Appendix 2: Commentary on Distinguishing Accessibility from Accommodation

Fundamental to designing and procuring accessible technology is an understanding of what accessibly actually means. This is important because patients, guests and staff with disabilities may be offered an accommodation as a way of adapting to an environment that was not designed with accessibility in mind. For example, people with low vision may need caregiver assistance with taking their blood pressure, if they cannot see the display of portable blood pressure monitoring devices. Such ‘work-arounds’ hinder independence.

There are two ways to design for accessibility. One is to build the accessible solution into the technology. For example, a blood pressure monitor may have an option to ‘speak out’ the blood pressure reading. Accessibility is often provided through such redundancy, also referred to as multi-modal functionality. In the case of closed, self-contained medical instrumentation, this may be the preferred method.

The other accessibility strategy is to design for compatibility. For example, a website with health information could be developed to conform with the Section 508 web accessibility standards so that users with assistive technologies can read the information. This ‘open architecture’ model allows people with disabilities to access technology with their preferred adaptive equipment (e.g. screen readers or refreshable braille displays).

Accessibility is “technology centered,” whereas accommodation is “person centered”. That means that people with a range of abilities would be considered at the time of design and procurement of technology, before the occasion of someone complaining or requesting help. Sometimes it is said that “accessibility occurs before the fact,” whereas “accommodations are provided after the fact”.

Accessibility focuses on how to design mainstream technology so that assistive technology may not even be necessary. For example, software installed in wireless PCs, which clinicians may use to enter patient information during office or hospital room visits, could provide display options to enable magnification and adjust contrast. Also referred to as ‘universal design’, accessibility can increase usability for many people and reduce the incidence of marginalizing people with disabilities as “special”.

Until those who manufacture, finance and request electronic and information technology transform their approach up-front to include the needs of people with a wide range of abilities, we can expect individuals with less apparent (“invisible”) disabilities to function less effectively because they may not ask for help. In addition, as the number of older people increases (both patients as well as employees), the impact of barriers to medical instrumentation can be expected to increase dramatically.