We conducted a comprehensive accessibility audit of OpenMRS to ensure compliance with the Web Content Accessibility Guidelines (WCAG) 2.1 Level AA standards and to create a more inclusive digital experience for all users. As part of our broader commitment to digital healthcare accessibility, we identified key challenges and provided actionable solutions that support inclusive design and align with the principles of Digital Public Goods. This audit enhances OpenMRS’s usability, setting a strong example for accessibility in electronic medical record systems worldwide.
OpenMRS
OpenMRS (Open Medical Record System) is an open-source platform designed for managing electronic medical records (EMRs) in healthcare settings, particularly in resource-limited environments. It offers a flexible and customizable framework that allows healthcare providers to efficiently capture, store, and retrieve patient information. With its modular architecture, OpenMRS supports various healthcare workflows and promotes interoperability with other health information systems, ultimately enhancing the quality of care delivered to patients.
Why digital healthcare accessibility matters
Accessibility is a fundamental aspect of creating an inclusive environment for all users, regardless of their abilities. In the context of healthcare, ensuring that digital platforms like OpenMRS are accessible is crucial for empowering healthcare providers and patients alike. By prioritizing digital healthcare accessibility, we aim to eliminate barriers that may prevent individuals with disabilities from effectively using the system, thereby enhancing their overall experience.
The accessibility landscape in OpenMRS today
OpenMRS has made significant strides in accessibility, with several areas of the platform already designed to be user-friendly for individuals with disabilities. These efforts reflect the commitment of the developers and community to create an inclusive environment.
However, our recent audit aimed to identify potential pain points that may still exist within the system. By conducting this assessment, we sought to uncover specific challenges that could affect the user experience for those relying on assistive technologies. The goal was to provide constructive insights that can guide future improvements, supporting the OpenMRS community in its ongoing commitment to accessibility and fostering a more inclusive digital environment for all users.
SolDevelo’s methodology
In conducting the accessibility audit for OpenMRS, SolDevelo adopted a strategic approach by selecting a representative sample of pages that are rich in user interface (UI) elements. This method allowed us to analyze a diverse range of components and interactions within the platform, ensuring a comprehensive understanding of the accessibility landscape.
By focusing on core UI components, we aimed to create a robust foundation for identifying accessibility issues. This approach is designed to be cost-effective, efficient, and scalable, ensuring that our findings and recommendations are relevant and actionable.
Why is this approach a good choice?
Efficiency
Streamlined process for identifying key accessibility issues without unnecessary complexity.
Cost-effectiveness
Maximizes resource utilization while minimizing costs associated with extensive audits.
Scalability
Allows for future audits and enhancements as the OpenMRS platform evolves.
Future-proofing
Focus on core UI components keeps findings relevant and actionable for ongoing improvements.
Hybrid testing
To ensure comprehensive and reliable results in our accessibility audit of OpenMRS, we employed a hybrid approach that combines both automated and manual testing methods. This strategy allows us to leverage the strengths of each testing type, providing a more thorough assessment of the platform’s accessibility.
- Automated Testing: We utilized tools such as WAVE for automated testing, which enabled us to efficiently identify common accessibility issues across various pages. These tools scan the code and highlight potential violations of accessibility standards, allowing us to cover a significant portion of the platform quickly.
- Manual Testing: To complement our automated efforts, we leveraged the expertise of our team – comprising web developers and testers who regularly build and test software. We conducted a thorough manual review using Accessibility Insights for Web. This hands-on approach was crucial in uncovering many accessibility issues, particularly in dynamic elements such as popovers, dialogs, loading states, and other interactive components that automated tools may overlook. This manual assessment ensured that even complex and nuanced issues were effectively addressed.
Key Findings
Overview
The accessibility audit revealed a range of issues that could impede usability for individuals with disabilities, leading to non-compliance with WCAG 2.1 Level AA standards. In total, we identified 22 accessibility issues categorized by severity:
critical issues
serious issues
moderate issues
minor issues
This categorization helps prioritize remediation efforts and ensures that the most significant barriers to accessibility are addressed first.
Severity Breakdown
| Severity level | Definition | |
|---|---|---|
| Critical | Critical issues are those that completely block users from accessing or utilizing essential parts of the application. These issues create significant barriers that prevent individuals, particularly those with disabilities, from completing key tasks or navigating the platform effectively. | |
| Serious | Serious issues represent significant violations of accessibility standards that adversely affect usability. While users may still navigate the platform, their experience is notably hindered, making it challenging to perform certain tasks effectively. | |
| Moderate | Moderate issues involve violations of accessibility standards that affect usability to a lesser extent. These issues may create challenges for users, particularly those with specific accessibility needs, but do not completely obstruct functionality. | |
| Minor | Minor issues do not violate accessibility standards but are recommended for improvement. These issues may include elements that could enhance usability or clarity, contributing to a more refined user experience. | |
Accessibility Strengths
In our audit of the system, we identified several elements that already demonstrate a strong commitment to accessibility and user experience. These existing features not only enhance usability but also provide valuable insights into the direction future system updates should take. By highlighting these strengths, we can ensure that future improvements align with proven good practices and continue to prioritize inclusivity.
