, VHA PROSTHETIC CLINICAL MANAGEMENT PROGRAM (PCMP) CLINICAL PRACTICE RECOMMENDATIONS FOR THE PROVISION OF COMPUTERS AND PERIPHERAL DEVICES TO VETERANS WITH A VISUAL IMPAIRMENT I. PURPOSE The purpose of these clinical practice recommendations is to assist practitioners in clinical decision-making and delivery of services, to standardize and improve the quality of patient care, and to promote cost-effective provision of computers and peripheral devices. II. BACKGROUND In 2001, VHA's Prosthetic and Sensory Aids Service Strategic Healthcare Group was directed by the Under Secretary for Health to establish a Prosthetic Clinical Management Program (PCMP). The objectives are to coordinate the development of clinical practice recommendations for prosthetic provision practices and contracting opportunities; assure technology uniformity and ease of veteran access to prosthetic devices; and provide patient treatment that leads to valid outcome evaluations and analysis for program monitoring and continuous quality improvement. A work group with input from selected clinicians, blind rehabilitation specialists, prosthetic representatives and a consumer representative from the Blinded Veterans Association (BVA) convened to develop clinical practice recommendations regarding provision of Computers and Computer related Devices and Access Software for eligible veterans who are visually impaired. III. CLINICAL PRACTICE RECOMMENDATIONS The following criteria must be met for visually impaired veterans to be provided, evaluated, and trained on a computer device with access technology. A. Determined by an eye care practitioner (optometrist or ophthalmologist) to have a visual impairment so significant that the veteran may benefit from adaptive computer access devices or software. B. Veterans with residual vision should complete a comprehensive low vision examination by an eye care practitioner. The eye care practitioner should determine the level of visual impairment and prescribe optical and non-optical devices to optimize computer use. C. The veteran has a stated goal(s) that require(s) the use of a computer, peripherals and access software. D. Veterans with suspected hearing impairment (dual sensory impairment) should have a comprehensive audiology evaluation by an audiologist. When indicated, the veteran should receive appropriate amplification devices, including but not limited to hearing aids and/or assistive listening devices, to maximize use of his/her residual hearing and speech recognition ability prior to recommending computerized speech output devices. E. The veteran must demonstrate the ability to independently use the provided devices and software to effectively meet the stated goal(s). F. Prior to providing a computer, peripherals and software, the veteran should evaluate all approved options to accomplish the stated goal(s) including, but not limited to, various sizes of liquid crystal display (LCD) monitors, types of printers (inkjet or laser), input devices (mouse or trackball), scanners and access software options. G. The computer, peripherals and access software that are recommended must prove to be the most efficient and effective means to meet the veteran's needs and accomplish the stated goal(s). H. If the veteran is determined by medical providers or instructional staff to have difficulty using a keyboard for inputting information, voice recognition or other computer input options may be considered. IV. EVALUATION/TRAINING RECOMMENDATIONS A. The local VIST program is responsible for recommending a veteran for computer access evaluation and training. VIST referrals may be made to a Blind Rehabilitation Center (BRC), Blind Rehabilitation Outpatient Specialist (BROS), Visual Impairment Services Outpatient Program (VISOR), Visual Impairment Center to Optimize Remaining Sight (VICTORS), VA Low Vision Clinic, or an approved non-VA agency or provider serving the blind and visually impaired. B. Visually-impaired veterans, who qualify for local computer access training as determined by the VIST Coordinator, may be funded for local training by Prosthetic and Sensory Aids Service according to VHA Handbook 1173.5 (dated September 9, 2002) Section 4d(3)(b) and 1173.5 Section 10. This funding may cover evaluation and training costs, as well as any costs associated with the purchase of equipment recommended by the instructor. C. The providing program must follow VA Computer Access Training (CAT) program procedures as described in the VHA CAT Handbook. D. The evaluation process should include consideration of ergonomics, comfort, health status, visual impairment, hearing impairment, physical limitations, special learning needs, patient preferences as well as performance level when determining efficiency and effectiveness. The evaluation process should include documentation of training needs, the appropriate learning environment, and/or any training modifications necessary for the veteran to successfully achieve his/her stated goals. E. Training should be designed and paced to meet the specific goals, objectives and capabilities of each veteran. Blinded and visually-impaired veterans will be given a reasonable opportunity to successfully complete necessary training. F. There is no requirement for training if, during the evaluation process, the veteran can demonstrate the ability to successfully meet the Outcome Measures outlined in Section VII. G. Portable Computer Systems: When the veteran presents with vocational, educational, and/or avocational goals requiring portability that cannot be adequately accomplished with a conventional computer, then the appropriate portable alternative may be issues or authorized. H. A portable computer system can be issued in addition to a standard desktop model when the veteran's needs necessitate the use of both devices. I. Scanners: The provision of a scanner is authorized when the goals of any eligible veteran involve the need to use a scanner to input documents and/or use optical character reader (OCR) software to scan and read. J. Replacement Printer Cartridges: The local Prosthetics Activity will provide replacement printer ink and toner cartridges to veterans who have been issued a VA computer system. K. Request for Upgraded Equipment: Veterans requesting upgraded computer systems or components must have a functional need