HIPAA Compliance and Web Accessibility for Healthcare Websites

Healthcare websites face a unique challenge: they must comply with both HIPAA privacy regulations and ADA accessibility requirements. This guide explains how to meet both standards while providing excellent patient experiences.

The Intersection of HIPAA and Accessibility

Why Both Matter

• HIPAA: Protects patient privacy and health information
• ADA: Ensures access for people with disabilities
• Together: Create secure, accessible healthcare experiences

Legal Requirements

• ADA Title III: Healthcare facilities are places of public accommodation
• Section 1557: Prohibits disability discrimination in healthcare
• HIPAA: Applies to all patient health information (PHI)

HIPAA Basics for Websites

What is PHI (Protected Health Information)?

PHI includes any information that can identify a patient and relates to:

• Past, present, or future health conditions
• Healthcare services provided
• Payment for healthcare services

When HIPAA Applies to Websites

• Patient portals
• Appointment booking systems
• Telehealth platforms
• Contact forms requesting health information
• Email communications about health

When HIPAA Doesn't Apply

• General health information (not patient-specific)
• Marketing content
• Provider directories
• Location and hours information
• Public educational content

Accessibility Requirements for Healthcare

ADA Title III Requirements

Healthcare facilities must ensure their websites are accessible, including:

• Appointment booking
• Patient portals
• Medical records access
• Telehealth services
• Billing and payment systems

Section 1557 Requirements

Healthcare organizations receiving federal funding must:

• Provide accessible websites
• Offer auxiliary aids and services
• Ensure effective communication
• Provide language assistance

Common Healthcare Accessibility Issues

1. Patient Portals: Often inaccessible to screen reader users
2. Appointment Booking: Complex forms without proper labels
3. Telehealth: Video platforms lacking captions
4. Medical Forms: PDFs that aren't screen reader compatible
5. Health Information: Complex language, small text

Building Accessible Patient Portals

Authentication

HIPAA Requirements:

• Strong passwords
• Multi-factor authentication
• Session timeouts
• Encryption (TLS 1.2+)

Accessibility Requirements:

• Password managers supported
• Clear error messages
• Sufficient time for authentication
• Alternative authentication methods

Best Practices:

• Support biometric authentication
• Allow password paste
• Provide clear instructions
• Offer phone/email support

Dashboard Design

Accessible Elements:

• Clear headings and navigation
• Keyboard accessible
• Screen reader compatible
• Sufficient color contrast
• Resizable text

HIPAA Considerations:

• Auto-logout after inactivity
• Secure session management
• Encrypted data transmission
• Audit logging

Medical Records Access

Accessibility:

• Documents in accessible formats (HTML, not just PDF)
• Alternative text for medical images
• Clear data tables with proper headers
• Print-friendly accessible versions

HIPAA:

• Access controls
• Download encryption
• Audit trails
• Right to amend records

Accessible Appointment Booking

Form Design

Accessibility Best Practices:

• Clear labels for all fields
• Error messages associated with fields
• Required fields clearly marked
• Logical tab order
• Date pickers keyboard accessible

HIPAA Considerations:

• Minimal PHI collection
• Secure transmission (HTTPS)
• Clear privacy notices
• Consent for communication

Confirmation and Reminders

Accessible:

• Multiple format options (email, SMS, phone)
• Clear, simple language
• Calendar file attachments
• Accessible confirmation pages

HIPAA Compliant:

• Patient consent for reminders
• Minimal information in messages
• Secure communication channels
• Opt-out options

Telehealth Accessibility

Video Platform Requirements

Accessibility:

• Captions for audio
• Screen reader compatible controls
• Keyboard navigation
• Visual and audio quality controls
• Alternative communication methods

HIPAA:

• End-to-end encryption
• Business Associate Agreement with vendor
• Access controls
• Recording consent and security

Pre-Visit Preparation

Accessible:

• Clear instructions for joining
• Technical support contact
• Test connection option
• Alternative formats for forms

HIPAA Compliant:

• Secure link delivery
• Patient identity verification
• Consent forms
• Privacy environment guidance

Accessible Health Information

Content Guidelines

Plain Language:

• 8th-grade reading level or below
• Short sentences and paragraphs
• Active voice
• Common words instead of jargon

Structure:

• Clear headings (H1, H2, H3)
• Bullet points for lists
• White space for readability
• Visual aids with alt text

Accessibility:

• Sufficient color contrast
• Resizable text
• No information by color alone
• Captions for videos

Medical Terminology

Best Practices:

• Define medical terms on first use
• Provide glossary
• Use analogies and examples
• Offer "plain language" toggle

Accessible Forms and Surveys

Health History Forms

Accessibility:

• One question per page (for complex forms)
• Clear labels and instructions
• Error prevention and correction
• Progress indicators
• Save and resume functionality

HIPAA:

• Secure transmission
• Encrypted storage
• Access controls
• Retention policies

Patient Satisfaction Surveys

Accessible:

• Multiple response formats
• Clear rating scales
• Optional open-ended questions
• Keyboard and screen reader accessible

HIPAA:

• De-identified when possible
• Secure collection
• Limited PHI
• Clear purpose statement

Third-Party Tools and Vendors

Business Associate Agreements (BAAs)

Required for vendors that handle PHI:

