WEBVTT NOTE This file was generated by Descript 00:00:05.274 --> 00:00:09.324 Damian Engel: Hello, my name is Damian Engel, and I'm the co-founder and director 00:00:09.324 --> 00:00:12.274 of Digital Accessibility at AccessiTREE. 00:00:12.474 --> 00:00:15.977 I'm thrilled to have you here today for our webinar, " A Colorado 00:00:15.977 --> 00:00:21.347 Healthcare Providers Guide to the new HHS Digital Accessibility Rules". 00:00:21.947 --> 00:00:25.004 Thank you for taking the time out of your busy schedules to 00:00:25.004 --> 00:00:26.579 focus on this important topic. 00:00:28.467 --> 00:00:32.397 Over the next 30 minutes, we're going to unpack a landmark shift in healthcare 00:00:32.397 --> 00:00:36.597 regulation that impacts every one of you in this room and watching online. 00:00:36.927 --> 00:00:40.407 My goal today is not to scare you with legal jargon, but to 00:00:40.407 --> 00:00:44.067 provide you with a clear, practical roadmap to navigate what's ahead. 00:00:44.637 --> 00:00:48.777 We'll start by breaking down the new federal rule, what it is, who it 00:00:48.777 --> 00:00:51.387 applies to, and when you need to comply. 00:00:52.047 --> 00:00:55.947 Then we'll demystify the technical standards and define what genuine 00:00:55.947 --> 00:00:58.227 accessibility actually looks like. 00:00:58.767 --> 00:01:02.907 We'll spend some critical time on a dangerous trend, so-called quick fix 00:01:02.907 --> 00:01:06.747 widgets, and I'll show you why they create more problems than they solve. 00:01:07.257 --> 00:01:11.127 After that, we'll look at the real world costs of non-compliance versus the 00:01:11.127 --> 00:01:13.527 significant return on investing in access. 00:01:13.852 --> 00:01:17.122 I'll then provide you with a concrete roadmap, including average 00:01:17.122 --> 00:01:19.132 timelines to help you start planning. 00:01:19.522 --> 00:01:23.422 We'll wrap up with three simple steps you can take next week to begin your journey. 00:01:23.902 --> 00:01:27.082 The core takeaway I want you to leave with today is this. 00:01:27.972 --> 00:01:31.932 This isn't just about compliance, it's about providing better care to 00:01:31.932 --> 00:01:36.492 a significant portion of our Colorado community and protecting your organization 00:01:36.582 --> 00:01:39.132 from very real legal and financial risks. 00:01:39.492 --> 00:01:40.152 Let's begin. 00:01:41.156 --> 00:01:45.116 What we're discussing today is a landmark shift in civil rights legislation. 00:01:45.626 --> 00:01:50.456 On May 9th, 2024, the US Department of Health and Human Services, or 00:01:50.456 --> 00:01:55.696 HHS, published a final rule that completely modernizes section 504 00:01:55.716 --> 00:01:58.326 of the Rehabilitation Act of 1973. 00:01:59.106 --> 00:02:02.946 This was the first full rewrite of these regulations in almost 50 years, 00:02:03.006 --> 00:02:04.806 bringing them into the digital age. 00:02:05.466 --> 00:02:10.446 The purpose of this rule is to strengthen and clarify non-discrimination protections 00:02:10.476 --> 00:02:15.576 for people with disabilities across every single program or activity that 00:02:15.576 --> 00:02:18.016 receives any federal funding from HHS. 00:02:18.016 --> 00:02:22.526 This is a powerful, sweeping update designed to ensure equity in healthcare. 00:02:24.386 --> 00:02:26.906 So let's break down exactly what this means for you. 00:02:27.356 --> 00:02:29.126 First, who is covered. 00:02:29.786 --> 00:02:34.766 The rule applies to any recipient of federal financial assistance from HHS. 00:02:35.306 --> 00:02:36.386 Let's translate that. 00:02:36.806 --> 00:02:40.616 If your organization accepts Medicare or Medicaid or government 00:02:40.616 --> 00:02:42.176 grants, you are covered. 00:02:42.506 --> 00:02:46.856 This isn't limited to large hospitals; it includes rural clinics, national 00:02:46.856 --> 00:02:50.876 insurers, dental and vision providers, and even assisted living facilities. 00:02:51.776 --> 00:02:53.666 The scope is incredibly broad. 00:02:54.536 --> 00:02:56.426 Second, what is required? 00:02:56.996 --> 00:02:59.246 The language is specific and unambiguous. 00:02:59.666 --> 00:03:03.956 All of your patient facing digital content and mobile applications must 00:03:03.956 --> 00:03:09.356 conform to the web content accessibility guidelines, version 2.1 at the Level 00:03:09.356 --> 00:03:11.996 A and Level AA success criteria. 00:03:12.596 --> 00:03:18.236 We'll unpack what WCAG 2.1 AA means in the next section, but for now, 00:03:18.416 --> 00:03:22.366 know that this is the specific testable standard you will be held to. 00:03:23.396 --> 00:03:25.346 And third, when is the deadline? 00:03:25.976 --> 00:03:29.606 For any organization with 15 or more employees the compliance 00:03:29.606 --> 00:03:32.156 deadline is May 11th, 2026. 00:03:32.996 --> 00:03:36.776 For smaller organizations with fewer than 15 employees, the deadline 00:03:36.776 --> 00:03:39.566 is one year later in May of 2027. 00:03:40.076 --> 00:03:44.276 While May, 2026 may seem like it's a long way off the journey to full 00:03:44.276 --> 00:03:46.856 compliance is a marathon, not a sprint. 