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by Paula S. Cochran
With the advent of telepractice and the notion of "cyber clinics" (Tanner, 2001) looming on the horizon, never has it been more important for clinicians to be well informed about the potential benefits and pitfalls of using computers directly with clients. "Clinical computing competency" refers to the effective use of technology for diagnostic and intervention purposes. In other words, clinical computing often involves clients directly, as opposed to administrative computing, which involves functions like report writing, billing, or generating an Individual Education Plan (IEP).
In some cases, telepractice involves not only remote services, but also computer-based activities that form part of the intervention plan. In addition to telepractice considerations, therefore, we should be asking what clinicians need to know in order to achieve clinical computing competency. Whether working with a client who is six inches away or 60 miles away, effective clinicians should make use of the same basic principles. It's time to revisit the topic of what clinicians need to know about using technology for everyday clinical activities.
Members of ASHA have been considering the question of computer competencies for more than 20 years, since the advent of microcomputers made the topic important. At the pivotal 1985 American Speech-Language-Hearing Foundation Leadership Conference in Technology, participants were passionate about the technology skills that would be needed by the next generation of clinicians. Some were focused on "hardware skills" such as how to format a floppy (truly, floppy) disk. Some were focused on "software skills" and fervently debated just which computer programming language(s) clinicians should be required to know.
The cross-fertilization of ideas among early innovators and adopters was crucial, however, for finding a middle ground of use to many. A few years later, a starter set of suggested competencies was published in Asha magazine (Cochran et al., 1993). With this list, the authors took a decisive step in changing the focus away from computer literacy and the hardware versus software dichotomy. Instead, the focus shifted to how a clinician could use technology to fulfill a clinical purpose.
With an emphasis on clinical skills instead of computer literacy, the early list of clinical computing competencies held up remarkably well. The list has since been updated to include the areas of clinical computing competency outlined below. The notable absence of augmentative and alternative communication (AAC) was not an oversight. Clinicians providing AAC services could benefit from many of the competencies listed, but the scope and practice of AAC go well beyond this list and have been outlined by others elsewhere. There are 10 recommended broad clinical computing competencies that individual clinicians might achieve in any of a number of ways, depending upon their caseloads, their own interests, and their access to resources (Cochran, in press).
Clinical computing competency is not about being a computer expert, like good driving is not about being a car expert. Clinical computing competency depends more on sound clinical practices than it does on technical expertise. But this does not mean that we should expect clinicians to intuit what has been discovered by research or established by extensive clinical practice.
Although in-depth knowledge of computers isn't a prerequisite, there is still much to learn about effective and appropriate use of these tools. New technology products and online innovations face clinicians every day. How can these be evaluated by professionals who may not be familiar with existing technology applications, their strengths and weaknesses, the existing literature, or the ethical considerations that might affect their implementation? As a profession, we must ensure that special measures are taken to prepare and support clinicians in making appropriate, ethical, and effective use of new technologies on behalf of their clients.
How can a clinician go about pursuing some or all of the competencies described below. There are more exciting and effective technology applications available for evaluation and intervention with clients than ever before. As summer approaches, it's a good time to re-evaluate interests and skills and consider pursuing continuing education opportunities related to clinical computing competency. This might include participation in organized events (see sidebar on the right) and/or designing technology-related independent study plans for ASHA CEUs. State associations hold workshops and conferences, and clinicians should petition these and other continuing education sponsors for more help in this area. Individually, clinicians can share their own technology tips and expertise with colleagues. The Internet also offers ever-increasing information and support for clinicians pursuing clinical computing competency.
This article outlines competencies and provides some direction for clinicians who want to enhance their expertise and knowledge of technology. A decade ago, surveys of academic programs and school clinicians indicated an extensive need for more and better opportunities to acquire these skills (McRay & Fitch, 1996; Walz & Cochran, 1996). According to the U.S. Department of Education, school clinicians continue to report that instructional use of computers with students is an area in which they feel inadequately prepared. Within our field, we must work to address this need.
Paula S. Cochran is professor of communication disorders at Truman State University. In 1989 and 1990, she chaired ASHA's Standing Committee on Educational Technology, where some of the issues in this article were originally discussed. She has published and presented widely on the topics of educational technology and clinical uses of computers. She is the author of the text Clinical Computing Competency for Speech-Language Pathologists (in press). Contact her by e-mail at paula@truman.edu.
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