At an initial doctor’s appointment, you might be given a code to access the hospital or health system’s patient portal, a secure online website (and app) intended to give you convenient, 24-hour access to your personal health information from anywhere with an Internet connection.
However, if you identify as a member of the disability community or are experiencing a decline in your abilities due to aging, using a patient portal may not also be the easiest way to access your health information. Websites, in general, can often have accessibility issues.
What to Know About Web Accessibility and Patient Portals
In March 2022, the U.S. Department of Justice released guidance under the Americans with Disabilities Act (ADA) on how state and local governments and businesses open to the public (such as hospitals and healthcare organizations) can make sure their websites are accessible to people with disabilities.
In the context of patient portals, it’s the hospital’s job to ensure their portal is accessible to all patients.
Reasons Why Patient Portals and Other Health Websites Might Not Be Compliant with ADA
- Poor color contrast. People with color blindness and other disabilities related to vision ─ such as diabetic retinopathy ─ may have difficulty reading text if the text color is similar to the color of the background.
- Lack or poor alternative text in images and graphics. If there is no alternative text, or alt-text, in an image or a graphic, someone who uses a screen reader will not be able to know what information is in the image or graphic.
- No captions on videos or transcripts for audio. Someone who is hard of hearing or blind will not be able to know or have difficulty understanding information that is in a video or podcast, for example.
- Inaccessible online forms. There need to be clear labels on forms for people who use screen readers. Having clear instructions is always helpful.
Patient Perspective: Meet Corbb
Corbb is a 34-year-old man from Minneapolis, Minnesota, who is blind from birth. In this video, he shares how living with a disability impacts his ability to access health information on the internet – including electronic health record systems. He says most are not compatible with assistive technology, and for him, this means he cannot easily use a screen reader on his phone or computer to send messages to his healthcare providers, review test results, pay or interpret medical bills, and refill medications.
Patient Portals and 508 Compliance
Any hospital or health clinic that receives federal funding also needs to be compliant with Information and Communication Technology (ICT) under Section 508 of the Rehabilitation Act and Section 255 of the Communications Act.
For example, if your hospital’s website does not have captions on instructional videos about what patients should know before going to an appointment in person during the pandemic, this could violate Section 508 because it is inaccessible to people who are Deaf and hard of hearing. To meet accessibility requirements under Section 508, patient portals need to be accessible to people:
- Without vision
- With limited vision
- Without the perception of color
- Without hearing
- With limited hearing
- Without speech
- With limited manipulation abilities
- With limited reach and strength
- With limited language, cognitive, and learning abilities
Patient Perspective: Meet Rion
Rion is a disabled veteran from Madison, WI, who uses the U.S. Department of Veteran’s Affairs healthcare website, My HealtheVet to schedule appointments online, refill prescriptions, view health records, and send secure messages to his team. Because My HealtheVet is compliant with Section 508, it works well with the assistive technology he uses to access the internet.
Digital Accessibility of Telehealth
An outcome of the COVID-19 pandemic was the rise in telehealth – in part out of necessity and also thanks to its coverage. However, not all teleconferencing products on the market are equal and vary in their compliance with digital accessibility best practices.
Accessibility Features to Look for in a Telehealth Platform
The Bureau of Internet Accessibility, a digital accessibility company, recommends finding a telehealth or teleconference platform that can accommodate the following:
- Screen reader accessibility allows assistive software to convert onscreen text to speech or Braille.
- Built-in screen magnifiers can helpful for some people with low vision.
- Automatic caption generation and third-party captions can be useful for some people with hearing or cognitive disabilities. Third-party captions instead of automated captions tend to be more accurate.
- Keyboard accessibility allows the software to be fully navigated without a mouse. Shortcuts or hotkeys can supplement keyboard navigation.
- Custom color themes are designed for people with color vision disabilities such as color blindness.
Tip: When signing up for a doctor’s appointment, you can also ask if it is possible to have an appointment in person instead of online if it is more accessible for you.
Digital Health Equity and Patient Portal Access
When it comes to accommodating the disability community, digitizing information and having online appointments may not be the most accessible for everyone due to what’s known as the “digital divide.”
According to a 2021 PEW Research Center survey, 62% of adults with a disability say they own a desktop or laptop computer compared with 81% of those without a disability. PEW also noted Americans with disabilities are three times as likely as those without a disability to say they never go online.
Look for Statements of Accessibility
If a patient portal is inaccessible to you or someone you care for, look for a statement of accessibility on the hospital’s website. Typically, it’s linked at the very bottom and includes a phone number and/or email address where you can report any issues you are experiencing. For example, UT Southwestern Medical Center includes an “Accessibility Policy” on its website and welcomes comments on how to improve the site's accessibility for users with disabilities.
At your next in-person visit with your healthcare provider, you can also ask for an alternative mode of communication that is more accessible for you.
Filing Complaints Under the ADA
Requesting changes or filing a complaint regarding the inaccessibility of your patient portal should be made directly to your healthcare provider and/or hospital. They may be able to help you and address your concerns in a more timely manner than filing with a federal agency.
Should you not receive a response after contacting your provider and/or hospital, you can file an online ADA Complaint with the Department of Justice, Civil Rights Division.
Additional Information:
- The Uncertainty of Website “Accessibility” (Journal of AHIMA)
- Accessibility of mHealth Self-Care Apps for Individuals with Spina Bifida (AHIMA.org)
- Introduction to Web Accessibility (Web Accessibility Initiative)
- Patient portals have benefits – but not everyone can access them (Healthcare IT News)
- Patient Portals (California Health Care Foundation)
- Accessibility and Usability in Health Information Technology: A Research & Action Conference to Empower
- People with Disabilities, Older Adults, and Caregivers (Interagency Committee on Disability Research)
A 2022 WebAIM report found 5.3% of all home page elements had a detected accessibility error.
Web accessibility is defined as, according to the Web Accessibility Initiative, “websites, tools, and technologies are designed and developed so that people with disabilities can use them.”