00:03:47.366 --> 00:03:50.541 As we'll discuss, the process can take many months and the 00:03:50.541 --> 00:03:51.771 clock is already ticking. 00:03:52.311 --> 00:03:55.431 This isn't an abstract federal issue happening somewhere else. 00:03:55.551 --> 00:03:59.091 This has a direct and profound impact right here in our communities. 00:03:59.451 --> 00:04:03.591 In Colorado, there are over 600,000 people living with a disability. 00:04:03.921 --> 00:04:06.021 Let's make those numbers more tangible. 00:04:06.501 --> 00:04:10.606 That means nearly 5% of our state's population, one in 20 00:04:10.606 --> 00:04:13.041 people, has a cognitive difficulty. 00:04:13.521 --> 00:04:16.101 Another 5% have a mobility difficulty. 00:04:16.636 --> 00:04:21.556 Over 3% have a hearing difficulty, and 2% have a vision difficulty. 00:04:22.156 --> 00:04:26.176 These are our neighbors, our family members, and most importantly, 00:04:26.446 --> 00:04:27.556 they are your patients. 00:04:28.366 --> 00:04:32.146 They are the people who rely on your websites to find a doctor, on your 00:04:32.146 --> 00:04:36.646 portals to check lab results, and on your media to learn about a procedure. 00:04:38.261 --> 00:04:40.121 There's a point of pride here as well. 00:04:40.181 --> 00:04:46.151 In early 2025, a study ranked Colorado as the number one state in the nation 00:04:46.331 --> 00:04:51.311 for people with disabilities, citing our commitment to inclusivity, healthcare 00:04:51.311 --> 00:04:53.501 access, and community resources. 00:04:54.191 --> 00:04:59.621 This new HHS rule is our mandate to ensure that our digital front door, the primary 00:04:59.621 --> 00:05:04.361 way many patients now interact with you, lives up to that standard of excellence. 00:05:04.946 --> 00:05:07.676 It's a call to lead, not just to comply. 00:05:09.056 --> 00:05:12.806 It is absolutely critical for healthcare leadership to understand that this 00:05:12.806 --> 00:05:16.886 new rule is not just a technical checklist for your IT department. 00:05:17.516 --> 00:05:20.576 The digital accessibility requirement is one piece of a 00:05:20.576 --> 00:05:25.076 much larger, more comprehensive patient equity initiative from HHS. 00:05:25.826 --> 00:05:30.596 The same final rule that mandates WCAG 2.1 conformance also includes 00:05:30.596 --> 00:05:33.986 powerful new provisions to combat other forms of discrimination. 00:05:34.361 --> 00:05:38.201 For example, the rule explicitly prohibits medical treatment decisions 00:05:38.201 --> 00:05:42.461 based on biases or stereotypes about people with disabilities, such as 00:05:42.461 --> 00:05:46.211 denying an organ transplant to someone with an intellectual disability 00:05:46.571 --> 00:05:50.261 based on a false assumption that they couldn't manage postoperative care. 00:05:50.651 --> 00:05:55.751 It addresses the discriminatory use of value assessment methods that might 00:05:55.751 --> 00:05:59.801 place a lower value on extending the life of a person with a disability. 00:06:00.171 --> 00:06:04.881 It even mandates that, within two years, providers must have accessible 00:06:04.881 --> 00:06:09.021 medical equipment like height adjustable exam tables, and weight scales 00:06:09.321 --> 00:06:10.971 that can accommodate wheelchairs. 00:06:11.361 --> 00:06:15.411 When you view the digital mandate within this broader context, the intention of 00:06:15.411 --> 00:06:17.451 the regulators becomes crystal clear. 00:06:18.081 --> 00:06:22.066 They view your website, your mobile app, your online documents, your 00:06:22.066 --> 00:06:26.506 media, and your patient portals as an integral, non-negotiable part of 00:06:26.506 --> 00:06:28.456 the total patient care experience. 00:06:29.026 --> 00:06:32.806 An inaccessible patient portal that prevents a patient who is blind from 00:06:32.806 --> 00:06:36.676 independently accessing their lab results is seen in the same light 00:06:36.676 --> 00:06:38.806 as a clinic with no wheelchair ramp. 00:06:39.346 --> 00:06:42.946 A recorded video without captions is viewed as a fundamental barrier 00:06:42.946 --> 00:06:47.146 to care, just like medical equipment that a patient cannot physically use. 00:06:47.716 --> 00:06:51.046 This means that a failure in digital accessibility won't be 00:06:51.046 --> 00:06:55.486 seen by the HHS Office for Civil Rights as a simple website error. 00:06:55.906 --> 00:06:59.926 It could be interpreted as evidence of a systemic failure to prioritize the 00:06:59.926 --> 00:07:04.006 needs of patients with disabilities, potentially linking it to other forms of 00:07:04.006 --> 00:07:06.166 discrimination within your organization. 00:07:06.826 --> 00:07:09.976 This is why this initiative cannot be delegated solely to 00:07:09.976 --> 00:07:11.926 your IT or marketing department. 00:07:12.496 --> 00:07:16.576 It requires engaged leadership from your compliance, patient experience, 00:07:16.606 --> 00:07:21.406 legal and executive teams to ensure that digital equity is woven into the 00:07:21.406 --> 00:07:23.506 fabric of your organization's mission. 00:07:23.981 --> 00:07:29.711 So the law says you need to conform to WCAG 2.1 level AA. 00:07:30.281 --> 00:07:32.861 For many of you, that might sound like technical jargon. 