Webinar: Meeting HHS’ New Digital Accessibility Standards by May 2026

Laura Clemons / HCIC:

Sorry about that. I'll be going over some housekeeping items before we begin this afternoon's panel discussion. During our time together, we'll be taking questions from attendees. To ask a question, please use the toolbox at the bottom of your screen to submit your questions in Q&A. Attendees will be in listen-only mode to cut down on background noises. And there will be a short seven-question survey after the webinar. And we would really appreciate your feedback. We're excited to welcome an exceptional panel of speakers today, each bringing a wealth of expertise and unique perspectives to our discussion.

Drew Westbrook is an attorney at Westbrook Health Law. He focuses his practice on counseling clients in the health care and digital health industries.

Mark Pope is the director of customer success at Pope Tech and accessibility platform. He has been helping website owners and content creators simplify their web accessibility since 2018.

Rachael Sauceman is director strategy at Full Media, a health care digital marketing agency. She focuses on ensuring that Full Media and its clients are executing the latest best practices, staying on top of changes in public policy, and have access to affordable tools.

Today's moderator, Loren Funk, the owner and lead consultant at TL Funk Consulting. He helps health care practices grow, build successful independent organizations. He is the former long-term chief operations officer of a large multi-specialty physicians' group. Now I'll turn it over to the panelists to begin this afternoon's discussions.

Loren Funk / Moderator:

Good afternoon, everyone. And Laura, thank you for those introductions. So, to get us started, let's ask the big question: What is digital accessibility?

Mark Pope / Pope Tech:

Yeah, I'm happy to jump in on this one and thanks for having me on the panel. So digital accessibility just simply put, is the ability for people to access the dig- digital content, all people to have equal access, but especially those people with disabilities, right? And so I like to think about it like, what if I didn't have a screen, right? Could I still access the content using my assistive technology like a screen reader? What if I couldn't use a mouse? Could I still get around that website and perform everything that needs to be done? What if I had some visual impairments and need good contrast just to see things just directly, right, is it coded in such a way that that contrast is just natively there?

And so digital accessibility deals with, can I use normal-considered standard assistive technologies to be able to have equal access to the content in that digital environment, right? So, whether it's a website or a web application, a mobile app, email, or any of the other forms of digital communication that we engage in, a document that's been loaded onto a website or shared. So, and it's just important to make sure that, you know, everyone, regardless if they have a disability or not, has that equal access.

Loren Funk / Moderator:

So why is it especially important in the healthcare context?

Rachael Sauceman / Full Media:

I can grab that one and if Mark has additional thoughts to offer, please do, as our accessibility expert. And I feel like whenever we were preparing for this, Mark reminded me of the importance of pointing out our closed captioning feature on the Zoom. So just wanted to make sure that people knew that that is available on the bottom. And we'll make sure that the transcript is available to you on the recording once it's out there. So from a health care context, digital accessibility is really important and it's something that we're focusing on as an agency.

Because not only do many Americans have disabilities-one in four people will become disabled before they reach retirement. In the United States, when we think about who health care people serve, it's really important to make sure that we're serving people with disabilities well. So from providing quality care and improving health care outcomes, which is an important goal for every health care provider, that's really critical for many of the missions of the organizations that are out there.

There's financial incentives, obviously, to serve all those patients, too. So when we think about getting market share, retaining our patients, those are patients who we are going to serve better and retain better, and whenever we can serve them well with our digital communications, which is now kind of the front door for most health care organizations.

And now we have new legal incentives. We're going to talk about this a lot today. So we'll consider those a little bit, but we have had legal incentives for a long time. I will say that to serve people with disabilities, we're just having a little bit clearer guidance that's coming out right now.

Drew Westbrook / Westbrook Health Law, LLC.:

Yeah, Rachel, one of the things you just said there was, you know, the front door. And if you think about it, I mean, a literal front door of a building, we've wanted to make sure that that door is open and accessible to everyone, so that we can provide healthcare. Now we're shifting, and we're creating all these tools. And we're trying to drive improved care, more efficiency and practice with the digital tools. And it's time that we start to make those accessible as well, just in the same way that the physical front door needs to be accessible.

Mark Pope / Pope Tech:

And I did want to point out that, you know, a lot of this is best practices anyway, like accessibility is probably good for everyone. Just like sometimes when I'm carrying some boxes or something like that, I hit that button to auto open that door and I'm glad that it's there. If things are coded right on a website, having the good form labels and color contrast and good heading structure and well written links that don't just say click here, and I don't know where it's going to go, right, this stuff's good for everyone. If I go out into a brighter light, the better contrast there is natively, it just helps me. Now it's good for me, but it's critical for people with disabilities. And that's where it's important to understand.

