After finishing the day at the mHealth Conference 2010 conference in Dubai by moderating a panel exploring the commercial aspects of mHealth with a particular focus on start-ups, I was left with some new concepts to consider in global healthcare engagement.

The conference focused on the worldwide mobile healthcare (mHealth) environment and featured delegates and speakers from regions including Japan, Australasia, India, the Middle East, Africa, Europe and the USA.

In this article I’ll share some of the impressions I came away with. I won’t try to cover all the case studies and insights from the conference; you can expect to see some of these covered in detail in future editions of Healthcare Engagement Strategy e-journal, including some excellent video interviews conducted by Paul Grant, which will also appear on the Creation Healthcare Youtube Channel in the future.

Global strategy; local implementation

Whilst mHealth solutions must be implemented at a local level, a clear message coming from many speakers and participants was a call for global strategies, integration and standardisation of systems internationally. Dr Nosa Orobaton, Deputy Executive Secretary of the World Health Organization’s Health Metrics Network, described a mission to strengthen global health information systems through international partnerships and called for an end to repeated, uncoordinated and fragmented pilots that duplicate spend at a cost to society.

When I asked Dr Orobaton what role the World Health Organisation is playing in supporting a move away from fragmented systems, he said that the Health Metrics Network, which has gained 85 country members in its first three years, is playing a key role by mobilising partners to work together, to strengthen global information systems. He also said that a platform exists for collaboration through working groups established by convention; and pointed out that the World Health Organisation’s availability at meetings such as the mHealth conference also plays a role in supporting worldwide collaboration.

Other work taking place to bring global standards includes the work of the Continua Health Alliance which includes major global health and technology stakeholders. Chuck Parker, Continua Health Alliance’s Executive Director, spoke about the Alliance’s vision to establish an ‘ecosystem’ of interoperable health systems. An exciting aspect of the Alliance’s activity with standardisation stakeholders includes working with regulators to encourage a global regulatory approach. There is a similar kind of global regulatory vision behind Creation Healthcare’s call for action on regulatory-compliant pharmaceutical communications, which seeks to address the issue of cross-boundary, international regulatory compliance in pharmaceutical engagement.

mHealth innovation led by the ‘developing world’

The case studies of mHealth solutions illustrated during the conference reminded me that there seems to be a tendency in the developed world, where smartphones are commonplace, to look at mobile technologies and ask questions such as ‘how could mobile play a role in healthcare?’; whereas in the developing world the questions that have been asked are more along the lines of ‘how can we solve this health problem?’

It’s no wonder then, that the most significant innovation with tangible health outcomes is taking place in the developing world. In this environment, mobile happens to be the channel of choice for many healthcare solutions because it is relatively low cost, and is the only way to reach people in rural communities quickly – it is the right healthcare engagement channel in this context.

So does mHealth have a role to play in the developed world? Certainly! And some good examples were shared at the conference. I still think we have a long way to go to fully realise the potential of mobile technologies for health outcomes in the developed world. I would suggest that it’s likely we will start to see the potential of mobile technology realised when the focus is moved away from the technology itself to consider healthcare engagement in a broader, multi-channel context.

Healthcare: luxury or lifestyle?

It was also interesting to witness the divergence between the kinds of mHealth solutions in the developing and developed worlds. As Dr Zaki Ahmad, National Coordinator for eHealth in the Government of Pakistan’s Ministry of Health put it, “In my country, health is seen as a luxury by 80% of people”. For these people, access to better healthcare in remote areas is literally a matter of life and death.

We learned for example from Shainoor Khoja of Afghanistan’s GSM provider Roshan that in Afghanistan, only 30% of the country’s 32 million people are literate. For the 70% who are not, text-based health information is useless without additional innovation. Dr Ahmad said that in Pakistan, this literacy divide is crossed through a text-to-speech mHealth solution.

Meanwhile, in the developed world, health is taken for granted by the majority of people and this means that many of the applications being developed and deployed focus more on lifestyle. This is natural if you consider Maslow’s hierarchy of needs.

Regulation vs innovation

I believe there are other significant factors that enable healthcare engagement innovation in the developing world, and prohibit it in the developed world. This is likely to be a controversial point, but I think it’s an important one to consider in the global context.