00:07:33.341 --> 00:07:35.321 Let's break it down into plain language. 00:07:35.801 --> 00:07:40.241 WCAG stands for the Web Content Accessibility Guidelines. 00:07:40.691 --> 00:07:44.261 It's the global gold standard for making digital content accessible 00:07:44.261 --> 00:07:45.431 to people with disabilities. 00:07:46.121 --> 00:07:51.321 It was created and is maintained by the Worldwide Web Consortium or W3C, 00:07:51.461 --> 00:07:54.701 the main international standards organization for the internet. 00:07:55.211 --> 00:07:57.281 Think of it as the building code for the web. 00:07:57.851 --> 00:08:02.501 It provides a single shared standard with testable criteria that organizations 00:08:02.501 --> 00:08:05.981 and governments around the world can use to ensure access for all. 00:08:06.611 --> 00:08:13.181 The HHS rule specifically mandates WCAG 2.1, which was released in 2018. 00:08:13.796 --> 00:08:18.536 It's important to note that a newer version WCAG 2.2 was 00:08:18.536 --> 00:08:20.516 released in October, 2023. 00:08:20.756 --> 00:08:25.736 While 2.1 is the legal minimum you must meet, adopting the newer 2.2 standard 00:08:25.736 --> 00:08:27.596 now is a smart business decision. 00:08:27.836 --> 00:08:31.106 It will save you time and money on future retrofits and better 00:08:31.106 --> 00:08:32.846 future proof your digital assets. 00:08:34.277 --> 00:08:38.837 To make WCAG easier to understand, the guidelines are organized 00:08:38.837 --> 00:08:40.547 around four core principles. 00:08:40.787 --> 00:08:42.807 You can remember them with the acronym POUR. 00:08:43.397 --> 00:08:47.807 For your content to be accessible, it must be perceivable, operable, 00:08:48.107 --> 00:08:50.267 understandable, and robust. 00:08:50.897 --> 00:08:53.777 Let's look at each one through the lens of a healthcare provider. 00:08:54.906 --> 00:08:56.436 First, perceivable. 00:08:57.096 --> 00:09:00.126 This principle states that information and user interface 00:09:00.126 --> 00:09:03.756 components must be presentable to users in ways they can perceive. 00:09:04.326 --> 00:09:08.946 In other words, the information can't be invisible to all of a person's senses. 00:09:09.366 --> 00:09:13.026 A perfect healthcare example is a video on your website that explains 00:09:13.026 --> 00:09:14.706 a complex medical procedure. 00:09:15.261 --> 00:09:19.461 For a patient who is deaf or hard of hearing, that video is useless without 00:09:19.461 --> 00:09:21.741 captions to convey the audio information. 00:09:22.011 --> 00:09:25.881 Similarly, if you post an infographic showing the location of a new 00:09:25.881 --> 00:09:29.901 clinic, a patient who is blind needs a text alternative, often 00:09:29.901 --> 00:09:34.011 called "alt text" that describes the information in the image so their 00:09:34.011 --> 00:09:35.751 screen reader can announce it to them. 00:09:36.111 --> 00:09:39.771 It's about ensuring that no one is locked out of information because it's only 00:09:39.771 --> 00:09:42.051 presented in a single sensory format. 00:09:43.208 --> 00:09:44.708 Second operable. 00:09:45.218 --> 00:09:48.278 This means that users must be able to operate the interface. 00:09:48.578 --> 00:09:51.668 The interface cannot require an interaction that a user is 00:09:51.668 --> 00:09:52.963 physically unable to perform. 00:09:53.708 --> 00:09:57.488 Think about a patient with severe arthritis or hand tremors from a 00:09:57.488 --> 00:09:59.438 condition like Parkinson's disease. 00:09:59.708 --> 00:10:03.008 Using a mouse with precision can be difficult or impossible. 00:10:03.248 --> 00:10:06.788 For them to book an appointment online, they must be able to navigate 00:10:06.788 --> 00:10:10.808 your website or patient portal using only their keyboard, tabbing 00:10:10.808 --> 00:10:14.738 from link to link, pressing enter to make a selection and filling out 00:10:14.738 --> 00:10:16.598 forms without ever touching a mouse. 00:10:16.978 --> 00:10:20.668 Another aspect of operability is avoiding content that can cause 00:10:20.668 --> 00:10:24.448 physical harm, such as flashing animations that could trigger seizures. 00:10:25.688 --> 00:10:27.308 Third, understandable. 00:10:28.088 --> 00:10:31.088 This principle is about clarity and predictability. 00:10:31.778 --> 00:10:36.188 Information and the operation of the interface must be easy to comprehend. 00:10:36.848 --> 00:10:39.128 This is incredibly relevant in healthcare. 00:10:39.398 --> 00:10:43.658 Consider a patient undergoing chemotherapy who is experiencing what is often called 00:10:44.228 --> 00:10:49.478 "chemo brain", a cognitive fog that can make complex information overwhelming. 00:10:49.808 --> 00:10:54.518 If they visit your website to pay a bill, is the layout consistent and predictable? 00:10:54.818 --> 00:10:57.668 Are the instructions written in simple, plain language? 00:10:57.998 --> 00:11:01.988 When they make a mistake filling out a form, are the error messages helpful 00:11:01.988 --> 00:11:03.938 and clear about how to fix the problem? 00:11:04.238 --> 00:11:08.738 Understandability is about reducing cognitive load for everyone, especially 00:11:08.738 --> 00:11:12.758 those who may be stressed, sick, or experiencing cognitive challenges. 