New research suggests U.S. hospital websites frequently fall short of international standards for digital accessibility, presenting challenges for older adults and people with disabilities. A new issue brief from the American Health Information Management Association (AHIMA) Foundation and Mathematica highlights findings from an accessibility audit of hospital websites and recommends steps that hospitals can take to make their websites more inclusive.
Web accessibility—or digital accessibility more broadly—involves designing web page content to be inclusive of people who have visual, motor, auditory, speech, or cognitive disabilities. More than 61 million people in the United States (nearly 1 in 4) and more than 1 billion people worldwide have one of these disabilities, including 46 percent of people age 60 years and older. With the number of Americans 65 and older projected to nearly double from 52 million in 2018 to 95 million by 2060, federal officials have already identified the accessibility of online health information as an urgent need. In fact, one of the objectives of Healthy People 2030, an initiative of the U.S. Office of Disease Prevention and Health Promotion, is to “increase the proportion of people who can view, download, and send their electronic health information.”
In partnership with AHIMA Foundation, Mathematica recently audited the home pages of more than 100 hospitals that were recognized as top hospitals by U.S. News and World Report. Using accessScan, a free automated evaluation tool for online web accessibility, Mathematica assessed whether these hospital homepages complied with Web Content Accessibility Guidelines (WCAG 2.1), published by the World Wide Web Consortium, which is the primary international standards organization for the internet. Kirsten Barrett, a principal researcher at Mathematica who co-authored the brief, stressed that automated audit tools can provide a first glimpse of a web page’s accessibility, but hospitals should follow up with a manual review to better understand accessibility problems across their websites.
Mathematica’s assessment revealed that only about 5 percent of sites fully complied with WCAG 2.1 requirements for web content accessibility. About 78 percent were semi-compliant, meaning that their websites met some but not all of the accessibility requirements. The brief notes that even a semi-compliant web page is likely to cause older adults and patients with disabilities trouble when they navigate it.
“There isn’t a health care facility in the country that would leave its main entrance without an accessible physical entrance, yet we found more work needs to be done to ensure equitable entry through the facility’s digital front door,” said Amanda Krupa, AHIMA Foundation director and lead author of the issue brief. “Everyone appreciates a good user experience, but it’s critical from a health access perspective as the population in this country ages and increasingly relies on technology to get both health information and care.”
The brief also includes findings from a qualitative survey of older adults and people with disabilities, which highlight common issues that people with disabilities face when trying to access information digitally. The survey, conducted by the AHIMA Foundation and the nonprofit Knowbility, found that people encountered websites with poor color contrast, the use of color alone to convey information, videos with no captioning, online forms that are not accessible to screen readers, and navigation that requires a mouse. The brief quotes several respondents who say they need someone to help them access blood test results, after-visit summaries, and other electronic health information.
As October is Health Literacy Month, the findings shed new light on what health literacy means in the context of digital technologies like health care websites, patient portals, and health-related apps. The brief’s authors note that health literacy extends beyond being able to read and understand health content online; it also includes the ability to access and use personal health information.
The brief recommends hospitals take the following steps to make their websites more inclusive:
- Hospitals can audit themselves using free evaluation tools available online to produce a list of potential errors that warrant human investigation.
- For long-term improvement, hospitals can hire and train full-time employees to oversee digital accessibility efforts.
- Hospitals can foster collaboration externally and internally. For example, hospitals can work with community advocacy groups, local centers for independent living, and Americans with Disabilities Act regional centers to ensure that they are engaging the disability community when developing solutions. They can also work within the hospital across administration, management, and operations to address the root causes of website issues.
“We hope these data shed light on the problem of inaccessible health care websites and empower hospital leaders to identify and address issues to improve digital access for older adults and those with disabilities,” said Barrett. “Hospitals across the country can use automated web accessibility audit tools to not only assess their homepage but also evaluate the accessibility of other parts of their websites, including portals where patients access their medical records.”
The research findings from AHIMA Foundation and Mathematica follow on the heels of federal guidance on web accessibility issued earlier this year by the U.S. Department of Justice’s Civil Rights Division and the U.S. Department of Health and Human Services’ Office of Civil Rights. As hospitals and health care systems across the United States prioritize initiatives centered on diversity, equity, and inclusion and environmental, social, and corporate governance, the new issue brief provides institutions with a starting place to improve their digital experience in a way that is compliant, accessible, patient centered, and data informed.
About AHIMA Foundation
AHIMA Foundation is a 501(c)(3) nonprofit organization and philanthropic arm of AHIMA dedicated to empowering people with health information literacy to achieve better health outcomes. Founded in 1962, AHIMA Foundation’s programs, research, and projects help families make informed health decisions, guide evidence-based health care system policies and practices, and educate and train aspiring and current health information professionals. Recognizing that health information is human information, AHIMA Foundation works extensively to convene interdisciplinary stakeholders to identify unmet public health and education needs. Learn more at AHIMAFoundation.org and follow it on Facebook, Twitter, LinkedIn, YouTube.
About Mathematica
Mathematica is a research and data analytics consultancy driven by a mission to improve well-being for people and communities. We innovate at the intersection of data science, social science, and technology to translate big questions into deep insights. Collaborating closely with decision makers and changemakers, we’re reimaging the way the world collects, analyzes, and applies data to solve urgent challenges.
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Christal Stone Valenzano
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