The other thing to consider too, is especially I mean, everywhere, but especially in the healthcare, this is a privacy issue as well, too. Because so much of our medical stuff is being transacted digitally now, if I have to go to someone else to read to me my medical records or know what's being communicated, that's a violation of- my medical privacy rights. And so, making sure that they can navigate around into if you have a portal that you're sharing test results and things like that, and I can't access them without, you know, even a family member, I may not want them to see those records, right.

And so, making sure that you know, the standard technologies that are used by people with disabilities- standard adjustments just work for them is a privacy issue as much as these other legal things we bring up.

Loren Funk / Moderator:

Right. I think that is definitely an important aspect of it. So Rachel, you mentioned some of the other legal incentives, but let's let Drew talk to us a little bit about some of the history around uh-the idea of digital accessibility.

Drew Westbrook / Westbrook Health Law, LLC:

Yeah, I mean, accessibility as a concept has been around for quite some time. The Rehabilitation Act of 1973. So that’s just a few years ago. It prohibits discrimination on the basis of disability and programs conducted by federal agencies, and programs receiving federal financial assistance and federal employment, and in employment practices of federal contractors.

So we've kind of established that's been around for quite some time. And that's the language that we're really, I mean, it's not the actual language of the statute, but that's what we're working off of. We also have the ADA, the Americans with Disabilities Act, which has been around for quite some time. And it, in part, prohibits discrimination on the basis of disability, and employment in state and local government and public accommodations, and then a few other items.

So, when those laws were first enacted, we didn't have many of the digital tools that we do today, the internet did not exist. The way that we see it today, perhaps some of the--if anyone wants to get super technical,--perhaps some of the groundwork was being laid at some of these times. But as the tools grew, and the internet and computers, and then we moved into more sophisticated and smaller packages like mobile apps, we started to see as a country that we needed a little bit more protections in place. We need to be more specific about certain aspects. And there have been for some time now certain protections and laws related to accessibility for websites for state and local governments. Then there have been quite a few lawsuits and arguments about whether the Americans with Disabilities Act Title III, which covers public accommodations, applies to websites. But we didn't have a lot of clarity, especially in the Title III public accommodations realm.

The circuit courts around the country have had a number of splits and disagreements about this. All websites must be accessible because they are public accommodations. But many of the circuits say a website has to have what's called a nexus to a physical space in order to be a public accommodation. So, we've been in a bit of a gray area for many entities and organizations that aren't state or local governments. So now we have some new rules that have come under Section 504 of that Rehabilitation Act. Among other things, it sets some standards for websites and mobile apps and kiosks for any recipient of federal financial assistance. It prohibits discrimination, in the same way that the Rehabilitation Act and the Americans with Disability Act prohibits discrimination against people with disabilities, and in those federally funded financial assistance programs. So we get a little more specific now, when it comes to what that covers and what those standards are.

Loren Funk / Moderator:

So with this new ruling from the Department of Health and Human Services, kind of back up a little bit and give us some context about what exactly an HHS rule is, and who it applies to.

Drew Westbrook / Westbrook Health Law, LLC:

Sure. So, the rule here is it's a full, full-fledged federal regulation. It has the full force of law. It went through a period where a proposed rule was published, and the public was able to comment on it. Then it went through the required processes and HHS finalized the rule, and it has now been published and codified. So, it is binding, enforceable regulation that applies to any organization or program that receives federal financial assistance.

Rachael Sauceman / Full Media:

Yeah, and Drew's the lawyer here, so obviously correct me if I'm saying anything wrong. But, essentially what we're talking about would be a covered entity. So that would be an organization that accepts Medicare/Medicaid payments, that is receiving insurance payments in general, submitting insurance claims. Is that correct overview of it?

Drew Westbrook / Westbrook Health Law, LLC.:

No necessarily. To get really nuanced, the covered entity under the HIPAA rules is not exactly the scope of this rule. I’m gong to call is the section 504 rule – it is very broad. So federal financial assistance is everything from a grant to payments for services to leases, discounts, services in kind, property in kind. Without trying to get super technical and specific, if there’s anything given from the federal government, of any kind, this is going to apply. If it comes from HHS, or other, you know, rules, if you might get it from the department of transportation or something like that.

Rachael Sauceman / Full Media:

One of the things I wanted to point out, Loren is that we're all here today specifically to talk about the digital communications part of this rule, but it's actually very broad, and it covers your actual operations, your diagnostic procedures; it covers things like childcare and mental health organizations. So one of the things that we're recommending that people do is make sure that you take this to your legal team and your operations, and you're talking about how you are doing business as well, in addition to what you're marketing and your communications teams know because this isn't just confined to that marketing communications function.

