The internet is an effective means for medical practices to extend their accessibility. Patients can learn about services, book appointments, and communicate with the medical staff. If the accessibility of the medical website is not there for those with disabilities, the medical practice is not catering to everyone in need of medical care.
Recently there has been a rise in ADA web accessibility lawsuits that target physicians. Making a medical website accessible to all is a top priority. One in four Americans has a disability. Access to a medical website is essential to a physical practice.
Three reasons a medical practice website needs to be accessible include
- An increase in client base and a boost to a physician’s reputation
- Mitigates website litigation and lawsuits risk
- It is the right thing to do
Finding new doctors or communicating with current ones has changed in this digital age. Sine 25 percent of the population consists of people with disabilities, medical needs vary. The disabled must have access to a physician’s medical website.
When a website is accessible, it increases the visibility of a business practice and potentially reaches new customers. Potential patients, reading about services provide, see the practice as all-inclusive, which affects its reputation.
Under the Americans with Disabilities Act (ADA), web accessibility is a protected civil right. The California Medical Association reports that small and solo medical practices have been sued for allegedly violating the ADA in California. There are also state laws prohibiting businesses from unlawful discrimination against anyone, including those with disabilities. Addressing the issue is of utmost importance.
Unless a practice has taken steps to ensure its website is accessible, it most likely is not. Most websites are not built with accessibility as a concern. Only two percent of websites are compliant with the Web Content Accessibility Guidelines and are currently accessible to those with disabilities.
There are excellent website accessibility tools available for websites to help determine a website’s level of compliance and accessibility. ADA Site Compliance has tools that perform comprehensive testing that provides results instantly. We conduct a free and private scan of a client’s website.
Medical Practice Issues
Websites for healthcare practitioners are a tricky subject. They provide a platform to engage with existing patients and attract new ones. Sometimes they pose a risk for website ADA compliance and HIPAA violations.
Building healthcare or medical websites is not as simple as it once was. Whether you are a yoga teacher, physiotherapist, dentist, or doctor, you must ensure medical website accessibility is available to people with disabilities.
ADA Law Concerning Website Accessibility
The ADA was enacted in 1990. It prohibits discrimination based on disability. All not-for-profit, private, and public entities and organizations must provide equal access to communication, information, services, and goods. These requirements extend to brick-and-mortar establishments that use the internet.
In 1973, the Rehabilitation Act, Section 508, became effective. A series of updates were put in place on January 18, 2017. The updates mandated all information and electronic technology, including electronic documents, websites, and more that are produced or procured within the United States by federal agencies comply with WCAG 2.1
Section 1575 of the Patient Protection and Affordable Care Act was enacted in 2010. It requires medical practitioners to make communication and information technology, including websites, accessible to those with disabilities. WCAG 2.1 is not mandated, but the US Department of Health and Human Services highly recommends it.
Those Subject to Section 1557
- Any health activity or program that in part or whole receives funding from the Department of Health and Human Services, such as reimbursements from Medicaid or Medicare
- Any activity or program directly administered by the HHS
- Health Insurance Marketplaces and plans issued by participants in those Marketplaces
For a medical practice, that means websites must ensure equal access and rights to people with disabilities. Websites must be accessible to people suffering from disabilities to comply with the ADA and Section 1557. The safest route to achieving website accessibility is to build websites to WCAG standards.
Entities that view websites include:
- Disability advocacy organizations
- Persons with disabilities
- Federal and state courts
- US Department of Health and Human Services
- US Department of Justice
- US Federal Government
That is a lot of people with a potential need to use a website. Statistics estimate 25 percent of the US population has a qualifying disability. Some of the reasons people find accessing a website difficult include
- Vision impairment
- Hearing impairment
- Difficulty using a mouse or keyboard
- Seizure prone users
The fine for a non-compliant website can be $75,000. The cost of a compliant site is much less expensive. Take the matter seriously. Medical practitioners who think it cannot happen to them are mistaken.
Financial and educational institutions, restaurants, and retailers have experienced lawsuits. It signals that people with disabilities are making a broader pushback for fair treatment on the internet. Before changes were made in 2018, a minimum of 814 lawsuits over website accessibility issues took place in 2017.
Do not take the chance when accusations have legal precedence and are backed by the ADA. Major companies like H&R Block, Netflix, and Target have been hit with hefty fines for not meeting specific ADA standards.
