CHS HEALTHCARE SOFTWARE LIMITED

BroadCare

Supports healthcare organisations managing:
-NHS Continuing Healthcare(CHC)
-Funded Nursing Care
-Children’s CC
-Complex/Specialist/Joint-Funded/Section 117 & 75 services
-CAMHS
The secure, 'whole-system approach' solution supports:
-Paperless caseload data collection/storage/retrieval
-Case management workflow
-Resource planning/scheduling/progress
-Invoicing
-Reporting: real-time/scheduled/ad hoc, inc. NHSEngland quarterly DHSC returns
-Digital referral portal/form functionality.

Features

  • Bespoke, scalable CHC data management: data collection, storage and retrieval.
  • In-built reporting including 50 standard reports and ad-hoc report builder.
  • Supports case management including workflow, actions, activity reporting, resource scheduling.
  • Supports invoice management and has robust NHSSBS interfaces.
  • Supports the paperless agenda through e-file storage.
  • Supports NHS England national reporting including the quarterly DHSC return.
  • Fully compliant with the national CHC framework, as revised.
  • Robust security features, UK-hosted, and fully Spine compatible.
  • Ongoing product support via in-house Technical Support team and Helpdesk.
  • Supports digitalisation agenda through digital referral portal and digital forms.

Benefits

  • Improved financial visibility and control through a comprehensive/interrogatable data set.
  • Scheme performance MI readily available through scheduled/ad-hoc reporting functionality.
  • Full visibility of CHC cohort and workload across case managers.
  • Improved invoice accuracy, leading to greater budgetary control.
  • Quicker, more secure data access and reduction in paper-based records.
  • Accurate/reliable/complete NHS E reports produced quickly/without manual input.
  • System set-up/workflows help to ensure national framework compliance.
  • Enables information governance/GDPR/Confidentiality protocols with IS risks mitigated/managed.
  • Expert support during office hours, incidents triaged ensuring timely assistance.
  • Reduces double-data entry -new referrals via SPINE and referral portal.

Pricing

£22,500 a licence a year

Service documents

Request an accessible format
If you use assistive technology (such as a screen reader) and need versions of these documents in a more accessible format, email the supplier at umer.shariff@chshealthcare.co.uk. Tell them what format you need. It will help if you say what assistive technology you use.

Framework

G-Cloud 13

Service ID

3 8 9 9 3 6 5 4 8 3 4 2 7 3 5

Contact

CHS HEALTHCARE SOFTWARE LIMITED Umer Shariff
Telephone: 0121 362 8840
Email: umer.shariff@chshealthcare.co.uk

Service scope

Software add-on or extension
No
Cloud deployment model
Private cloud
Service constraints
No
System requirements
Access to a supported browser (Chrome or IE).

User support

Email or online ticketing support
Email or online ticketing
Support response times
Tickets are prioritised. Our response times for requests logged via our support portal are:
Critical - 1 hour (resolution time: 4 working hours)
Disruption - 1 hour (resolution time: 8 working hours)
Inconvenient - 1 hour (resolution time: 30 days)
Minor - 1 hour (resolution time: 30 days).
Support is available weekdays only.
User can manage status and priority of support tickets
Yes
Online ticketing support accessibility
None or don’t know
Phone support
Yes
Phone support availability
9 to 5 (UK time), Monday to Friday
Web chat support
No
Onsite support
Yes, at extra cost
Support levels
Our in-house support team is available 8.30am - 5.00pm Monday to Friday via telephone, email and online support desk. Incidents will be assigned a ticket number and will be dealt with in priority order and in order of receipt.

We acknowledge all tickets within 1 working hours of receipt.

Priorities are:
1: Urgent, Not Usable (4 working hours resolution target)
2: High, Severe Limitation (8 working hours resolution target)
3: Medium, Moderate limitation
4: Low – Slight limitation or Request/ Query.

The advisor will notify the caller with the estimated time of resolution, according to the priority / severity of the incident.

Support is included in the licence cost.

Primary functions of the support desk include:
• Call management
• Incident and problem management
• Change and release management
• User administration and support.

The support team will answer all calls and attempt a resolution where possible. In the event that a first time fix is not possible the incident will be routed to the appropriate Technician.

