PeraHealth Submits IPO Filing as Rothman Index Gains Traction Across U.S. Hospitals for Continuous Patient Monitoring

Professional medical caregivers at Houston Methodist Hospital in Texas use markers displaying the Rothman Index to monitor patients' health conditions.

Patients typically present with mild symptoms prior to clinical deterioration, yet the consequences can be extremely severe. To better monitor these early warning signs, most hospitals are implementing a novel early warning system.

Postoperatively or during hospitalization, patients are highly susceptible to other complications, most of which can rapidly prove fatal. For instance, respiratory depression caused by adverse reactions to excessive use of sedatives or anesthetics can easily lead to cardiac arrest. Studies have shown that patients exhibit warning signs six to eight hours before experiencing cardiac or respiratory arrest; in medical terminology, this condition is referred to as "decompensation."

However, not all signs can be detected by healthcare professionals. Although patients in the intensive care unit are constantly interacting with various medical devices and monitors, unlike them, patients in general surgical wards are not under 24/7 monitoring.

Hospitals have also adopted various methods to monitor patient characteristics. For instance, wireless monitors, typically concealed beneath bedding, alert nurses when changes in a patient’s respiration or heart rate are detected. Another real-time method for assessing whether a patient’s condition is deteriorating relies on three types of data collected through electronic health records: laboratory results, vital signs, and nursing assessments.

“We need to conduct a simple assessment of patients and then identify those at high risk,” said Professor David Westfall Bates of Harvard Medical School, who also serves as Chief Quality Officer and Chief of Medicine at Brigham and Women’s Hospital.

Application of the Rothman Index on Mobile Devices. The Children’s Hospital at UPMC has implemented the Pediatric Rothman Index, developed by Peral Medical, within its emergency response teams, enabling real-time notifications to physicians and nurses whenever a patient experiences an emergency.

A study published in a U.S. medical journal, featuring clinical charts of 7,643 patients compiled by Dr. Bates’ team, shows that at California Advanced Medical Center in Los Angeles—a hospital equipped with under-bed wireless monitors—patients had shorter hospital stays and a lower incidence of “Code Blue” events. (Code Blue is a medical term indicating that a patient requires emergency resuscitation or urgent medical intervention.) In contrast, hospitals without such configurations reported relatively higher rates for both metrics.

Early Sence, a company based in Ramat Gan, Israel, has developed a monitor that alerts nurses when patients get out of bed. Similarly, it signals nurses when patients need to turn over in bed to prevent skin breakdown. Gladys Castro, nurse manager at California Medical Center, stated, “This device prevents patients from falling out of bed and also helps prevent pressure ulcers.”

Newton-Wellesley Hospital in Newton, Massachusetts, became a pilot site for the EarlySense monitoring system five years ago and has since implemented the technology hospital-wide. Dr. Perry An, Chief Medical Officer at Newton-Wellesley Hospital, stated, “The adoption of this technology helps alert healthcare providers to aspects that might otherwise be overlooked. For instance, bradycardia poses significant risks and can lead to myocardial infarction; traditionally, patients would require implantation of a cardiac pacemaker to manage this condition. This device, however, provides timely alerts to clinicians regarding changes in patients’ heart rates. Additionally, patients receiving analgesics may experience shortness of breath; the monitor enables early detection of respiratory changes, allowing healthcare providers to intervene promptly.”

The cost of installing such monitors depends on the hospital’s size and the scale of the device’s deployment within the facility. For a hospital with 30 beds, the installation cost may range from RMB 80,000 to RMB 200,000.

Hospitals are under increasing pressure to devise better methods for detecting changes in patients’ conditions before they spiral out of control. In the United States, collaborative organizations dedicated to ensuring the safety of patients receiving anesthesia have emerged, calling for enhanced continuous electronic monitoring. Last year, the Centers for Medicare & Medicaid Services (CMS) issued a strong mandate requiring postoperative monitoring for patients who have received Type IV anesthetics, regardless of whether they are housed in the ICU or general wards. Additionally, CMS requires healthcare providers to strengthen patient and family education, emphasizing the importance of promptly notifying medical staff if any difficulty in breathing is observed.

