Inaccessible Telehealth Apps Don’t Just Exclude – They’re A Matter Of Life And Death
inaccessible telehealth apps don’t just exclude – they’re a matter

Inaccessible Telehealth Apps Don’t Just Exclude – They’re A Matter Of Life And Death

African American woman has medical consultation appointment video call with her doctor.

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The Covid-19 pandemic reshaped the healthcare landscape in a myriad of ways – mainstreaming multiple elements that were previously non-existent or on the periphery.

Face masks and vaccination websites are all here to stay at some level or another but the most seismic shift has undoubtedly been the explosion in telehealth in the form of remote medical consultations.

At the outset of the pandemic, telemedicine comprised less than 1% of primary care visits but this figure had skyrocketed to 43.5% within two short months.

Now the genie is out of the bottle and telemedicine consultations in healthcare are about as normalized in day-to-day life as Zoom calls are in business.

There are multiple societal benefits to be enjoyed from reduced waiting times to increased patient choice and convenience while digital health applications can also improve outcomes in monitoring the symptoms of long-term conditions.

Unfortunately, the very group of people with the most to gain from telehealth, namely the one in five American citizens living with a disability, risk being shut out of the healthcare revolution due to the proliferation of inaccessible apps and websites providing these services.

In an article published on Toptal earlier this year, former Apple digital accessibility expert Cezary Tomecyk commented on his experiences testing dozens of telehealth apps stating, “I haven’t found any single application [that’s] fully digitally accessible.”

While full digital accessibility may represent a high bar to attain, the past few months have witnessed the U.S. Justice Department enter into five separate settlement agreements with digital platforms offering Covid-19 vaccination booking services over breaches of the Americans with Disabilities Act (ADA) relating to poor accessibility.

The most recent of these was back in April in a settlement with CVS Pharmacy Inc, the country’s largest retail pharmacy, with nearly 10,000 locations.

For people living with disabilities and long-term health conditions, inaccessible digital healthcare is not simply a moderate inconvenience – it can end up severely diminishing a vulnerable individual’s quality of life and potentially shaving years off it.

Setting out the ground rules

In recognition of this precarious predicament for the 15% of people on the planet living with a disability, the World Health Organization (WHO) and International Telecommunication Union (ITU) have collaborated to create a new accessibility standard for telehealth services.

The Standard delves into granular detail on the specific technical requirements providers of digital healthcare need to consider to enable their platform to cater to a wide range of disabilities.

As one might expect, classic checklist items such as ensuring that apps and websites are compatible with screen readers so they can be navigated by blind users is included – as is guidance on the use of captions and sign language for the hearing impaired and ways menus can be made simpler to interact with for those with mobility and dexterity issues.

Interestingly, the standard addresses some vital areas that are likely to be of extra importance in a telehealth context such as enhanced video accessibility, with particular consideration to the presence of background noise, and the capacity to easily synchronize calls with multiple parties so that a person’s carer can participate.

Given the complexity of the subject matter, specific attention is paid to the use of language and how information is organized for people who may not possess high levels of health literacy including individuals with intellectual and learning disabilities.

Building empathy

Beyond simply attempting to comply with the regular Web Content Accessibility Guidelines (WCAG 2.1), general usability and creating a feeling of empathy is pivotal in the digital healthcare sector as failure to do so leads to low patient adherence and associated health risks.

Merita Bushi, a Senior Delivery Lead at TXI, a Chicago-headquartered digital strategy and innovation firm, explains further:

“The main difference between healthcare solutions and regular digital platforms lies in really understanding the place that the patient is at. A lot of times, health issues, particularly if they are chronic, become all-encompassing and affect somebody’s physical, mental and social well-being as well as their overall quality of life,” says Bushi.

“That’s why we always emphasize the importance of empathy and usability as part of the process for inclusive design. Yes. You need to maintain the same type of accessibility standards that are necessary for all other websites but the key differentiators are really getting to understand what the users need,” she explains.

By means of an example, Bushi shares some insights on TXI’s experience building a digital healthcare solution to monitor the symptoms of overactive bladder in conjunction with Renalis.

“When we were exploring the issue of overactive bladder – we learned that trust is a huge theme,” says Bushi.

“The tool eventually became a chatbot and it was vital to make it feel friendly and build trust. The illustrations we used were of utmost importance too. When you use human illustrations, it helps destigmatize a condition like overactive bladder that can sometimes create a lot of shame for people having to live with a chronic issue like that.”

Concerning the more tangible accessibility compliance elements in telehealth, Bushi does feel that the revolution in remote working has raised the bar.

“Patient expectations have been raised by our experiences during the pandemic,” she says.

“Now, when I use telehealth to speak to my doctor, I expect certain features to be there because I use Zoom every day.”

Aside from the pressing need for equity and social justice to ensure that the one group with the most to gain from the digital health revolution is not the very same group shut out of it – there’s also plenty of money to be made for designers who prioritize accessibility from the get-go.

This could be as much as $16 billion according to analysis published last year by Forrester.

At a design level, rigorous testing with people with disabilities at the earliest possible stage of the process is the best starting point. Bright-eyed young designers with no lived experience of disability making rash assumptions about what people with disabilities want and need is a big no-no.

The same can be said for attempting to retrofit accessibility remediations after a product has already launched and received poor feedback from users with disabilities.

However, given the extremely high stakes intrinsic to the healthcare sector, one classic no-no that may have to become a yes-yes is the offer of an alternative communication system.

Alternative communication offerings such as connecting to an agent over the phone to complete tasks for the user are commonly viewed as a major accessibility fail because it proves that the stand-alone website or app is not fully accessible.

Nevertheless, with telehealth and digital healthcare apps still in their infancy, alternative communication options might just be the best sticking plaster for now to keep everyone happy and healthy whilst the accessibility model continues to mature.

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