Each customer is also allocated an account manager for escalation purposes and contractual discussions.
Support available to third parties
No

Onboarding and offboarding

Getting started
Our training programme can be tailored but typically includes workplace training, e-learning packages and accompanying materials.

Training can be delivered in a traditional classroom setting with users working hands-on, providing opportunity for staff to ask questions/provide feedback, thus increasing user confidence and reducing resistance to change.

We also offer webinars which are viewed on-screen at the user’s desk and delivered by BroadCare staff remotely, we have a suite of eLearning modules for users to work through autonomously.

We also provide User Guides, Quick Reference Guides and a comprehensive online knowledgebase.

Training is provided in modules to reflect roles and responsibilities within the organisation.

We provide key training modules for each standard user profile as listed below; every user must also complete the New User (45-minute session) and End User (3-hour session) Training Module.

• Administrator (for users who will enter/manage patient information)
• Nurse Assessor (for Nurses/Case Managers, who will work with reviews, enter case management information and E-Files)
• Finance (for users who will enter invoices, run payment schedules, analyse payments, review budget information, complete DHSC Quarterly Reporting)
• Supervisor (for users who provide administration support, work with BroadCare Users, Lookups Tables and Letter templates.
• Database Manager.
Service documentation
Yes
Documentation formats
  • HTML
  • ODF
  • PDF
  • Other
Other documentation formats
As requested. This could include accessible formats including large print.
End-of-contract data extraction
We have a defined Exit Strategy and Plan, which is managed by a designated project manager to ensure a controlled, safe, secure, on-time exit is delivered to the outgoing customer.

A key deliverable in the Exit Plan is the exporting of the agreed data set in the agreed format, at the agreed time, all of which will be agreed with the customer as part of the exit planning process, and documented within the plan. Data will be transmitted according the recipient’s preferences; we will capture these during exit planning, ensuring the data is sufficiently protected during the transfer process (e.g. through encryption).

We will not delete the customer’s data from our servers until we have received written acceptance of the data set from the customer.

Throughout this process, BroadCare will conduct a professional engagement with the customer and their new supplier to ensure both parties have every opportunity to understand and transfer information and knowledge about the services previously delivered by us.
End-of-contract process
We have a defined Exit Strategy and Plan, included in the price of the contract, which is managed by a designated project manager to ensure a controlled, safe, secure, on-time exit is delivered to the outgoing customer.

Our plan will document:
• Respective responsibilities and obligations of all parties involved
• Exit timetable
• Activities of all parties
• Documentation to be provided
• Formal milestone acceptance.

Throughout the exit process, BroadCare will conduct a professional engagement with the customer and their new supplier to ensure both parties have every opportunity to understand and transfer information and knowledge about the services previously delivered by us.

Using the service

Web browser interface
Yes
Supported browsers
Internet Explorer 11
Application to install
No
Designed for use on mobile devices
Yes
Differences between the mobile and desktop service
Broadcare has not been designed for mobile usage.

The digital referral portal has been designed for mobile usage but there are no differences between the mobile and desktop services.
Service interface
Yes
User support accessibility
None or don’t know
Description of service interface
Broadcare is a web-based system, designed to be intuitive and user friendly for users and administrators. Its functionality covers full case management including workflow, actions, activity reporting, resource scheduling, invoices, NHS England national reporting including the quarterly DHSC return, e-files and SPINE integration. Users can readily access information on patients' cases, as well as information on providers. Administrators can access a comprehensive suite of reports via the Report Builder.
Accessibility standards
None or don’t know
Description of accessibility
We are aware of web accessibility best practice; we ensure:
•Minimal non-text content.
•No live/pre-recorded audio/video content.
•Information/structure/relationships conveyed through presentation available in text.
•Our instructions for understanding/operating content don’t rely on sensory characteristics of components (shape/size/visual location/orientation/sound).
•We don't use only colour to convey information/indicating actions/prompting responses.
•Text/images are on white background in high-contrast colours.
•Users can zoom-in to increase text size -no loss of content/functionality.
•Text conveys information, not images of text (except logos).
•All functionality operable through keyboard-no timings for keystrokes.
•No flashing/moving/blinking/scrolling/auto-updating information.
•Pages/headings/labels describe topic/purpose.
•Labels/instructions for user input.
Constraints:Users cannot adjust/turn-off inactivity time limit.
Accessibility testing
We have not currently carried out any testing with users of assistive technology, but would be willing to do so, if required.
API
Yes
What users can and can't do using the API
The API is currently not open source API and is managed by BroadCare working with clients on specific API integration.
API documentation
Yes
API documentation formats
PDF
API sandbox or test environment
Yes
Customisation available
Yes
Description of customisation
BroadCare uses 'look-ups'; whereby customers can define drop-down lists to meet their requirements.

