An algorithm that turns electronic health data into proactive insights

The Rothman Index uses SAS to improve patient outcomes

Hospitals collect mountains of data during their patients’ stays. But even though each patient’s data is stored in the hospital’s electronic medical record (EMR), the data isn’t integrated in such a way as to facilitate the understanding of a patient’s condition and how it’s changing over time. It just isn’t easy to answer the simple question, “Is this patient getting better or worse?” Michael Rothman, an Advisory Data Scientist at Spacelabs Healthcare, has long focused on the goal of using data to signal when a patient’s health may be at risk before the patient reaches a crisis.

The Rothman Index^®, developed by Michael and his brother Steven, is a pioneering patient acuity score that is presented in an easily understood color-coded graph that updates in real-time and clearly shows any upward or downward trends. “With the Rothman Index, we’ve created a real-time data visualization to make it clear when a patient is deteriorating,” explains Michael Rothman. “And we’re able to identify deterioration before it becomes a crisis.”

In 2023, Spacelabs took a bold step in advancing predictive health care by acquiring PeraHealth, the company co-founded by Michael and Steven Rothman, to equip clinicians with a powerful, real-time window into patient health – which allows them to detect subtle changes before they become crises.

The partnership is a natural fit. Spacelabs’ journey into real-time remote health monitoring began during the early years of space exploration—supporting NASA’s historic Gemini and Apollo missions. The company’s medical telemetry helped make the first spacewalk possible for Edward H. White II in 1965. They provided remote monitoring of astronauts’ physiological systems for the Gemini program. And when Neil Armstrong stepped onto the moon in 1969, he was wearing a Spacelabs telemetry system. Today, Spacelabs brings that same innovation to Earth-bound health care, enabling clinicians to remotely monitor patient conditions whenever and wherever they need it.

The Rothmans’ journey into health care began with a personal loss: their mother’s slow, undetected decline after what seemed like a successful surgery. Determined to prevent similar tragedies, Michael and Steven, both from non-medical backgrounds, used their expertise in advanced analytics to design the Rothman Index.  

How the Rothman Index works

The Rothman brothers started at the hospital where their mother had passed away, interviewing physicians and nurses and creating a simple model to capture risk in a new way.  Working over the next two years, they refined those original ideas via statistical analyses with large data sets. They developed the patient acuity score, now known as the Rothman Index, named in memory of Florence Rothman.

What they discovered was that while physician researchers focused on interpreting vital signs and lab tests, there was another important source of longitudinal data which was typically ignored, the head-to-toe assessments that are regularly conducted by nurses. These evaluations capture the subtle changes in a patient’s condition – such as confusion, appetite loss or swelling – that may precede a crisis, which is typified by extreme values of vital signs.

“Our goal is to let the doctor or nurse know that something is going wrong before the patient is in crisis,” Rothman says. “If you can get there before a crisis, you can change an outcome.”

Hospitals use the Rothman Index in various ways. In some cases, the Rothman Index is a 24/7 monitoring system that triggers alerts when a patient’s score dips below a safe threshold. In a large hospital, nurses are typically responsible for four to eight patients during each shift, hospitalists (physicians who practice solely in the hospital) may have 15-25 patients. Doctors and nurses can use the Rothman Index to quickly prioritize patients during rounds. Rothman Index graphs indicate how sick each patient is and how they’re trending over time – are they getting better or worse?

“The nurse can use a single screen to see what’s going on with all of his or her patients,” says Rothman. “That’s hundreds of pages of medical data integrated into an easy-to-digest visualization so the nurse can prioritize who needs to be seen first.”

Without the Rothman Index, nurses and doctors would have to sift through pages of patient data, piecing together vital signs, labs and patient history to detect those patterns. In the meantime, patients suffer, and staff resources are stretched thinner.

Impact on patient outcomes

The Rothman Index has helped reduce mortality rates, emergency escalation of care and unplanned ICU transfers across several hospitals. Studies have found that a Rothman Index-driven care pathway can reduce 30-day readmissions and accurately predict when patients need to be moved to a higher level of care.

Hospitalists organize rounds based on their patients’ Rothman Index scores. The system’s use in palliative care has also been transformative, facilitating specialist communications, aiding timely consultations and improving end-of-life decisions.[i]

“SAS has been an essential tool in the development of the Rothman Index,” Rothman adds. “We’ve used it for model development and large-scale data management. SAS has been critical for studying Rothman Index’s impact on patient outcomes. SAS has allowed us to test hypotheses quickly, which helped accelerate our research.”

As Rothman and Spacelabs look to the future, they envision adapting the Rothman Index for use beyond the hospital, integrating it with remote patient monitoring systems. With the potential for personalized alerts based on individual health patterns and pre-existing conditions, the Rothman Index evolution will further Spacelabs’ legacy of innovation and patient-centered care.

Sources:

Mortality:
Mortality Reduction Associated With Proactive Use Of EMR-Based Acuity Score By An Rn Team At An Urban Hospital | BMJ Quality & Safety
06 - Prospective RCT Mortality - 2016 - BMJ Qual Saf-2016-Walsh-1014-5.pdf
07 - Improving_care_quality_through_nurse_to_nurse.6 - BLESSING.pdf

Unplanned Transfer:
Can proactive rapid response team rounding improve surveillance and reduce unplanned escalations in care? A controlled before and after study - ScienceDirect

Readmission:
02 - 30-day readmission for gynecologic oncology - 2019 - e2a4c466931e1215be4c64d3403cb1bf3b02.pdf