EHRs and accessibility

[medisec]

I'm taking a grad class on web accessibility and disability this summer and am writing my final paper about nursing and EHRs, well I had hoped to....I can't find anything specific to this topic in nursing, mostly PHRs and patient access. Does anyone have any experience or observations about how EHRs help or even hinder accessibility for disabled nurses or clinicians in the workplace, or nursing students? If so, how do the medical facilities modify or accommodate for disability with employees accessing the EHR?

(I had another post on the Nurses with Disabilities thread, but it seemed to get lost in the shuffle. Would really like some insight since the available literature is sporifice to none.)

[RNewbie]

This is an interesting subject. Sorry I don't have any helpful input. I can not recall working with clinicians who needed any type of accommodations for EMR. Can you give examples of disabilities that would require accommodation to chart/access charts?

[mlbluvr]

There are all kinds of ways everyone, not only the disabled, can access EHRs. Touch screens. Wands. Voice recognition software. To name a few.

[HouTx, BSN, MSN, EdD]

The only real application that I can think of is accommodation for color blindness. Standards for EHRs include this... avoidance of using certain colors as the only method to highlight important areas of the screen, etc. Another option is 'sticky keys' so you don't have to manipulate 2 separate keys for any command... but that has been pretty much overridden by graphic interfaces that use touch screen or mouse clicks.

Although there are all types of accommodations that can be programmed into software, it is unlikely that severely disabled persons would be able to work as health care clinicians, so I don't know of many instances where it would be used.

This is a very interesting topic.. suggest you also take a look at the research on human interface / usability. Here's a great link to get you started https://www.dchi.duke.edu/publications-1/publications/Johnson-EHR_Usability_Toolkit_Background_Report.pdf

[medisec]

Thanks HouTx. Good info. I'll take a look at that link. Question, do all EHR system builds/vendor products provide those options you mentioned? It's the first I've heard of the sticky keys as an accommodation. For vision impaired, are the graphic interfaces with touch screen easy to navigate? Do the interfaces need a screen reader?

I just completed my literature review and it seems as though schools and hospitals do provide accommodations for hearing and vision impaired nurses, many are working as healthcare clinicians especially accommodations for hearing impaired. I have read how PHRs are being worked on to be compliant with Web 2.0 accessibility and Section 508 standards for disability, but concerns lie with I think with visually impaired and HIPAA. I think what sparked my curiosity even more is when I asked a publisher of one of the educational SIM EHRs used in nursing schools, and they said they have not modified but are currently in discussions about how to modify for students. I read about all the past studies about nursing students and nurses with disabilities "capabilities" to equally perform in a clinical setting/point-of-care, and how many have successfully transitioned from school to the workplace, but then all the a barriers and attitudes of instructors, program admissions that disabled nurses encounter. I thought the same thing too, about the "severely disabled ability to work as health clinicians," but the studies showed that many have supposedly met the technical standards set based on the ADA and Rehab. Act. and graduated from medical schools and practice medicine. Although, patient safety was still a concern that came up by participants AND the researchers. There are some great "I" stories published by Donna Carol Maheady in her books "Nursing Students with Disabilities" and "Leave No Nurse Behind: Nurses Working with Disabilities" but no mention of more advanced assistive technologies beyond amplified stethoscopes, digital monitors, etc. Because EHRs are still being integrated into healthcare facilities and slowly into nursing schools, I wondered what kinds of accommodations or modifications are available or should be available.