or reason for an upgraded system. The local VIST program is responsible for recommending additional training (when needed) and determining where the training should take place. If additional training is not needed, the decision to upgrade a computer component or system is the responsibility of the local VIST program in consultation with the Prosthetics Manager. L. Service. Repairs and Replacements: The local Prosthetics Activity will be responsible for servicing or replacing computer equipment not covered by the warranty section of the national contract. This includes arranging a service call or shipping the computer equipment to a vendor when necessary. When issuing new equipment, upgrades, or replacement components, the local Prosthetics Activity will be responsible for set-up and delivery as needed. This may include configuring the equipment, setting up email, and providing instruction to ensure proper use of the new equipment. Additional information regarding the provision of local services to veterans with computers, peripherals and software issued by the VA is contained in the "Local Service Guidelines" which are a supplement to this document. M. Appeals:. Each program providing computer related equipment must have an appeal process in place for veterans denied these devices. V. DOCUMENTATION Appropriate documentation must be maintained in the medical record that clearly identifies the need and justification for these computer devices based upon the veteran's stated goals, the evaluation and training provided, and the veteran's functional ability to use the provided equipment and software effectively to meet the stated goals. VI. QUALITY MANAGEMENT These programs will maintain documentation of an active quality management program that regularly identifies issues, concerns and problems, strives to provide the highest quality of care, and maximizes patient outcomes. VII. OUTCOME MEASURES At the conclusion of training, veterans must be able to demonstrate the ability to independently and safely operate the computer hardware and software to achieve their stated goal(s). Outcomes for use of computers and peripheral devices may include the following: A. Ability to identify components and effectively use the computer hardware, software and peripherals. B. Ability to appropriately use the devices to meet stated goal(s). C. Ability to functionally use the access software, D. Ability to load software programs as needed. E. Ability to clean, care for, maintain and trouble shoot the device. F. Ability to print documents. G. Ability to use the major operating commands designed for the particular software/hardware package. H. Ability to touch type or demonstrate ability to enter commands. I. Ability to perform basic word-processing tasks (as appropriate). J. Ability to use a scanner to meet stated goals. K. Ability to read, send and receive E-mail in a functional manner. L. Ability to independently navigate the Internet. VIII. References A. BRS CAT Policy and Procedures Manual (When published) B. VHA Handbook 1173.5, Aids for the Blind, dated 9/23/02., C. Supplemental guidelines for the Provision of focal Services for Computers. Peripherals and Software tattacileM IS APPROVED: Michael Kussman, MD, MS, MACP Acting Under Secretary for Health Date: 2147/07 Computer Instructor Competencies Checklist COMPUTER ACCESS TRAINING COMPETENCIESRATINGS: 1– Is not able to perform basic tasks. 2 – Understands basic principles; can perform tasks with assistance or direction 3 – Performs routine tasks with reliable results; works with minimal supervision. 4 – Performs complex and multiple tasks; can coach others 1. Demonstrates the ability to assess a person's readiness for computer access training.12342. Demonstrates the ability to assess the equipment that will best meet a person's needs1234(computer, printer, scanner, monitor, keyboard & mouse).3. Demonstrates the ability to setup, configure and teach Magnification Access software1234used in the national contract (e.g. Zoom Text, Magic, etc.).4. Demonstrates the ability to setup, configure and teach Screen Reader Software used in1234the national contract (e.g. JAWS, Window-Eyes, etc.)5. Demonstrates the ability to setup, configure and teach OCR software used in the national1234contract (e.g. Open Book, Omni Page Pro, Kurzweil)6. Demonstrates the ability to setup, configure and teach peripheral devices (e.g. scanner,1234printer)7. Demonstrates the ability to plan and instruct in the basic Windows environment12348. Demonstrates the ability to plan and instruct computer basics.12349. Demonstrates the ability to plan and teach the installation and removal of software and1234hardware. 10. Demonstrates the ability to plan and instruct in using the Internet and setting up an1234Internet account.11. Demonstrates the ability to plan and instruct in reading and sending E-Mail_123412. Demonstrates the ability to plan and instruct File Management – including the folder structure; saving, copying, pasting, moving files and folders; deleting files and folders.123413. Demonstrates the ability to plan and instruct in the use of the CD-RW123414. Demonstrates the ability to plan and instruct in basic problem solving and maintenance (paper jams, viruses, scandisk).123415. Demonstrates the ability to plan and instruct in the use of a laptop computer123416. Demonstrates a functional understanding of the VA guidelines regarding issuance of computers, peripherals and software.123417. Demonstrates the ability to assess whether a veteran has met the requirements for being issued a computer system.123418. Demonstrates and verbalizes knowledge of age related competencies of Early1234Adulthood (18-40 years) by assisting clients to cope with physical, emotional and cognitive factors related to health and focus' • on stren • I - rather than weaknesses.19. Demonstrates and verbalizes knowledge of age related competencies of Middle1234Adulthood (40-60 years) by assisting clients to cope with physical, emotional and cognitive factors related to health and focusing on strengths rather than weaknesses.20. Demonstrates and verbalizes knowledge of age related competencies of Older1234Adulthood (60 years and older) by assisting clients to cope with physical, emotional and • •nitive factors related to health and focusin • on strengths rather than weaknesses.