Over 50 customisable look-ups exist, including for fields such as client groups, types of contract, case management notes, etc.

The system can be customised via the System Settings functionality, by those granted administration access rights. General users cannot make such amendments.

Scaling

Independence of resources
As part of general maintenance protocols, our development team, working with our hosted service provider, monitors service availability through load balance testing in relation to demand from the current user population.

In the event that monitoring reveals any capacity or stress issues, or in the event of increased user numbers, the team will increase the hardware requirements such as memory, space, load balance drives until an acceptable level is once again reached.

Analytics

Service usage metrics
Yes
Metrics types
We provide scheduled reporting to our customers on a monthly basis, covering the specific service metrics agreed during contract mobilisation. These could cover a range of metrics including:
- A list of all named users
- Systems usage
- Uptime
- Etc

The above to be discussed via a local review meeting if required by the customer.
Reporting types
  • Regular reports
  • Reports on request

Resellers

Supplier type
Not a reseller

Staff security

Staff security clearance
Other security clearance
Government security clearance
Up to Baseline Personnel Security Standard (BPSS)

Asset protection

Knowledge of data storage and processing locations
Yes
Data storage and processing locations
United Kingdom
User control over data storage and processing locations
Yes
Datacentre security standards
Managed by a third party
Penetration testing frequency
At least once a year
Penetration testing approach
Another external penetration testing organisation
Protecting data at rest
Physical access control, complying with another standard
Data sanitisation process
Yes
Data sanitisation type
Explicit overwriting of storage before reallocation
Equipment disposal approach
A third-party destruction service

Data importing and exporting

Data export approach
BroadCare is an SQL Database – any information recorded can be reported against using either the comprehensive suite of standard Reports, or via the in-built Report Builder.

BroadCare’s search functionality for Patient/Provider data uses full record search using metadata elements. Additionally, Report Builder allows the retrieval/display of a set of data taken from different data tables within the database and exported to Excel for analysis.

Additionally, the system can provide a Total Data Report which provides a full data extract from the system in Excel.
Data export formats
  • CSV
  • Other
Other data export formats
SQL
Data import formats
CSV

Data-in-transit protection

Data protection between buyer and supplier networks
  • Private network or public sector network
  • Other
Other protection between networks
Connections are secured point to point via SSL and are further secured via an allow list.
Data protection within supplier network
Other
Other protection within supplier network
The data is protected within the system by user profile. Data is held within a secure UK-based data centre compliant with ISO27001.

Availability and resilience

Guaranteed availability
We use all reasonable efforts to ensure the service (excluding for the duration of any event of force majeure) will have a minimum Uptime of 99.95% at all times. Uptime is calculated monthly over each calendar month, using the following formula:

U% = (S-D)/S x 100
Where:
U% = Uptime Percentage
S = Available Usage Hours per calendar month, within the service provision time.
D = Downtime aggregate hours (excluding any period of force majeure).
Scheduled downtime may occasionally be necessary to carry out essential maintenance or network upgrades. This will be kept to a minimum and scheduled to minimise disruption.

We have achieved all uptime targets in the last 12 months.

We aim to provide 7 days’ notice of scheduled downtime, which will be performed during a window between the hours of 19:30 and 07:30 UK-time, Monday to Friday.

In the event emergency maintenance is required, we will use reasonable endeavours to give prior warning and will endeavour to keep such maintenance to an absolute minimum.

We do not offer refunds for downtime events.
Approach to resilience
Our service is hosted by Xicon, who host our cloud platform across two data centres in the UK that are configured in a highly resilient architecture. This means that the failure of any component will not adversely affect the availability of our service. This architecture means that business continuity and disaster recovery requirements are addressed. The data centres have world class security services to protect equipment from threats and comply with all of the standards required as part of ISO27001:2013 accreditation. Further information is available on request.
Outage reporting
All components of Broadcare's cloud platform are monitored by Solarwinds monitoring software which is set up and managed by Xicon's (our hosting / development provider) technical engineers. Alerts are messaged to Xicon engineers (P1) and emailed to Xicon service desk (P2 and P3). Proactive monitoring of alerts (including text alerts for P1 incidents) is undertaken 24*7. Customers are notified by phone or email as necessary in the event of an outage affecting access in normal working hours.

