Improving Health IT by Learning from Users with Disabilities Madeleine Rothberg National Center for...

Improving Health IT by Learning from Users with Disabilities

Madeleine RothbergNational Center for Accessible Media at WGBH

September 18, 2015

Media Access at WGBH

The Caption Center(est. 1972)

IF YOU HOLD THE BIRD LIKE THIS, IT CAN’T FLY OUT OF THE KITCHEN.

Descriptive Video Service(est. 1990)

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Digital TV Theme parks

Web meetings

OnlineMultimedia

OnlineAssessments Museums

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Health IT: Access to PHRs

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Barriers to Accessible Health IT

AT images

Photo credits: Yahoo! Accessibility Lab, cobalt123, Glenda Sims, ingoism, Robert Murphy.© 2015 WGBH

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Accessible Designs for Personal Health Records Carl and Ruth Shapiro Family National Center for

Accessible Media at WGBH (NCAM): Madeleine Rothberg; Geoff Freed

The Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia: Dean Karavite

Inglis, Philadelphia, PA: Lea Frontino

US Dept. of Ed NIDRR Field Initiated Project H133G110095

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Accessibility review of current PHRs

PHRs for outpatient clinic, hospital, and consumer

•Demonstrate disparity and variability in achieving accessibility, usability and functionality•Can be easy to use, but inaccessible — or difficult to use, yet fully accessible•Have accessibility issues that can be readily addressed•Are only beginning to provide the information, resources and tools required to help consumers manage their own health and healthcare

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Talk to users

Semi-structured interviews (16 consumers)—Most important goal: independence—What health IT tools would support your goals?—Resulted in 22 requirements

Web-based survey (150 consumers)—Confirmed importance of requirements

Extensive user testing of a prototype PHR (26 consumers)

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Initial FindingsPeople with disabilities:

•Are high-volume consumers of health care•Are sophisticated consumers of health care•Are not satisfied with current non-PHR tools for managing health care•Described technology innovations that map well to governmental standards for health IT•Would benefit greatly from a usable and accessible PHR

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Importance/ Satisfaction

Consumers told us that a wide range of health care tasks are important, and current options are unsatisfactory.

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Learning from Users with Disabilities

Usability testing with users with disabilities taught us the value of relevance.

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Prototype Scenarios

Scenario 1: Preferences Scenario 2: Equipment Scenario 3: Medications Scenario 4: Care Plan Scenario 5: Lab Results

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Usability Testing

Formative TestingRapid iterationLow cost PHR mockups shown to people with different disabilities Discovered issues that would have been difficult and expensive to address in functioning prototypes

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Usability Testing, cont.

Hands-on Iterative TestingTested and refined the prototype iterativelyTesting with blind users uncovered errors in code accessibility; once those were corrected satisfaction improved.Testing with Deaf users uncovered the need for education materials in ASL; once those were provided, satisfaction improved.

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Feedback

What did you like LEAST about the system?

“Nothing, except I wish it was mine.”

More user testing feedback on the Web site:http://healthitaccess.wgbh.org

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How did we build it?

Entire prototype is available on the Web site Code samples for accessibility

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Code Sample: Icons and Text

<section role="presentation" class="cplanDetails cresourcesCol secondList" aria-labelledby="cresourceHdr1"><h3 role="heading" aria-level="3" id="cresourceHdr1">Resources <a href="#" role="button" class="stub" aria-describedby="stubMsg">Add/Edit</a></h3> <ul class="resourceList"> <li><a rel="external" href="http://www.wikihow.com/Use-a-Hoyer-Lift" class="logLink">How to Use a Hoyer Lift (external link)</a></li> <li>…</li> <li>…</li> </ul> </section>

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Code Sample: Navigation

Navigation markup makes a complex site easier to use for assistive technology users.

Most document areas (header, section) use aria-labelledby to associate them with a visible heading.Navigation elements have been labeled with role="navigation" for cases where the browser does not establish the appropriate landmark role based on the nav element alone.To address a bug in older versions of some screen readers where headings nested inside sections have their levels increased by one, aria-level is specified and the section's role is assigned as presentation.

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Code Sample: Navigation

<div role="banner" aria-labelledby="phrHdr" id="masthead"> <h1 id="phrHdr">Your Personal Health Record</h1> <nav role="navigation" id="utilityNav" aria-label="Main Links"> <ul> <li><a href="preferences.html">Preferences</a></li> <li><a href="#" class="stub" aria-describedby="stubMsg">Account</a></li> <li><a href="#" class="stub" aria-describedby="stubMsg" id="logout">Logout</a> </li> </ul> </nav>

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Code Sample: Information Links

<a href="http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682461.html" aria-hidden="true" role="presentation" tabindex="-1"> <img src="i/info-icon.png" alt="" role="presentation" /></a>

<a href="http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682461.html" class="pad"> Levothyroxine</a>

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Steps to Accessible Health IT

Talk to users Create valuable features Use accessible coding techniques Provide accessible multimedia Test – test – test!

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