If fines and lawsuits happen to major sites, they can happen to you. The cost outweighs the risk. There is no reason to be non-compliant and many reasons to make your website compliant.
Building Patient Trust
Doing what the government requires is always advisable. It is not the only reason for making a website accessible. Unfortunately, in recent years, trust in the healthcare system has declined. In fairness, distrust in many industries has occurred. It is still a poor excuse not to build confidence through practice.
Reasons for Trust Decline in Healthcare
- Consumers feel the diminished quality of healthcare services
- Lessened quality of interaction
- Lower autonomy of practitioners
These reasons present a challenge to healthcare practitioners. They need to instill trust in their service. There are substantial benefits if they do. The most notable is the willingness of many Americans to try another practitioner if they have a better experience,
Facts About Patient Satisfaction
It takes 12 favorable experiences to make up for one negative one. Nearly 90 percent of patients visit a competitor after a poor experience. It is five times more costly to attract new patients than retain existing ones.
Patients are two times more apt to share a bad experience than a positive one. Relationships that start on a website mustn’t end after the first log-on. One of the best means of boosting patient favorability is making a website accessible to everyone.
How to Make a Website Accessible
WCAG 2.1 compliance has four overarching areas that guide the website’s efforts to keep it accessible. It must be
Users must understand a website presentation whether they have navigational limitations or are deaf or blind. Anyone should be able to navigate a site or have the ability to use a version that is simplified but maintains functionality.
The information on a website must be easy and accessible for people with disabilities. They must be able to interpret the information accurately. The most common disabilities are
- Visual impairment
- Hearing impairment
- Mobility and browsing impairment
People with vision impairment may have difficulty reading and interpreting a website. There is no universal fix, but there are ways to help ensure blind users visiting a site have web content accessible to them.
Make sure the text on a website is easy to read. You need to ensure text scales appropriately so that it is not pixelated or blurred when a magnifying device or app is used.
Those who are colorblind are a demographic you need to consider. They can partially see to use a website but sometimes find it difficult to distinguish between the foreground and background of a site.
It makes navigating and reading content difficult. ADA Site Compliance has a tool that checks the contrast ratio of colors and conducts background process scans on a website. We help ensure people with this vision-impaired profile can see everything on a website and use the site effectively.
Blind Users Profile
Another demographic of patients who are visually impaired are those who are fully blind. They utilize various assistive features that include Braille and screen readers that help read the content of a webpage.
The website’s components include the website’s images, alt tags, and headings. You must provide accurate form labels in the web site’s code or navigating and finding needed information is difficult. It is also helpful for forms patients fill out on a website. If required fields are not appropriately tagged, the experience can be frustrating.
Netflix was penalized because they had videos not containing closed captions on their website. Closed caption allows those with a hearing impairment to read video content. It provides equal access to shared information. That is why it is of importance for videos to meet ADA standards and avoid disenfranchising patients with hearing impairments.
Mobility and Browsing Impairment
Many disabilities cause patients difficulty in using a mouse. It is next to impossible for them to navigate or use a website. A keyboard test helps determine if a site is accessible using only a keyboard. With the mouse unplugged, a user should use the enter, tab, and arrow keys to browse a site. The users must also be able to find resources, such as blog posts and patient bulletins, and have access and fill out forms.
Patients who find content skip menus on a site can easily skip some elements and read a page’s main content. The menus streamline a site and make it possible to navigate the website as efficiently as other patients.
The website must comply with ADA and Section 1557. A website owner who does not keep a website up to these standards runs the risk of hefty fines or lawsuits. An inaccessible site damages the trust patients have in a practice and impair the ability to help them. Taking steps to ensure individuals with visual, hearing, and mobility impairments have easily accessible use of a website is both wise and right.
What Is Meant by Web Accessibility?
Essentially, web accessibility is a set of design guidelines, code standards, behaviors, and rules created by the World Wide Web Consortium’s WCAG 2.1. It is the global standard for website accessibility. It is the benchmark used in legislation.
WCAG is a 1000-page set of guidelines covering a range of disabilities that include hindering internet use and making using the internet impossible. The spectrum comprises about 25 percent of the general population. Many disabilities are covered. The primary categories are
- Blind people using screen readers
- Cognitive disability profile
- Epilepsy and color blindness
- Motor-impaired using only a keyboard to navigate
- Visual impairments and more
Why Medical Websites Accessibility is Important?