Identity and authentication

User authentication needed
Yes
User authentication
  • 2-factor authentication
  • Dedicated link (for example VPN)
  • Username or password
Access restrictions in management interfaces and support channels
Access to the Broadcare system is requested through an email to our in-house support team. New user requests must be approved by a designated manager from the customer's team. Log on details are sent to the new user via secure email and the new user is prompted to change their password immediately. Thereafter, access is only available through the secure log-in process.
Access restriction testing frequency
At least once a year
Management access authentication
  • Dedicated link (for example VPN)
  • Username or password

Audit information for users

Access to user activity audit information
Users contact the support team to get audit information
How long user audit data is stored for
Between 1 month and 6 months
Access to supplier activity audit information
Users contact the support team to get audit information
How long supplier audit data is stored for
Between 1 month and 6 months
How long system logs are stored for
Between 1 month and 6 months

Standards and certifications

ISO/IEC 27001 certification
No
ISO 28000:2007 certification
No
CSA STAR certification
No
PCI certification
No
Cyber essentials
Yes
Cyber essentials plus
Yes
Other security certifications
No

Security governance

Named board-level person responsible for service security
Yes
Security governance certified
Yes
Security governance standards
  • ISO/IEC 27001
  • Other
Other security governance standards
DSP Toolkit
Information security policies and processes
BroadCare operates the following:
-Information Security Policy
-Confidentiality & Data Protection Policy
-Information Governance Policy
-Records Management Policy
-Privacy Impact statement

The Board leads on IG and is responsible for ensuring all necessary support/resources are available for effective policy implementation. Our Senior Information Risk Owner (SIRO) leads on Information Security matters. Our Caldicott Guardian leads on Confidentiality and Safeguarding matters.

The Board is responsible for accessing/providing specialist advice and support on all aspects of IG, reviewing policies and ensuring they are updated in line with changes in legislation and best practice.

Employees are trained on all the policies listed above during induction and on a scheduled basis to refresh their knowledge. Thereafter they are responsible for ensuring compliance with all policies, and for seeking appropriate advice and guidance where required.

Operational security

Configuration and change management standard
Supplier-defined controls
Configuration and change management approach
Our configuration/change management process ensures all changes are recorded/evaluated/authorised/prioritised/planned/tested/implemented, documented/reviewed in a controlled manner.

Change Requests are assessed for impact/resource requirements before being considered by the Change Advisory Board (CAB). Identification of related systems/components affected by proposed changes/input from other affected groups may be required.

If acceptable, the CAB will authorise. Once implemented, it will be reviewed/closed once acceptance criteria are met.

Change categories:

1. Service
2. Normal
3. Emergency
4. Major.

Major changes are referred to the IT Steering Group, then raised as projects with their own business case/project team/budget.

Emergency changes are fast-tracked via an emergency (CAB) meeting.
Vulnerability management type
Conforms to a recognised standard, for example CSA CCM v3.0 or SSAE-16 / ISAE 3402
Vulnerability management approach
Patches to the hosted platform are deployed in scheduled maintenance windows by Solarwinds. This software contains detailed release information for all software patches made available by the major software vendors allowing our hosting provider Xicon to selectively release/apply patches based on category.

Threats to the Broadcare software, our email system and local devices including firewalls, etc, are identified via a number of methods including real-time/continual monitoring using Solarwinds MSP Service Desk software.

Potential/actual threats are dealt with immediately by our IT team, in consultation with directors.

Threats are logged centrally and discussed at a monthly IT Governance meeting.
Protective monitoring type
Supplier-defined controls
Protective monitoring approach
The Data Centre and Broadcare system are protected via firewall configurations, monitored in real-time using Solarwinds MSP Service Desk software.

For the hosted platform, Xicon identify potential compromises via Solarwinds monitoring software. Alerts are generated to the Xicon service desk by email and to Xicon engineers by text (depending on severity) P1 alerts are responded to within 15 minutes P2 alerts are responded to within 3.25 hours P3 alerts are responded to within 47.25 elapsed hours.