Two components that are generally less developed in the developing world are regulatory constraints, and consumer attitudes to privacy of their data. Certain aspects of regulation in healthcare communications and data handling, for example, allow greater flexibility in the way that data is used in developing countries.

After pointing out that health is seen as a luxury by the majority of people in Pakistan, Dr Ahmed went on to say “They just want healthcare or they die. They don’t care so much how many people see their data. mHealth technology makes it possible for us to deliver healthcare.”

Dr Ahmed’s point illustrates that in the context of people’s needs, issues about data privacy are relatively unimportant in life-or-death situations.

Conversely, in the developed world, the challenge of innovating in healthcare engagement without falling foul of regulatory or data privacy obligations takes up much of the time and energy of innovators in healthcare engagement. This is certainly what I have found in my experience of developing and studying healthcare engagement strategies in Europe, Japan and the United States.

A commercial model for mHealth

One of the concepts that came up again and again was that successful mHealth must have a commercial model to be sustainable. Successful commercial mHealth examples included excellent initiatives from GSM provider Roshan in Afghanistan. Shainoor Khoja explained that Afghanistan is a difficult country to travel in, with more land mines than the rest of the world put together. Delivering health by mobile was a necessity.

Ms Khoja explained that the prime driver for Roshan is not the provision of telecoms, but the delivery of solutions for economic growth. “We must be profitable, but profit is not what drives us”, she said.

One of the interesting mHealth innovations shared by Ms Khoja was the deployment of multi-functional, mobile-connected rugged motorcycles which provided both communications and health resources to rural areas. These motorcycles were originally designed for clearing land mines and Roshan are deploying them as what is effectively an mHealth solution.

Shainoor Khoja presents Roshan’s multi-functional, mobile-connected mHealth motorcycles used in Afghanistan

mHealth and pharmaceutical companies

Amongst the lively debate taking place around the conference via Twitter, a question was asked about pharmaceutical companies and mHealth. Although this topic was not covered in depth by the conference program, it’s an interesting area to consider and I’ll provide some thoughts here.

Pharmaceutical companies play a role as key stakeholders in healthcare provision. There was much discussion in the conference about multi-stakeholder partnerships; and Dr Orobaton from the World Health Organization stressed the importance of public/private partnerships. I believe that this is one area where pharmaceutical companies can play a role.

I’m not thinking only about pharmaceutical companies making CSR donations to support mHealth initiatives. It is possible to find win-win commercial solutions. Pharmaceutical companies should look for opportunities that will ultimately benefit both patients and themselves.

One obvious area is in supporting patients who are taking the company’s medicines, to ensure adherence. I learned about an initiative by a major pharmaceutical company in India that is partnering with pharmacies and doctors to automate repeat prescription reminders for patients on a long-term course of medicine.

Other mHealth solutions that pharmaceutical companies are already involved with include health literacy initiatives; anti-counterfeit tools; and healthcare professional education.

Ultimately though, I don’t think it is constructive to look for mHealth solutions for pharmaceutical companies – or for any stakeholders, come to that. What we need to be considering is healthcare engagement. The same issues apply, regardless of the channel, when a pharmaceutical company engages other health stakeholders. The pharmaceutical company must consider:

• Commercial outcomes
• Patient / health outcomes
• Outcomes for other stakeholders, e.g. improved efficiencies for doctors, pharmacists, payers

In my article in last month’s Healthcare Engagement Strategy I advised against developing an mHealth strategy because of the risk of missing the point. mHealth must be considered as just one of many possible channels of engagement, and its particular characteristics seen as opportunities to engage more effectively in a relevant way to solve specific problems or achieve specific goals.

There has been considerable discussion in recent times about ‘local’ versus ‘global’ engagement strategy, or whether there is some kind of mystical balance of the two. Earlier this year Creation Healthcare was pleased to facilitate seminars in New York and London with leading global pharmaceutical and healthcare companies, during which the constraints and opportunities of global healthcare engagement strategy were discussed.

Creation Healthcare are long-time proponents of setting aside time to define an overarching global strategy; we are therefore sometimes asked by new clients, “Do you really think we should have a global engagement strategy?”

This is a great question, to which we (almost) always answer “Yes”.