00:11:13.823 --> 00:11:15.533 Finally robust. 00:11:16.403 --> 00:11:20.243 This means your content must be robust enough that it can be interpreted 00:11:20.243 --> 00:11:24.503 reliably by a wide variety of user agents, including assistive 00:11:24.503 --> 00:11:27.203 technologies, both now and in the future. 00:11:27.773 --> 00:11:31.683 This is the most technical of the four principles, but the concept is simple: 00:11:31.938 --> 00:11:34.158 your digital assets need to be well-built. 00:11:34.398 --> 00:11:38.238 It's about using clean, standard compliant code so that it plays nicely 00:11:38.238 --> 00:11:40.398 with the technologies your patients use. 00:11:40.728 --> 00:11:45.438 For example, a patient who is blind uses software called a screen reader that 00:11:45.438 --> 00:11:47.298 reads the content of a webpage aloud. 00:11:48.068 --> 00:11:51.908 If your website's code is sloppy or non-standard, the screen reader 00:11:51.908 --> 00:11:55.868 might misinterpret a dosage for a medication, skip over an important 00:11:55.868 --> 00:11:58.238 allergy warning, or crash altogether. 00:11:58.568 --> 00:12:03.098 Robustness ensures that as technology evolves, your content remains accessible. 00:12:04.108 --> 00:12:08.488 So what does poor look like in practice across your digital ecosystem? 00:12:09.058 --> 00:12:12.928 On your websites, it means having high color contrast between text and 00:12:12.928 --> 00:12:17.908 backgrounds, ensuring all functions can be accessed with a keyboard, and using 00:12:17.908 --> 00:12:22.378 proper heading structures so a screen reader user can easily scan the page. 00:12:23.488 --> 00:12:27.808 In your patient portals, it means forms for prescription refills are properly 00:12:27.808 --> 00:12:32.248 labeled, error messages are clear and helpful, and a patient can use 00:12:32.248 --> 00:12:36.148 their screen reader to independently access sensitive lab results or 00:12:36.148 --> 00:12:37.558 communicate with their doctor. 00:12:38.788 --> 00:12:42.178 For your media this means providing synchronized, accurate captions for 00:12:42.808 --> 00:12:44.548 all prerecorded videos that have audio. 00:12:45.448 --> 00:12:48.898 If a video has important visual information that isn't described in 00:12:48.898 --> 00:12:52.918 the audio, like onscreen text, it must also have an audio description. 00:12:53.218 --> 00:12:57.868 For audio only content such as podcasts, you should provide an accurate transcript. 00:12:58.862 --> 00:13:02.852 Even for kiosks and tablets in your waiting rooms, the principles apply. 00:13:03.392 --> 00:13:07.502 While the HHS rule doesn't set a specific technical standard for 00:13:07.502 --> 00:13:13.082 kiosks yet, it suggests applying WCAG principles to the software. 00:13:13.352 --> 00:13:17.102 And crucially, the rule states that any workaround you provide, like 00:13:17.102 --> 00:13:20.732 asking a patient who can't use the kiosks or tablets to go to the front 00:13:20.732 --> 00:13:25.472 desk, must offer the same access, convenience, and confidentiality. 00:13:26.147 --> 00:13:28.517 Real accessibility is not a single feature. 00:13:28.877 --> 00:13:33.047 It's the result of thoughtful design and development woven into every digital 00:13:33.047 --> 00:13:35.087 touchpoint you have with your patients. 00:13:36.587 --> 00:13:39.737 Now, I need to address a critical and dangerous trend in the 00:13:39.737 --> 00:13:41.567 world of digital accessibility. 00:13:41.957 --> 00:13:46.217 As awareness of these legal requirements has grown, a cottage industry of 00:13:46.217 --> 00:13:50.807 products has emerged promising, a quick, cheap, and easy solution. 00:13:51.542 --> 00:13:52.742 You've likely seen them. 00:13:52.922 --> 00:13:58.022 A small icon often shaped like a person that sits in the corner of a website. 00:13:58.532 --> 00:14:03.632 When you click it, a toolbar opens with options to change colors or text size. 00:14:04.502 --> 00:14:07.382 These are called accessibility overlays or widgets. 00:14:07.772 --> 00:14:12.062 They are marketed aggressively, often using AI as a buzzword, and they all 00:14:12.062 --> 00:14:16.682 make the same seductive promise: add one line of code to your website and 00:14:16.682 --> 00:14:20.552 you will be instantly compliant with the law and protected from lawsuits. 00:14:20.927 --> 00:14:25.607 It sounds too good to be true, and I'm here to tell you that it absolutely is. 00:14:26.627 --> 00:14:29.897 The central technical failing of every overlay on the market 00:14:29.897 --> 00:14:33.347 is that it cannot alter your website's underlying source code. 00:14:34.157 --> 00:14:38.327 These tools use JavaScript to apply a temporary, superficial layer 00:14:38.327 --> 00:14:42.347 of fixes over your existing site structure within the user's browser. 00:14:43.007 --> 00:14:44.657 Worse than being ineffective. 00:14:45.047 --> 00:14:48.317 These overlays frequently make websites less accessible. 00:14:48.797 --> 00:14:52.727 They often conflict with the very assistive technologies like screen 00:14:52.727 --> 00:14:56.627 readers, that people with disabilities have spent years mastering and 00:14:56.627 --> 00:14:58.997 customizing to their specific needs. 