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Universally accessible e-health services for all
How to develop accessible health services in Norway

Halgeir Holthe
Norwegian centre for e-health research,Po. box 35 UNN, 9038 Tromsø, Norway Correspondence to: halgeir.holthe@telemed.no (tel. +47 957 29763)

The Norwegian Anti-Discriminatory and Accessibility Act adopted in 2008 states that web based electronic services geared towards the public should be accessible to all- regardless of level of functioning. Today, the web content accessibility guidelines (wcag 2) is an agreed standard in Norway. However, it should be fair to state that the developers of Norwegian e- health services have not so far focused on universal design to any particular extent. To obtain a brief estimate of the status in the field , we have investigated the accessibility to some randomly selected e-health services, applying an ad hoc user panel of 4 persons.

Methods and materials
We have during 2015 set up a Windows 7 machine with NVDA synthetic speech output and a Brazie Powerbraille display installed. Using Mozilla Firefox, we have investigated the accessibility to 11 Norwegian web based health services. Our investigation included state, municipal and private service providers. The wcag 2 standard and the Referansekatalogen for e-helse constituted the point of offset for our evaluation. Four users were given specific tasks in connection with each website, and we observed and interviewed the informants as they interacted with each service.

We focused especially on the users' ability to operate the services with the keyboard, and if all the functionality on the web pages could be utilized without applying a mouse.

The Helseportalen provides access to the electronic health record for Norwegian citizens and constitutes a major national initiative in the field of e-health. To which extent can this service be regarded as universally accessible? The html code was found to be robust and consistent, and the functionality, which we investigated, could be operated by the keyboard. This was not true for all of the services, which we evaluated. The login to Helseportalen can be done with mobile bank id, or by a code generator equipped with synthetic speech. However, the initial registration of login method could not be performed by our users. The login to Helseportalen relies on services from private enterprises, and are not necessarily free of charge. The quality of the code on the various sites varied considerably, which potentially causes problems for users of peripheral equipment. Inconsistent use of h-tags (html headline tags) slows down navigation on several of the evaluated pages. Multimedia content is not followed by a descriptive text (but this is not required by wcag 2 level aa).

If the construction of e-health services is regarded a work process involving planning, prototyping, implementation, testing, refinement and documentation, the users should be involved in each of this phases to ensure accessibility to the services made. User oriented design methods have a stronghold in Scandinavia, but if for economic or practical reasons such approaches are not regarded feasible, expert evaluations with emphasis on accessibility should be performed on each stage in the development cycle.

Key-words: universal design, e-health services, wcag 2, anti discrimination legislation

ETC Oslo November 2016

Dear EHiN-FH/ETC 2016 attendee, | |We look forward to see you at the conference next week in Oslo Spektrum! Until then, here is some practical information for you. | |  | Before the conference (Monday 14th) | |Pre-registration at Oslo Spektrum from 16.00-17.30 for those of you who would like pick up your badge in advance and enter by the fast-lane on Tuesday. | |Plan your days at the conference by downloading the conference app. | |  | Conference day 1 (Tuesday 15th) | |Registration | |Bring your ticket by print or on your smartphone and we will give you a badge/access pass to enter the conference venue. This pass contains a QR code | |that can be scanned by sponsors if you are willing to share your contact information, it is up to you. | |Doors open from the main entrance at 08.00 and coffee will be served! | |Expo is open, this is also where the opening show will be. | |Opening show | |The opening show starts at approx. 0850, and the keynote starts at 09.00. We recommend you to enter the conference early, as there are many attendees | |entering the doors at the same time. | |Don´t miss out on a great opening! | |  | |  | |Conference Reception/Dinner (Tuesday 15th) | |On Tuesday evening we are hosting the conference dinner, starting off with an informal reception in the entry level at 18.45. There you can buy a | |beverage in the bar and mingle before we open the doors to the dinner at 19.30.  | |400 attendees will attend this dinner, and we hope to see you there. If you have not ordered a ticket for the conference dinner, you can still join, we | |have a few places left. Send an email to ehin@macsimum.no if you want to buy a ticket for the dinner as well. | |For those of you who have ordered the dinner, please visit the infodesk in the expo close to the coffee stand to get your sticker for the dinner. | |Be sure to collect your sticker by 18.00 on Tuesday. |During the conference (15th-16th) | |Parallel sessions | |The first parallel session start at 10.45, and 7 tracks will be held | |throughout the day.  | |Food | |Visit our 4 restaurants in the expo area, our chef´s are ready to serve up some great food! If you have any allergies, please see our signs, or ask the | |chef´s in charge at the restaurants. | |Expo area | |We have a dynamic expo area with over 40 sponsors and partners, municipalities, lounges and more. Please visit them all and get to know them, their | |technologies and services. | |  | |If you have any questions regarding the conference, please contact us at ehin@macsimum.no. | |Hope you have a nice weekend, see you at Oslo Spektrum. | |Best regards, | |EHiN/ETC 2016 |