Some may say, “What about the local nuances?”; “What about the language challenges?”; “What about the regulatory variations?”; “What about the different technology constraints in each region?”; and so on.

We certainly do understand these issues. With 30 consultants all over the world Creation Healthcare is well aware of the challenges facing each territory, and we are constantly increasing our local in-country knowledge in order to make the best recommendations for our global clients. As much as we often encourage global strategy, we also know that it is absolutely necessary to have a local, tailored strategy to suit each individual territory or brand.

It is also true that at a global and companywide level, there are inevitably some common guiding principles that can bring continuity and consistency to the way an organization communicates, presents the brand personality, and ultimately engages with people – even on an international scale.

Incidentally, if you are skimming this article to find the quick-fix, ‘give-me-the-ten-tips’ commandments, you may wish to pull out now.

The reason for the title of this article is that it describes an approach, rather than a one-size-fits-all solution.

Let me explain using a ubiquitous metaphor. Most people in the world – regardless of their own personal religious belief, country of origin, or language – have heard of the so-called “10 commandments”. Indeed, quite a few people could list at least some of them from memory.

Interestingly, orthodox followers of the ‘Torah’ (as these books of laws are known) usually insist that there are actually 613 commandments all told, and that the 10 commandments are more of a ‘table of contents’ – a sort of cheat sheet for remembering the detailed laws and regulations.

Elsewhere, there is even a further distillation in to just two guiding principles. It is fair to say that in religious circles the 10 commandments have certainly permeated the human race over the past several thousand years, across millions of people in many languages and cultures.

We’ve found that this same concept also works for guiding an organization in healthcare engagement. Creation Healthcare maintains that it is possible to create ‘10 commandments’ which can be implemented globally, to bring new levels of (consistent, on brand) engagement.

Of course there really isn’t a single set of ‘10 commandments of healthcare engagement’ that would apply equally well to every company or organization, hence you will find no simple list here as a ‘take-away’.

Rather, each organization is uniquely different in its own right, with particular heritage, traditions, idiosyncrasies and ‘personality’. Therefore it makes perfect sense that each company should really develop their own global engagement strategy (and resulting 10 commandments).

Creation Healthcare can deliver a customized process to help you formulate your own global strategy 10 commandments; all you have to do is give us a call now.

The Global Fund to Fight AIDS, Tuberculosis and Malaria describes Born HIV Free as one of the most ambitious campaigns of its kind. Its aim, to mobilize public support for the work of the Global Fund and for a world where no child is born with HIV by 2015, is huge.

The Global Fund manages funding of US$ 19.3 billion for more than 572 programs to fight AIDS, Tuberculosis and Malaria in 144 countries. Endorsed by governments and individuals as diverse as Ban Ki-moon, Bill Gates and Bono, the Global Fund is currently saving 3,500 lives every day and 1.3 million lives every year.

Founded in 2002, backed by the United Nations after a call from Kofi Annan for the creation of a global fund, the organisation is unlike others in the United Nations family. When I met John Busch, Manager Online Communications at the Global Fund’s headquarters in Geneva, he told me that the organisation had a vision to use the web from the start.

And it shows: with a total staff of 600 people, The Global Fund employs a team of nine people dedicated to online communications. That’s 1.5% of the entire organisation. So when the organisation says this is one of the most ambitious campaigns of its kind, it’s no wonder that digital engagement is embedded deep into the strategy.

Integrating channels

It’s not all about digital. With films produced by Oscar-winning creative team H5 and featuring music by Amy Winehouse; a special video by actor and director Vincent Pèrez featuring Carla Bruni-Sarkozy; collector’s items produced by Tiffany & Co. and Jean-Paul Gaultier; a live concert by Paul McCartney in London’s in Hyde Park; and events around the world, the campaign is well resourced with assets around which to build engagement.

The campaign’s goal is for people to show support for their country’s contribution to the Global Fund by signing up on the campaign website. It’s important, because The Global Fund relies primarily on public funding, so it is not asking individuals to donate money. And in October this year, UN Secretary-General Ban Ki-moon will chair a meeting of donor countries in New York where they will pledge financial support to The Global Fund for the next three years.

