During the first year of the pandemic, I was working at a local health department as a compliance and privacy officer. As in other places benefiting public health, it was all “hands on deck” once COVID-19 vaccines were available.
And while not my typical HI compliance duties, my skills in reading and interpreting regulations and evolving federal and state guidance came in handy. I drafted clinical protocols and standard operating procedures for the COVID-19 vaccine rollout. I helped organize and implement a mass vaccination clinic, and I assisted with scheduling and the overall organization of our efforts – including the information on the health department’s website.
Accessibility Challenges with COVID-19 Vaccine Consent Forms
Prior to the pandemic, the health department’s public website housed a handful of forms and documents that could be downloaded and completed in paper form (i.e., PDFs).
In our efforts to reduce wait times at mass vaccination clinics, one challenge we had was getting the registration and consent forms out to potential patients prior to their vaccination appointment in order to reduce wait times and limit long lines at the clinic.
In our haste – and with limited understanding of web accessibility standards – we posted PDFs of the consent forms in English and Spanish on the health department’s website. And we learned pretty quickly we had a lot more work to do for equitable COVID-19 vaccination access in our community.
Website Translation into Spanish Adds Another Layer
The health department’s website wasn’t translated into Spanish. Simply posting a PDF consent form in Spanish and putting it on a website in English somewhat defeated the purpose. And so, we engaged an outside website vendor to make our website available to those who speak Spanish in the community. The process, in retrospect, took a considerable amount of time – which we didn’t have in a pandemic.
Partnering for Long-term Accessibility
Once we translated our website into Spanish, maintaining the content and ensuring it was accessible long-term involved both utilizing the internal bilingual staff we had plus partnering with a local hospital system’s marketing team. This partnership also led to the promotion of COVID-19 vaccine clinics in ways we had not thought of before — working with local social justice organizations and a growing number of community-based organizations.
The Silver Lining
The pandemic really opened our eyes to meeting community members where they were – often at home. We implemented telehealth as federal and state regulatory waivers allowed, including reproductive health and mental health services — going from zero to 60 in just a few weeks. As this new method of service delivery rolled out, my colleagues and I questioned the literacy level of the forms, instructions, and services we provided. COVID, for all intents and purposes, helped us begin seeing things from the perspective of our patients in a better and more equitable light.
Outside of a public health emergency, digital accessibility is something we should care about or take ownership of as health information professionals.
Health information professionals – no matter their role – help bridge the space between clinical and non-clinical, between the technical and non-technical, and between clinician and consumer. Our skills in reading health records and regulations serve both the patient and the provider. There is no better role to help advocate for digital accessibility in healthcare.
The American Health Information Management Association (AHIMA) Code of Ethics Preamble states: “The ethical obligations of the health information management (HIM) professional include the safeguarding of privacy and security of health information; appropriate disclosure of health information; development, use, and maintenance of health information systems and health information; and ensuring the accessibility and integrity of health information.”
As more patients utilize patient portals, having a HI professional on the implementation team or the operational team brings a unique perspective.
According to Health IT.gov, “nearly 40 percent of individuals nationwide accessed a patient portal in 2020 – this represents a 13 percentage point increase since 2014.” This will only increase as the ONC Cures Act Final Rule aims to make electronic health information more easily accessible to patients.
How often, where, when, and why a patient accesses their patient portal could be influenced by many things including their understanding of how one works and its importance. HI professionals could easily help fill this role by ensuring the user experience of the portal is accessible to all patients – regardless of ability and language spoken.
Many factors impact an individual's access to their medical records including geographic location, socio-demographic characteristics, internet access and use, and health conditions.
Ask Yourself These Questions to Champion Accessibility in Your Day-to-Day Work:
- How can I step into that patient’s shoes and see what they are facing before I react?
- Is there a way I can improve our process or system to better accommodate the needs of our patients?
- Before I dismiss an email or deny authorization for records based on a black and white interpretation, can I reach out and ask clarifying questions?
- How can I bring a lens of empathy and understanding to my actions?