The Xicon team will notify Broadcare as soon as a compromise has been verified, to allow us to plan next steps, including notifying customers.
Incident management type
Supplier-defined controls
Incident management approach
BroadCare has a Recovery Process Plan for serious incidents (defined in our Incident Reporting policy/plan):
• Discovery/communication of incident
• Form Executive/Coordination Teams to assess extent of incident
• Decide on Recovery Strategy
• Form Recovery Teams
• Follow Checklist for selected Recovery Strategy
• Return to Normal Service once resolved

Our policy/plan includes processes for common events including those relating to potential security breaches (unauthorised access/hacking incident/data loss, etc).

It instructs users on how to report incidents/to who/how quickly, and describes investigation/remedial action processes followed after a report is made.

A register is kept of all incidents/recoveries/outcomes/lessons learnt.

Secure development

Approach to secure software development best practice
Supplier-defined process

Public sector networks

Connection to public sector networks
Yes
Connected networks
  • NHS Network (N3)
  • Health and Social Care Network (HSCN)
  • Other
Other public sector networks
NHS Spine

Social Value

Fighting climate change

Fighting climate change

Our Group-wide initiative, Champions of Change, focuses on combating climate change as well as recycling and waste reduction, community engagement and carbon footprint and sustainability initiatives. To ensure our operations minimise environmental impact, we:

• Contribute to the NHS Net Zero plan by achieving fewer patient attendances and journeys
• Train our staff to implement and deliver sustainability activities
• Produce office/location-specific recycling and energy saving plans
• Deliver inductions/onboarding completely electronically, removing paper/ink usage
• Produce electronic versions of patient communications
• Have Environmental Champions across the Group to discuss and disseminate initiatives, i.e. encouraging greater recycling whilst people are working at home.

Clean Air Commitment: Where possible, we encourage green business travel options for staff where appropriate, including:

• Using public transport
• Car-sharing
• Use of digital solutions
• Working from home
• Cycle to work scheme
Covid-19 recovery

Covid-19 recovery

Since the pandemic outbreak in 2020, we have worked extensively with clients to deliver innovative service-models to support rapidly-changing priorities. Since January 2021, our staff have delivered:
• 800,000+ covid tests
• 19,000+ PoC tests
• 30,000+ LFTs

Our work to support local and national recovery Covid-19 impact has included:
• Supported workforce delivery to provide healthcare services to NHS Trusts (including Nightingale hospitals), e.g. short-notice cover for staff sickness/absence to ensure continuity of healthcare-delivery
• Developed remote and digital services to support NHS clinical services and alleviate waiting-time pressures
• One of our clients created a pool of 300+ volunteers willing to support in response to COVID-19’s first wave. They were struggling to manage this large additional workforce and scheduling duties. As part of our social-value commitment, we offered to manage this new bank of volunteer staff for them, using skills/infrastructure we already had in place. This resulted in a joint partnership where we also provided marketing time to ensure volunteer opportunities were advertised. As a result, the client could utilise this volunteer-workforce to its full potential, positively impacting its wave-1 Covid19 response.
• As a government-approved provider of Covid testing, we were instrumental in supporting universities with their student/staff testing-programmes (c.100,000 tests) to support attendance at lectures and for students to return home.
• Supported our clients, as a government-approved provider of vaccinations, to deliver Covid vaccination programmes through supplying volumes of appropriately-trained staff, to NHS frontline staff and patients at NHS locations, community centres and within Nightingale Pods. This included managing the complete workforce-delivery of these venues.
• Supplied Life Sciences staff to pharmaceutical and clinical research organisations for vaccine development and trials.

Where onsite presence is required, COVID safety protocols are adhered to at all times, including social distancing, PPE and face masks utilised.
Tackling economic inequality

Tackling economic inequality

We do all we can to support our clients’ working redressing economic imbalances where possible, including offering in-work progression help people move into higher-paid work by developing relevant skills. All staff attend three-monthly appraisals, with objectives to meet CPD requirements. Worker-development is promoted through our development-programme; one-to-ones/appraisals ensure:
• Areas-for-development are highlighted
• Defined personal-objectives/goals are met.

Crucially, we use this time to discuss/facilitate additional skills/training. As well as mandatory training, we offer access to additional CPD courses, including 200+ RCNi-approved training modules.

