Provider Directory Accessibility Audit

Man looking about Section 508 Compliance on his computer in an office

Equidox has been collaborating with healthcare organizations to ensure provider directory accessibility, as required by law. As part of our research, we audited over 70 publicly available online PDF physician directories. Surprisingly, over 50% of these physician directories lacked tags for accessibility.  Of those tagged, many contained errors rendering the document unusable for someone who uses assistive technology to read PDFs. 

Applicable laws

Current laws such as the Americans with Disabilities Act, the Affordable Care Act, and Section 508 of the Rehabilitation Act mandate that customer communications for healthcare companies be accessible for people with disabilities.  All online communications, including PDF documents, need to function with assistive technology, which helps people with disabilities access digital information. Many state-specific laws also apply to customer communications. This means organizations must ensure provider directory accessibility for PDFs as well. 

Challenges of remediating enormous PDFs

Healthcare organizations compile numerous physician or provider directories across multiple health plans and regions, which are provided in multiple languages. The sheer volume and complexity of these directories, often spanning thousands of pages, pose a formidable challenge in remediating them to meet accessibility standards.  While some organizations handle remediation in-house, many opt for outsourcing, which introduces the risk of inaccessible content if proper accessibility testing is not conducted.

Additionally, the cost of staff time or financial outlay for outsourcing can be considerable when addressing thousands of PDF pages. Further, organizations must also take into account human error. To ensure remediation is being done correctly, checking of the remediated PDFs is also required. Automated testing alone cannot determine whether or not remediated documents are accessible. Manual checks for heading structure, reading order, alt text, and overall usability are necessary. 

Common errors

The most common errors encountered by this audit were flawed heading structure, incorrect reading order, and lack of alternative text (alt-text) on images. While these may seem minor, they significantly impact the usability of these directories for individuals with disabilities. Notably, automated checkers often fail to detect these issues, necessitating manual checks with assistive technologies like screen readers. 

Heading structure

Headings make a document navigable so the user can find specific content. A lack of proper heading structure can make it difficult or impossible for users to locate specific information, such as differentiating dermatologists or cardiologists among thousands of other physicians. It could take hours to tab through the content of a 1500-page directory to find the correct entry. 

Reading order

Another common issue among tagged documents is reading order. In tagged documents, visual appearance may not accurately reflect the digital reading order.  This often isn’t observable to a sighted person, only someone using assistive technology. 

Discrepancies in reading order can lead to inaccuracies in finding essential information, such as contact details for a specific doctor. Most physician directories are arranged in 3-column format.  This means that without the correct reading order, someone using assistive technology might get content from line one of EACH column reading from left to right across the page, rather than reading down each column and then continuing to the next one. That will not provide accurate information to help a patient find the right doctor. 

Incorrect reading order can also result in content not being read together that belongs together. If all content is not in exactly the correct order, wrong phone numbers or addresses may be read along with the wrong doctors. 

Alt-text for Images

Many directories we audited contained untagged images. This means rather than explaining what the image portrays, the assistive technology would just announce “IMAGE” without providing context. This is particularly problematic when directories contain icons conveying crucial information, such as proximity to public transportation or accessibility features. The absence of alt text deprives users of valuable information vital to their decision-making process. 

Ensuring accessibility with Equidox AI

To streamline the process of ensuring accessibility compliance, Equidox offers an automated solution, Equidox AI. This solution efficiently remediates physician directories, ensuring proper heading tags, alt text for images, and reading order. PDFs remediated by Equidox AI not only pass automated checkers but also undergo thorough manual checks with screen readers, guaranteeing accessibility for all users.

Are your directories accessible?

Ensuring accessibility is not just a legal requirement; it’s a commitment to inclusivity. If you’re uncertain about the accessibility of your physician directories, we can help with a complimentary provider directory accessibility audit. Discover how Equidox AI can simplify the process, providing accessible content for all your customers. Contact us for your free consultation.


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Tammy Albee

Tammy Albee | Director of Marketing | Equidox Tammy joined Equidox after four years of experience working at the National Federation of the Blind. She firmly maintains that accessibility is about reaching everyone, regardless of ability, and boosting your market share in the process. "Nobody should be barred from accessing information. It's what drives our modern society."