SIO strategies

I recieved a quite interesting epost the other day. I guess internet marketing skills do not only apply to the trade of peanuts: by means of some easily available tools the spread of (specific) words is at hand to everyone for an affordable price. Charlie writes: Hey, I just wanted to share with you my latest blog post (https://www.seomechanic.com/5-components-of-a-successful-seo-plan/) . Let me know what you think. 5 Components of a Successful SEO Plan (https://www.seomechanic.com/5-components-of-a-successful-seo-plan/) Do you ever ask yourself this question: what do top websites in your industry do that others do not? Once you know the answer, it becomes easier to adjust your SEO strategy and improve future results. If your online presence has fallen behind the competition, it is time to revisit your SEO strategy and make changes for the better. [click to continue] (https://www.seomechanic.com/5-components-of-a-successful-seo-plan/) Thanks Charlie I have during the spring of 2016 completed a project about accessability to web-based health services, financed by DIFI. The report is now available in full text at hholthe.net under publications. Also, I have prepaired a summary in english, which will appear as a poster presentation at The European telemedical conference arranged in Oslo 15. and 16. of November this year.

Mail amusements

Powertech is shutting down their e-mail services later this year. Hence, I'll have to serve mail myself. Since mail is an essential part of my work routine, I have tried to be a little bit careful when constructing my server. Among other things, I have written a little memo more or less to myself to be able to hack errors when they arise. I have entitled the writings "mail amusements", and put it on my home page June 3. "The thing is that in early 2016 I received a notification from my mail provider informing me that their mail service will be shut down later this year. After about 20 years with access to a Unix server which allowed me to make my own mail configurations, I'll have to reorganize one of my main work routines. As it seems, from now on I will have to serve mail myself. Obviously, the graphic interfaces at the many mail providers on the Internet do not usually fit with the needs of a blind man. Possibly, the big Internet companies will pay at least some attention to the w3 consortium's guidelines concerning accessible web pages before too long. But then again sending mail from a local Linux machine using emacs is pretty straight forward under ubuntu or debian, even if the fine tuning of the system may be debated a little bit back and forth..." If you want to see the debate's themes, look at the front page!

Old news...

I have uploaded the english version of the report about the UN convention in practise. From time to time interested parties still ask me where to find the manuscript. May 28, 2016, it's available for download.

Valg Nbf Troms 2016

Valgkommiteen i NBf Troms har hatt møte nylig. Kommiteen består av Roger Riise, Grete Kongsbak, Anette Nilsen og Halgeir Holthe. Vi skal foreslå 4 medlemmer/varemedlemmer til styret, landsmøterepresentanter samt valgnemnd for 2017. Vi tar gjerne imot innspill fra alle registrerte medlemmer i NBf Troms. Vi regner med å ha iinnstillingen klar ca. 2.mars.

Regjeringens handlingsplan for universell utforming: Norges Handikapforbund med horn i siden til Horne.

