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ATTACHMENT
VHA PROSTHETIC CLINICAL MANAGEMENT PROGRAM (PCMP)
SUPPLEMENTAL GUIDELINES FOR THE PROVISION OF LOCAL SERVICES FOR COMPUTERS,
PERIPHERALS AND SOFTWARE
As part of the process of developing a comprehensive national strategy to
provide standardized computers, software, peripherals and training to
blinded veterans, it was determined by the PCMP workgroup that a need also
exists to provide guidelines for local support services to blinded veterans.
I. Covered Services
The following reasonable, necessary and required support services will be
provided to blinded veterans requesting assistance with computer systems,
peripherals and software. Identified providers in the community will provide
the services on a fee for services basis.
1.. The Computer hardware and software may be prescribed through an
outpatient or inpatient program, i.e., VIST, BROS, VA low vision clinic,
BRC, VISOR, or approved non-VA agency or provider serving the blind and
visually impaired.
B. Blinded veterans, who are deemed appropriate for local
training by
the
VIST Coordinator may be considered for local Fee Basis services, if
eligible. If Fee Basis service will not cover cost, the local Prosthetic
and Sensory Aids Service is permitted to procure computer equipment,
evaluation and training according to VHA Handbook 1173.5 (dated September
23, 2002), section 4d(3) (b) and 1173.5, section 10. The veteran needs to
be enrolled and vested.
C. Training may take place in the veteran's home or at another acceptable
location. This includes education and training on upgrades of software and
hardware.
D. In home repair service (includes education, training, repair,
configuration
and/or set-up) within 14 working days after Prosthetics receives a written
request from the Visual Impairment Services Team Coordinator. If in-home
service is not available, Prosthetics will arrange to have the equipment
shipped to and from an authorized service center.
5.. All telephone support will be provided within 24 hours of
notification
to the VA.
6.. Set-up and delivery of computer hardware, peripheral devices and
software that are being replaced or upgraded. Replacement of a hard drive
will include installation of operating system and access software.
7.. Diagnosis and troubleshooting of all computer related problems that
prevent full use of the computer system (e.g. removal of viruses, solving
e-mail problems).
8.. Replacement ink and toner cartridges will be provided for all
printers
issued by the VA.
9.. Set-up and configuration of e-mail and Internet access.
10.. Set-up and configuration of anti-virus programs.
II. Identification of Local Service Providers
1.. Qualified service providers will provide verification of competency
to
provide quality training and installation of computer equipment, software
and access technology. (See Attachment).
2.. A list of qualified service providers will be established with a
collaborative effort between VIST, BROS and Prosthetics.
3.. The Prosthetic Activity will maintain a roster of qualified and
competent service providers.
III. Procedures
A. Veterans requesting local training to qualify for issuance of
a
computer, peripheral or software will present a written request with
justification through the VIST Coordinator or BROS.
B. The VIST Coordinator will send a consult to Prosthetics
containing a
justification of need.
C. After the Prosthetics Activity receives the consult, they will
authorize and make arrangements to have services provided by an authorized
service provider.
D. Computer packages provided under the national contract will be
configured and delivered to the location stipulated in the purchase/delivery
order.
E. After delivery, the computer will be set up in an
appropriate
location and tested to ensure proper configuration. E-mail and Internet will
be connected. Anti-virus programs will be installed and configured.
F. All equipment and software will operate properly at the
completion
of set-up and the veteran will be provided any necessary orientation and
continued education.
G. Blinded veterans experiencing difficulties using VA issued
computer
equipment and software will report problems to the VIST Coordinator.
H. The VIST Coordinator will identify the nature of the problem
and
submit a consult to Prosthetics Service requesting a local service provider
be authorized to evaluate and troubleshoot the problem.
I. After the Prosthetics Activity receives the
consult requesting
service, repair or issuance of computer related equipment or software, they
will authorize and make arrangements to have services provided.
J. The service provider will contact the veteran within
one workday to
assess the extent of the malfunction and determine if the problem can be
resolved through telephone consultation.
K. If the problem cannot be resolved through a telephone
consultation,
the service provider will be authorized to conduct an on-site evaluation.
Veterans residing in remote areas that are difficult for a service provider
to conduct an on-site assessment will be instructed to ship the computer
system or components to a service provider.
L. Contractors will submit a completed work order to the
Prosthetics
Activity for payment. The report will include an itemized listing of charges
and fees as well as a description of the services provided.
