In early 2003 Florence A. Rothman, age 87, underwent aortic valve replacement surgery. After initial improvement, she was transferred to an inpatient rehabilitation area where she experienced a gradual deterioration that was not recognized until she was desperately ill. She was transferred back to the regular hospital, appeared to have recovered and was discharged. Four days later she collapsed and was taken to the emergency department where she died because of a medical condition that could have been successfully treated if recognized.
Stunned by this unexpected turn of events, her sons, Michael and Steven Rothman, worked with the cooperation of hospital officials and staff to understand how their mother’s gradually deteriorating condition could have escaped notice. They spent 3 weeks observing the nurses and physicians and were immediately struck by the problems in continuity of care due to the number of "hand-offs" and the difficulty in understanding a patient's day to day condition. They were surprised to learn that the hospital’s sophisticated electronic medical records (EMR) system, while amassing substantial quantities of data over the course of an admission, generated very little information of a patient’s overall condition that might be used in communication between caregivers for continuity of care. The Rothmans vowed to find a way by which future patients might avoid their mother’s fate.
Although neither of the brothers was trained in medicine or health services research, they were no strangers to massive electronic databases. Michael Rothman, who holds a PhD in chemistry, spent much of his career as a computer scientist at the IBM Watson Research Laboratory and then became chief information officer for a major bank. Later he founded a company specializing in large data system design and analytics. Steven Rothman is an electrical engineer who began his career at the MITRE Corporation, a contract research organization spun-off from Massachusetts Institute of Technology. While working on aerospace projects in Colorado and New Mexico he became interested in oil and gas exploration and created a company that applied sophisticated computer analytics and data visualization to the analysis of seismic data.
With active support from the hospital, the Rothmans put their expertise to work exploring the EMR data repository. Their vision was to create algorithms that would utilize existing EMR data to track patient health status over time, and to present this information as simple and meaningful metrics, available to the clinician in near real time. Several years of effort culminated in the Rothman Index (Ri), a score of a patient’s general condition. This score is calculated automatically from information routinely collected in the EMR, and displayed in a graphical format that depicts the patients’ condition over time. These Ri graphs are now being used in hospitals, and long-term care facilities across the nation to help save lives and improve outcomes for millions of Americans.