By Jennifer Sagerian (MEDITECH), Member, EHR Association User Experience Workgroup

For many, the pandemic shed light on issues related to web accessibility. Ninety percent of US adults said the internet was “essential” during the pandemic yet many people with disabilities were at a disadvantage; unable to schedule vaccines, communicate with their providers, and schedule appointments. Since then, web accessibility has become a high-priority social determinant of health (SDOH) – and a fundamental human right.  

Declared a human right by the United Nations in 2016, the critical importance of web access was further codified in April 2024 when the United States recognized digital accessibility as a civil right with an update to Title II of the Americans with Disabilities Act (ADA). In May 2024, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) subsequently finalized revisions to regulations implementing Section 504 of the Rehabilitation Act of 1973, which protects against discrimination on the basis of disability. This final rule provides protections for people with disabilities who seek services from federally funded health and human services programs. 

These actions were important steps to ensure those with disabilities have equal access to digital web content and mobile applications.

WCAG 2.1 Compliance

Within the next three years, healthcare organizations and the electronic health record (EHR) vendors they contract with will need to ensure that web products used by patients to access health information and programs meet WCAG 2.1 AA standards. This includes tools like patient portals, bill pay services, third-party and mobile applications that give patients access to their health information and/or allow them to proactively participate in their healthcare. 

Accessible web content is foundational to inclusive healthcare and ensuring that EHR design includes users with disabilities. It is the driving force behind the EHR industry’s adoption of several strategies to help healthcare organizations provide accessible services and programs. 

Accessible web content is foundational to inclusive healthcare and ensuring that EHR design includes users with disabilities. It is the driving force behind the EHR industry’s adoption of several strategies to help healthcare organizations provide accessible services and programs. 

Accessibility Design Strategies

Embedding accessibility into EHR design DNA not only supports healthcare organizations in meeting WCAG 2.1 regulations but is also simply the right thing to do. It might seem like an overwhelming prospect, but there is a proven strategy for accessible development at scale; implementation of design systems.  

Design systems in software development is a framework intended to manage accessible design at scale with reusable design patterns, components, and guidance. A well-crafted design system includes accessibility guidelines and best practices in the early design and development phases. Its use promotes accessibility in several ways:

• Accessibility standards integration. Accessible components and design patterns ensure that software development teams are building workflows for both usability and accessibility at the outset.
• Consistency. Promoting consistency in product design elements and navigation is crucial for users with disabilities who rely on predictable and understandable interfaces.
• Scalability. Centralizing accessible components and design best practices makes it easier to update the accessibility of multiple products in a faster and more consistent manner. 

Design Systems in the Real World 

Meet Mary Alice. She has arthritis and wears glasses for farsightedness. While filling out the pre-registration in the patient portal for her upcoming appointment, she struggles to read the text and has to zoom in to enlarge it. 

“I can’t see the checkboxes on the form. I always need to scroll back and forth,” she says. 

Using the mouse instead of the keyboard is also problematic. It’s difficult for her to handle and some parts of the form still require mouse interaction, leading to her frustrated exclamation, “ This is taking too long!”.

A design system with built-in accessibility features could address Mary Alice’s issues. Building workflows with accessible components and evidence-based guidance from a design system can provide accessible keyboard navigation, meaningful use of color, consistency, and semantic meaning at the onset without each design team needing to recreate the wheel.

In response to the recognition of digital accessibility as a civil right and to forthcoming regulations, the EHR industry faces a pivotal moment to embed accessibility into its core practices. Design systems offer a strategic approach to managing accessibility at scale, providing reusable components, accessibility guidelines, and design best practices. 

A Pivotal Moment

In response to the recognition of digital accessibility as a civil right and to forthcoming regulations, the EHR industry faces a pivotal moment to embed accessibility into its core practices. Design systems offer a strategic approach to managing accessibility at scale, providing reusable components, accessibility guidelines, and design best practices. 

However, while design systems offer a concrete strategy, they are not a panacea. Complementing their implementation with user testing, ongoing education, and a deep understanding of users’ diverse needs is crucial.

EHR designers and developers must remind themselves that they are not the user and that a human’s ability and preference to access and comprehend information is complex. Testing designs with individuals who have a range of disabilities helps to identify accessibility barriers and provides valuable feedback to inform workflow improvements and refine an accessible design system.  

Stakeholders, such as designers, developers, product owners, management, and support staff, must also be educated on how to develop EHR technologies so that people with disabilities can use them. Sharing this information, along with examples of obstacles and personal experiences, helps achieve the type of understanding that empowers design teams. 

Finally, solutions should be validated at each stage of the design and development process to ensure accessibility objectives are being met and the design is inclusive to all users. 

Proactive Accessibility Integration

When navigating the evolving landscape of healthcare accessibility, it’s imperative for the EHR industry to proactively integrate accessibility into product design DNA by collectively embracing the principles of inclusive design and committing to creating digital experiences that empower all patients, regardless of ability. 

By leveraging design systems as a foundation for accessible development, EHR developers can ensure that healthcare organizations meet regulatory requirements and, more importantly, fulfill their ethical obligation to provide equitable care for all.

Also contributing to this blog were Vice Chair Tammy Coutts (MEDITECH) and other members of the EHR Association User Experience Workgroup.