[SEC508] HIT accessibility rulemaking

["Baquis, David " <baquis@Access-Board.gov>]

I wanted you to be aware that the Access Board submitted these comments today. I have attached a PDF and  pasted the comments below for your convenience. So far, these are the only comments that  have been submitted about HIT accessibility in response to that rulemaking.

 

Thanks

David B.

 

David Baquis

Accessibility Specialist

U.S. Access Board

www.access-board.gov

202-272-0013

 

 

March 5, 2010

 

Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

Attention: HITECH Initial Set Interim Final Rule

Hubert H. Humphrey Building, Suite 729D

200 Independence Avenue, SW

Washington, DC 20201

 

 

Introduction

The U.S. Access Board appreciates the opportunity to provide comments on Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Record Technology.

 

The Access Board is an independent federal agency that promulgates accessibility standards and guidelines. In addition to the built environment (e.g., buildings and transportation) the Access Board writes standards and guidelines for information and communications technology (ICT).  Health information technology (HIT) would be considered a subset of ICT.

 

In these comments, the Access Board will provide recommendations specific to HIT, in addition to process recommendations. This is responsive to the section of the Federal Register notice requesting public comments “…on whether specific certification criteria could be adopted to further promote the capabilities Certified EHR Technology should provide with respect to meeting the accessibility needs of individuals with disabilities”. In general, the Access Board recommends that accessibility standards be applied to Certified EHR Technology and elevated to the highest level, as an essential value that would be considered no less important than standards for security, privacy, confidentiality, transport and exchange.

 

Background on Process

The Access Board has raised the issue of HIT accessibility numerous times over a period of several years, both orally and in writing. This has included recent participation in an HHS-sponsored summit on consumer health information; comments about HIT accessibility submitted with respect to objectives of Healthy People 2020; dialogue at Health Information Technology Standards Panel (HITSP) and American Health Information Community (AHIC) meetings; presentations at American Public Health Association (APHA) Conferences; coordinating staff meetings on HIT accessibility at the offices of both the Access Board and HHS; and speaking directly to the current and former National Coordinators for Health Information Technology. At the recommendation of the Access Board, the Interagency Committee on Disability Research (ICDR) identified HIT disability concerns as a primary issue during a strategic planning meeting a couple years ago and has planned a federal conference (invitation only) scheduled for May 2010 to address HIT accessibility, along with other issues.

 

Nevertheless, until now, accessibility (as defined in the disability context) has not appeared on the Federal or national HIT agenda. As evidenced in the text of this Federal Register Notice, technological civil rights was not recommended by the HIT Standards Committee as one of the categories for organizing the adopted standards, nor would accessibility fit into one of the existing 4 categories. In addition, accessibility was not included in the ONC HIT Strategic Plan intended to guide nationwide implementation of interoperable HIT in public and private sectors.  The Access Board hopes that “future deliberations” on accessibility referenced in the Federal Register notice will lead to a paradigm shift in public health culture that will result in inclusion of accessibility standards in HIT standards, as well as other evolutionary systemic changes that will positively impact the inclusion of people with disabilities.

 

Accessibility and Non-discrimination

The term “accessibility” in this context refers to design criteria, which remove barriers that make it difficult or impossible for some people with disabilities to use HIT.  The intent behind accessibility is to implement the principle of non-discrimination. It is a way of demonstrating that healthcare entities (such as organizations, providers, academic institutions and companies) wish to be welcoming to all people, including people with disabilities. Accessibility can be viewed as a means toward an end of reducing health disparities or achieving health equity. It is also important to recognize that accessible HIT facilitates employment of people with disabilities.

 

Accessible HIT supports the needs of people with a variety of needs including those with vision, hearing, cognitive and manual dexterity disabilities. Stakeholders who will potentially benefit from accessible HIT include patients, clients, families and guests with disabilities; students with disabilities in training to become healthcare professionals; clinicians with disabilities; researchers with disabilities; payers and administrative personnel with disabilities and many others. Types of healthcare technologies addressed by ICT standards include: websites, software, computers, hand-held wireless devices, videos, and telecommunications products.

 

Specific examples of HIT-related problems encountered by people with disabilities include the inability to use assistive technology, such as screen readers commonly utilized by people who are blind, to: fill out electronic forms, navigate health portal websites, or operate software for creating health records.