The Born HIV Free website features a call to sign up in support

Engagement with the campaign takes place across all major social media platforms: Twitter, supported by Twibbon; Facebook; and a dedicated Youtube channel which has received over 13.5 million views to date.

Spreading the word

To encourage sharing on social media and internet platforms, the website makes available downloadable spreadkits of campaign material: logos, banners, photos, videos and facts. Meanwhile, each social media platform utilised includes plenty of opportunities to share and link with other channels. Over 31,000 Facebook users have ‘liked’ the Youtube Channel.

Born HIV Free Youtube Channel

With so many places to connect with the campaign, it would be possible that some Internet users might not make it back to the campaign website to sign up in support. To ensure that opportunities for support are not missed, a separate sign-up mechanism is included on the Youtube channel, whilst a Facebook Cause has already captured over 47,000 sign-ups directly from Facebook.

Multi-language engagement

The campaign’s reach is also strengthened by its use of multiple languages – the website is available in English, French, German, Spanish and Italian; as is the Youtube channel which switches instantly between languages. Language-specific Facebook pages add thousands of followers in Spanish and French, and even the campaign spreadkit includes logos and banners in five languages.

This is a great example of a strategy that builds on a compelling cause with powerful creative assets both offline and online, doing so in a highly effective way through the integration of complimentary digital channels that truly engage and direct users to clear, measurable calls to action.

Earlier this year I wrote about how language barriers are creating a new digital health divide and I suggested that the single biggest barrier to successfully connecting patients online internationally is language. On the one hand, the Internet has broken down many boundaries and has changed the geography of healthcare, uniting patients and healthcare stakeholders all over the world so that people are not constrained by information available in their own country alone. Yet on the other hand, language has become an even greater barrier as it separates people into groups – the advantaged or the disadvantaged – based on the information they can access.

I concluded that innovation is required, and offered some ideas about how to tackle language barriers in healthcare engagement. Now, in this report, I explore some of the innovative solutions being developed that are transforming healthcare engagement, improving access to healthcare, and literally saving lives by breaking down language barriers.

Solving patient-clinician language barriers

In the United States, over 34 million people speak Spanish as their primary language at home. When it comes to providing effective and reliable healthcare to this Spanish-speaking population, it is in the face to face encounter between physician and patient that any language barrier becomes critical.

I spoke with Dr Martha Bernadett, Executive Vice President at Molina Healthcare, a leading national healthcare provider in the United States, about the challenges of ensuring effective healthcare communication amongst non-English speaking communities in the US.

“It’s in the patient-clinician face-to-face encounter that patients gain the most important information and have the most important interaction,” says Dr Bernadett. “All other non-face-to-face interactions are trusted in a secondary manner, compared with the face to face encounter with a nurse or physician. After that is any written communication that the patient might take home, that they use to convey to family members what happened at that encounter. Those are the two critical elements in healthcare delivery where you don’t have as much margin for error.”

Molina Healthcare focuses on enhancing the relationship between patients and physicians, enabling them to communicate effectively with each other. Dr Bernadett told me that matching physician and patient language is an important aspect of the work they do. Where language matches or bilingual healthcare professionals are not available, interpreters are used for face-to-face encounters. Pre-translated documents also play an important role in efficient and accurate cross-language interactions.

Automating patient-physician interaction

Meanwhile, new technologies for automating translation are emerging and have been used successfully in healthcare. Staff at Bayshore Community Hospital in Holmdal, NJ, communicate with Spanish-speaking patients using an automated spoken translation tool that listens to a sentence in English, translates it to Spanish and speaks the Spanish sentence to the patient.

I spoke to Dr Mark Seligman, President and Founder of Spoken Translation whose product, Converser for Healthcare, is the innovative tool used by the hospital to engage patients in their own language and I asked him what makes the product reliable enough for use in a medical environment.

One of the keys to the product’s effectiveness, as Dr Seligman demonstrated to me, is ‘back-translation’ which confirms to the original speaker in text, what the translated text looks like when translated back into its original language. Through this innovation, it is easy to identify whether the context of an English word with multiple possible meanings has been correctly understood. If not, the correct meaning or inference can be specified by the user before the correct translation is spoken by the tool.

