The Rothman Index

Evolving the Electronic Health Record

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The Rothman Index is a single score that is calculated for a patient using 26 common observations and results that are already available from the hospital's EHR system. The Rothman Index graphs automatically update hourly for each patient and produce a graph of the patient's score for the last several days. This creates an easily understood picture of the patient's condition so physicians and nurses can spend less time parsing data and more time treating patients. The Rothman Index graph allows physicians and nurses to instantly identify a patient's condition and gives them timely notice of any upward or downward trend.

Panels of graphs can be viewed to see an entire floor or even an entire hospital at a glance. Our trial at Sarasota Memorial Hospital demonstrated that our visualization of patient health enabled doctors to send significantly more patients home safely.

Providing ease of use, a fully EHR integrated platform, early warning capabilities, and far greater continuity of care, the Rothman Patient Condition Tracker is setting a new standard in hospital patient care.

The Problem

In the current hospital system, patients are monitored continuously but by multiple doctors and nurses. As a result, medical personnel are frequently forced to make quick decisions without the benefit of a thorough familiarity with a patient's medical history and progressive changes. In time limited situations, often only current vital signs and health indicators are considered. This causes health professionals to function reactively instead of proactively, and only after a health decline is already underway. A hospitalist sees anywhere from 15 to 20 or more patients in a shift, and spends just three to five minutes reviewing each patient's medical record. "Hospitals have a difficult job: they have to provide customized care to hundreds of patients, 24 hours a day, using hundreds of nurses and doctors," explained Michael, the Chief Science Officer at RHC, "The electronic health record tries to provide continuity, but it's so long that nobody has time to read it. And so many mistakes are made."

Discerning a slow decline in a patient's condition is difficult even with a careful review of the medical record, especially if the physician or nurse has not seen the patient before. It is not that there is not enough data, but rather, too much data that is too time consuming to decipher. To a large extent, electronic health records (EHR) are used simply as electronic filing cabinets. Many studies have indicated that EHRs often provide little benefit in terms of increasting quality of care and reducing cost. Our work leverages this digital resource. We extract, integrate, summarize and visualize.

The Solution

We have created a single-number index based on a patient's vital signs, lab results, and nursing assessments. This index, named the Rothman Index in honor of the late Florence A. Rothman, is a measure of a patient's condition, and is particularly useful for showing changes in that condition. It is set on a scale of 0 to 100, with 100 being unimpaired. When plotted vs. time, the Rothman Index illustrates at a glance to physicians and nurses if their patient is getting better or getting worse. Also, by representing the patient's general condition as a single number, we facilitate communications between healthcare providers as well as between institutions. The Rothman Index is computed from vital signs, nursing assessments, and lab results commonly found in EHR systems. No extra data entry is required from doctors or nurses.

Validation

Comparison with Historical Data

We have done extensive statistical analyses of data from several hospitals to show that the Rothman Index correlates with other measures of a patient's condition. Strong correlations were found between the Rothman Index value and the APACHE score (assigned when a patient enters the ICU), the likelihood that a patient returns to the hospital within 30 days after discharge, and the likelihood that a patient dies within a year after discharge. Please note that the Rothman Index is not intended to predict these events, but rather to track the ups and downs of a patient's condition. The studies show that the Rothman Index is a meaningful indicator of patient condition.

Clinical Trial Results - Improved Patient Outcomes

We are also preparing to publish results of a 5-month clinical trial involving 1600 patients at Sarasota Memorial Hospital which showed that use of Rothman Index graphs leads to improved patient outcomes in terms of a statistically significant increase in patients sent home rather than to a skilled nursing or rehab facility. In addition to improved patient health, this result represents savings of thousands of dollars per patient to our health care system.

Saving Lives

Our goal in creating the Rothman Index is to provide a universal metric for patient assessment packaged as an integrated patient care tool. Our technology allows for greater continuity of care, increased quality of care, and reduced costs while saving lives.

Dedicated to

Florance

The Rothman Index is dedicated to the loving memory of

Florence A. Rothman