What the Cherokee Nation has done to manage the threat of COVID-19 is a story of leadership, with data at its core. Cherokee Nation Public Health, a small team of epidemiologists and public health experts—with the support of Tableau—moved quickly to collect, analyze, and communicate the complex data on this previously unknown threat. With the ability to visualize and share critical data in near real-time, the team was able to support the tribe’s quick response effort to keep its communities informed as they continued to navigate through an evolving situation.

When the pandemic first started, Principal Chief Chuck Hoskin, Jr. called the Cherokee Public Health team in for a meeting and immediately took action when they informed him of the growing threat of COVID-19.

In March, a resident of Adair County, Oklahoma became the first Cherokee citizen to test positive within the Cherokee Nation health system and die of COVID-19. Cherokee Nation Public Health knew it would just take a few cases of this virus to become a major threat to the 380,000 citizens of the Cherokee Nation and its surrounding communities so the leadership and the people of the Cherokee Nation were determined to keep the threat from escalating.

Initial challenges: Working with multiple data sources

Nearly two weeks before the state of Oklahoma began shutting things down, Cherokee Nation and Cherokee Nation Business began suspending casino and other business operations, and had employees of its government office work from home while ensuring the people whose jobs were impacted would still receive pay. This initial action served the Cherokee Nation well and bought their medical system some time, but initially the public health team was challenged to quickly gather and analyze relevant data so they could provide Cherokee leadership and the public with critical information in a timely manner.

The Cherokee Nation Public Health team were working 14 to 16-hour days while they looked at global and national data from Worldometer and Johns Hopkins, along with state-level data and Cherokee Nation data from Cerner, to show what was going on in their healthcare system. They were trying to capture and clean all of that data every day, produce spreadsheets and charts, and conduct analysis to understand the situation. They were tracking cases and looking at the pandemic from many different perspectives, given the organization's large clinical delivery system with over 1.4 million visits per year across eight clinics, one hospital, and a brand new outpatient health center.

Learning Tableau and communicating with data

While other areas of the Cherokee Nation had previously been using Tableau, the public health team didn’t have any experience with the platform – but they knew they needed a way to work with data more quickly, and to effectively communicate it out to an audience beyond just epidemiologists and health professionals. Members of the public health team worked with Tableau to rapidly learn Tableau from the ground up in just two weeks.

"Ultimately, we were just blown away," said Dr. David Gahn, Medical Director at Cherokee Nation Public Health. "We were able to create a dashboard to take into meetings and show the status of cases in the community in a visualization, which has been extremely helpful to Cherokee Nation leadership. We've been able to map all 14 counties of the Cherokee Nation and show cases and deaths for our community, as well as cases and deaths for the broader population of the state."

Sharing the data also meant making some adjustments. Because the dashboards are widely available, the team had to ensure all protected health information was removed before feeding the data into Tableau. Likewise, the team needed to clean the data they got from their own health system via Cerner.

Data to empower leadership and proactive decision-making

The dashboards created by Cherokee Nation Public Health helped tribal leadership make decisions in an effort to protect its workforce, communities and citizens.

To date, the public health team can see that it's had 684 cases and 6 deaths among patients in the tribe’s reservation boundaries. "That's a tragedy for our community, but when you look at the numbers in Cherokee Nation compared to everywhere else, you see that it’s so much lower," Gahn points out.

"Tableau has really helped us communicate with our leadership to show what we know, and then turn this data into an understandable story."

When the pandemic hit, many local primary care and specialist practices were shut down, with people having to defer surgeries or other care. But this wasn’t an option for many in the Cherokee Nation who have chronic medical conditions like diabetes or heart disease. In these cases, the public health team was able to work with clinics to track how many people were coming in for testing, what the clinic capacity was, and how they could design appointment times and facilities to keep those with chronic conditions separate and still able to access care.

The team could also see through mapping that one of the poorer counties was experiencing a spike in cases. A lot of Cherokee people lived there, but so did other community residents, many of whom were attending the same church. When the team saw that case rates were five to 10 times higher, they tested everyone, not just people of the Cherokee Nation. They then took the test result data and worked across county health departments to keep people isolated and safe.

Looking to the future: reopening with data

Cherokee Nation has reopened with staggered shifts to keep employees safe and an executive order to wear masks on Cherokee Nation property, and the leadership knows that data is going to be central to that. "This pandemic is a massive threat to our community and to communities all over the world, but for us, it’s really galvanized the importance of the approach we take with data in public health," Dr. Gahn said. "We really make it a priority to use data and work closely with leadership, so they can communicate that people should still be wearing a mask, should still be on their guard. This has been an enormous learning task for us, and now we know what we need: We need a dedicated team to work with public health data. We need a permanent contact tracing program and more epidemiologists. And we need Tableau.”

As Cherokee Nation builds out this system, they’ll be able to apply it to other outbreaks in the community, like Hepatitis C, and share their strategy with colleagues in other tribal nations.

"We've put in a tremendous amount of work to collect and analyze data on COVID-19," Dr. Gahn concludes. "We’ve seen how powerful it can be in the hands of our Chief, and we’ve seen how effective it can be in backing up strategies that keep people safe. And now, we have a strong system in place to respond to future outbreaks and other health challenges by using data."

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