In the example below, the ambiguous meaning of the word ‘right’ in “Your right knee is broken” is clarified by selecting the correct meaning:

This is certainly an effective tool for reliable, context-sensitive translation that is making a real difference to areas including patient safety and compliance. The tool includes pre-translated compliance tools such as an informed consent form.

“Consent becomes a stronger thing when you can know and prove what you have said in a foreign language”, says Dr Seligman. The tool retains a transcript of conversations so it is possible to review exactly what was said. This opens another possibility for the future – the integration of transcripts with electronic medical records. Dr Seligman hopes this will be achieved next year.

“The challenge [of integrating with electronic medical records] is organisational rather than technological”, says Dr Seligman.

If this is starting to sound a little too much like a move towards fully-automated medical interactions, Dr Seligman is quick to reassure that Converser is not trying to replace human interpreters.

“Human minds, human hearts, human cultural understanding is irreplaceable.” says Seligman. “We’re not trying to replace humans. Converser will always work along with human interpreters.”

Emerging applications for automated translation

I asked Dr Seligman about the potential application of Spoken Translation’s technology into digital engagement channels such as social media. He explained that this is where he started out in the mid-1990’s, working on automating chat translations and it is certainly something that he hopes Spoken Translation will return to in the future. The company has a vision for applying their technology of today to live, verifiable, chat translation:

Spoken Translation’s vision of the future: live, verified chat translation

Other innovation in the pipeline includes server-based technology that would allow Converser to be used from portable and mobile devices. Dr Seligman hopes this will be available for iPhone and Blackberry during 2011.

Purpose built automated healthcare translation

During my research for this article, I was pleased to learn from TAUS, a think tank on translation strategies, about customized machine translation systems (aka automated translation) which are designed for use in specific sectors. This is in contrast to Google translate which can be unreliable for specialist areas such as healthcare. These customized engines are trained using database of previous translations from a specific industry and include features to ensure consistent use of terminology. The result is better quality, more accurate translations.

Just such a sector specific solution is used by the Pan American Health Organization (PAHO). Their system was originally developed in the 1970s, and today covers all combinations of English/Spanish and Portuguese and is being used daily for 90% of all PAHO’s translation needs, as well as by 75 clients. Another example is a Danish customized machine translation provider, Languagelens, whose purpose built solutions are used during clinical trials by pharmaceutical companies. Whilst human translators are needed to ensure that the final text is up to the high quality needed, the use of such customized automated engines drives down the cost of translation, increasing the amount of translation that can be done, and speeds up time to market.

TAUS also told me that it is possible to create automated engines rapidly when needed – within three weeks of the recent crisis in Haiti both Google and Microsoft added Haitian to the list of languages supported by their automated engines.

Real-time translation crowdsourcing

As automated translation technologies are deployed into healthcare environments, other innovative approaches to solving the automation challenge are emerging. New York, US based SpeakLike has developed a process that is enabling social media engagement to take place across 37 languages. Sanford Cohen, SpeakLike’s CEO told me that they were looking for a solution to enable real-time chat amongst people speaking different languages.

“We explored machine translation and found it was not good enough for our needs,” explains Cohen. “So we thought, ‘if machine translation were perfect, it would be integrated into everything we use – it would be in our email systems, in our chat systems, and in our content  management systems; but it’s not. But why can’t we have something that can be integrated into everything we use, with good quality translation?’ That’s when we started looking at crowdsourcing.” Cohen says this idea was how SpeakLike started:

“We got a large number of translators on our system, and users could send in a request when they needed it, 24/7, and then whatever translators were available or logged in first would provide the translation.”

The first application of the process was live chat, and in a 2008 beta SpeakLike demonstrated live, real-time chat between three users speaking English, Spanish and Chinese. This technology was implemented by PETLinQ, a provider of radiology imaging software management tools, to enable their user base of 71,000 doctors to collaborate in their own language.

After experimenting with the physician-patient interaction, where a dental reconstructive surgery in New York could support its worldwide patients pre- and post-surgery via international chat, SpeakLike started to develop other applications of the process. The translation platform was expanded to integrate with email, website content, and social media applications.

Today, a Twitter connector automates the translation of tweets, enabling either a single, multilingual Twitter feed or separate feeds for each language. Meanwhile, for bloggers using WordPress, a plugin automatically posts translated content into languages selected by a content author.