But from the digital marketing and communications function, making sure that you're thinking about it as really widespread is important too, because what we're talking about is not just your website. You have to be thinking about email communications, PDFs, social media accounts that you manage, video, if you have a Vimeo or YouTube account, if you're running advertising. Are your digital health platforms if you have an online scheduling tool, wait times tool, those types of things, all of those are things that you have to consider right now as part of this.

Loren Funk / Moderator:

Right. Well, that really leads into my next question because, I'm from a healthcare organization standpoint with all of the different programs, initiatives like the EHR incentive program, to the HIPAA privacy laws, all of those things. It can seem somewhat daunting to try to understand what an organization is going to have to do to comply. So, how would you compare this initiative to those other kinds of programs in relation to the scope and budget? You know, how much could this be costing? Ongoing maintenance? Those kinds of issues.

Rachael Sauceman / Full Media:

I can hop in here. I mean, so I'm a digital marketing expert. From an operational standpoint, it's challenging to know exactly how things might be implemented in your organization, but when it comes to your digital communications in particular, I think that the key right now is that we have a runway. So, organizations that have 15 or more employees have until May 2026, and organizations with fewer than 15 employees have until May 2027.

One of the reasons why they decided to set those guidelines was to try to help organizations kind of defray the potential costs that they might have to invest into it. So, it gives a little bit of time to consider in budget in the meantime, if that makes sense? But more than anything, it depends on where you are, right? So, you may need to remediate and the larger the organization, the more that that undertaking might look like.

So kind of auditing where you are right now, deciding what your goals are and where you want to be. That's a really good first step to understand, what is this going to look like for you? Do I need partners to help me execute it? So that's something where I need to budget time and money behind that effort. Could I need a new website? That could be a question you might have to consider and budget for. Beyond their remediation and the potential for website design, it’s going to be investing in training. And potentially, you may need to select some different vendors, if you find that your vendors just don't understand these issues. If there are pieces that you're outsourcing.

But ultimately, investing in helping your social media folks understand what's going on, the people who are sending out emails, anyone who's adding content to your website. And luckily there's a lot of free training and free resources that are out there. It just has to be something where if you start now, you can make sure that you're planning for that time that you need to make those changes across the different areas where you're communicating. Mark, did you have anything to add to that in particular or things that you've seen organizations do?

Mark Pope / Pope Tech:

One of my recommendations often is exactly what you're saying, right, getting clear about what your goals are, and then looking at the different outcomes that you want to accomplish and then prioritizing them.

The training aspect you brought up is something I regularly push. Everyone should know digital accessibility for their role, right? I don't need to know everything, maybe like a web developer needs to know, but if I'm a content writer there's probably five to six things if I know them about accessibility, then it's going to cover 80-90% of the content that I'm producing.

And so, just knowing things like how to write a good link. I joked about the click here read more type of link before. So if I am a person using a screen reader, right, and it's not just blind people, maybe I'm dyslexic and using a screen reader to help me out there's a lot of times we often miss some populations that are using assistive technology when we think about this. But one way you navigate is that you could just tell the screen readers just start reading the web page, but that's going to start reading all your heading stuff and menus or whatever, and that's very inefficient, so they don't do it that way. I don't look at a web page that way as well either. Right?

I might jump to heading levels, bolded things, or I might jump to looking at images, or I might jump from link to link and seeing visually what's on that page. The same thing with the screen reader. They’re jumping from link to link to link, so knowing how different people utilize different technologies to access the website is important to know. Things like good color contrast, good heading structure, tables that are written in a way that the header and column rows are scoped out so that it knows it's a table and what's in a cell when I get there. Right? Little things like that can make a big difference for accessibility.

So, learning accessibility for your particular role is important and having the training for the people for that. But going back to that prioritization thing I brought up: it's great to take those free tools and just start hitting every page and tackling it, but I tell people that automated testing is great, but what's the most important? and I'm thinking from a website perspective because that's what I focus on right?

So, when a person comes to a website, what are the key functions that they're going to do? Maybe going to the web page, logging in or creating an account, signing up for something, or going and viewing a medical record. I think about those key four or five user journeys and map out what are the pages along the way, and then I want to go prioritize making those accessible first before going and fixing, maybe, a contrast error on a blog page that hasn't been visited for six months.

