By the EHR Association SDOH & Health Equity Task Force

The digitalization of healthcare means that accessibility is now a strategic priority. To help guide accessibility strategies, the EHR Association offers the EHRA Accessibility Checklist. Designed to raise awareness and provide guidance for EHR developers in creating software that meets the needs of individuals with disabilities, the checklist presents scenarios and emphasizes the importance of considering the human aspect of accessibility when designing EHR products. 

While Social Determinants of Health (SDOH) traditionally focus on housing, food security, transportation, and education – all of which shape patient outcomes long before a clinician makes a diagnosis – there is another determinant that is often overlooked, yet equally critical in optimal healthcare delivery: Accessibility.

Global Accessibility Awareness Day recognizes that the more than 1 billion people worldwide living with disabilities rely on accessible digital experiences to fully participate in society. This means that, for healthcare, accessibility isn’t just a design concern; it is a health equity issue. 

A Direct Driver of Health Outcomes

Despite the profound digital transformation of healthcare, which finds patients engaging digitally in nearly every aspect of their care, accessibility is still too often viewed through the lens of relevant regulatory requirements; a matter of compliance with standards rather than a core component of care delivery. 

That framing understates its significance. Accessibility is not simply a feature layered onto healthcare systems; it is sometimes a fundamental determinant of whether patients can engage with care at all, thereby creating a direct relationship between added functional capabilities and health outcomes. 

Accessibility intersects with each of the traditional determinants and also functions independently, shaping how patients interact with the healthcare system.

Accessibility intersects with each of the traditional determinants and also functions independently, shaping how patients interact with the healthcare system. Today, when care is increasingly mediated through digital tools and complex workflows, accessibility functionality can determine whether patients can easily schedule appointments, complete intake processes, understand clinical information shared by their provider, and follow through on treatment plans. When systems are not designed with accessibility in mind, the result is not a minor inconvenience but a meaningful barrier to care.

Interestingly, these barriers often surface in ways that can be misinterpreted. Missed appointments, incomplete histories, or failure to adhere to treatment plans are frequently misattributed to patient behavior. Rather, the underlying issue is often that systems are difficult or impossible for certain patients to navigate. 

• A patient with low vision may be unable to access a portal to review lab results. 
• A hearing-impaired individual may struggle with telehealth visits that lack reliable captioning. 
• A patient with limited health literacy may find discharge instructions too complex to follow. 

In each of these scenarios, the breakdown is not due to lack of motivation, but to the way care has been designed and delivered.

The Digital Divide: A Nuanced View

The conversation around the digital divide has evolved in parallel with accessibility challenges confronting many of today’s patients. Early efforts focused primarily on access to devices and broadband connectivity. While those gaps remain in some cases, a more nuanced issue has emerged: whether patients can even use digital tools effectively once access is established. 

Usability, clarity, and adaptability have become central concerns. Interfaces that are intuitive for one population may be unusable for another, and information that is technically available may still be functionally inaccessible if it is presented in overly complex or technical language. 

As healthcare continues to digitize, there is a quandary: these tools will expand access for some patients while inadvertently excluding others.

As healthcare continues to digitize, there is a quandary: these tools will expand access for some patients while inadvertently excluding others.

Another often-overlooked dimension of accessibility is cognitive load. Healthcare interactions frequently require patients to process dense information, navigate fragmented systems, and make decisions under conditions of stress or illness. For individuals with limited health literacy, neurodivergence, or even just particularly stressful life events, these demands can become overwhelming. Simplifying communication, standardizing workflows, and reducing unnecessary complexity are essential to enabling all patients to engage meaningfully with their care.

Telehealth captures the paradox of modern care delivery: it expands access by reducing transportation and convenience barriers, yet can introduce new exclusions for patients with limited digital literacy, inconsistent platform experiences, or reliance on assistive technologies. Without deliberate attention to accessibility, telehealth risks shifting barriers rather than removing them. 

The most effective strategies for addressing accessibility now lean on hybrid models that offer multiple pathways for engagement and tailor care to individual needs. This requires rethinking responsibility within healthcare systems: when patients struggle to engage, the question is not their capability but whether the system’s design is creating barriers. 

Reframing accessibility challenges in this way reduces stigma, sharpens the identification of obstacles, and positions clinicians to recognize when accessibility affects health outcomes and, therefore, to advocate for system‑level improvements. 

In this light, accessibility becomes a strategic priority rather than a peripheral concern.

Small Steps Toward Meaningful Improvements

The good news is that progress does not require immediate, large-scale transformation. Meaningful improvements often begin with targeted changes, such as simplifying patient communication, evaluating digital tools across diverse user groups, and ensuring multiple access methods are available. 

Meaningful improvements often begin with targeted changes, such as simplifying patient communication, evaluating digital tools across diverse user groups, and ensuring multiple access methods are available. 

To help guide accessibility strategies, the EHR Association offers the EHRA Accessibility Checklist. We also offer the following recommendations to EHR and other health IT developers:

• Design for diverse patient capabilities. This includes support for screen readers, keyboard navigation, and voice interaction, as well as ensuring clear language for patients with varying health literacy levels.
• Enhance patient portal usability. Simplify navigation and reduce cognitive load, clearly highlight critical actions (e.g., results, follow-ups), and test accessibility functionality with real patients.
• Integrate accessibility into clinical workflows. Ensure providers can easily capture SDOH-related accessibility needs, surface patient accessibility preferences (e.g., communication method, assistive needs) at the point of care, and reduce documentation burden while improving inclusivity.

Reframing Accessibility

Ultimately, the most important shift is conceptual: moving from viewing accessibility as an accommodation for a subset of patients to understanding it as a baseline requirement for effective health care. 

Global Accessibility Awareness Day offers an opportunity for the healthcare industry to do just that by broadening its definition of access to encompass not just insurance coverage and geography, but also the ability to understand information, navigate systems independently, and engage with care without unnecessary barriers. In this sense, accessibility is not adjacent to social determinants of health; it is embedded within them.