• Patient portal platforms
• Appointment scheduling systems
• Telehealth platforms
• Email marketing services (if PHI included)
• Analytics tools tracking patient data

Accessibility Widget Vendors

Considerations:

• Does widget track user data?
• Is data shared with third parties?
• BAA required if PHI could be captured
• Review privacy policy carefully

Analytics and Tracking

HIPAA Concerns:

• Google Analytics can capture PHI in URLs
• Facebook Pixel may track patient behavior
• Heatmaps may record sensitive information

Solutions:

• Anonymize IP addresses
• Exclude PHI from URLs
• Use server-side tracking
• Implement strict data retention policies

Mobile Accessibility

Native Apps

Accessibility:

• VoiceOver (iOS) and TalkBack (Android) compatible
• Dynamic text sizing
• Sufficient touch target sizes
• Alternative text for images
• Keyboard support for external keyboards

HIPAA:

• Device encryption required
• Secure authentication
• Remote wipe capability
• App-level encryption

Responsive Web Design

Accessibility:

• Mobile-first approach
• Touch targets 44×44 pixels minimum
• Simplified navigation
• Readable text without zoom
• Accessible form inputs

HIPAA:

• Responsive security (same protections on mobile)
• Secure mobile sessions
• Mobile-optimized authentication

Testing and Compliance

Accessibility Testing

Automated Tools:

• axe DevTools
• WAVE
• Lighthouse
• Pa11y

Manual Testing:

• Keyboard navigation
• Screen reader testing (NVDA, JAWS, VoiceOver)
• Mobile device testing
• User testing with people with disabilities

Healthcare-Specific Testing:

• Patient portal workflows
• Appointment booking process
• Telehealth platform
• Medical forms and documents

HIPAA Compliance Testing

Technical Safeguards:

• Penetration testing
• Vulnerability scanning
• Encryption verification
• Access control testing

Administrative Safeguards:

• Policy review
• Staff training verification
• Risk assessment
• Incident response testing

Combined Testing Scenarios

Test both accessibility and security:

• Accessible authentication that's still secure
• Screen reader compatibility with encrypted portals
• Keyboard navigation in secure areas
• Timeout warnings that are accessible

Common Compliance Mistakes

1. Inaccessible Patient Portals

Problem: Portal only works with mouse Impact: Violates ADA and excludes patients with disabilities Solution: Ensure full keyboard and screen reader accessibility

2. PHI in URLs

Problem: Patient information in query parameters Impact: HIPAA violation, data exposed in logs Solution: Use POST requests, session variables

3. Unsecured Contact Forms

Problem: Health information collected without encryption Impact: HIPAA violation Solution: HTTPS, encryption, BAAs with form providers

4. Inaccessible Medical Documents

Problem: PDFs that aren't screen reader compatible Impact: ADA violation, patients can't access records Solution: Create tagged, accessible PDFs or HTML versions

5. Missing Captions on Health Videos

Problem: Educational videos without captions Impact: ADA violation, deaf patients excluded Solution: Add accurate, synchronized captions

6. No BAA with Analytics Provider

Problem: Google Analytics tracking PHI without BAA Impact: HIPAA violation Solution: Sign BAA, anonymize data, or use HIPAA-compliant alternative

7. Inaccessible Telehealth Platform

Problem: Video platform not screen reader compatible Impact: ADA violation, excludes patients with disabilities Solution: Choose accessible platform, provide alternatives

Creating an Accessibility and Privacy Statement

Accessibility Statement

Include:

• Commitment to accessibility
• Standards followed (WCAG 2.1 AA)
• Known limitations
• Alternative access methods
• Contact for accessibility concerns
• Grievance procedure

Privacy Notice (HIPAA)

Include:

• How PHI is used and disclosed
• Patient rights
• How to file complaints
• Contact information
• Effective date

Combined Approach

Consider a unified "Patient Rights" page covering both accessibility and privacy.

Staff Training

For All Staff

• Disability awareness
• Accessible communication
• Privacy basics
• Reporting accessibility barriers

For IT and Development

• Accessible coding practices
• HIPAA technical safeguards
• Secure development lifecycle
• Accessibility testing

For Content Creators

• Plain language writing
• Accessible document creation
• Image alt text
• Video captioning

For Patient-Facing Staff

• Assisting patients with disabilities
• Privacy in communications
• Accessible appointment scheduling
• Telehealth support

Enforcement and Penalties

ADA Enforcement

• Department of Justice investigations
• Private lawsuits
• Consent decrees
• Ongoing monitoring requirements

HIPAA Enforcement

• Office for Civil Rights (OCR) investigations
• Fines: $100 - $50,000 per violation
• Criminal penalties for willful violations
• Corrective action plans

Recent Cases

• Hospital System (2024): $3.5M settlement for inaccessible patient portal
• Medical Practice (2023): HIPAA violation for unsecured contact form
• Telehealth Provider (2025): ADA lawsuit for inaccessible video platform

Conclusion

Healthcare organizations must balance accessibility and privacy, ensuring all patients can access services securely. By following this guide and implementing both HIPAA and ADA requirements, healthcare providers can create inclusive, secure digital experiences.

Ready to make your healthcare website accessible and HIPAA compliant? Start with a combined accessibility and security audit to identify gaps in both areas.