There has been a 200 percent rise in ADA compliance lawsuits from year to year. The number of threatened lawsuits and demand letters and litigation that target businesses of all sizes are tens of thousands.
Medical practices are included in the mix. Initially, only government institutions and large enterprises were legally pressured into becoming accessible. In 2018, the Department of Justice affirmed all websites are considered public accommodations.
Consequently, they are required to comply with ADA Title 3. The number of papers served tripled in 2018. A business being served for not being compliant in 2019 averaged one per every business hour. The plaintiff wins almost every case on its merit due to the strict liability law and sympathetic judges to those with disabilities wanting equal rights. When a business is not ADA compliant, there is little chance of winning a case. Many lawyers advise clients to write a check because there is little reason to fight it.
How to Tell if a Medical Website is ADA Compliant
The answer to determining compliance is complex. It is not a pass/fail test. No gold stars or stickers are awarded. Compliance is on a spectrum. The more compliant a site is, the lower the risk of a lawsuit or demand letter.
The ADA Site Compliance team proactively takes reasonable steps to make clients’ websites as accessible as possible. Some, but not limited to, the steps we take include.
- Create consistent navigation from page to page
- Create forms with indicators and clearly labeled fields
- Create more than one hover state or link indicator
- Create strong color contrast
- Make sure text size is legible on all screen sizes and devices
- Make sure there are multiple ways to access different information and pages on a site, such as helpful links after content, breadcrumbs, sitemap-navigation, menus, and search bar
- Provide alt text for images read by screen readers
How Can a Medical Practice Decrease Its Legal Liability?
We want to clarify that there is still a chance of a threatening letter or lawsuit if reasonable steps to be compliant are taken. Experts created the tools we use in assistive and accessibility technologies. We provide high success rates for exceeding the standards for compliance. The benefits of using our services include compliance with ADA, Section 508, WCAG, and more.
Best Practices for Improving Medical Websites Accessibility
Eighty-one million people have a vision impairment. They either rely on screen magnifiers or suffer from a form of color blindness. We use optimal text size so that people with impaired vision can access text through a device that turns written text into audio. You can resize the text on a website to 200 percent without assistive technology.
Screen readers allow those with visual impairments or blind people to use a computer efficiently. When a blind user’s computer is compatible with screen readers, they convert content on a screen into audio that can easily be heard and understood. Popular screen readers include
- Apple VoiceOver
- Jaws Screen Reader
- Windows Narrator
Desktop publishing and word processing programs for computers use different methods for adjusting letter spacing. Most systems have a letter-spacing default of zero and use the character widths and letter spacing built into a font.
Essential screen reader requirements include screen reader optimization and keyboard navigation optimization. Screen reader users should have as few limitations as possible. Our team uses an accessibility interface allowing people with specific disabilities to adjust the website’s user interface and make screen reader adjustments suited to their personal needs.
An Artificial Intelligence-based application runs in the background. It remediates a website’s HTML, and adapts its behavior and functionality for blind users and keyboard functions for those with motor impairments.
We implement the Accessible Rich Internet Applications (ARIA) techniques and a variety of behavioral changes that ensure blind users who visit with a screen reader can read, understand, and enjoy a website’s functions.
Color accessibility permits people with visual impairments or color vision deficiencies to have a better website experience. We avoid using color as the only cue. Forms that have required fields in red have an alternate way to convey the required fields for those who use screen readers or do not see red. No color at all is noted.
Websites emphasize essential elements with text color that contrasts with the background, ensuring elements are easy to read. We help test color accessibility and help choose contrasting color palettes that pass contrast tests.
About 15 percent of adults report hearing problems. The closed caption shows spoken words for those who cannot hear video audio. Our professional services include adding captions to videos. The captions are placed near the bottom so that significant features and faces are not covered.
Use of Image Alt Tags
Alt-text is the website’s HTML attribute added to an image to describe the content for those who cannot see the images used on a website. Alt tag text explains the significance of an image in less than 250 characters. The phrases ‘picture of, ‘ graphic of,’ or ‘image of,’ or copyright information is not included.
Keyboard Navigation for Mobility Impairment
Nearly 20 million people have difficulty grasping or lifting. The condition may impact the use of a keyboard or mouse. Making a page accessible through the keyboard requires only a few keys. The most common keys are the left and down arrows, enter, shift, space bar, and tab. Users navigating with the keyboard should jump between focusable elements on a page in the same order they appear in the document’s source code.