Skuffende handlingsplan M?let om universell utforming innen 2025 er ikke med i regjeringens handlingsplan for universell utforming. Og regjeringen vil satse stort p? IKT og velferdsteknologi. 02. FEBRUAR 2016 13 0 Fredag 29. januar presenterte Solveig Horne regjeringens nye handlingsplan for universell utforming. Det aller mest p?fallende med planen er at m?let om at Norge skal v?re universelt utformet innen 2025, formulert av den r?dgr?nne regjeringen i handlingsplanen som utl?p i 2013, er borte. I den nye planen er ingen tidsfrister ? finne, annet enn 2025-fristen Statsbygg har valgt ? beholde p? egne vegne. Dermed blir planen betydelig mer diffus enn det som er n?dvendig for ? gi samfunnsutformingen et realt l?ft. Det nest mest p?fallende med handlingsplanen er at regjeringen satser tungt p? IKT og velferdsteknologi. Med det representerer denne planen en dreining mot helse- og omsorgstjenester og eldre. Dette er helt i tr?d med de signalene regjeringen tidligere har gitt, spesielt tydelig kommunisert i presentasjonen av fjor?rets statsbudsjett. Den gangen gikk Handikapforbundet hardt ut og p?pekte at det ? investere i IKT og velferdsteknologi alene ikke er nok, hvis vi skal skape et samfunn der funksjonshemmede kan delta p? lik linje med andre. Til det trengs en aktiv satsing p? mange samfunnsomr?der. Klikk her for ? lese fjor?rets kommentar om handlingsplanen. Den nye handlingsplanen har rett nok innlemmet flere omr?der enn tidligere signaler tydet p?. Spesielt nevnes satsingen p? nasjonal transportplan, med gode tiltak for universell utforming av veier, tog, ferger, flyplasser og jernbanestasjoner. Planen?viser dessuten til at universell utforming fordrer et?tverrsektorielt fokus.?Videre har?KS?f?tt nytt?ansvar, ved ? overta?nettverkssamarbeidet mellom kommunene som tidligere ble ledet av to departementer. Det kunne alts? v?rt verre. Innvendingen er bare at det burde v?rt s? mye, mye bedre. De tiltakene regjeringen nevner i planen er ikke nye, de har allerede eksistert noen ?r. Det er ordin?re ordninger, som eksempelvis Husbankens grunnl?n og boligtilskudd, det refereres til. Nysatsinger gjennom friske midler til nye tiltak finner vi lite av. Og nettopp nye midler er det som trengs for ? gi samfunnsutformingen et ordentlig l?ft. Dette er ogs? noe kommunene som har v?rt med i pilotprosjektet om universell utforming stadig har etterlyst. Planen burde inneholdt b?de konkrete m?l om og midler til store, gjennomgripende samfunnsendringer. Handlingsplanen nevner dessuten ingen tiltak for universell utforming av skolebygg, noe Handikapforbundet har kjempet for i en ?rrekke og spesielt siden likestillings- og diskrimineringsloven kom i 2008. Det er forstemmende, n?r vi vet at 80 % av norske skoler fortsatt ikke er tilgjengelige for funksjonshemmede barn. De samme dystre tallene finner vi n?r det gjelder eksisterende bygningsmasse. Regjeringen oppgir selv i planen at kun 7% av offentlige bygg har tilgjengelig inngangsparti. Det er med god grunn det har blitt satset p? universell utforming de siste ?rene. Det finnes mye og god dokumentasjon p? at funksjonshemmede ikke har de samme mulighetene som andre til ? skaffe seg en egnet bolig, gjennomf?re et utdanningsl?p, v?re i arbeid eller ha en meningsfylt fritid. Fysiske barrierer i samfunnet m? bygges ned for at funksjonshemmede skal f? reelle muligheter til ? utfolde seg p? alle livets omr?der. Hvis ikke, fortsetter vi ? bryte menneskerettighetene for funksjonshemmede, som Norge har forpliktet seg til gjennom FN-konvensjonen. ? Regjeringen handlingsplan for universell utforming er n? engang det verkt?yet regjeringen vil bruke framover. Uansett hva vi mener om den, er vi n?dt til ? forholde oss til den som den er. Det betyr at vi m? se etter muligheter og handlingsrom der det finnes. Vi m? fortsette ? insistere p? betydningen av ? bevilge midler til universell utforming i forbindelse med statsbudsjettene. Vi m? holde ?rv?kent ?ye med og gi innspill til KS og nettverkssamarbeidet i kommunene. Vi kommer ikke til ? gi oss i kampen for universell utforming. Klikk her for ? laste ned handlingsplanen fra regjeringens nettsider.

As the sun is just returning here in Tromso this year, I have quickly put this blog on the net. Lately, I have used facebook a lot for communication, but at present it seems ok to have a place to share documents in progress (which facebook is not always a good option for). Also, facebook might be taken to favour rather short messages, as well as pictures of course. Sometimes it's good though to be able to work in a somewhat larger format, and I'll give it a try here. On the other hand, I'll obviously stay put on facebook, since after all there's where people are...:-)Do not hesitate to leave me a note on the blog as well whenever you feel for it.

Winter Tromso 2016

First glimpse of sunshine in Tromso 2016

Winter Tromso 2016

The sun is returning to winter Tromso 2016