M. Appropriate fees and charges will be determined by the Prosthetics
Service at each facility
IV. Quality Assurance
A. Service call work orders, training, and repair invoices will
be
signed by the veteran to indicate completion of the work.
B. The VIST Coordinator and Prosthetics will be responsible for
quality
control in a collaborative manner. The stakeholders will also be consulted
and involved.
V. Training and continuing education by Non-VA Service Providers
A. Non-VA service providers (e.g. community based agencies,
technicians
and vendors specializing in access computer training, equipment) will
provide initial training when authorized as well as continuing education and
training to the veterans at the time of a service call.
B. All education and training will be documented in the repair or
service invoice that is submitted to Prosthetics for payment.
VI. Service to remote sites
A. Veterans residing in areas too remote for on site service
calls will
be authorized to ship their computer and/or peripherals to the local service
provider via UPS, FedEx or other suitable mode of transportation.
B. The cost of shipping to and from the veteran will be paid by
Prosthetics.
VII. Non-VA Local Service Provider
Responsibilities
A. Technicians and instructors will be technically and
functionally
competent to deliver, set-up accessible computer equipment provide on-site
education and training on access and computer related issues, diagnose and
troubleshoot computer related problems. (See Attachment).
B. Technicians will adhere to any instructions provided by
manufacturers
or VA staff regarding special set-up of equipment and/or software.
C. Technicians may provide support or initial diagnosis of
computer
related problems via telephone consultation with veteran. If the problem
cannot be resolved through telephone consultation, then an on-site service
call will be provided.
D. When replacing a hard drive, Technicians will also reinstall
the
operating system (OEM) and access software.
E. Technicians will provide any necessary on-site education
and
training during installation of initial equipment or upgrades of hardware
and software. This will be done to minimize unnecessary service calls and
repairs.
F. If appropriate, Technicians will connect or re-connect
electronic
mail and Internet access and configure the operating system as required.
G. Technicians will remove detectable viruses and install
anti-virus
software or the latest upgrade of anti-virus software during on-site service
calls.
H. Instructors providing initial computer, peripheral and
software
training will have established the same competencies as instructional staff
at a
VIII. VIST Coordinator and BROS responsibilities
A. Assist Prosthetics in the identification of qualified local
service
providers.
B. Educate veterans about the process for obtaining services
C. Partner with Prosthetics Service in problem solving and
dispute
resolution.
D. Assist in developing and monitoring quality assurance issues.
IX. Prosthetic Service Responsibilities
A. Maintain a list of qualified vendors.
B. Purchase access software upgrades.
C. Pay for services authorized.
D. Monitor quality and timeliness of services.
E. Partner with VIST in resolving disputes.
F. Partner with VIST to develop a local quality assurance
monitoring
process.
G. Determine fees for services.
H. Umbrella contracts may be authorized.
I. Contract with multiple service providers.
J. Develop contracts with regional repair facilities and
vendors where
the remoteness of an area prevents local services.
K. Pay for justified and necessary computer training in the local
community.
X. Service of Computers, Peripherals and Software not provided under the
National Computer Contract or under its warranty
A. Local Prosthetic Activities will be responsible for repair,
replacement and service of computers and peripherals not covered under the
National computer contract.
B. Local Prosthetic Activities will be responsible for providing
service
locally on computers, peripherals and software issued under the National
computer contract when the need for such service is not covered under the
national contract.
C. Local Prosthetic Activities will be responsible for providing
the
service, repair and replacement of peripheral devices no longer covered
under the manufacturer warranty
VHA PROSTHETIC CLINICAL MANAGEMENT PROGRAM (PCMP)
CLINICAL PRACTICE RECOMMENDATIONS FOR THE PRESCRIPTION OF
COMPUTERS AND
PERIPHERAL DEVICES TO BLIND AND VISUALLY IMPAIRED VETERANS
I. Purpose
The purpose of these clinical practice recommendations is to
assist practitioners in clinical decision-making, to standardize and improve
the quality of patient care, and to promote cost-effective prescribing.
II. Background
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 develop
clinical practice recommendations to be used by clinicians to write appropriate
prescriptions; to standardize issuance criteria, evaluation and training; to
assure technology uniformity; to provide patient care that will lead to valid
outcome measures and analysis for research purposes.
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
recommend clinical practice recommendations regarding issuance criteria for
Computers and Computer related Devices and Access Software.
III. Issuance Criteria
The following criteria must be met for veterans to be
evaluated and trained on a computer device with access technology.
