Computers and the rehabilitation field.

Computers and the Rehabilitation Field

Computers -- those machines that rapidly process words, calculate numbers, store massive amounts of data, merge files, remember instructions, and find information -- have invaded the workplace, including rehabilitation settings. Computers, according to the Dreyfus brothers, "are more deliberate, more precise, and less prone to exhaustion and error than the most conscientious human beings." Rehabilitation administrators have joined their business counterparts in exploring ways to use the new information technology to improve efficiency and perhaps even effectiveness of their service delivery systems.

In 1987, as a Mary E. Switzer Distinguished Fellow, I surveyed state rehabilitation agencies, researchers and educators to determine present and potential uses of computer systems in the rehabilitation field. Eighty-nine percent of the state rehabilitation agencies responded. Seventy-six percent of the 5-year grantees of the National Institute on Disability and Rehabilitation Research and seventy-three percent of the Regional Rehabilitation Continuing Education Programs participated.

Uses

State rehabilitation agencies reported a wide range of computer applications. The most frequent use of computer systems, as might be expected, revolves around statistical and financial reporting related to client services. Several agencies reported integrating caseload and expenditure/encumbrance data. Some automated the billing and payment process to improve the timeliness of payments and to comply with new state laws governing payments to vendors, clients and personnel.

Other central office uses of computers relate to personnel, inservice training, program planning, program evaluation, and other administrative areas. Here, too, the budgetary and expenditure aspects have been automated along with inventories, mailing lists and calendars. Sixty-three percent of the respondents indicated they daily use computer networks such as Rehabnet, and eighteen percent indicated a weekly use of electronic networks. The networks help state agency staff stay updated on legislative and administrative issues. One state director reported networking electronically with directors of other departments in his state on a regular basis.

Automation of rehabilitation professional functions is occurring more slowly. However, the potential is great not only for rehabilitation counselors, but also for vocational evaluators, placement specialists and others. Automation is occurring in a few agencies in psychological and vocational testing, career information and guidance systems, and job matching as well as in client tracking and budget monitoring at the local level. Even clients are getting involved in a few instances and using computers directly to give intake data, explore vocational interests or train for programming or word processing jobs.

Hardware and Software

The 1987 survey also revealed information on the hardware and software in use among rehabilitation agencies. Fifty-seven percent of the agency repondents indicated they had computer terminals in one or more field or district offices and seventy-three percent had microcomputers in one or more field or district offices. When it comes to computer brands, IBM leads the way among state agencies at both the mainframe and microcomputer levels. Most mainframe software used in state agencies is customized, while micro-computer software is generally commercial. Commercial word processing software include the most popular brands: Display Write, Word Perfect, Word Star, and Multimate. Among spreadsheets and database managers, Lotus and D-Base are the more popular.

A variety of software is available or being developed by Research and Training Centers, Rehabilitation Engineering Centers and rehabilitation agencies. The new software programs assist with tracking clients in rehabilitation facilities, disability determination units, business enterprises, client assistant projects, independent living programs, and field rehabilitation settings. Special software programs have been created for assessing visual demands in the work environment, neuropsychology, motor skill performances, work personality, muscle fatigue, muscle strength, and available motion. Some software programs such as Spectrum are designed for a complete electronic workstation for rehabilitation counselors.

Costs of agency owned computer equipment for 74 percent of the responding rehabilitation agencies is less than $500,000.

Benefits and Problems

Agencies reported a number of benefits in the new information technology. Quicker access to stored information, 93 percent, and greater capacity to process information for making more effective decisions, 90 percent, were at the forefront of the list of perceived benefits. Other benefits included increased capabilities for intra-and interorganizational communications, 68 percent; time freed from information acquisition or processing for other tasks, 67 percent; significant space saved for information storage, 63 percent; reduction in paperwork, 60 percent; more timely availability of caseload data for rehabilitation counselors, 54 percent; and increased sense of professionalism among users, 49 percent.

When it came to identification of problems associated with computerization, agencies reported more nontechnical problems than technical ones. Nontechnical problems ranged from insufficient staff to train or implement the new systems to delays in obtaining state approvals or funding. Difficulties in clarifying information needs or in handling internal resistance seemed more problematic than difficulties related to computer equipment.

Individuals interested in further details about the 1987 national study may request a copy of Uses and Potential Use of Information Technology by State Rehabilitation Agencies, NIDRR Five-Year Grantees, and RCEP's from the National Rehabilitation Information Center, Macro Systems, 8455 Colesville Road, Suite 95, Silver Spring, Maryland 20910. That final report describes not only the results of the survey but also six case studies, a cost-effectiveness model for information technology, a discussion on automation of the rehabilitation counselor function, and discussion on inter- and intra-organizational collaborations. A companion document, entitled, An Administrator's Guide to the Selection and Cost-Effective Use of Information Technology, is also available.

The Future

The rehabilitation field is on the computer bandwagon. Organizations such as the Rehabilitation Technology Association and the West Virginia Research and Training Center are helping pave the road to effective uses of information technology. The Rehabilitation Technology Association (RTA) provides opportunities for information exchange among administrators, supervisors, technical support staff, and field staff interested in information technology. Public and private rehabilitation organizations and facilities are invited to participate. RTA publishes a newsletter and sponsors an annual conference. They are developing an electronic bulletin board to provide online information exchange.

The West Virginia Research and Training Center is the first center sponsored by the National Institute on Disability and Rehabilitation Research to focus on "Improving the Management of Rehabilitation Information Systems." Over the next 5 years the center will be developing a number of technology related resources with the help of varied focus groups. The focus groups include people with disabilities and their families, service providers, employers, policy makers, legislators, and educators. The resources include, but are not limited to:

* a comprehensive computer software system for service planning and case management;

* a computer-based model for evaluation of rehabilitation process and outcomes;

* a "how to" guide for processing information to make better decisions;

* enhanced access to and use of disability-related information systems;

* standards for database construction;

* training to improve rehabilitation information management; and

* technical consultation.

Ms. Edwards, a former Mary E. Switzer Distinguished Fellow, 1986-1987, is Assistant Professor, Pennsylvania College of Optometry.