Thinking about what the goals are, what the priority is, what the gap is from today to where we want to be, and what resources are needed to get there, including training and funding. Then just putting them in your queue like other things and go prioritizing them and knocking off. This is the biggest thing: let's tackle that, then move on to the next one.

Accessibility really isn't one and done thing, as you probably are picking up here. It’s a new way of thinking about equal access. I wouldn’t even say new, we’ll get to that when we get to the WCAG requirements, but people have been thinking about this for a while. But maybe you haven't been, right? So it's new to you. But, you know, prioritizing things and thinking about how you want to approach it and tackle it, it’s just part of everything we do, right?

Loren Funk / Moderator:

Okay, Mark, you brought it up. The WCAG. What is that and why is the HHS following that in its rule?

Mark Pope / Pope Tech:

Yeah, so the WCAG is the Web Content Accessibility Guidelines. It's actually written by a group called the Web Accessibility Initiative, which is actually a group in the W3C. So, that's a lot of groups within groups, I know, but, the W3C are the people who write the guidelines for the internet, right? They write the coding standards for how developers should code websites, so they write the browser standards of how browsers should work, they're the people who write the guidelines, so the internet just works the way we all have come to expect it to work. They've been around since pretty much the internet came around. And early on, they did start thinking about digital accessibility.

That Web Accessibility Initiative group that I brought up, they had formed it by 1997, I believe. By 1999, they had released the first Web Content Accessibility Guidelines, or the WCAG 1.0. S, early on, they saw the internet and the great power that it could be for equalizing a lot of access for people with disabilities and those who might use assistive technologies, like screen readers, or maybe can't use a mouse to get around a website and had to focus only on keyboard strokes.

The most recent version is 2.2. The health requirements are under 2.1 AA, which came out in 2018, I believe. So these guidelines are just a set of principles that help us understand how to create and code website that works for everyone, with a reasonable level of accessibility for those using assistive technologies. If you get into the guidelines, you might get overwhelmed by them, but there are some easy checklists to understand. My friends at WebAIM have a WCAG checklist that might break it down a little bit easier, but they break it down into different levels. There's level A, level double A, level triple A, and the WCAG. Most of the legal requirements are at the double AA level. Some of the triple A stuff is great to strive for. Some of it may not even be technically possible, which is why it's probably not required in some of the legal requirements. But the double AA stuff is very achievable, so you just go through the process of doing it.

Now, accessibility testing to achieve these requires both automated and manual testing to do it. Automated testing is using one of the free tools. I'm a little bit partial to Wave from WebAIM, partially because that's the engine I use on my platform, but there's a reason why we chose it. It's great for beginners, but it's very powerful for professionals even. And it's one of the most used and trusted engines out there, but it's free if you go to wave.webaim.org, you can go put in a web URL, and it'll scan it?

A lot of people focus on the red errors that are fully detectable in an automated way. There's yellow alerts, that's suspicious, but requires human judgment. And then there's other categories that help with the manual testing. But in addition to that, to achieve the AA standards, they require some level of human review. So, we automatically test every page, but then we think about those key user journeys and use both automated and manual testing. Manual testing means that I test with the same technologies users with disabilities use? So, I need to learn,--or someone needs to learn--how to open up a screen reader. Or try to fill out that form using the keyboard and listening to a screen reader. A lot of times people get overwhelmed because they're not used to it, right? But if I lost my sight, I'd very quickly learn how to use that technology at a much more proficient level. So, it's just really a mindset, right?

When I work with people, I'm like, just kind of start by turning it on and turning it off. Then turn it on and jump from link to link and listen to it. Then turn it on and go listen to how it sounds when it hits the images. If I couldn't see that image and that were read to me, does that seem reasonable that it's conveying the same content as what purpose that image was serving when it was put there?

The WCAG guidelines map onto requirements that cover the breadth of what's on the website, from images and links and contrast to video content to everything else. It requires both automated and manual testing to determine that.

Rachael Sauceman / Full Media:

Loren, let me jump in really quick because we've got a couple questions that are related to what is 100% compliance, if that makes sense [laughing]. Like, how do you know if you're doing enough? Or how do you manage it when you have a lot to manage? And I thought that was a worthwhile question to stop and talk a little bit about because, I think this, like many areas, is one where there’s some gray area. Having your processes in place, having your goals and working toward them, documenting on an ongoing basis exactly what you’re doing, the manual audit process, if you’re doing automated scanning and you’re going back and making changes as you go. It’s going to be really important to continue to document and show the work that you’re doing given that this an area where even when you’re following the WCAG 2.1 AA standards, there’s still some subjectivity in whether that’s fully accessible to a person or not.

