Helathcare IT Today
August 23, 2022 — Andy Oram
Of all industries, health care above all should provide accessible web sites to support people with disabilities or special needs. Our field deals disproportionately with the elderly and with people who suffer a range of disabilities, physical and mental. Furthermore, the field is getting more and more digital with wellness sites, telehealth, and fitness devices—so making them accessible is crucial to making health care accessible.
Caroline Jerome, a designer who is a partner and chief creative officer at TBGA, pointed out to me that digital technologies have expanded the options available to disabled people. Accommodations, televisits, haptic feedback, etc., are great advances. But services designed without disabled people in mind can be discriminatory.
Many countries require web sites to meet accessibility guidelines; in the United States, both the Americans with Disabilities Act (ADA) and HIPAA include such requirements. Lawsuits to enforce these regulations have hit many companies. As Dylan Barrell, CTO of Deque Systems, writes in his Agile Accessibility Handbook (available for free by filling out a form): “The number of disability-related lawsuits increased by 181% in 2019 alone, and the cost of responding to a lawsuit (independent of the settlement costs) is $350,000.” (page 32 of the PDF)
But conforming to the innumerable recommendations is exhausting, and few site designers even know them all. I heard a story from Rafael Glantz, Partnership Success Manager at accessiBe, which offers tools for making web sites more accessible. When he spoke at an optometrists’ conference, he couldn’t interest the doctors in making their web sites more accessible to vision-impaired visitors. I guess it was an achievement at least to be invited to their conference.
During my interview with UserWay we ran a test on Healthcare Scene, the site where this article appears. Healthcare Scene uses a WordPress template. The test quickly turned up a lot of accessibility problems: For instance, some text would be hard for many people to read because its color was too close to the background color.
This series explores what constitutes accessibility online, and what experts are doing to move the health care field forward. We’ll hear more from accessiBe, as well as UserWay, UniDoc, and Deque Systems, creators of the open source Axe-core. The series will also interview an UI/UX design expert and some organizations that are succeeding in the continuous process of making their sites accessible.
Accessibility isn’t simple
A huge number of conditions get in the way of people traversing online interfaces. A few such conditions include vision problems, hearing problems (applicable to videos and some alerts), attention problems such as ADHD, and mobility problems that make it hard to use a keyboard or mouse.
Most web sites today are not hand-coded, but use templates from DIY tools such as WordPress and Squarespace. Many of the early DIY tools omitted the clues that disabled visitors depend on—for instance using raw markup to make a phrase look like a heading when they should use an HTML tag for headings. The tools are doing better, though.
Brandon Cooper and Jennifer Dunphy Bowers, who lead the accessibility efforts at Get Real Health, point out that a disability might be temporary, caused perhaps by an accident or a surgical operation that requires extended recovery.
The topic of accessibility gets even broader. We shouldn’t forget people who are trying to understand displays in a language they don’t know well, or people who didn’t get the education to help them parse complex sentences. I’ll touch on these issues later in the series.
Jerome mentioned the experiences of their CTO, who is in a wheelchair and requires a ventilator. He navigates websites by traversing each link and tab. Each extra click on a mouse requires a great expenditure of energy. To him, accessibility includes minimizing the number of pages he has to click through and the number of dialogs he has to confirm.
The series focuses on web sites because they are ubiquitous, they benefit from comprehensive Web Content Accessibility Guidelines (WCAG) from the World Wide Web Consortium, and most of the experts I talked to were working on them. Some principles also apply to devices and other interfaces.
For instance, UniDoc designed a modular virtual clinic that offers a private physical space for telehealth visits that offer full diagnostic capabilities. This H3 Cube environment, which I covered in a recent article. The Cube was designed specifically to meet ADA Standards for Accessible Design and international equivalents. The Cube is wheelchair-accessible and accessible to blind people as well as those who have trouble using computers. A trained technician or nurse is also always present and can enter the Cube to help the patient, if requested to do so.
The next article in the series looks at the relationship between automated and manual reviews of accessibility, and discusses some automated tools.