Understanding in-work progression issues affecting market/industry/sector: Our Insights team help us maintain an innate understanding of in-work progression issues, for our market and within our organisation. We use this information to highlight areas of concern/best-practice across the market, internally, and within individual contracts to review policies/processes to ensure progression/development-pathways support sustainable workforces.
Equal opportunity

Equal opportunity

Equality/Diversity/Inclusion (EDI) is at the heart of our approach. With everyone we meet in our work, we consciously consider the need to:
• Eliminate discrimination
• Advance equality-of-opportunity
• Foster good relations.

We:
• Champion people’s differences and their positive impact on our organisation/work
• Encourage inclusion of diverse experiences/backgrounds/knowledge/skills to enrich us
• Create environment of dignity/respect/inclusion; diversity thrives free of bullying/harassment/victimisation/discrimination, individual differences/contributions are recognised/valued

In all work/settings, we strive:
• To represent local society
• For clients/patients/employees/stakeholders to feel respected/valued
• To provide accessible services that respect each individual’s needs and do not exclude anyone.

In Due Regard to Equality duty, we highlight our expectation that staff treat each other and patients as equals. We take complaints of bullying/harassment/victimisation/discrimination extremely seriously, dealing with such acts as misconduct under grievance/disciplinary procedures; serious complaints may amount to gross-misconduct and lead to dismissal.

We have a dedicated post-holder heading up EDI, leading strategies and working with HR/leadership-teams to:
• Deliver EDI-related strategic goals
• Provide expert guidance/advice across business-cycles.

Our account-management/dedicated teams work closely internally/with clients, to continually review processes, including Recruitment/Retention/Pay/Development to ensure they reflect equity/equality, diversity/inclusion within/across all workplaces/contracts.
Wellbeing

Wellbeing

Leading a fulfilling/healthy/balanced life is central to our culture. During difficult times we ensure staff have accessible support in formats suited to them e.g. Social-Media, an onsite presence, peer-support networks, drop-in sessions and phone/online access as well as specific health programmes, activities/sessions, and our WellbeingWay healthy lifestyles App. We continue to use innovative, wide-ranging services to connect/support our staff.

Regarding the Six Standards of Mental-Health; we:
1. Adopt a ‘people-first’ approach and have developed Four Pillars of Wellbeing (mental/physical/financial/social) offering initiatives e.g. Wellbeing-Champions and a Wellbeing calendar.
2. Proactively design culture, driving positive mental-health outcomes, including workload-management/actively encouraging staff to ‘switch-off’ after working-day. We give access to mental-healthcare pathways, with appropriate specialism/intensity/support as employees move through each stage.
3. Promote open culture around mental-health. Our sister-companies include specialist mental-health recruiters and counselling-providers, giving an inbuilt openness towards mental-health. Our “get-to-know-your-senior-managers” communications include managers’ personal experiences of mental-health/coping-mechanisms, demonstrating that employees are not alone.
4. Increase organisational confidence/capability, an ongoing process.
5. Provide mental-health tools/support: access to support-networks, including MIND-trained Mental-Health First-Aiders; 24/7 Employee-Assistance-Programme; SilverCloud online-CBT; Access-to-Work service delivered by specialist-advisors, with tailored support for mental-health difficulties at work.
6. Increase transparency/accountability through internal/external reporting.

In every contract we build appropriate engagement so workforce help decide issues to prioritise, via surveys, one-to-one-discussions, focus-groups and training-workshops.

Engagement activity regarding physical and mental health is an ongoing process. We measure staff engagement quantitively, via number of staff who respond to specific initiatives, and quantitively, via formal/informal engagement which sees us record comments/observations/suggestions for improvement.

Pricing

Price
£22,500 a licence a year
Discount for educational organisations
No
Free trial available
Yes
Description of free trial
We provide one month's free trial version of a test environment.

For customers wishing to access a demonstration, a tailored environment will be set up and log-ins provided to allow users to explore the functionality in relation to their own requirements.
Link to free trial
https://client-demo.broadcare.co.uk/

Service documents

Request an accessible format
If you use assistive technology (such as a screen reader) and need versions of these documents in a more accessible format, email the supplier at umer.shariff@chshealthcare.co.uk. Tell them what format you need. It will help if you say what assistive technology you use.