Month: September 2023

My old friend Catbird asked me a question.

Hi Roger— When you need to get information from your medical provider(s), how do you do it? Phone? Email?  USPS? Online system?

My only access is through a “patient portal” that is “protected” by Captcha. I can’t use a captcha because I have a visual deficit, and I am trying to find out how widely it’s used to guard medical information (and even access to my provider). The captcha workaround is widely known, so at best, it’s only an illusion of security or privacy.  The best I can do is take my own notes and try to remember to ask for a paper copy of any results before I leave a medical visit.

Thanks for any info or perspective.

  It wasn’t THAT long ago (was it?) that I could call my primary physician’s office, and usually within two hours, my doctor’s nurse, who knew me by name because we had such a long-term relationship, would call me back.

That’s gone by the boards, as virtually every transaction I have is on my cellphone or the portal. The cell to acknowledge appointments and check-in. Some places don’t want you inside until they text you to avoid overcrowding; COVID accelerated this tremendously. I finally grudgingly embraced the cell phone out of necessity.

Everything else is on the portal. Or portals. I have to access more than one. While most of my providers, for good and for ill, are affiliated with one entity, there are outliers, such as my podiatrist, dermatologist, and allergist, who are not. My computer knows who I am vis-a-vis these gateways; when it inevitably dies, I’m probably screwed.

ADA

It occurred to me that the offices would be subject to the Americans with Disabilities Act. Indeed, per Dreamscape, THE IMPORTANCE OF THE TITLE IV REVISION TO MODERN LIVING: “The Title IV amendment came in 2008. From telephonic communications to the internet, television, and other digital services, it was apparent that Americans with disabilities needed special accommodations. Everyday tasks such as surfing the web or watching television ranged from inconvenient to impossible with hearing, vision, or other physical impairments. 

“Thus, Title IV set a new standard for telecommunications. Through it, certain requirements came into effect for digital communications, including closed captioning and guidelines for web accessibility. These guidelines [which are very wonky] include site navigation, alt text for photos, and other information shared through web content or applications.”

There should be accommodations made. For instance, the Equalweb page suggests that “the Visually Impaired profile automatically activates the Screen Reader Adjustment function, the Low and High Saturation and Contrast modes, and the Image Descriptions, Magnifier, Reader Font, Highlight Links, Highlight Headers, and Text Magnifier functions for individuals who live with visual impairments.”

More on point from the AHIMA Foundation: What To Do If Your Patient Portal Is Not Accessible. “In March 2022, the U.S. Department of Justice released guidance under the Americans with Disabilities Act (ADA) on how state and local governments and businesses open to the public (such as hospitals and healthcare organizations) can make sure their websites are accessible to people with disabilities.

“In the context of patient portals, it’s the hospital’s job to ensure their portal is accessible to all patients….

Things to fix

Reasons Why Patient Portals and Other Health Websites Might Not Be Compliant with ADA

• Poor color contrast. People with color blindness and other disabilities related to vision ─ such as diabetic retinopathy ─ may have difficulty reading text if the text color is similar to the color of the background.
• Lack or poor alternative text in images and graphics. If there is no alternative text, or alt-text, in an image or a graphic, someone who uses a screen reader will not be able to know what information is in the image or graphic.
• No captions on videos or transcripts for audio. Someone who is hard of hearing or blind will not be able to know or have difficulty understanding information that is in a video or podcast, for example.
• Inaccessible online forms. There need to be clear labels on forms for people who use screen readers. Having clear instructions is always helpful.

Patient Portals and 508 Compliance

“Any hospital or health clinic that receives federal funding also needs to be compliant with Information and Communication Technology (ICT) under Section 508 of the Rehabilitation Act and Section 255 of the Communications Act.

“If a patient portal is inaccessible to you or someone you care for, look for a statement of accessibility on the hospital’s website. Typically, it’s linked at the very bottom and includes a phone number and/or email address where you can report any issues you are experiencing. 

“Requesting changes or filing a complaint regarding the inaccessibility of your patient portal should be made directly to your healthcare provider and/or hospital. They may be able to help you and address your concerns more timely than filing with a federal agency.

“Should you not receive a response after contacting your provider and/or hospital, you can file an online ADA Complaint with the Department of Justice, Civil Rights Division.”

I wonder if one reasonable accommodation could be talking to you on the phone and mailing stuff to you if they can’t quickly fix their website. I put it as a short-term solution, not a permanent fix.

One last thing on the topic of medical care. My primary physician used to be in a partnership. Then, the practice was gobbled up by Big Med. Since then, her office has moved FOUR times, including this month. This most recent change means it’ll take me two buses and an hour to get there. [Sigh.]