply it to
all of the facilities. And it
gave us a really solid
foundation, a really realistic
perspective of the timing, the
scope, and the magnitude of the
outbreak. That's really
internally focused. And we were
really thinking about the, the,
uh, the resource constraints,
which are, as we all know, the
ICU beds and the ventilators.
And that was a population that
we were projecting. As the, the,
the world has caught up with
COVID, there have been a
tremendous number of external
models built, and I really have
to call out the IHME model,
which has been extremely
accurate. The concern now is as
we loosen social distancing, as,
as policy start to change some
of the models and the IHME is
one are predicting a small
resurgence in some areas with
high population density. So the
new models take into account
mobility as measured by people's
moving from, with their cell
phones, population density,
global connectedness by means, I
mean, the travel between cities
and so forth. And so we run some
risk.
Well, what I think is so
important about the work that
you're doing is that you're
bringing it down to the scale of
our HCA markets, because the
picture of what's going on
across the United States, isn't
a picture of what's going on in
Nashville or Dallas or Miami,
Florida, and you know, frankly,
a picture of Nashville is not
what's going on across all of
Tennessee and your ability to
really tailor those models to
our specific markets really
helps us operationally make sure
that we have the supplies, the
PPE, uh, that's necessary, uh,
and to move about resources. Um,
uh, if there are areas that are
at risk of a recrudescence, this
is really spectacular work, uh,
Edmond town. Let me thank you
for your, your leadership on
that. Uh it's um, I think the
fulmination of learning health
system, that concept I mentioned
before, where the data created
through every encounter go into
a collective memory that helps
us improve the system and
improve patient care with every
touch. Uh, and we know that each
of you are our clinical
community members are that
patient touch. Uh, this is a
challenging time. Uh, we wish
you the best, uh, on behalf of
Dr. Edmund Jackson, myself. We
certainly thank you for all that
you are doing.