But, Mark, I know you help people set goals and work toward those goals. And then, Drew, I know you have a lot of experience in the realm of risk management, so I thought we would comment on that quickly.

Mark Pope / Pope Tech:

I guess I'll let you go for a second, Drew, because I was just chatting.

Drew Westbrook / Westbrook Health Law, LLC.

Okay, okay. One thing to remember, alright, so we have standards. You need to meet these standards. That is what the rule says. The 2.1 level AA, you need to comply with. But, also, the reason we have those standards is to prevent discrimination against those with disabilities. So, if efforts are being made to meet those standards, and there is a standard that requires a little bit of human interaction or judgment, and a company has put in the effort, especially if you've done so with someone who might have a disability that you're trying to make sure that they can access your site, you've worked through that process, if you still have some sort of technical non-compliance, you'll be able to show we're complying with these standards because we did these processes, and a screen reader can read this or we have alt text that sufficiently descriptive.

Also, and we can talk about enforcement later as a bit of a separate conversation, but thinking about enforcement of the HIPAA privacy rule, since we’re in the Office of Civil Rights in HHS. If you're not complying with that, and you're faced with an investigation, there's a process, it's not just, “well, you didn't meet this tiny little piece of it, and so now we're going to fine you millions of dollars”. There's an investigation process response, and there may be remedial action required, but if you're talking about, “we were 99.9% compliant with 2.1 AA”, your remedial action is probably not going to be a big lift at that point.

So, you know, it is important to think about how do we fully comply. Absolutely. But also the thought process should be: we need to try to comply, and we'll get there. Because it's a long-term process. This isn't set it up once, and you're done. There’s social media, where you’re constantly going to be posting. You need to make sure that people know what they're doing as they post, because your website might be compliant, but if you make a bunch of social media posts in the future, those might not be compliant.

Mark Pope / Pope Tech:

And to me, it comes back to that prioritization stuff that I was chatting about earlier, right? There's a whole list of things you want to do. Map it all out, that's great. But don't wait to start working on stuff that you know is impactful while you're mapping stuff out.

My first advice is just to get going. Get some of those free tools and start running them on your key user journeys and working on that. Map out what you need to do and have a running list like everything else that you do that has complexity, and keep adding things to it and adjusting the priorities as you need to. But focus on those key user journeys. I’d get as quickly to that human testing as possible. Because if someone came to me and said, your website’s not accessible, I would be like – yeah, show me where.

It underscores the importance of a website accessibility statement. You’re going to put that on your website at the bottom and link to it. You’re going to talk about what you’re doing, what your goals are, but more importantly, having a way for people to reach out and communicate to you when they're having issues, so that you're aware of what the issue is, and also how you can help them out so they can accomplish what were they trying to do. Can we help them get that outcome right now while we prioritize and remediate the barriers that were there for them?

So having that statement early on is great, then thinking about what the priorities are that we need to do and breaking them down. A lot of people newer to web accessibility, I tell them, go tackle a bunch of easy errors so that you start understanding accessibility. You start leveling up, and you start making an impact. And then very quickly start getting someone in your organization knowing how to use some of these assistive technologies.

Content scaling's easy. Zoom to 400%, control plus-plus-plus till you get to 400%. Is the header a sticky header that now covers all the content or not? Did that disappear so I now can view the screen. If I scroll everywhere, does it look good at 400%? Taking some practical first action steps is what I recommend, then start mapping out those cues or journeys, then get going and tackling those and getting them there. Having that accessibility statement. Then thinking about what are the different roles and what training do they need? If you're doing that and you're moving forward, that's great. A lot of times when people start talking to me about, “how do I be 100% compliant”, sometimes I feel like they're using that, “oh, I don't think I can get there or anyone can”, and they're using it as an excuse to not get started. But I say we shift it back and go like, “what's the reason we're doing this for?” And why does this matter? We want to have equal access for everyone to be able to access this content, and let's consider how we can make this available to them.

Drew Westbrook / Westbrook Health Law, LLC:

I recognize that we’re primarily focused on our own web content, meaning each organization. But one thing to remember is that the rule also covers contractors. So, if my organization subscribes to a vendor that provides an app that we use for collecting forms prior to visit, that vendor needs to be--even if that vendor is not directly federally funded, if my company that's hiring them and they're providing that service on my behalf--that vendor's got to start complying with these requirements as well.

So, you’ve got to look at your vendors, your vendor contracting process, and maybe you can make somebody else do some of this work. It depends on what your contract says, but sometimes you'll see things like “if the law changes, then we've got our right to cancel if you can't comply.” Well, this might be one of those instances where you say, “I have to comply with this law, and this vendor now needs to comply with this law”.

