This study evaluated the relationship between physician experience and accuracy of developmental screening documentation in electronic medical records. The study reviewed records of 591 pediatric patients screened using the SWYC and M-CHAT tools. It found that only 45% of SWYC and 52% of M-CHAT screening results were documented, and only 73% of documented results were accurate. More experienced attending physicians did not differ from resident physicians in documenting SWYC screening results. Resident physicians were more likely than attendings to document M-CHAT results but less accurate in developmental screening documentation overall. The study highlights the need to improve standardized developmental screening documentation practices to facilitate early intervention.

1. Relationship between Physician Experience and Documentation Accuracy in
Early Childhood Developmental Screening
Anqi Zhou, Fatima Malik M.D., Marsheena Murray Ph.D., Melissa Armstrong-Brine Ph.D.
MetroHealth Medical Center affiliated with Case Western Reserve University School of Medicine, Cleveland, Ohio
Background
Hypotheses
Purpose
Methods
Results Discussion
Limitations
Implications
References
Acknowledgements
1. Screening results will be documented in the EMR in 90% of
cases for M-CHAT and SWYC.
2. 85% of the documented screening results will be accurate.
3. Level of physician experience (attendings vs. residents) will
positively impact the presence and accuracy of SWYC/M-CHAT
documentation.
 To evaluate how pediatric physician’s level of experience affects
documentation accuracy of M-CHAT and SWYC in EMR;
 To improve pediatric patient care quality and early intervention
through pursuing proper medical documentation.
 We thank the Chester Summer Scholars Program and the MetroHealth System
for providing the undergraduate research opportunity and financial support.
 The American Academy of Pediatrics suggests all infants and
young children be screened for developmental abnormalities at
regular intervals. Early detection of children's developmental
issues ensures optimal early intervention1
.
 The Survey of Well-being of Young Children (SWYC) and the
Modified Checklist for Autism in Toddlers (M-CHAT) are two
commonly used developmental screening instruments for
parents of children (ages 0-5 years for SWYC, 16-30 months for
M-CHAT) at well-child visits2
.
 Most U.S. hospitals use Electronic Medical Records (EMR) to
document patient visits, including screening results. Ensuring
accurate medical documentation is essential to improvements in
patient safety, future treatment, health care quality evaluation,
and hospital funding3
.
 Participants:
o 591 patients (ages 2mo – 7yr) at MHMC’s Pediatric Clinic
from November 17, 2015 to June 3, 2016.
 Database:
o EPIC, the Electronic Medical Records software used in the
MetroHealth System;
o M-CHAT/SWYC parent report data in hard copy.
 Procedure:
o Patient demographic information, physician experience level
(1st
to 4th
year residents and attending physicians), and the
presence and accuracy of screening results documentation
by physicians were extracted from the EMR;
o Analyses included descriptive statistics and non-parametric
analyses on categorical data.
 Factors other than physician experience might also affected the
accuracy of developmental screening documentation, such as
race and ethnicity, physician-patient communication efficiency,
and parents’ personal interest and concerns in developmental
and behavioral issues.
 These factors were not explored in the current study, due to its
retrospective nature.
1. Sand, N., Silverstein, M., Glascoe, F. P., Gupta, V. B., Tonniges, T. P., & O'Connor, K. G.
(2005). Pediatricians' reported practices regarding developmental screening: Do guidelines
work? Do they help? Pediatrics, 116(1), 174-179.
2. Moodie, S., Daneri, P., Goldhagen, S., Halle, T., Green, K., & LaMonte, L. (2014). Early
childhood developmental screening: A compendium of measures for children ages birth to five
(OPRE Report 201411). Washington, DC: Office of Planning, Research and Evaluation,
Administration for Children and Families, U.S. Department of Health and Human Services.
3. Thoroddsen, A., Sigurjonsdottir, G., Ehnfors, M., & Ehrenberg, A. (2013). Accuracy,
completeness and comprehensiveness of information on pressure ulcers recorded in the
patient record. Scandinavian Journal of Caring Sciences, 27, 84-91.
 Results show that about half of the screening results were
missing from EMR, and about a quarter of documented results in
EMR were inaccurate.
 EMR documentation should become more effective in crediting
the physicians for the time and effort they spend counseling
patients on developmental concerns.
 Inconsistent documentation may be a limiting factor to proper
patient care and early intervention for children in diverse
populations.
Actual Hypothesized
percent SWYC documented in EMR 45% 90%
percent M-CHAT documented in EMR 52% 90%
percent accuracy if documented in EMR 73% 85%
II. Hypotheses 1 & 2:
I. Patient demographics:
III. Hypothesis 3:
(1.5%)
(49.1%)
(22.0%)
(22.3%)
(5.1%)
 N = 591  In M-CHAT, a positive screen denotes “high risk
for autism.” In SWYC, a positive screen means
potential developmental or behavioral concerns.
=====================================================================================================================
==
 Among all SWYC and M-CHAT forms completed, only 45% of SWYC
and 52% of M-CHAT results were documented in EMR.
 Among the documented screening results in EMR (both SWYC and M-
CHAT), 73% of the cases were documented accurately in EMR.
 Chi-squared test for Independence:
o p = 0.445 > 0.05  Not significant;
o Attendings and residents are similarly
likely to document SWYC screening
results in EMR.
 Contrary to Hypothesis 3, level of physician
experience did not remarkably impact the
presence of SWYC documentation.
 Chi-squared test for Independence:
o ** p = 3.25 x 10-13
< 0.05  Significant;
o Residents are significantly more likely to
document M-CHAT screening results in
EMR.
 Contrary to Hypothesis 3, level of physician
experience negatively impacted the
presence of M-CHAT documentation.
 Chi-squared test for Independence:
o * p = 0.0466 < 0.05  Significant;
o Residents are significantly more accurate
in developmental screening
documentation in EMR.
 Contrary to Hypothesis 3, level of physician
experience negatively impacted the accuracy
of developmental screening documentation.
=====================================================================================================================
==
 Min. Max. Average Median
2 mo 92 mo 29.8 mo 24.6 mo
 This study reveals current weaknesses in the documentation of
early childhood developmental screening results. These
weaknesses may affect physician billing, clinical procedures, and
patient access to services.
 Given the importance of patients’ medical documentation, this
study further demonstrates a need to improve standardized
screening documentation to facilitate early intervention for
children’s developmental, behavioral, and psychological needs,
particularly in children from diverse backgrounds.
 Ways to enhance documentation may include using technology
to facilitate accurate scoring, and continuing education on
developmental screening practices for physicians.
 Overall, documentation accuracy of developmental screening
warrants continuing Quality Improvement efforts.