00:14:59.297 --> 00:15:04.097 A user with a disability already has tools on their computer or in their browser 00:15:04.247 --> 00:15:06.442 to adjust text size or change colors. 00:15:07.062 --> 00:15:10.307 The overlays features are, at best, redundant. 00:15:10.667 --> 00:15:15.667 At worst, the overlay hijacks their keyboard controls, clutters the page 00:15:15.667 --> 00:15:20.737 with confusing announcements, and creates a frustrating, unusable experience. 00:15:21.337 --> 00:15:24.457 The disability community has been overwhelmingly vocal in 00:15:24.457 --> 00:15:26.017 its rejection of these tools. 00:15:26.407 --> 00:15:31.297 When the supposed "fix" makes a website unusable even for an expert, you 00:15:31.297 --> 00:15:33.007 know there is a fundamental problem. 00:15:34.357 --> 00:15:38.737 For years, the argument against overlays was that they were simply ineffective. 00:15:39.127 --> 00:15:41.257 But the landscape has shifted dramatically. 00:15:41.687 --> 00:15:44.897 The presence of an overlay on your website is no longer a neutral 00:15:44.897 --> 00:15:48.707 factor; it is now being used as evidence against companies in court. 00:15:49.877 --> 00:15:54.287 Let me be very clear about this because it is the single most important thing 00:15:54.287 --> 00:15:56.477 you need to understand about this topic. 00:15:56.837 --> 00:16:03.257 According to a 2024 report on digital accessibility lawsuits, 25% of all 00:16:03.257 --> 00:16:07.787 lawsuits were filed against websites that were using an accessibility overlay. 00:16:08.087 --> 00:16:12.137 Plaintiffs are no longer just suing inaccessible websites that happen to 00:16:12.137 --> 00:16:16.137 have an overlay; their legal complaints are now specifically citing the 00:16:16.277 --> 00:16:18.827 overlay itself as a barrier to access. 00:16:19.367 --> 00:16:23.807 The legal and regulatory environment has turned decisively against these products. 00:16:24.182 --> 00:16:29.282 In early 2025, the Federal Trade Commission, the FTC, fined a major 00:16:29.282 --> 00:16:33.962 overlay company for false advertising and misleading claims about its capabilities. 00:16:34.712 --> 00:16:39.302 Major advocacy organizations, like the National Federation of the Blind have 00:16:39.302 --> 00:16:43.622 publicly condemned and even banned these companies from their national conventions. 00:16:44.462 --> 00:16:46.802 This represents a fundamental change. 00:16:47.357 --> 00:16:50.567 The legal argument that an overlay constitutes a "good faith" 00:16:50.567 --> 00:16:54.257 effort to comply with the law has been completely dismantled. 00:16:54.947 --> 00:16:58.307 Installing one of these widgets is now a documented, legally 00:16:58.307 --> 00:17:02.177 recognized misstep that demonstrates a fundamental misunderstanding of 00:17:02.177 --> 00:17:04.397 what digital accessibility requires. 00:17:05.027 --> 00:17:08.957 Far from reducing your risk, it can paint a target on your back for litigation, 00:17:09.287 --> 00:17:12.467 signaling to plaintiff's attorneys that you are aware of the issue but have 00:17:12.467 --> 00:17:14.807 chosen an inadequate and harmful solution. 00:17:15.572 --> 00:17:18.452 Understanding the risks of overlays leads us to the broader 00:17:18.452 --> 00:17:20.192 question of the cost of inaction. 00:17:20.552 --> 00:17:24.992 Failing to comply with the new HHS rule and other accessibility laws like the 00:17:24.992 --> 00:17:29.762 Americans with Disabilities Act carries significant and multifaceted risks. 00:17:30.182 --> 00:17:32.822 First, there are the direct financial penalties. 00:17:33.362 --> 00:17:38.702 While the HHS rule is new, we can look to the enforcement of the ADA for guidance. 00:17:39.122 --> 00:17:43.452 Under the ADA, the Department of Justice can levy civil penalties of up 00:17:43.452 --> 00:17:50.562 to $75,000 for a first violation and $150,000 for each subsequent violation. 00:17:51.102 --> 00:17:55.362 Beyond federal fines, you face the high cost of private litigation. 00:17:55.842 --> 00:17:59.322 Defending against an accessibility lawsuit is incredibly expensive. 00:18:00.392 --> 00:18:04.532 Even if you settle quickly, you will likely be responsible for the plaintiff's 00:18:04.532 --> 00:18:09.212 legal fees, which can run into the tens of thousands of dollars, on top 00:18:09.212 --> 00:18:13.352 of your own attorney's fees, which one expert conservatively estimates at 00:18:13.352 --> 00:18:17.302 $5,000 to $15,000 just to get started. 00:18:18.712 --> 00:18:24.742 Under Colorado House Bill 21-1110, it is a state civil rights violation 00:18:24.742 --> 00:18:27.922 for a government-led entity to exclude people with disabilities 00:18:27.922 --> 00:18:29.542 due to a lack of accessibility. 00:18:30.232 --> 00:18:33.952 This law empowers individuals with disabilities to sue non-compliant 00:18:33.952 --> 00:18:35.152 entities in state court. 00:18:35.152 --> 00:18:39.412 It found liable, your organization could be ordered to pay a statutory 00:18:39.412 --> 00:18:44.322 fine of $3,500 per violation to the plaintiff, in addition to actual 00:18:44.322 --> 00:18:48.547 monetary damages and attorneys fees, which can quickly escalate the cost. 00:18:49.937 --> 00:18:53.777 Perhaps the most significant cost, especially in healthcare, is the 00:18:53.777 --> 00:18:55.907 damage to your brand and reputation. 