Loren Funk / Moderator:

What do y'all think is the rate of how many people know about this? I was thinking when you were talking about the vendors, if they're one step away, how many of them, really know about the implications to their services?

Rachael Sauceman / Full Media:

I haven't seen much about it at all. Drew, I don't know if many people have been asking you, or Mark, if many healthcare organizations have been reaching out.

Drew Westbrook / Westbrook Health Law, LLC:

I would say there's a lot of people who know about the Web Content Accessibility Guidelines and are curious about whether they must comply. But I don't know if there's a specific knowledge about this requirement and how it applies. I get questions all the time about accessibility for digital health tools, but it's usually not in the context of this particular regulation.

Loren Funk / Moderator:

It just comes from an organizational desire to do it correctly?

Drew Westbrook / Westbrook Health Law, LLC:

Yeah, and you know, in the past it's come from, ”does the ADA apply to us?” And then often you'll see with some of the large healthcare institutions, they have some of this baked into their contracting process and they'll require it. And so, then it comes about that way, but not all of them.

Rachael Sauceman / Full Media

So the ADA has been a law, like Drew noted, this is something that's not new so any organization-any business really,--has a certain responsibility to be accessible, but have the guidelines been specific? No. So, it’s kind of come down to the judgment of the courts if something goes to them. Many organizations care about it because they already had a legal responsibility to care about it, and they may have cared about it from a mission standpoint or a financial standpoint as well. So, it's definitely something that people have built in before, but this specific new standard, I haven't heard a lot of folks talking about it yet. From our standpoint, we've been educating our clients about it.

Loren Funk / Moderator:

So maybe this time will help in getting the word out. Because I'm thinking from a leadership standpoint that May 2026 is a long way away. But I think it's important that we think about how long it's going to take. Mark, I was going to ask you again about the tools that are available. I was thinking of it as a way to set a benchmark, “okay, this is where we're starting, so it helps us know where to go”. So, what's a good way to get access to those tools?

Mark Pope / Pope Tech:

Yeah, the cheapest, easiest way to get started is with the fully automated tools, right? I can test every page on my website automatically with automated testing. Even if you have a 5,000-page website, it might take an hour or two to run that scan. Again, it's not going to detect all issues, but it gives you breadth of coverage and a good starting place. And, if you want to do one page at a time and don't have budget, go to wave.webam.org. Go check it out.

Go look up Axe by Deque? That's another great free tool that's out there that you can download and install.

You can even use Lighthouse. That's built into the developer's tools to check things.

I always tell people, though, that sometimes people get confused by Lighthouse because it'll be like, “hey, you got a perfect 10. I must be fully accessible”. But remember, this is just automated. If you read their documentation, they're say that even if you got a 10 on the automated stuff, manual testing is still an important thing to consider. I’m paraphrasing their stuff, but I would be more forceful in saying that, no, manual testing is absolutely essential to do to determine this.

So, you know, getting started with the automated is just low friction. There are things to do with manual testing to get going easier. WebAIM has a hybrid between automated and manual testing called an AIM score, where you do a gut check by answering 10 things from manual testing on those pages. And, again, the manual testing, think about your cues, your journeys, important pages, and go start testing them.

Even like I mentioned before, just doing some basic content scaling. Zoom to 400%, see what happens. Just start tabbing around the screen. Can I get everywhere, or do I get stuck? There's a keyboard cheat sheet of how to start keyboard navigating that shows you what to do. If I start tabbing and hit a radio button, space bar should check or uncheck it, right?

So there's some easy things, some great free tools to get started with, but then I'd say take some action. Start working on it. Before you publish new content, have that free Wave browser extension and hit it and look at it and make sure you're not introducing any new errors, right?

That's going to be critical as part of that journey if you don’t want to keep adding fuel to the fire, so to speak. Wave is a great one, Axe is a great one, Lighthouse is built in. There's a lot of great tools to start with. I would say just pick one and start using it.

Loren Funk / Moderator:

Great. Well, in the spirit of good cop, bad cop, Drew, you get to be the bad cop, tell us a little bit about what the implications are with non-compliance, and how are they going to know?

Drew Westbrook / Westbrook Health Law, LLC:

Well, all right. So, I will caveat all of this by saying there is some uncertainty with respect to the enforcement of this regulation. That’s true for all new rules in a change of administration. We have a little bit more evidence of this not being a top enforcement priority with the new administration. There’s a sister regulation, section 508 of the Rehabilitation Act that applies to government websites, and—I’m trying to think of the best way to say it—but it appears that its not going to be an enforcement priority. So we can assume and imply that this rule, 504, may not be an enforcement priority.

