The Vision of Universal Access

One outcome of the rapid changes in telecommunications and information technologies has been our perspective on access to information and services. Expectations have changed. For instance, teachers often expect students to have access to word processing and to the Internet, and young people now consider themselves to have an unalienable right to a cell phone, to email, and to instant messenging on the computer. The change is real, and is affecting the fabric of our civilization, including how governments view access. "Universal access" is both a principle and a process, and difficult to define precisely. Here we utilize, as a starting point, the following definition of Universal Access that would make sense in Module 2: access to products and services by all persons, including older adults and those with disabilities.

However, the term "universal access" has multiple meanings, depending on the context and the stakeholder group:

• To the Office for the Advancement of Telehealth, it ties to equitable access to educational and health services - especially as related to setting up infrastructure to help break down barriers of distanace for those in rural or impoverished communities.
• To standards bodies such as the International Telecommunications Union (ITU), "universal access" refers to technological communications access, where the focus is on the equipment rather than on the person using the technology. Similarly, to agencies such as the FCC, universal access refers to the technical reach and degree of competition for various forms of telecommunications access (e.g., radio, broadcast and cable TV, cell phones).
• To the rehabilitation community, univeral access refers to access of individuals to information and services, no matter what their disability. It ties closely to the concepts of universal usability and universal design that we covered in Module 2, i.e. products that are usable by everyone to the maximum extent possible.
• To the U.S. Access Board, it is a legal responsibility: To develop (and periodically update) accessibility guidelines (e.g., see Part 1193), in conjunction with the FCC. This mission was set by the Rehabilitation Act of 1973 (Section 502), with Section 508 of the same act requiring that electronic and information technology purchased by the Federal government be accessible to individuals with disabilities. But it didn't have "teeth" until the Rehabilitation Act Amendments of 1998 of Section 508a, motivated in part by the Americans With Disabilities Act of 1990, required the Access Board to publish standards that set forth a definition of electronic and information technology and the technical and functional performance criteria necessary for accessibility for such technology; these accessibility guidelines & standards became official in 2001, available in various formats and with technical assistance. Key Federa laws Mandating Accessibility:
  • Section 255 of Telecom Act of 1996 - All telecom products and services be accessible and usable by persons with disabilities to extent readily achievable
  • Section 508 of Rehab Act of 1973/1998 - accessibility requirements for federal departments and agencies that use electronic and information technology
• To the W3C, the key body for web protocols (see also Module 2, Part 5), it related to web accessibillity. W3C has established the Web Accessibility Initiative that includes web content accessibility guidelines for web page design.

From our perspective, all of these are relevant, and synergistic.

Perspective on Universal Access

From this perspective, universal usability is a subset of universal access in that universal access also considers the barriers of distance and socioeconomic status.

As an example, consider the plan of our RERC on Accessible Medical Instrumentation for developing universal interfaces (through Project D3, targeting emerging technologies) that help make medical products more universally accessible, thus increasing the number of individuals with timely access to such technologies. We employ two strategies that, at a basic level, target access through telecommunication technologies (D3.1) and access through multimodal interfaces (D3.2). The former is the approach of this module (Module 3), when the latter targets user accessibility and was a theme in Module 2, Part 5.

Universal Access and Universal Design Market Potential

There are tight ties between the terminology of Universal Access and Universal Design, and the Universal Design Performance Measures for Products are applicable in that they address Universal Usability. Pragmatic motivation for these principles includes the following:

• 15% have functional limitation
• Aging society (more likely to purchase/use accessible/usable products)
• Often products are about the same price, if designed on the "front end"

Thus the principle of Univeral Access suggests a need for univerally designed telecommunication interfaces that enable telehealth to be a viable option for all individuals.

Vision of Telehealth as Tool for Improving Universal Access

From an engineering perspective, the key concept is to maximize access for individuals, irregardless of their location, abilities and socioeconomic status. This is essentially an optimization problem, and engineers like to use problem-solving tools to solve such problems. However, currently engineers are not trained to think in terms of universal access, despite the fact that there are laws that mandate enhanced access to information, services and products. Ideally, decisions related to access should be addressed at the front end of the product design and evaluation process.

From a healthcare "systems" perspective, the aim is to find the optimal solution that minimizes/maximizes key performance indices, subject to a set of system constraints. The healthcare "system infrastructure" can be viewed as providing a set of constraints on the viable set of alternative solutions. This include the practical barrier of distance. Telehealth relaxes some of the constraints imposed by the infrastructure, and thereby expands the solution space. In principle, the addition of such alternative tools should, if used wisely, only improve care. By breaking down the barrier of distance, telehealth tools add possibilities for more timely access to assessment information, support services, and treatment. For instance, telecommunications tools in the home can provide alternatives to the conventional model of outpatient and home visit services, that typically include the constraint of limited weekly encounters, each with a pre-specified amount of time.

With this conceptual framework, why isn’t telerehabilitation flourishing? Reasons include (Rosen, WInters and Lauderdale, 2002, Winters, 2002b):

• The reality that there is not one optimal protocol for telerehabilitation, with different problems requiring different technologies and procedures,
• Lack of outcomes research studies, both those comparing telehealth vs. conventional approaches, and comparing different forms of telehealth,
• Low penetration of electronic healthcare records (EHRs) and of standardized protocols in rehabilitation, which makes incorporation of telehealth tools more difficult,
• Pragmatic turf and financial concerns, especially in the allied health professions, and
• A lack of educational materials and training programs.

Hopefully this Module, by being available through the Internet, helps address this last barrier.

| Univ Access | Telecom Access | Tele-Encounter | Tele-Interface Design |