[nabs-l] Has Anyone Used Titanium (Electronic Health Records system) or MyOutcomes App?

[Sarah Meyer]

Good afternoon,

I am writing to you seeking help and guidance regarding two
accessibility issues that I am encountering in my counseling practicum
clinic: 1) Titanium (an electronic Health records system) with the use
of JAWS (version 17) on a PC computer running Windows 7; and 2) the
MyOutcomes App and its associated measures (specifically the Outcome
Rating Scale, ORS, and the Session Rating Scale, SRS) with the use of
VoiceOver on an iPad as well as JAWS on a PC computer.  I will provide
some more information below but will do my best to not overcrowd this
list, so if anyone has any experience with either one of these issues
or any suggestions, please let me know; also, please let me know if
you need further clarification.  I have been working with my practicum
supervisor and the director of our clinic as well as Disability
Services to try to come up with short-termsolutions, and we are also
planning to engage in an interactive dialogue with the developers of
the MyOutcomes app to ensure accessibility from this point forward.
Even so with the support I am receiving, this process of encountering
these barriers has been extremely frustrating and exhausting in trying
to come up with solutions when I could be spending my time studying,
working on schoolwork, and preparing in more fulfilling ways for
working with my first client.

1.	In Titanium, I am somewhat able to navigate the system, but once I
find a client, I am not able to add a phone note or any other note for
that matter.  I am also unable to read the information entered on the
intake forms, which is a problem because I should be able to read
through that information independently like any other counseling
student would before his/her first session. Did I mention that I am
seeing my first client early next week? So I need to be able to access
this kind of information.
2.	Our clinic has every client fill out two evaluative measures during
every session: the ORS and the SRS.  There are 4 questions on each
measure and the client indicates their rating along a line ranging
from values of 0 to 10.  On the ORS, which is administered at the very
beginning of the session in order to provide the counselor with
information on the client’s functioning over the course of the past
week, the questions have to do with how the client is doing
interpersonally and in relationships, emotionally, etc.  The SRS is
administered at the end of the session and asks the client to indicate
if he/she felt like his/her goals were addressed, if the counselor
made him/her felt heard, etc.  The idea here is that once the
counselor sees this feedback, if there are any significant problems or
evidence of rupture, the counselor can address it in the present
moment before the client walks out the door before the possibility of
client not returning.
It was suggested by my supervisor’s supervisor that another clinic
staff administer the ORS to my client while she/he is in the waiting
room and then tell me the results before I go to get my client so I
can address any concerning results at the start of session.  Again,
the same concept for accommodation was suggested for the SRS that
someone would read me the results afterwards; however, in my mind this
is problematic because I would not be able to address any concerns
with the client unless she/he had felt comfortable to verbally bring
them to my attention at the end of session before walking out the
door. I think it will be my natural style to check in with clients at
the end of each session anyway to see how we are doing interpersonally
and to see how he/she is feeling about his/her needs being met and
being listened to as well as other factors.  But I can’t help but
wonder if there are other accommodations, such as tactile versions of
the scales and tactile methods of marking responses, to allow me
real-time feedback and processing just like other counseling trainees.
I have been playing around with different ideas in my mind and have
discussed options with our adaptive computer technology lab, and the
consensus is that it doesn’t seem like they can create a regular,
standard print version of the evaluation forms (which were used prior
to the app) with a tactile overlay.  I thought about using wicky
sticks to represent the lines and some kind of other material for the
marks, but then I start to wonder if this would make clients
uncomfortable to use such different techniques. Of course, they could
still mark their responses with pen on paper and the responses would
be entered into the app by clinic staff later.  The ideal will
obviously be for the developers to respond quickly to our request for
compliance with accessibility and that I will soon be able to read and
interpret my client’s responses and progress over time through the
app.

Thanks in advance for any feedback or suggestions.

All the best,

Sarah


-- 
Sarah K. Meyer
Graduate Student, Clinical Mental Health Counseling/Social Psychology
Ball State University
Board Member, National Federation of the Blind Human Services Division
Board Member, National Federation of the Blind of Indiana State Affiliate
sarah.meyer55 at gmail.com
(317)402-6632

The National Federation of the Blind knows that blindness is not the
characteristic that defines you or your future. You can live the life
you want; blindness is not what holds you back. Together with love,
hope, and determination, we transform dreams into reality.