Example 1: Loading Announcements
OpenMRS effectively manages loading states by ensuring that they are properly announced to assistive technologies. The loading state includes the appropriate role=”alert” and implements aria-live=”assertive”, allowing users relying on screen readers to understand what is happening during the loading process.
This practice is crucial, as users often encounter delays when navigating digital platforms; clear announcements help them recognize that the system is processing their request, reducing confusion and enhancing the overall user experience.
To follow best practices, it would be beneficial to include clear messaging, such as “Loading appointments, please wait,” to provide additional context. Nevertheless, the implementation of the role and `aria-live` attributes is commendable and significantly improves accessibility.
Example 2: Toast Notifications
The platform also implements toast notifications that are properly announced to assistive technologies. These brief messages inform users about important actions or updates, such as successful form submissions or error messages.
OpenMRS utilizes role=”alertdialog” for these notifications, ensuring that they are communicated effectively to users. Additionally, the notifications include an `aria-labelledby` attribute, with the name indicating, “Patient already booked for an appointment at this time.”
This clear messaging is essential, as it allows all users, including those using screen readers, to stay informed about the system’s status and any necessary actions they may need to take. By providing immediate feedback, these notifications enhance the overall user experience and ensure that users are aware of important updates.
Major Accessibility Concerns
Example 1: Interactive elements inaccessible via keyboard
| Description | Certain interactive elements cannot be accessed or operated using only the keyboard. This means that users who cannot use a mouse are unable to interact with these elements. | |
| Impact | Users with motor impairments, screen reader users, and power users who rely on keyboard navigation are unable to access essential features, leading to frustration and exclusion. | |
| Business consequences | This limits the usability of the platform for a significant portion of the population, impacting user engagement, conversion rates, and overall customer satisfaction. It also creates a risk of legal action due to non-compliance with accessibility standards. | |
| WCAG standards | 2.1.1 Keyboard (Level A) | |
Example 2: An `aria-labelledby` or `aria-describedby` reference exists, but the target for the reference does not exist
| Description | Certain interactive elements on the OpenMRS website have `aria-labelledby` or `aria-describedby` attributes that reference targets that do not exist. This can lead to confusion for users relying on assistive technologies, as they may not receive the necessary context or information about these elements. | |
| Impact | Users with motor impairments, screen reader users, and power users who depend on keyboard navigation may struggle to access essential features. This lack of accessibility can result in frustration, exclusion, and an overall negative user experience. | |
| Business consequences | The inability to interact with key features limits the usability of the platform for a significant portion of the population, adversely affecting user engagement, conversion rates, and overall customer satisfaction. Additionally, this issue poses a risk of legal action due to non-compliance with established accessibility standards. | |
| WCAG standards | 1.1.1 Non-text Content (Level A) 4.1.2 Name, Role, Value (Level A) | |
Summary of our efforts
In conclusion, the accessibility audit of OpenMRS represents a significant step toward fostering an inclusive digital environment for all users. Our comprehensive approach, combining automated and manual testing, allowed us to identify critical accessibility issues and provide actionable recommendations for improvement. By selecting a representative sample of UI-rich pages and focusing on core components, we ensured that our methodology was both cost-effective and scalable.
Key takeaways
- Accessibility Commitment: SolDevelo is deeply committed to digital healthcare accessibility by ensuring that platforms like OpenMRS are accessible to all users, particularly individuals with disabilities. We believe that everyone deserves equal access to vital healthcare information and services, striving to eliminate barriers that hinder usability.
- Developer Focus: Our methodology emphasizes a developer-centric approach, recognizing the importance of equipping developers with the tools and knowledge needed to create accessible solutions.
- Continuous Improvement: Identifying accessibility issues is just the beginning of our journey. Our findings will serve as a foundation for ongoing enhancements, guiding future updates to ensure compliance with WCAG 2.1 Level AA standards.
Join our journey to improve digital accessibility
At SolDevelo, we recognize that every organization faces unique challenges and goals. That’s why we customize our approach to align with your specific needs, ensuring that our accessibility solutions are impactful and seamlessly integrated into your existing workflows. We believe that accessibility is not merely a compliance requirement; it is a fundamental aspect of creating a positive and equitable user experience for all. By fostering a culture of inclusivity, we aim to eliminate barriers and empower all users.