The person in the upper center of the image is Lenore Alexander, who founded a nonprofit organization aimed at advocating for continuous electronic monitoring of patients who have received anesthetic injections.

According to data provided by the Joint Commission (a U.S.-based nonprofit organization dedicated to accrediting healthcare institutions), 29% of anesthesia-related medical malpractice incidents (including those resulting in death) were attributable to inadequate monitoring of patients’ conditions.

Generally, to prevent such incidents, a common solution is to equip patients with fingertip sensors that can measure the concentration of oxygen molecules in the blood. Another device assesses room ventilation by measuring the patient’s exhaled breath. While both devices are commonplace in intensive care units (ICUs), they have not been widely adopted in general wards.

Approximately 70 hospitals and healthcare institutions are currently using the Rothman Index system. A mid-sized hospital with 300 beds would incur a cost of approximately $150,000 for implementation.

This software was jointly developed by brothers Michael Rothman and Steven Rothman. In 2003, their 87-year-old mother, Florence, showed signs of clinical deterioration while hospitalized. However, due to inadequate monitoring mechanisms at the time, it was too late for medical staff to intervene effectively when these signs were detected. This experience motivated the brothers to develop the software. The software utilizes information from 26 medical variables to assess a patient’s physiological status, assigning a score on a scale of 1 to 100, which is updated regularly on a daily basis. A lower score indicates that the patient requires closer observation and immediate medical attention.

Following a review of existing medical protocols by the Department of Pediatric Critical Care Medicine, the University of Pittsburgh Medical Center’s Children’s Hospital will launch the Rothman Index system for pediatric use next month. This software updates the clinical status of pediatric patients every 15 minutes and promptly alerts the rapid response team when a patient’s condition deteriorates to a predefined threshold.

“Every child admitted to our hospital is extremely vulnerable, so we use electronic eyes to monitor them around the clock,” said Robert Clark. Dr. Clark currently serves as the Director of the Division of Critical Care Medicine at UPMC Children’s Hospital of Pittsburgh and is a co-investigator in the aforementioned study.

Houston Methodist Hospital in Texas began piloting the Rothman Index software in two departments last July, and has now expanded its use to 11 departments. Katherine Walsh, a nurse and Associate Director of Operations at the hospital, stated, “Within three months, the software identified 25 cases of subtle deterioration that were difficult for healthcare providers to detect manually. It not only serves as a diligent nurse but also highlights areas where improvements are needed.” If a patient’s condition continues to decline, the software can also assist medical staff in determining when to discuss end-of-life care with the patient’s family.

Yale-New Haven Hospital in Connecticut began using the system in 2011. The hospital has also partnered with Rothman developer PeraHealth, based in Charlotte, to co-develop additional medical devices. According to research conducted by the hospital, the Rothman Index can more accurately predict whether discharged patients’ post-discharge health status will deteriorate to a critical level requiring readmission. Dr. Thomas Balcezak, an attending physician at Yale-New Haven Hospital, stated, “In this way, the software can effectively reduce the likelihood of patient readmissions.”

Lenore Alexander established a nonprofit organization, Leah’s Legacy, in 2013. The organization’s mission is to advocate for continuous electronic monitoring of patients who have received anesthetic agents. Alexander had an 11-year-old daughter who passed away 12 years ago at Cedars-Sinai Medical Center in Los Angeles. Her daughter died from respiratory arrest triggered by the administration of anesthetic analgesics. This respiratory arrest went undetected by any medical staff, and her lawsuit against the hospital has long since been resolved.

She said, “Monitors are one of the life-saving tools currently available to us.” She is now collaborating with another non-profit organization dedicated to patient safety. In fact, she does not advocate for any specific medical company or product; her sole aim is to advise patients and their families, encouraging them to ask hospitals, “How is our health status being monitored, by whom, and for how long?”
A female spokesperson for Cedars-Sinai Medical Center stated, “Patient privacy laws prohibit us from discussing any specific case. However, we conduct meticulous monitoring of patients who have received anesthetics, and we provide additional risk assessment and treatment to those experiencing respiratory distress. We are committed to helping them overcome the suffering caused by their conditions while safeguarding their lives.”

Compiled by: Zhou Changling | Editor: Mo Renying