Facilitating Pediatrician Buy-in: a Technological Solution for Integrating An Autism Screener into the Medical Office Work Flow

Background: Following the CDC report that approximately 1 in 150 children in the United States has an autism spectrum disorder (ASD), the American Academy of Pediatrics has released clinical guidelines recommending that pediatricians screen all infants for autism, at 18- and 24- months, during well baby checkups. In the managed care environment where doctors may have limited time to spend with each patients, the question then becomes how do we make it feasible for physicians to engage in the systematic use of a given autism screening instrument?

Objectives: Our goal was to design a technological solutions that would facilitate the integration of an autism screening form into the medical office's work flow and to engineer incentives that would provide value added data for the physician.

Methods: We conducted a case study on a parent who had well baby checkup experience for two children from 2005-2008. The well-baby visit protocols were analyzed for two medical offices in two states. The routines were found to be very similar. First, a staff member would measure the child's height, weight and head circumference. Then the physician would discuss the measurements with the parent, making reference to how the child compared to the norm. In one case, the parent was given a print out of the child's longitudinal data to keep for her records. The case study also revealed that because the family relocated to another state the older child saw different pediatricians during the second year of life.

Results: Our case study suggests that in order to increase physician buy-in to the practice of screening for autism at 18- and 24-months the medical staff must administer and process all logistical issues related to the instrument and physicians should be provided with data concerning normed values. We also found that continuity of care cannot be assumed and that physicians need to have access to longitudinal data. Thus we created a software program that accounts for these factors in two steps: scanning a demographic sheet and the autism screener. The software generates a personal identification code using the 4 questions on the demographic sheet. When the screener is scanned the program automatically tags it with the id, scores the screener and stores the results. Our program then generates data concerning the child's performance compared to the normed values and if applicable, data from the child's 18-month results. The staff can then give these to the physician and the parent.

Conclusions: To date researchers that study ASD have devised many screening and diagnostic tools. However, there has been little research into how these tools can be integrated into the work flow of the medical office to ensure physician buy-in. The next step for our study is to deploy our program in local medical offices. The technological solution we propose has the potential to penetrate the work flow of pediatrician's offices because it follows standard protocol that are the mainstay of well baby visits and provides comparison to normed values as well as longitudinal data across different medical offices.