So the ways this might come up. How would anybody know? Well, for one, your users will know if an individual with a disability needs to access your web content or your mobile apps. You will recall is not limited to marketing activities, and it could be patient intake activities.

We haven't really talked about kiosks. Not everybody uses kiosks, but there is a specific section in this rule that requires kiosks to be accessible. You might use a digital tool inside your physical building that needs to be accessible.

So, your users will know. Those users, if they are subject to discrimination, can bring a private lawsuit. That's certainly a way to face some consequences for failing to comply with these standards and discriminating against an individual with a disability. Through some cross-references in the rules, if a company faces a lawsuit and loses for violation of this regulation, the person suing can get their attorney's fees recovered on top of damages. So that is a somewhat expensive proposition.

An individual user can also bring a complaint to the Office of Civil Rights, which should trigger an investigation or the Office of Civil Rights has the power to initiate an investigation without any reason or cause. They can audit. If you're found to be in violation through that route, whether that's a complaint or an OCR-initiated investigation, then OCR can require remedial action.

What you'll often see is there'll settlements reached during the investigation, where you'll have a very long agreement with the government that says you will do these things, and it's a long list. There are enforcement actions that you can find on OCR's website that don't necessarily apply to this new rule and the web accessibility standards, but they still apply to discrimination on the basis of disability, and you'll see that there are significant damages involved paid out to individuals. I even saw that there was one institution that had to set up a multi-million-dollar fund to pay out for various things in addition to direct damages to individuals.

So, there are certainly enforcement incentives to comply, whether that's having to spend money to take action to correct or to pay out money in damages. Then there's also the damage to a reputation. If you're found to be discriminating against individuals on the basis of disability, there could be repercussions simply from a business standpoint.

Loren Funk / Moderator:

So, very serious and deserves a lot of attention and work.

Drew Westbrook / Westbrook Health Law, LLC:

Yes.

Rachael Sauceman / Full Media:

Well, Loren, I'm going to jump in, if that's okay. There have been a lot of questions. So, apologies that we probably won't get to all of them. But I will say that we have emails, and we'll have your questions and so, we can follow up with folks individually if we didn't get to your question. And of course, you will have our contact information as well.

So, if you want to reach out, feel free to do that. But a couple of themes that I've seen bubble up a few times. One was on social media, and how to meet WCAG 2.1 AA guidelines on social media.

So I'll comment on this and then I'll let Mark talk about it because I feel like he probably has a lot smarter things to say. But really, you're looking at the same set of standards that are going to be on social media that will be on your website, you're just going to apply them in slightly different ways knowing that when you're posting on social media, it's kind of a smaller thing that you're controlling and changing.

So, you're uploading images, you're going to want to look at color contrast. You're going to want to consider is there text put in this image that a person wouldn't be able to read if they're visually impaired that I need to put below in the actual text of my posts? Do I need to describe the image in detail below it, so that someone, again, who's visually impaired, can understand that.

If you're uploading video content, you need to consider closed captioning, transcription. Are those types of things available?

Alt tags, that's something that is widely available, in social media platforms. So, making sure that you're actually using those features that are available.

Mark, you feel like I've missed anything that you want to add?

Mark Pope / Pope Tech:

You know, I probably don't spend enough time on a lot of these social medias to know what features and stuff they do have, but those are some of the common ones I'd be looking at, you know, images, alt text on that, or having text equivalent in the body of the content can meet that requirement as well. Writing good links, again, would be in there.

And so, you know, sometimes just thinking about that, if it gives you the ability to write, “Pope Tech” and make that the link instead of “https://popetech”. Now that's a short one, but a screen reader would read possibly that whole link and you can imagine some links we've seen are really long and trying to listen to that and know where it goes would just be impossible. Right?

So, writing good links, having good color contrast, alt text on images, and then your video content, making sure that it's captioned. Some people stop there, which is great, but I want you to think about is there information conveyed in there that the descriptive audio from like a movie, like the eagle flies over the mountain. If I couldn't see what's going on. We train our video creators to be verbose and instead of saying, “oh, open up the menu”. It's like, “in the upper right-hand corner, here is the profile button. If I activate that, it drops down a menu. I select the settings option.”

Then I don't have to be using the descriptive audio because I already did that in the narration. Learning things like that is great. The same principles apply, but a lot of things in social media I think are covered by what you said.

