By BETH RUDLOFF
Stephanie Alexander was an unusual engineering student 30 years ago. Not only was she a woman, she wanted to focus her engineering skills on healthcare. "I love to learn, I'm constantly trying to learn, and that's why I stay in healthcare. I'm constantly learning what nurses do, what physicians do, and will most likely always stay in this industry because it needs so much help."
Stephanie was one of the pioneers at Premier, Inc. where the first Medicare demonstration project rewarding hospitals for their quality results was awarded in 2003. "It was probably the proudest moment I have seen...we were able to leverage the 150 hospitals through just commitment from CEOs who believed in what we were doing, because we didn't have a contract, and we needed the commitment to go to Washington. It was a lot of courage on the CEO's part because they were going to have to be transparent," said Stephanie.
The risk paid off. CMS awarded incentive payments of more than $60 million to the participating hospitals. The secret to their success? Standardizing the data available for hospitals to see their performance, as well as comparing it to the data of other hospitals in order to facilitate further improvements.
While Stephanie was honing her engineering skills in process improvement with the use of data, Michael and Steven Rothman were also entering the healthcare field, albeit unexpectedly. The pair began innovating in healthcare after a personal tragedy highlighted cracks in the system. After their mother suddenly took ill, she was admitted to a premier hospital, fully equipped with an electronic medical records system and a physician at the helm - all of which were quite unusual at the time. Despite receiving excellent care from the skilled nurses and doctors, she slowly deteriorated and died. But what went wrong and why? With an electronic medical record in place, shouldn't there be sufficient data to give clinicians enough meaningful information about a patient to prevent this?
With Michael's mathematical and data analytics expertise, and Steven's manufacturing background, they were able to take routine data points in an EMR to develop a standardized risk index for each patient. Named the Rothman Index, this index can be monitored over time as well, highlighting deterioration requiring intervention. Think of it as a computerized, predictive, hardwired "rapid response team" to avoid unnecessary deaths. They tested their theory and their index at a few pioneering hospitals and determined that it could in fact make a statistically significant difference in patient outcomes.
In 2012 Stephanie joined forces with the Rothman's, developing the Rothman Index into PeraHealth and taking the helm as CEO. Now integrated into the EMRs of more than 80 hospitals, the team has developed additional uses for the data that are keys to solving some of the most vexing problems healthcare systems face: bed management, readmissions, and palliative care. She bases all these assumptions on strong, scientific and peer-reviewed data.
"Doctors will never use something that has not been peer reviewed...so we put a lot of focus around that," said Stephanie, "Once we achieved a peer reviewed 30 percent reduction in mortality at two sites, then I said 'OK, now it's time to forge forward with scaling the business.'"
What does the future hold for Stephanie and PeraHealth? They have three major goals: increased usage of the Rothman Index by more hospitals, development of telehealth surveillance of the index, and involvement of the family in monitoring the index - all of which should align PeraHealth even more closely to IHI's Triple Aim.
