Utilizing an EMR Tool to Demonstrate Increased Feasibility of Autism Diagnosis
Douglas Wells1, Mikael Guzman Karlsson1, Christina Massrey1, Meagan Newell1, Steven Lazar1, Kristen Fisher1
1Baylor College of Medicine and Texas Children's Hospital
Objective:
To increase the amount of autism spectrum disorder (ASD) diagnoses by pediatric neurology fellows through utilization of an integrated electronic medical record (EMR) tool.
Background:
Early initiation of applied behavioral analysis (ABA) therapy children with autism spectrum disorder (ASD) leads to increased language and communication skills. In the United States, the mean age for a child to receive a diagnosis of ASD is between 3.8-4.4 years, despite symptoms developing within the first two years of life. The American Academy of Pediatrics recommends screening for autism at 18 and 24 months, and positive screens should be referred. While it also recommends referral for intervention without an ASD diagnostic evaluation, most insurance companies do not cover ABA therapy without a diagnosis, and the therapy is not affordable for families without insurance coverage. Referrals for diagnosis typically go to neuropsychologists, developmental behavioral pediatricians, and pediatric neurologists.
Design/Methods:
In this study, we surveyed the frequency that pediatric neurology fellows at a large children’s hospital made diagnoses of autism, and how often they referred children to other providers for the diagnosis. The most common tests used to make the diagnosis is the Childhood Autism Rating Scale-2 (CARS-2). We converted this tool from a paper format to an electronic test via our EMR. We surveyed whether this would make fellows more likely to make a diagnosis rather than refer the patients to another provider, and trained them on proper utilization of the tool itself.
Results:
The availability of the CARS-2 electronically rather than on paper decreased the likelihood of referral for an autism diagnosis.
Conclusions:
Utilizing an electronic tool increases the feasibility to make a diagnosis, and this could be expanded to providers with or without the paper tool and allow them to make the diagnosis, decreasing the time between referral and diagnosis, allowing children to receive treatment sooner.