00:18:56.237 --> 00:18:58.127 Trust is the currency of healthcare. 00:18:58.457 --> 00:19:02.207 A lawsuit or even a public complaint about your digital services being 00:19:02.207 --> 00:19:06.767 inaccessible to patients with disabilities sends a powerful and damaging message. 00:19:07.037 --> 00:19:10.427 It suggests that your organization is not inclusive, not patient 00:19:10.427 --> 00:19:14.027 centered, and is failing a vulnerable segment of the community you serve. 00:19:14.792 --> 00:19:18.122 Now, let's flip the coin and talk about the return on investing 00:19:18.122 --> 00:19:19.622 in authentic accessibility. 00:19:19.982 --> 00:19:23.672 This is not just an expense to mitigate risk; it is an investment 00:19:23.762 --> 00:19:25.522 in a better healthcare organization. 00:19:26.229 --> 00:19:28.989 First and foremost, you expand your patient reach. 00:19:29.259 --> 00:19:33.639 By making your digital services fully accessible, you are explicitly opening 00:19:33.639 --> 00:19:39.279 your doors to the more than 664,000 Coloradans with disabilities, along 00:19:39.279 --> 00:19:42.549 with their families and caregivers who help them manage their health. 00:19:42.909 --> 00:19:45.849 This is a significant and often underserved market. 00:19:46.479 --> 00:19:49.689 Second, you improve the patient experience for everyone. 00:19:50.079 --> 00:19:53.349 The principles of accessible design are the principles of good design. 00:19:53.994 --> 00:19:57.654 Features that are essential for users with disabilities, like clear 00:19:57.654 --> 00:20:02.214 and simple language, predictable navigation and helpful error messages, 00:20:02.424 --> 00:20:06.324 improve the usability of your digital platforms for all of your patients. 00:20:06.654 --> 00:20:10.374 This includes older adults who may be less tech savvy, someone with 00:20:10.374 --> 00:20:13.824 a temporary injury like a broken arm trying to navigate with one 00:20:13.824 --> 00:20:18.444 hand, or any patient who is feeling stressed, sick, and overwhelmed. 00:20:19.442 --> 00:20:22.682 Finally, this investment can lead to tangible operational 00:20:22.682 --> 00:20:24.512 efficiencies and revenue growth. 00:20:24.992 --> 00:20:26.402 This isn't just a theory. 00:20:26.642 --> 00:20:29.492 We have real world examples from the healthcare sector. 00:20:29.792 --> 00:20:33.452 WakeMed Health and hospitals in North Carolina embarked on a major 00:20:33.452 --> 00:20:35.762 initiative to improve patient access. 00:20:36.452 --> 00:20:41.852 A key part of their strategy was patient access, which resulted in an 81.6% 00:20:41.852 --> 00:20:45.842 increase in patients directly scheduling appointments through their patient portal. 00:20:46.592 --> 00:20:47.342 The outcome? 00:20:47.697 --> 00:20:53.127 In just one year, they saw a $25.4 million increase in revenue, which 00:20:53.127 --> 00:20:57.417 they attributed in part to a nearly 16% rise in outpatient visits. 00:20:58.435 --> 00:21:01.195 Another powerful example is CVS Health. 00:21:01.465 --> 00:21:04.435 They recognize that accessibility is a business and ethical 00:21:04.435 --> 00:21:05.725 imperative in healthcare. 00:21:06.025 --> 00:21:09.325 They made a strategic decision to scale their internal accessibility 00:21:09.325 --> 00:21:13.885 department from just 4 people to over 100, intentionally hiring 00:21:13.885 --> 00:21:17.155 professionals with disabilities to ensure they were building solutions 00:21:17.155 --> 00:21:19.090 with the community, not just for them. 00:21:19.720 --> 00:21:22.900 This level of commitment demonstrates how industry leaders are moving 00:21:22.900 --> 00:21:26.770 beyond mere compliance to embed accessibility into their core strategy. 00:21:28.150 --> 00:21:30.100 So how do you get there? 00:21:30.430 --> 00:21:35.080 The most effective way to approach the May, 2026 deadline is to stop 00:21:35.080 --> 00:21:37.720 thinking of this as a single "project". 00:21:38.470 --> 00:21:43.930 To be successful, you must conceptualize and manage this as a comprehensive program 00:21:44.140 --> 00:21:48.400 with at least three distinct parallel work streams, running concurrently: your 00:21:48.400 --> 00:21:52.540 interactive platforms, your document library, and your multimedia content. 00:21:53.170 --> 00:21:58.330 Each of these has its own unique process, timeline, and budget considerations. 00:21:58.720 --> 00:22:02.500 A plan that only accounts for your main website will fail because it ignores the 00:22:02.500 --> 00:22:07.360 vast universe of PDFs and videos that most healthcare organizations possess. 00:22:08.364 --> 00:22:11.484 The first work stream is the most complex and is typically 00:22:11.484 --> 00:22:13.014 where organizations start. 00:22:13.374 --> 00:22:17.184 It covers your public facing website, your secure patient portal, 00:22:17.274 --> 00:22:19.254 and any mobile apps you offer. 00:22:20.244 --> 00:22:22.584 The process generally follows four key phases: 00:22:22.914 --> 00:22:25.614 Phase 1 - Inventory and Triage. 