A. Determined by an eye care professional (optometrist or
ophthalmologist) to be legally blind or 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 professional. The low
vision examination should evaluate the veteran's ability to benefit from
corrective lenses, reading glasses, and low vision devices, to maximize access
to computer information. It is the responsibility of the eye care professional
to determine the level of visual impairment and the best set of optics
available for the veteran to properly access the computer system.
C. The veteran has a stated goal's that require the use of a
computer, peripherals and access software.
D. A comprehensive audiologist evaluation should be
completed for veterans requiring speech output computer access technology. This
will ensure that veteran has maximized his or her ability to hear the speech
output.
E. The veteran demonstrates the ability to independently use
the prescribed devices and software to effectively meet the stated goal's.
F. Prior to prescribing a computer, peripherals and
software, the veteran should evaluate all approved options to accomplish the
stated goal's including, but not limited to, different size 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
prescribed must prove to be the most efficient and effective means to meet the
veteran's needs and accomplish the stated goal's.
H. Veterans determined by medical providers or instructional
staff to have difficulty using a keyboard for inputting information may be
considered for voice or other input options.
IV. Clinical Practice Recommendations for
Evaluation/Training
A. The Computer hardware and software may be prescribed
through an outpatient or inpatient program, i.e., VIST,
B. Blinded veterans, who are deemed appropriate for local
training by the VIST Coordinator may be considered for local Fee Basis
services, if eligible. If Fee Basis service will not cover cost, the local
Prosthetic and Sensory Aids Service is permitted to procure
computer equipment, evaluation, and training according to VHA Handbook 1173.5
(dated September 9, 2002), Section 4d(3)(b) and 1173.5, section 10. The veteran
needs to be enrolled and vested.
C. Evaluation and Training Procedures: The prescribing
program must have a VA approved evaluation and training program that is
outlined in a policy and procedure manual that addresses evaluation, training
and issuance procedures on computers, peripherals and adaptive access software
and devices.
D. The evaluation process should include consideration of
ergonomics, comfort, health status, 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 veterans
will be given a reasonable opportunity to successfully complete any necessary
training.
F. Training is required if a veteran is unable to
demonstrate the ability to functionally use a computer, peripherals and access
software in an effective manner to meet stated goals. There is no requirement
for training if the veteran can demonstrate the ability to successfully meet
the standard outcome measures outlined in this document during the evaluation
process.
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 evaluated. These alternatives include,
but are not limited to, portable laptop computers suitable for use by a blind
and/or visually impaired individual.
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 OCR software to scan and read.
J. Replacement Printer Cartridges: Local Prosthetics 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. Veterans requesting additional training for an upgraded
system may return to a BRC program for training, however, this is not required
if training is not necessary or there are local options available to provide
the training. The decision to upgrade a computer component or system is the
responsibility of the local VIST program and Prosthetics Manager when a veteran
does not return to a BRC program for additional training.
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
e-mail, 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 prescribing computer related
equipment must have an appeal process in place.
V. Documentation
Appropriate documentation will be maintained in the medical
record that clearly identifies the veteran's stated goals; the evaluation and
training provided; and the veteran's functional ability to use the prescribed
equipment and software effectively to meet the stated goals.
VI. Quality Management
Prescribing programs will maintain documentation of an
active quality management program that regularly identifies issues, concerns
and problems and strives to provide the highest quality of care.
VII. Outcomes
Veterans must demonstrate the ability to independently
operate the computer hardware and software to achieve their stated goal(s).
Outcomes may include the following:
1. Ability to identify components and effectively use the
computer hardware, software and peripherals.
2. Ability to appropriately use the devices to meet stated
goals.
3. Ability to functionally use the access software.
4. Ability to load software programs as needed.
5. Ability to clean, care for, maintain and trouble shoot
the device.
6. Ability to print documents.
7. Ability to use the major operating commands designed for
the
particular software/hardware package.
8. Ability to touch type or demonstrate ability to enter
commands.
9. Ability to perform basic word-processing tasks (as
appropriate).
10. Ability to use a scanner to meet stated goals.
11. Ability to read, send and receive E-mail in a functional
manner.
12. Ability to independently navigate the Internet.
VIII. References
A. BRS CAT Policy and Procedures Manual (When published)
B. VHA Handbookj 1173.5, Aids for the Blind, dated 9/23/02.
C. Supplemental guidelines for the Provision of Local
Services for Computers, Peripherals and Software (attached)
APPROVED/: _ SIGNED 8/16/04
Jonathan B.
Acting Under
Secretary for Health
