EHR Accessibility Module Challenge

About the Challenge

Background:

According to 2000 estimates from the U.S. Bureau of Census, people with disabilities constitute 19.3% of the non-institutionalized population 5 years of age or older. Among adults, individuals with disabilities are four times as likely to report having fair or poor health compared to those without a disability (40% vs. 10%). This population faces considerable difficulties with accessing and receiving care and the lack of coordinated care for this population is particularly costly.  Health expenditures for people with disabilities are estimated at $400 billion, more than a quarter of all heath expenditures.   

Health information technology (HIT) and electronic health records (EHRs) hold great promise in improving the health outcomes and coordination of care for people with disabilities. However, the accessibility and usability of HIT is a matter of serious concern to people of diverse disabilities, including those who have vision, hearing, intellectual, manual dexterity, mental health, developmental and other types of disabilities. The disabled population cannot afford to miss out on the multitude of benefits that can be derived from having access to the health information stored in EHRs just because existing tools are not compliant with their needs. Building an accessible system from the ground up can be more cost effective than retrofitting current ones to suit this large group and can prevent future interoperability issues. In addition, innovation in this area can also help older individuals with changing abilities due to aging, and can help inspire usability improvements for all consumers on a more general basis.

Challenge Description:

Accessibility and usability in health IT are high priority issues for the disability community. A consumer-oriented system providing easy-to-use access to health information would be a valuable tool and significantly improve the health of disabled individuals.

ONC is challenging multidisciplinary teams to create and test a module or application that makes it easy for disabled consumers to access and interact with the health data stored in their EHRs. The application should:

• Be easy for individuals with disabilities to consume and interact with their health data
• Be simple to install and learn to use
• Identify and link to relevant local or online communities and organizations
• Be able to download data from one or more EHR systems – it does not need to be fully integrated across all systems
• Leverage and extend NwHIN standards and services including, but not limited to, transport (Direct, web services), content (Transitions of Care, CCD/CCR), and standardized vocabularies.

Standards for compliance include:

• Web Content Accessibility Guidelines (WCAG 2.0) of the W3C Web Accessibility Initiative (WAI) for website accessibility.
• Section 508 Standards developed by the U.S. Access Board through a process that involves industry, government, consumers, international representatives and others. Federal agencies are required to follow the Section 508 Standards in order to comply with Section 508 of the Rehabilitation Act. Furthermore, the 508 Standards may be used by non-federal entities as well as a way to show commitment and leadership to making technology accessible and usable for people with disabilities. These guidelines and standards are well known and there is over a decade of experience in using them.
• Standards for telecommunications services providers and equipment in the Communications Act at Section 255. Rules at 49 CFR Part 6, Access to Telecommunications Service, Telecommunications Equipment and Customer Premises Equipment by Persons with Disabilities, provide extensive requirements on how to design and develop for disability accessibility and usability. Similarly, rules at 49 CFR Part 7, Access to Voicemail and Interactive Menu Services and Equipment by People with Disabilities, provide extensive operational requirements to ensure such interfaces work for people with disabilities.

Other Resources:

• U.S. Equal Employment Opportunity Commission: Definition of the Term Disability from The Americans With Disabilities Act Amendments Act Of 2008 (ADAAA)
• National Institute of Standards and Technology (NIST): Human Factors Guidance to Prevent Healthcare Disparities with the Adoption of EHRs

Prizes:

• First Place: $60,000
• Second Place: $20,000
• Third Place: $5,000

Submission Requirements:

In order for an entry to be eligible to win this Challenge, we recommend that it must meet the following requirements:

1. General – Contestants must provide continuous access to the app, a detailed description of the app, instructions on how to install and operate the app, and system requirements required to run the app (collectively, “Submission”)
2. Acceptable platforms – The app must be designed for the Web, a personal computer, a mobile handheld device, console, or any platform broadly accessible on the open Internet
3. Data used – The app must utilize 508 or W3C compliant EHR modules and associated data (as described in the section on review criterion, #3) from available sets. Entries need not include all data fields available in a particular resource. Data from Federal sources may be used alone or in combination with other available data resources at the discretion of the entrant. Related data and resources can be found at: http://healthdata.gov.
4. No ONC logo – The app must not use ONC’s logo or official seal in the Submission, and must not claim endorsement.
5. Functionality/Accuracy – A Submission may be disqualified if the software application fails to function as expressed in the description provided by the user, or if the software application provides inaccurate or incomplete information.
6. Security – Submissions must be free of malware. Contestant agrees that the ONC may conduct testing on the app to determine whether malware or other security threats may be present. ONC may disqualify the app if, in ONC’s judgment, the app may damage government or others’ equipment or operating environment

Review Criteria:

The ONC review panel will make selections based upon the following criteria:

1. Design and Usability for the Disabled User
2. Creative and Innovative Use of Technologies
3. Compliance with disability and accessibility standards including 508 and W3C
4. Integration of Module with HIT and EHR Systems
5. Potential for Impact and Ability to Drive Adoption and Engagement
6. Use of NwHIN standards including transport, content, and vocabularies