Radio and checkbox elements on a website’s form screen reader allow users to choose from an item list. Radio buttons enable single selections. Checkboxes are used to select from a choice in a group such as pizza toppings or confirm something like accept, cancel, or continue processing.
Checkboxes are not usually associated with a question. Radio boxes are nearly always associated with a question. A website’s form reader needs all input fields to have labels linked to the field using an ‘ id’ attribute. The ‘name’ attribute is essential for checkboxes and radio buttons to maintain the groupings.
Supported Disabilities Profiles
Disability profiles supported by websites we help make Disability Act ADA compliment are
- Epilepsy safe profile
- Vision impaired profile
- Cognitive disability profile
- ADHD friendly profile
- Blind users profile
- Keyboard navigation profile.
The epilepsy safe profile enables epileptic individuals to use your website safely without the risk of seizures that result from risky color combinations and blinking or flashing animations.
The vision-impaired profile enhances a website, making your website accessible to people who have a visual impairment, such as Glaucoma, Cataract, Tunnel Vision, and Degrading Eyesight.
The cognitive disability profile assists users with cognitive disabilities like CVA, Dyslexia, and Autism to focus on essential elements more easily.
Additional User Interface, Design, and Screen Reader Adjustments
Screen reader adjustments include font adjustments that increase or decrease the size, change type, adjust the spacing, and more.
Color adjustments allow users to select from a variety of color contrast profiles like monochrome, inverted, dark, and light.
The audio muting option lets users mute an entire website if they experience headaches when using hearing devices.
The ADHD-friendly profile significantly reduces distractions or noise. When a profile significantly reduces distractions and noise, it helps those with neurodevelopment disorders and ADHD focus, browse, and read essential elements.
The blind user profile adjusts your website to be compatible with screen readers.
The HiTech Act and HIPAA protect a patient’s privacy. Healthcare organizations are required to use measures that keep patient records secure. Disclosure and legal use of protected information must be in compliance with specific HIPPA regulations.
Healthcare organizations can collect information via electronic forms used in the collection of patient data. Examples include
- Medical records
- MRIs, X-Rays, photographs
- Names, addresses, social security numbers, phone numbers
- Patient demographics
- Payment information and insurance data
- Tests and lab results
If a medical practice collects any of this information on a website, the site must be HIPAA-compliant. The data can be from a website to schedule doctors’ visits, request appointments, send medical records, or make payments.
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The ADA prohibits any private businesses that provide goods or services to the public, referred to as “public accommodations,” from discriminating against those with disabilities. Federal courts have ruled that the ADA includes websites in the definition of public accommodation. As such, websites must offer auxiliary aids and services to low-vision, hearing-impaired, and physically disabled persons, in the same way a business facility must offer wheelchair ramps, braille signage, and sign language interpreters, among other forms of assistance.
All websites must be properly coded for use by electronic screen readers that read aloud to sight-impaired users the visual elements of a webpage. Additionally, all live and pre-recorded audio content must have synchronous captioning for hearing-impaired users.
Websites must accommodate hundreds of keyboard combinations, such as Ctrl + P to print, that people with disabilities depend on to navigate the Internet.
Litigation continues to increase substantially. All business and governmental entities are potential targets for lawsuits and demand letters. Recent actions by the Department of Justice targeting businesses with inaccessible websites will likely create a dramatic increase of litigation risk.
Big box retailer Target Corp. was ordered to pay $6 million – plus $3.7 million more in legal costs – to settle a landmark class action suit brought by the National Federation of the Blind. Other recent defendants in these cases have included McDonald’s, Carnival Cruise Lines, Netflix, Harvard University, Foot Locker, and the National Basketball Association (NBA). Along with these large companies, thousands of small businesses have been subject to ADA website litigation.
Defendants in ADA lawsuits typically pay plaintiff's legal fees, their own legal fees for defending the litigation, and potential additional costs. In all, the average cost can range from tens of thousands of dollars, to above six figures. There are also high intangible costs, such as added stress, time and human capital, as well as reputational damage. Furthermore, if the remediation is incomplete, copycat suits and serial filers can follow, meaning double or triple the outlay. It's vital to implement a long-term strategy for ensuring your website is accessible and legally compliant.