By Tammy Coutts (MEDITECH), Vice Chair of the EHR Association User Experience Work Group, and Mike Shonty (MEDITECH), Member of the User Experience Work Group

One in four Americans has a disability, whether temporary or permanent, including physical, mental, intellectual, or sensory impairments that hinder their full and effective participation in society on an equal basis with others. The EHR Association has long focused on identifying ways health IT can be leveraged to advance disability inclusion across healthcare benefitting not only patients but also providers and other healthcare workers requiring accommodation to fully and effectively participate in both the provision and receipt of healthcare. 

Most recently, the Association’s User Experience Work Group has turned its focus toward advancing disability inclusion with our latest project: building awareness of how disability exclusion impacts health IT users and identifying design solutions to eliminate the challenges. This includes expanding the Association’s Personas Library to include Accessibility Personas and potentially creating workflow scenarios.

What Disability Exclusion Looks Like

Technology has been the solution to so many daily challenges that it can be difficult to view it as anything but helpful. Often, however, the features that make technology user-friendly for most can block healthcare professionals with disabilities from fully performing their core responsibilities. 

Spending a day observing EHR users lays bare the accessibility issues with health IT tools, many of which are not obvious to anyone who has not been in the shoes of users with specific disabilities:

• Drop-down menus make it difficult for someone whose severe rheumatoid arthritis or hand injury affects their ability to operate a mouse to do electronic charting for patient registration.
• Color enhancements like red for critical alerts and blue or green for notifications do not have the desired effect on someone with a color vision deficiency. 
• Patients with low vision struggle to log into patient portals or message their provider unless there is an option to zoom in on the text.
• Drag and drop design elements are challenging for those with a hand injury or other that makes gripping or maneuvering a mouse problematic.

In some cases, the accessibility solution is hampered by design misfires. A clinician with low vision, who was a guest speaker at an EHR Association User Experience Workgroup, shared a story about how she was stopped in her tracks during a patient exam when the screen reader she used to document in the EHR glitched because of an unlabeled button on the screen. Instead of alerting her to the needed input command, the reader could only repeat “button” until a colleague was able to step in to help. HIPAA implications aside, the clinician was obviously frustrated at both the disruption to her care process and the need to rely on a colleague to successfully perform such a basic task because of a missing label. 

Assistive Technology Tools

Knowing how different disabilities impact the healthcare professional’s use of technology provides us with the insights developers need to eliminate barriers and ensure that tools are not standing in the way of their ability to perform a job for which they are eminently qualified. There are already a multitude of examples in the health IT space, for example, the use of subtitles and/or transcripts on video content to assist those with hearing impairments, and ensuring touch targets are sized large enough in mobile applications to be easily activated by users with low vision or dexterity limitations. 

The W3C Web Accessibility Initiative (WAI) also shares a number of techniques and tools that people with disabilities use to interact with the web such as web browser settings, text-to-speech, and voice recognition. According to the WAI, how people with disabilities access and navigate the web differs depending on their individual needs and preferences, with some able to configure software and hardware while others rely on specialized tools to help them perform tasks. 

Common approaches include assistive technologies in the form of hardware and software that improve online interactions, such as refreshable Braille displays, screen readers, voice browsers, screen magnifiers, voice recognition software, and selection switches for those who can’t use a mouse or keyboard. Adaptive strategies are another approach and include things like the ability to enlarge text sizes, reduce mouse speeds, and turn on captions. Other examples include auditory, tactile, and visual notifications, Braille, and text-to-speech.

The EHR Association’s goal with our Accessibility Persona Project is to better understand ways these types of advancements can be leveraged by health IT developers to design truly inclusive technology to assist healthcare workers and patients alike.

Get Involved

If you have insights you’d like to share or if you’d like to be part of the EHR Association User Experience Work Group Accessibility Persona Project, please reach out to us at staff@ehra.org.

In part two of this blog series, we will examine the ways EHRs can support accessibility, in particular the role of personas in advancing inclusivity.