Healthcare companies have a responsibility to ensure every patient receives the best possible care. That includes ensuring that necessary information is available to all patients. Documents saved as PDFs retain their security and structure on most platforms and devices. However, those PDFs may not be accessible to all clients, particularly people with disabilities who may use assistive technology. Over 25% of the population has some disability, either temporary or permanent. Patients and employees who use devices like screen readers or refreshable Braille displays may not be able to access necessary documents to review statements, medication information, or treatment options to manage their health. Providing accessible digital information is vital to ensure patient health and employee success.
PDF documents that need to be accessible:
- Billing Statements
- Directories of healthcare providers
- Brochures about health issues
- Brochures about medications
- Explanations of benefits
- Health plan manuals
- Staff procedural manuals
- HIPPA Information
- Patient records
- Lab results
- Test results
What laws apply?
Besides being necessary to provide the best service for your patients, if you receive any federal funding, accessibility is legally required by Section 508 of the Rehabilitation Act, whether you’re a public or private company.
If your healthcare facility receives federal funding through Medicare or Medicaid, Section 508 of the Rehabilitation Act applies to you. Section 508 requires that websites and all files on the website, which most often include PDFs, be accessible to both employees and the general public who may access them. Inaccessible documents can cost you government contracts, or even funding.
If your privately owned healthcare facility doesn’t receive government funding, you are still required to provide accessible resources to the general public as a place of public accommodation under the ADA. While this most commonly refers to physical locations, the Supreme Court has recently sided with a number of circuit courts that have held that websites are also places of public accommodation.
What standards should you meet to be compliant?
The ADA, Section 508, and Section 504 don’t specifically outline digital accessibility standards. The Department of Justice has left digital accessibility vague because accessibility will look different for each website depending on its content and structure.
However, Web Content Accessibility Guidelines (WCAG) will give you the most comprehensive standards for ensuring an accessible website. WCAG is the industry standard, though it’s not officially part of any regulations. A number of different countries and circuit courts in the US consider it the standard for digital accessibility.
What happens if your website isn’t compliant with Section 508 or the ADA?
Patients and employees- as many as 25% of them- who rely on assistive technology to access your website and files won’t be able to access important health documents. When people are denied access to their information, they become frustrated and may take legal action if the accessibility issues remain unresolved. In 2019 alone there were 2,256 lawsuits filed against companies who failed to make their digital resources accessible to people with disabilities. If there are a number of other clients who also are unable to access important documents you might be faced with a class-action ADA lawsuit.
Visitors with disabilities who are unable to reach the information required to manage their healthcare may feel discriminated against. They may respond by taking their business elsewhere. They may tell their friends and family that your company doesn’t consider their needs, and out of support for their loved one, those people may also seek care options elsewhere as well
All of these risks amount to one major issue- they cost a lot of money. Whether you’re facing a lawsuit or have patients who are choosing other providers, inaccessible PDF documents will cost your company reduced revenue, increased expense, and damage to your reputation.
Frazier v. HCA Holdings, Inc.
HCA Holdings, LLC was sued in federal district court on January 25, 2017. Plaintiff Lisa Frazier is blind and uses assistive technology to access the internet. Frazier alleges that hospital and clinic websites operated by HCA and its affiliates are inaccessible to assistive technology users. This blocks visually-impaired users from equal access to information, and therefore violates Title III of the Americans with Disabilities Act.
The American Blind Community vs. Tenet Healthcare
Tenet Healthcare Systems, headquartered in Dallas, Texas, owns and operates hundreds of facilities across the United States. In 2016 a class-action lawsuit filed on behalf of all Americans with visual disabilities claimed Tenet’s website was inaccessible. The healthcare organization failed to make its company websites accessible to people who use assistive technology, which violates Title III of the ADA, as well as Section 504 of the Rehabilitation Act. Parties settled the case shortly after filing.
Steven Mendelsohn & Sam Chen vs. WellPoint Inc. (2014)
California residents Steven Mendelsohn and Sam Chen, who are both blind, were unable to access their health insurance information from WellPoint Health Networks, Inc. (now Anthem). They became frustrated and filed lawsuits to address the issue. However, this case is a success story of how a settlement agreement can create a win-win situation for both parties. WellPoint used this opportunity to learn from the plaintiffs how it could improve its website for members with visual disabilities. As a result, WellPoint adopted Web Content Accessibility Guidelines (WCAG) as the standard towards which it will work.
Sam Chen had this to say about the progress: “Getting health care information in Braille, and being able to use WellPoint’s digital tools independently, are very important to me as a blind consumer. This program builds on WellPoint’s excellent reputation in the field of health care, and I value being associated with a company that recognizes the needs of all members, including those with visual impairments.”
How to avoid litigation:
When you begin working towards digital accessibility, you must include all digital resources, not just web pages. Video and audio files, and PDF documents located on your website or in emails, must also be accessible.
These PDFs might include individual documents like physician directories or pamphlets explaining common procedures. These PDFs can be quickly and easily remediated in-house with PDF remediation software such as Equidox.
Other PDFs may include mass-produced form documents with differing information for each client such as monthly billing statements. Those high-volume PDFs can be instantly made accessible using a batch processing service like the one offered by Equidox. Equidox can create custom coding just for your batch documents. This coding can identify key components on the page and recognize the varying data automatically and instantly.