00:22:26.154 --> 00:22:30.384 The first step is to map out every patient facing digital asset you own. 00:22:30.954 --> 00:22:33.084 You can't fix what you don't know you have. 00:22:33.594 --> 00:22:37.614 Once you have your list, you must prioritize, focusing on the most 00:22:37.614 --> 00:22:41.724 critical and high traffic areas first, like your appointment scheduling 00:22:41.724 --> 00:22:43.554 workflow or your bill pay function. 00:22:45.084 --> 00:22:46.794 Phase 2 Audit. 00:22:47.454 --> 00:22:49.944 This is the cornerstone of your entire program. 00:22:50.274 --> 00:22:54.114 A comprehensive accessibility audit involves a combination of automated 00:22:54.114 --> 00:22:58.464 scanning and, most importantly, manual testing by experts. 00:22:59.154 --> 00:23:00.804 This is not a simple scan. 00:23:01.314 --> 00:23:04.729 It involves trained professionals attempting to use your site 00:23:04.824 --> 00:23:08.934 with a keyboard alone and with screen reader software, just as a 00:23:08.934 --> 00:23:10.614 patient with a disability would. 00:23:11.514 --> 00:23:15.589 The output is a detailed report that lists every violation and 00:23:15.589 --> 00:23:17.449 provides guidance for remediation. 00:23:19.429 --> 00:23:21.139 Phase 3 - Remediate. 00:23:21.769 --> 00:23:24.739 This is the phase where your development team or a specialized 00:23:24.739 --> 00:23:28.459 partner like AccessiTREE gets to work, fixing the code and design 00:23:28.459 --> 00:23:30.379 issues identified in the audit report. 00:23:32.079 --> 00:23:33.849 And Phase 4 - Validate. 00:23:34.449 --> 00:23:38.079 After the fixes are implemented, a second round of manual testing is 00:23:38.079 --> 00:23:41.769 conducted to verify that the issues have been resolved correctly and 00:23:41.769 --> 00:23:43.809 that no new problems were introduced. 00:23:45.129 --> 00:23:46.719 Now let's talk about timelines. 00:23:47.259 --> 00:23:51.129 Based on industry data, for a small to medium sized website, this 00:23:51.129 --> 00:23:55.119 entire four phase process typically takes 2 to 6 months to complete. 00:23:55.479 --> 00:23:59.199 For a large, complex hospital system with an integrated patient portal 00:23:59.199 --> 00:24:03.269 and mobile apps, this can easily extend to 12 months or much longer. 00:24:03.809 --> 00:24:06.639 And it's critical to remember that this timeline only starts 00:24:06.639 --> 00:24:08.229 after you've selected a partner. 00:24:08.589 --> 00:24:12.699 The procurement process itself, getting quotes, legal reviews, and contract 00:24:12.699 --> 00:24:17.199 approvals, can add another 2 to 3 months before any auditing work even begins. 00:24:17.619 --> 00:24:21.369 So, a realistic end-to-end timeline from decision to completion 00:24:21.369 --> 00:24:23.559 can easily be 7 months or more. 00:24:25.224 --> 00:24:28.854 The second major work stream is your library of digital documents, which, 00:24:28.854 --> 00:24:32.904 for most healthcare organizations means an enormous number of PDFs. 00:24:33.234 --> 00:24:37.224 Think of every patient intake form, informational brochure, explanation 00:24:37.224 --> 00:24:40.254 of benefits and research paper you have available for download. 00:24:40.644 --> 00:24:44.574 Under the new rule, any of these documents used by patients must be accessible. 00:24:45.572 --> 00:24:47.342 The challenge here is one of scale. 00:24:47.702 --> 00:24:51.992 A large health system can have thousands of these documents living on its website. 00:24:52.322 --> 00:24:56.432 The process for making a PDF accessible is a specialized skill. 00:24:56.672 --> 00:25:00.542 It involves adding a "tag" structure to the document that defines 00:25:00.542 --> 00:25:04.832 the reading order and identifies elements like headings, paragraphs, 00:25:04.922 --> 00:25:09.602 lists, and tables so that a screen reader can navigate it logically. 00:25:10.609 --> 00:25:14.929 Given the potential volume, this is often a long-term project that can take 00:25:14.929 --> 00:25:17.479 several months or even longer to complete. 00:25:17.839 --> 00:25:20.899 The good news is that this work can be done in batches. 00:25:21.289 --> 00:25:24.799 A typical turnaround time from a professional remediation service 00:25:24.799 --> 00:25:28.219 for a single batch of documents is about five business days. 00:25:28.579 --> 00:25:33.139 The key is to develop a systematic plan to inventory, prioritize, and 00:25:33.139 --> 00:25:35.059 remediate your documents over time. 00:25:36.095 --> 00:25:38.975 The third work stream covers your multimedia content. 00:25:39.365 --> 00:25:43.715 This includes any pre-recorded videos on your website or social media channels, 00:25:43.895 --> 00:25:48.215 such as patient testimonials, physician interviews, or instructional videos. 00:25:49.130 --> 00:25:51.350 The requirements here are very specific. 00:25:51.650 --> 00:25:56.330 All pre-recorded videos with audio must have synchronized, accurate captions 00:25:56.510 --> 00:25:58.700 and the option to display a transcript. 00:25:59.030 --> 00:26:02.540 If the video contains important information that is only presented 00:26:02.540 --> 00:26:06.890 visually, for example, text on a slide or a key action that isn't 00:26:06.890 --> 00:26:10.850 described in the dialogue, It must also have an audio description. 