Hospitals should pay attention to website accessibility
IIt would be anathema for a healthcare facility in the United States to have a main entrance that is not physically accessible to everyone. Yet many of their digital gateways block people with disabilities. They have to change that.
More than 30 years after the Americans with Disabilities Act took effect signed into law In an effort to break down barriers for people who are blind, deaf or with other physical or mental disabilities, the digital landscape continues to erect barriers to access. A Kaiser Health News survey in 2021 showed that nearly all Covid-19 vaccine registration websites examined were not accessible to blind people, a major violation of disability rights laws amid a public health emergency.
Digital accessibility involves designing inclusive web pages for people with visual, motor, hearing, speech or cognitive disabilities. More … than 61 million people in the United States – nearly 1 in 4 Americans – and more than a billion people worldwide have one of these disabilities, including 46% of people aged 60 and over. With the number of Americans age 65 and older expected to nearly double from 52 million in 2018 to 95 million by 2060, federal officials have already identified the accessibility of health information online as an urgent need.
A information note we wrote on behalf of the American Health Information Management Association (AHIMA) Foundation and Mathematica sheds light on how difficult it can be for people with disabilities to navigate the healthcare system. Our research found that among the top 106 hospitals in the United States, most of their homepages — their digital front doors — are not accessible to disabled users and elderly users.
Using accessScana free audit tool for online web accessibility, we assessed whether the websites of these hospitals, all recognized as Top Hospitals by US News and World Report in 2021-2022, complied guidelines created by the World Wide Web Consortium, the main international Internet standards organization. Only 4.9% of landing pages fully complied with the Consortium’s most recent web content accessibility guidelines. Nearly 80% were semi-compliant, meaning their pages met some of the accessibility requirements, but not all. However, even a semi-compliant web page is likely to cause navigation problems for people with disabilities, likely making it inaccessible.
The accessibility issues we found were often the same from hospital to hospital. The most common problem was lack of color contrast – strong contrast between the color of text on a page and the color of the background is essential for readability. Many pages lacked alt text, which is used by screen readers to describe what an image is meant to convey. Our analysis also highlighted a pattern of missing or inaccessible labels, which is important because buttons and search boxes on websites need to be clearly labeled so they can be easily identified by assistive technology. .
Some people with disabilities or injuries cannot use a mouse and must be able to navigate a site using only the keyboard. Many hospital web pages lacked such keyboard accessibility, which was not detected by the type of automated audit we performed for our analysis.
Medical records are an essential part of health management. But as with hospital homepages, millions of Americans struggle to access their personal health information through patient portals. People with disabilities who are unable to successfully navigate their electronic health records are at a disadvantage in managing their health care. This includes the ability to message health care providers, review test results, book appointments, and renew prescriptions. This can translate into less than optimal health for these people, who are already at higher risk of disease and injury.
As the digital age flourishes and technology becomes more advanced, healthcare websites and patient portals are becoming increasingly complex. Unfortunately, this means a steady decline in accessibility. In a recent study conducted by the AHIMA Foundation and Knowbility, people with low vision, mobility disabilities, who are deaf or hard of hearing, or who have cognitive disabilities reported a daily struggle when trying to access information numerically.
The Website and Software Application Accessibility Act (S. 4998 and HR9021) was introduced to Congress by Sen. Tammy Duckworth (D-Ill.) to build on the Americans with Disabilities Act and address current gaps in digital accessibility enforcement. While this legislation represents a step towards improving the experience of all users of hospital websites, including people with disabilities, it will take time and effort to address the lack of awareness and ambiguity surrounding digital accessibility today.
We see five key steps hospitals can take to improve the accessibility of their websites:
Use a combination automated and manual audits to inspect web pages for accessibility issues and produce a list of potential errors that warrant further investigation.
Hire and train full-time digital accessibility employees to ensure long-term improvement. Experts strongly recommend appointing a digital accessibility coordinator who is different from the one currently appointed by the hospital ADA Coordinator and the establishment of an interdepartmental working group bringing together decision-makers from a wide range of departments: information technology; health information management; human ressources; diversity, equity and inclusion; procurement/selection of suppliers; and marketing and brand management.
Foster multi-sector collaboration with community advocacy groups, local Independent Living Centers, and regional ADA Centers to ensure they engage and conduct user-based testing with older adults and people with disabilities during the solution development.
Collaborate within the hospital system across administration, management and operations to address the root causes of website issues. For example, color contrast and other color errors on the hospital’s homepage may be an issue that falls within the hospital’s branding guidelines and the purview of marketing.
Provide educational opportunities for hospitals and health care systems in the United States on the role of web accessibility in ADA compliance.
In a digital-first — and often digital-only — society, the wide diversity of functional user needs must be taken into consideration, and healthcare facilities must keep their physical and digital doors accessible to all.
Amanda Krupa is director of the AHIMA Foundation, where Jill B. Roark is a health communications consultant. Kirsten Barrett is a Principal Researcher at Mathematica.