E-Access to Health Care?

Northeast ADA Center Staff April 26, 2020

We live in an increasingly digital world. So much of the day-to-day tasks we do are done on the internet on our computers and mobile phones. This is true in all aspects of life, including our health. We don't just count our steps with our phones; we also make doctor appointments, login to patient e-portals, access our medical records online, and even have virtual doctor visits. With this increased reliance on technology, it is important that all individuals have an equal opportunity to access their medical care. Some individuals with disabilities can face e-barriers, just as some other individuals may encounter physical ones. If a patient e-portal or hospital website is not accessible to an individual that cannot manipulate a mouse, then that individual is denied equal participation in those services. If a visually impaired person's screen reader cannot properly read the PDF of the medical forms he or she must complete, then that individual is not receiving communication in an effective manner.

Electronic information technology related to health care must be made accessible, but let's look at the why and how of it. There are several federal laws and regulations that come into play. The Americans with Disabilities Act (ADA) requires that individuals with disabilities be given an equal opportunity to participate in and to access the programs and services of both state and local government entities, as well as those of private businesses and nonprofits. Title II of the ADA covers state and local government and related entities while Title III of the ADA addresses public accommodations: essentially private businesses and nonprofits. Both Titles mandate that communication be equally effective with people with disabilities as communication with individuals without a disability. Section 504 of the Rehabilitation Act requires that any recipient of federal funds not discriminate against individuals with disabilities. Furthermore, recipients must furnish auxiliary aids to ensure equal communication for individuals with disabilities. Section 1557 of the Affordable Care Act (ACA) applies to any program receiving funding from the Department of Health and Human Services (HHS), any program HHS itself administers, and health Insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces. Section 1557 also requires that electronic and information technology is accessible to individuals with disabilities. And finally, the Center for Medicare and Medicaid Services (CMS) rules require the use of “electronic information and services which comply with modern accessibility standards such as section 508 guidelines, section 504 of the Rehabilitation Act, and W3C’s Web Content Accessibility Guidelines (WCAG) 2.0 AA and successor versions.”

But what are these "modern accessibility standards" to help measure the accessibility of websites and other forms of electronic communication? As the CMS rule suggests, WCAG 2.0 (Web Content Accessibility Guidelines) is one standard that is widely judged to be the best current practice. WCAG 2.0 is a framework established by the Web Accessibility Initiative (WAI) of the Worldwide Web Consortium (WC3). WCAG 2.0 is based on testable statements designed to create greater universal accessibility and usability. The Department of Justice -- the federal agency that enforces Title II and III of the ADA -- has used WCAG 2.0AA as a measuring stick in its enforcement activities under the ADA that involve websites and electronic information. WCAG has not been officially adopted by the Department as of this date, but it continues to apply this standard when designing settlement agreements. Section 504 does not have its own explicit standard, but serves as a framework for the application of Section 508; an electronic communication technology standard that applies to federal agencies and which now largely mirrors WCAG 2.0AA. Finally, Section 1557 of the ACA's implementing regulation states that it would be difficult for a covered entity to comply with its requirements without using a standard such as WCAG 2.0 or Section 508.

So in the end, what does this all mean? It means that individuals with disabilities should expect to have access to their health care, including when it is electronic. For hospitals, doctors' offices, managed care organizations, insurance providers, and other health care professionals it means that thoughtful consideration, planning, and effort need to be given to ensuring that individuals with disabilities can access their electronic information, services, and products.