 

Accessibility to electronic content can be achieved through conformance to known guidelines and standards for website accessibility.  Authors may use the Web Content Accessibility Guidelines (WCAG 2.0) of the W3C Web Accessibility Initiative (WAI). They may also use the Electronic and Information Technology Accessibility Standards (commonly referred to as “the Section 508 Standards”) developed by the U.S. Access Board. Federal agencies are required to follow the Section 508 Standards in order to comply with Section 508 of the Rehabilitation Act, but the 508 Standards may be used by non-federal entities as well.  These guidelines and standards are well known and there is over a decade of experience in using them. In addition, there are many commercial-off-the-shelf software tools that can aid in the process of website evaluation and repair and a list of those tools can be found on the WAI website (http://www.w3.org/WAI/eval/Overview.html).

 

HIT Recommendations

·         Add accessibility requirements as HIT certification “floor” pass criteria, through reference to the Access Board’s Section 508 Standards in the HHS Standards for EHR Technology to be adopted by the Secretary.  Clarify that this would apply to EHR Technology outside of the Federal sector, as well as HIT in the Federal sector. (EHR Technology is defined in the Federal Register notice.)

·         Specify accessibility as a critical feature for determination of “meaningful use of HIT” under the Medicare and Medicaid HR Incentive Program.

·         Recommend that the National Institute of Standards and Technology (NIST) include accessibility standards and guidelines in the development of evaluation methods for testing HIT for conformance to certification criteria. In addition, recommend that NIST consider the capability to perform valid accessibility testing as part of the criteria for recognizing programs that wish to perform voluntary certification of HIT.

·         Include accessibility in the Certification Guidance Document. The Federal Register notice indicated that this would occur through a separate rulemaking process. That rulemaking process could flag accessibility as a new issue for public comment and should affirmatively solicit comments from the disability community.

·         Add technological non-discrimination as one of the “goals” to use in guiding a future approach for adopting the HIT standards and implementation specifications and certification criteria (as described in the Federal Register notice).

 

Process Recommendations

·         Appoint an accessibility issues manager in the Office of National Coordinator for Health Information Technology (ONCHIT).  This person could also serve as an agency Section 508 Coordinator.

·         Raise accessibility as a core value to be reflected in all forms of communication from the ONCHIT and other components of the federal HIT ecosystem. This could impact: official announcements, speeches, multimedia presentations, meeting agendas, websites, publications, and advice to the Secretary.

·         Include accessibility in future revisions to the strategic plan or similar ONCHIT policy documents.

·         Appoint people with accessibility expertise on advisory committees that report to the ONCHIT.

·         Provide accessibility “use cases” to standards development organizations (e.g., HITSP) providing technical recommendations to the ONCHIT.

·         Conduct affirmative outreach to the disability community to ensure sufficient input on accessibility issues from users with disabilities.  Maximize accessibility in communication and information related to such outreach efforts, including public meetings.

·         Coordinate a process for providing technical assistance and training on HIT accessibility.

·         Present seminars on HIT accessibility at federal and national mainstream conferences on assistive technology and information technology accessibility, including IDEAS, ATIA and CSUN.

·         Include accessibility in criteria for evaluating project performance in the National Health Information Network. 

·         Participate in the development of a federal research agenda related to HIT accessibility. Coordinate this with the Federal Collaboration on Health Disparities Research and Interagency Committee on Disability Research. Consider funding research to develop solutions to HIT accessibility barriers.

·         Convene a federal interagency workgroup on HIT accessibility to meet on a regular basis to address implementation of accessible HIT. Invited members could include: The National Council on Disability; Access Board; General Services Administration; Department of Education; Federal Communications Commission; Social Security Administration; Department of Veterans Affairs; Department of Defense; HHS Office on Disability; HHS Office on Minority Health; HHS Office of Civil Rights; HHS Center for Medicare and Medicaid Services; HHS Centers for Disease Control; HHS National Institutes of Health; HHS Agency for Healthcare Research and Quality; and HHS ONCHIT.

·         Review the status of federal agency compliance with respect to HIT and Section 508, to serve as a model of excellence in accessibility for the rest of the country.

 

Thank you again for the opportunity to comment and help promote the ONC objective of advancing the design and implementation of health technology to ensure that it is accessible to all.

 

Sincerely,

David Baquis

Accessibility Specialist

 

Attachment: COMMENT to HHS HITECH Initial Set Interim Final Rule.pdf
Description: COMMENT to HHS HITECH Initial Set Interim Final Rule.pdf