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Improving accessibility for online healthcare service users


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Presentation given by Prof Jonathan Hassell on the UK Faculty of Health Informatics Programme of Health Informatics Congress 2012.

Covers: why disabled and elderly audiences are potentially the main users of online healthcare information; how to design for their particular needs; examples of how online healthcare can learn lessons from web accessibility.

More information on BS 8878 can be found at:

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Improving accessibility for online healthcare service users

  1. 1. Improving accessibility for online healthcareservice users - inclusive design and BS 8878Prof Jonathan Hassell (@jonhassell)Director, Hassell Inclusion ltd.Chair, BSI IST/45Panel: applying Usability & Human-Centred Design principles in health & social care information systemsHealth Informatics Congress, UK Faculty of Health Informatics Programme2nd May 2012 © hassellinclusion
  2. 2. 1Human-centred Design starts with knowingwho your audiences are © hassellinclusion
  3. 3. What groups of people are likely to be using healthcare the most? © hassellinclusion
  4. 4. Older, disabled and long-term sick are the most likely patients © hassellinclusion
  5. 5. And the number of older people is growing rapidly © hassellinclusion
  6. 6. 2How should that influence the design of information systems? © hassellinclusion
  7. 7. What do elderly & disabled people need from online information?- a few examples Blind people: want sites which they can ready easily with screenreaders (good reading order of content and heading use) Older people: want sites with a text size that‟s big enough for them to read People with hearing impairments: need subtitles on video People with Aspergers: want sites that are easy to process, in the colours they want, without images or video distractions People with learning difficulties: need pages to just include the important information, preferably in images/video, with no clutter © hassellinclusion
  8. 8. 3 Is healthcare unique or can lessons learnton the web be applied? © hassellinclusion
  9. 9. Inclusion Issues: • Will people with literacy difficulties understand all this text, and be able to take apart their password letter by letter to get through secondary authentication? • Do the terms of use include the ability for people with learning difficulties to nominate intermediaries (carers) to access records on their behalf?Challenge 1: security vs ease of access © hassellinclusion
  10. 10. Inclusion Solutions: • Advice on how to secure access without preventing accessibility…Lessons can be learnt from accessibility to online banks © hassellinclusion
  11. 11. Inclusion Issues: • Information communicated solely in text (will people with literacy or learning difficulties get access?) • Information uses specialist terms, aimed at health professionals, not patients (will patients understand?)Challenge 2: data vs information © hassellinclusion
  12. 12. Inclusion Solutions: • Browsealoud provides text to speech facilities • Word Bank provides explanations of difficult words: • These are underlined with a dashed hyperlink. • When you click on these words, a pop-up box opens to show a clear text definition of the word and short animation • [But why not for „Cancer‟ or „Drugs‟?]Lessons can be learnt from elsewhere in healthcare © hassellinclusion
  13. 13. Inclusion Issues: • Information communicated solely in text (Can older people get it in a text size they can read? Can people with Aspergers or Dyslexia get it in the colours they need?)Challenge 3: I need it my way © hassellinclusion
  14. 14. Ana Menendez 146. At 08:24am on 14 Jul 2010, thrifty wrote: ( says: * The secondary menu bar is a bright red - glares Your website claims to be "danger" in western psychology. Perhaps you could accessible, but it is not, at least not use a darker shade of the burgendy instead. 100% AA compliant. It fails the criteria: 1.4.3 Contrast (Minimum): • design it background colour is strain &to white - high * The forced for everyone headaches. contrast contributes to eye The visual presentation of text and images of text has a contrast ratio of • tweak it soa disabled help here? Perhaps light grey would people at least 4.5:1(Level AA)- can use Assistive Technologies or OS/browser settings to make 115. At 08:05am on 14 Jul 2010, chris b wrote: it work for them … Awful UK News/World New panel - … Terrible contrast too between the text and dark background.The rest of the web has the same challenges… © hassellinclusion
  15. 15. Before… during…After… © hassellinclusion
  16. 16. Inclusion Solutions: • DNPR Standards already created for „recording additional needs, including issues of accessibility‟ • If additional accessibility needs are stored in patient records, patient information systems should automatically personalise themselves to present information according to the patients recorded needsHealthcare professionals are looking at how to capture thesepreferences and use them to improve patient experiences © hassellinclusion
  17. 17. 4 So how should youapproach accessibility? © hassellinclusion
  18. 18. Thinking of Accessibility as Compliance with Standards…… gets rid of some of your legal and reputational risks © hassellinclusion
  19. 19. But it’s better to listen to your diverse audiences’ needs…this identifies challenges…but innovation often follows a challenge © hassellinclusion
  20. 20. What accessibility really should be…• all about disabled & elderly people• aim shouldn‟t be accessibility… or even usability… but a great user experience for disabled & elderly people• whether they can get the right value out of what you create• exactly what you aim for, for every other audience• you don‟t want to exclude 10m+ people from using your products… © hassellinclusion
  21. 21. Integrating accessibility in human-centred design processes• relating web accessibility to wider • and bringing in concepts of human-centred and inclusive design user-personalised practices approaches… From: ISO/FDIS 9241-210 Human-centred design for interactive systems © hassellinclusion
  22. 22. BS 8878 does that and more– presents the business-case for accessibility and digital inclusion– gives advice for how to embed accessibility strategically within an organisation– recommends a human-centred process which identifies the key decisions which are taken in a web product’s lifecycle which impact accessibility– recommends an informed way of making these decisions…– and a way of documenting all of this to ensure best practice Organizational Web Web Web Product Product Accessibility Accessibility Accessibility Policy Policy Statement © hassellinclusion
  23. 23. “BS 8878 is an integral partof our web accessibilitystrategy.It has given us theframework to help reducecosts and improve thequality when deliveringaccessible web products forour customers.” Rob Wemyss Head of Accessibility Royal Mail Group
  24. 24. 5Find out more… © hassellinclusion
  25. 25. Get slides on all 16 BS 8878 © hassellinclusion
  26. 26. Get latest news, tools, blogs, training: the © hassellinclusion
  27. 27. 6 An international issue…We could set the Standard © hassellinclusion
  28. 28. Many countries are facing the same challenges…but the UK should lead… "Digital technology has changed the way we do so much and has opened up a world of new possibilities. Accessing essential services have become so much easier thanks to the Internet. Some of those who could benefit most from the digital revolution are currently being excluded. We must ensure technology is accessible to as many people as possible.” “The UK and US are the countries which are furthest ahead in this agenda – and we must build on this…” Ed Vaizey, Communications Minister © hassellinclusion
  29. 29. If you need support & training – I’m happy to help... © hassellinclusion
  30. 30. Training & Innovation support for BS8878 StandardsStrategy &research © hassellinclusion
  31. 31. e: jonathan@hassellinclusion.comt: @jonhassellw: © hassellinclusion