“Putting the patient at the centre of care” has become a mantra in the hustle and bustle of EMR and information technology adoption and use. Selection, implementation, and use of information technology places significant additional load on healthcare practitioners as well as allied clinical and administrative staff, particularly in the first year(s) of use. Everyone becomes so busy learning how to become effective users of technology they sometimes forget the reasons for implementing an EMR — namely to provide more efficient and higher quality patient care. In an effort to extend the functionality of EMRs and share clinical information more effectively with patients and their caregivers, personal health records and patient portals are becoming more commonplace.
These are all steps in the right direction; however, there are patients who can benefit from technology, but often exist at the periphery because they are in a minority and we do not always consider their needs as we design and implement clinical systems — namely the blind and the hearing disabled.
I met Jeff Berwick in 2002/2003 when he was living in Vancouver. Jeff became blind at the age of 14 due to untreatable tumours on both optic nerves. An avid computer enthusiast, being blind did not hold Jeff back from becoming an adept software programmer and despite never having seen Windows or a graphic user interface, he was able to learn how to develop accessible websites in a graphical environment. At the time of our meeting I was in the process of developing a website for my family practice and, with Jeff’s assistance, made the site completely accessible to the visually disabled. I sat in on design sessions with Jeff as he used a text to speech converter to enter and read code as he adjusted, colours, layouts, text, and hyperlinks. Although I had few patients in my practice who could benefit from the effort that had gone into developing the practice website, it was an example of advanced use of technology to improve access and place patients with the greatest need at the centre of care.
Jeff is still designing accessible websites and I had an opportunity to catch up with him a few weeks ago. I asked him to share some expertise with readers of CanadianEMR by answering the following questions:
Q: How would someone know if a website was accessible to the visually disabled?
A: An accessible site need not look any different from a regular site; therefore, it should not be possible to tell that a site is accessible just by looking at it.
Q: What are some common design problems that reduce accessibility?
A: Some of the main issues are:
- Ensuring all relevant images are identified with their alt attribute.
- Using a consistant layout.
- Avoiding too many links or providing a mechanism (link) to skip over them to get to the main content faster.
- Ensuring that all colours provide enough contrast.
- Ensuring that your site is not mouse dependant… Can people access elements through keyboard navigation?
Q: Have you had any experience with Apps and mobile access? What makes a mobile App more usable to the visually disabled?
A: I use an iPhone so am very familiar with mobile Apps. It is important to ensure that all icons have their accessible text set so that the button is descriptive, i.e. a button that says “button1” is not descriptive, but a button that says “Play” is.
The same design rules apply to designing patient portals and personal health records in addition to any other web-based patient accessible interface. Today, Jeff also works as an accessibility consultant, providing design and audit services for health organizations in order to validate and improve accessibility of their websites.
As we move beyond basic functionality and become more comfortable using EMRs and other health IT tools, accessibility experts will become increasingly important to ensure that we are not just placing patients at the centre of care, but doing so in a way that recognizes and supports those who are most vulnerable.
If you would like to contact Jeff, you can reach him via email at email@example.com