00:26:11.210 --> 00:26:14.420 Audio descriptions are a separate audio track where a narrator 00:26:14.420 --> 00:26:16.490 describes the key visual elements. 00:26:17.600 --> 00:26:21.320 The timeline for this work is typically on a per-file basis. 00:26:21.680 --> 00:26:26.180 Professional, human verified captioning for a video usually has a standard 00:26:26.180 --> 00:26:28.430 turnaround time of 2 to 4 days. 00:26:28.820 --> 00:26:33.110 Audio description is a more intensive process and can take longer, often around 00:26:33.110 --> 00:26:35.480 5 to 7 business days per video file. 00:26:37.055 --> 00:26:41.285 Finally, it's crucial to understand that remediation is not the end of the journey. 00:26:41.645 --> 00:26:45.125 The goal is to build a sustainable accessibility program so that you 00:26:45.125 --> 00:26:48.335 don't find yourself in this same position a few years from now. 00:26:49.265 --> 00:26:51.185 This involves two key long-term strategies. 00:26:52.340 --> 00:26:54.890 First, update your vendor contracts. 00:26:55.310 --> 00:27:00.050 The HHS rule makes it clear that you are responsible for the accessibility 00:27:00.050 --> 00:27:04.160 of third-party tools and platforms that you use to serve patients. 00:27:04.460 --> 00:27:10.670 You must update your contracts to require WCAG 2.1 AA conformance from 00:27:10.670 --> 00:27:14.420 all of your digital vendors, from your patient portal provider to your 00:27:14.420 --> 00:27:18.140 scheduling software, and you must demand proof of their conformance. 00:27:18.995 --> 00:27:23.945 Second, you must embed accessibility into your internal workflows. 00:27:24.305 --> 00:27:28.475 Accessibility needs to become part of your organization's DNA. 00:27:28.925 --> 00:27:33.365 This means incorporating it into your procurement processes, your quality 00:27:33.365 --> 00:27:37.905 assurance testing, your content creation guidelines, and providing 00:27:37.905 --> 00:27:39.690 ongoing training for your staff. 00:27:40.020 --> 00:27:44.160 By making accessibility a standard part of how you operate, you prevent 00:27:44.160 --> 00:27:49.410 new barriers from being created and ensure long-term sustainable compliance. 00:27:50.790 --> 00:27:54.810 I know this is a lot of information and it can feel overwhelming, but you don't 00:27:54.810 --> 00:27:56.460 have to solve everything overnight. 00:27:56.790 --> 00:28:00.175 The journey to compliance starts with a few simple concrete steps. 00:28:01.325 --> 00:28:03.635 Step 1: Designate a leader. 00:28:04.175 --> 00:28:07.595 Go back to your organization and identify a single person 00:28:07.625 --> 00:28:10.805 or a small cross-functional committee to own this initiative. 00:28:11.255 --> 00:28:14.435 This cannot be an orphan project that falls between the cracks 00:28:14.435 --> 00:28:15.725 of different departments. 00:28:16.055 --> 00:28:19.325 It needs a clear owner who is empowered to drive it forward. 00:28:20.765 --> 00:28:23.195 Step 2: Start your inventory. 00:28:23.795 --> 00:28:28.025 Begin the process of mapping every patient-facing digital asset you have. 00:28:28.385 --> 00:28:29.225 Start simple. 00:28:29.945 --> 00:28:31.775 What is your main website address? 00:28:32.165 --> 00:28:33.365 Do you have a mobile app? 00:28:33.755 --> 00:28:35.675 What is the link to your patient portal? 00:28:36.035 --> 00:28:40.595 What are the top 20 most visited pages or downloaded patient forms on your site? 00:28:41.015 --> 00:28:44.375 You can't scope the problem or build a budget until you know what you have. 00:28:45.380 --> 00:28:48.320 Step three, schedule a professional audit. 00:28:48.920 --> 00:28:52.640 This is the single most important and impactful next step you can take. 00:28:53.030 --> 00:28:57.380 A professional manual accessibility audit will give you a clear, objective 00:28:57.380 --> 00:28:59.330 baseline of where you stand today. 00:28:59.750 --> 00:29:02.150 It will move you from the unknown to the known. 00:29:02.750 --> 00:29:06.260 The audit report will become the foundation of your entire compliance 00:29:06.260 --> 00:29:11.240 strategy, providing you with a concrete, actionable list of issues to address. 00:29:12.875 --> 00:29:15.755 At AccessiTREE, this is precisely what we do. 00:29:16.085 --> 00:29:20.375 We specialize in helping healthcare organizations like yours navigate this 00:29:20.375 --> 00:29:25.265 complex process from providing the comprehensive inventory and priority 00:29:25.265 --> 00:29:29.315 assignments that form the foundation of your strategy to performing the 00:29:29.315 --> 00:29:33.815 hands-on technical remediation, to helping you consult with your vendors, 00:29:34.145 --> 00:29:38.525 our entire focus is on being a dedicated partner to the healthcare community 00:29:38.585 --> 00:29:40.625 on this journey to digital inclusion. 00:29:41.510 --> 00:29:43.490 Thank you for your time and attention today. 00:29:43.820 --> 00:29:47.150 I hope this has provided you with a clear and valuable framework for 00:29:47.150 --> 00:29:51.650 understanding the new HHS rule and the path to compliance and inclusion.