Document accessibility is one we haven’t talked about as much. I know people aren't posting that as much in there, but you know, PDFs are probably the hardest thing to make accessible in the document front. So using other versions because PDFs aren't good for most people anyway. We're accessing the internet on our mobile phone that has a hard time with the PDF anyway, so turning it into HTML, or using some other format. We always say, do I need the PDF is the first question you ask. And then second is having someone trained to do that.

Rachael Sauceman / Full Media:

I'm sorry. Go ahead, Drew.

Drew Westbrook / Westbrook Health Law:

Well, I was just going to jump, in and distinguish some exceptions from slightly different versions that aren't exceptions. So, social media posts, your posts, need to comply. You don't have to worry about Facebook's compliance as a company.

You also don't have to worry about anybody that's not acting on your behalf or controlled by you posting on your Facebook page or something like that. Those are third parties who are acting as true third parties, not for you. But your social media posts do.

Then, you know, Mark, you mentioned PDFs and there is an exception for preexisting, what they call “conventional electronic documents”, which includes PDFs, but not if you're actively using them. So, if you're like, well, to apply for our program, you need to fill out this PDF. Well, now you've brought that into the realm of you do need to comply. So, I just wanted to hit those two things talking about there are exceptions that you might see but be careful because they're not that broad.

Rachael Sauceman / Full Media:

Mark, did you have any tools that you might recommend too for auditing social media, or even scheduling tools that are helpful in that regard?

Mark Pope / Pope Tech:

It gets a little trickier. But anything that loads in a page, the way browser extension can often hit, it can hit many of those social medias. But really, a lot of social media stuff comes down to learning five things about accessibility, and then you post just following those, right? Writing the good content, good links, and things like that. That I've already covered.

A lot of them can be hit because they're just on a webpage or something in the context, where the WAVE browser extension can hit it. But sometimes, they are a little bit trickier and, if you can't hit it with other things, then you're just left with the manual testing tools and hitting it that way with your screen reader and keyboard navigating through it.

Rachael Sauceman / Full Media:

Awesome. Well, I know we're coming up on time. Laura, cut us off anytime we need to be.

One question that I thought we would answer, because it came up a few times, was on overlays. It seems like there's a lot of folks who use some different tools like UserWay or AccessiBe, which essentially are kind of overlays that are meant to adapt your website for people with different impairments. I'll just say, from a personal standpoint with Full Media, our agency chose to go a different direction and instead use more of an automated tool, over recommending that our clients go with overlays.

And the reason why we chose that route was because we had seen some negative feedback. I know there's been some independent organizations, including folks who are disabled, who say that overlays, have not been particularly helpful to them and sometimes interfere with their assistive technologies.

We also know that… I think it's AccessiBe that's under a class action right now,--I think it's in New York state,--for not meeting its promises. So, that's the reason why we chose to go that route.

I don't know if that helps anyone to think through, but, we're not necessarily for or against it. If we had a client who chose to go that route, that's kind of their prerogative. But that’s where we would recommend that our clients go with an automated testing tool.

Mark Pope / Pope Tech:

With an overlay, on a website that automatically changes content and you don't have the power to do it, the only testing that's left for you is all manual testing. It negates the ability for automated testing to be as effective. I mean, it still has some value, but let's say you have an image with no alternative text, overlay threw a small text in. Is that alt text meeting the requirement? The requirement isn't just that there's alternative text on the image, but that the text alternative serves an equivalent purpose.

So, now I know that there was an image without alt text, there's something in there, so automated testing totally ignores it now, because there's alt text in there. I don't know if that image meets the guidelines or not. So, I have to actually go look at the alt text to see if it's accurate. And you know, AI is getting smarter and smarter, but it's--on the stuff I've seen—still not smart enough, and it can additionally impose additional barriers for accessibility. So, again, if you install an overlay on your website, do your homework on it to make sure that it's fully accessible itself too, because sometimes they're even not. And you're responsible for third-party stuff you put on your website.

Best practice is that the code should be natively accessible. And so, that's what we promote.

Laura Clemons / HCIC:

And with that, we are at the hour. So, I think if we could try to wrap up a little bit here. I'd like to thank you all for being here today and Full Media for sponsoring this afternoon's panel discussion. You'll be receiving a recording presentation within the next 24 hours. And remember, there's a short survey following the conclusion of this. Also, I wanted to remind you that Rachael and the rest of the folks, will get back with you if your question was not answered. So, just rest assured, we'll answer all the questions via email. Thank you so much to everyone, and hope everybody has a great afternoon.

Rachael Sauceman / Full Media:

Thank you, Laura. Thank you, everybody.

Laura Clemons / HCIC:

Thank you.

Loren Funk / Moderator:

Thank you. Thanks for having us.