SpeakLike’s system is designed to manage the end to end process, automatically notifying translators, managing translated content, and publishing based on user options.

Cohen told me of a customer who was previously waiting typically for two weeks to have website updates translated into nine languages, but their content was out of date within four days. By integrating SpeakLike into their content management system, they were able to publish translations within less than 24 hours.

Responding to international health crises

The potential for transformation that can be achieved when people from different countries collaborate to solve healthcare challenges is exemplified in the work of international aid organisations such as Médecins Sans Frontières, where healthcare specialists from around the world work together in response to a crisis. But when the international team leaves an area of need, local physicians are often left without access to the international knowledge pool that exists during an aid mission.

Murdo Bijl, Founder and Executive Director of Health Connections International, saw this situation first hand when working with Médecins Sans Frontières in the former Soviet Union. The experience inspired him to set up an organisation focused on facilitating and promoting communication between professionals through multi-lingual exchanges of information. Health Connections International operates on a non-profit basis and focuses on improving responses to the HIV, tuberculosis and drug use epidemics in developing countries and resource-poor environments.

The organisation’s online knowledge and information sharing platform has been designed to allow healthcare professionals across the globe to share their experiences and exchange information, quickly and easily across multiple languages.

Healthcare professionals register as members of My Health Connections and can ask medical questions in their own language. Most questions are then manually translated and labelled by subject area (such as HIV/AIDS, treatment, medication) before being routed to an appropriate expert to be answered. Once answered, the response is translated back into the language in which the question was originally asked. It’s a laborious process but the result is a rich and growing knowledge base accessible in multiple languages.

MyHCI includes a growing, multilingual expert medical information knowledge base

I spoke with Murdo Bijl about his vision. He told me that in the proof of concept that has been running since April this year, 600 unique questions and answers have been posted. He said that as the number of questions and answers continues to grow, the knowledge base will be able to provide the answers to most commonly asked questions:

“There will be a moment when the knowledge base will have enough information for people to find the answers to their questions. Then all the questions will be translated into Russian, Spanish, Arabic and Chinese. Right now we have 500 Q&As online, translated into Russian.”

Supporting hard-to-reach healthcare professionals

In Kyrgyzstan and Tajikistan, local ‘focal points’ have been set up to bring Health Connections International’s service as close as possible to those healthcare professionals who may not have access to the Internet. As Bijl told me:

“We work with the medical academies and the ministry of health in the countries where we operate. They create their own knowledge centre in the capital city, with small focal points throughout the country which are equipped and manned by local physicians.

“In Kyrgyzstan and Tajikistan, we have twenty four ‘focal points’ on the premises of the ministry of health’s facilities, such as an AIDS centre or tuberculosis clinic, where local doctors who may not have access to the Internet can take their questions.”

Bijl says that the online model has allowed Health Connections International to continue to support medical professionals when other more traditional methods and have been unable to:

“What we’ve seen in Kyrgyzstan is that when many organisations had to halt their programmes because of political unrest and violence, we had an increase in user traffic. So even in political unrest, the work goes on.”

But Bijl is not content to stop at the existing online solution. He is already exploring new channels to increase the reach into low-income countries using mobile technologies.

“The next step for us will be to use mobile technology. 3G is virtually everywhere now in the low-income countries where we operate.”

Global collaboration

Amidst these examples of innovation in translation, TAUS supports the translation industry and aims to help the world communicate better through better translation, actively encouraging collaboration, sharing of knowledge amongst stakeholders and open innovation.

I spoke with Rahzeb Choudhury, TAUS’ Operations Director, about their vision for collaboration between translation organisations. He told me about the TAUS Data Association, a collaboration platform for sharing translation data, where Molina Healthcare is one of 40 founding members. This non-profit organisation provides an open platform for sharing translated texts into a single shared database which is a key enabler for experimentation and innovation, providing open access to language resources to help train better customized automated language solutions such as those used by PAHO and Languagelens.

The resulting repository of translations currently contains 2.6 billion words in 315 languages, including a giant corpus from the European Medicines Agency. The benefit of such a platform for healthcare (or any industry) can be seen by searching for a medical term in the free language search engine.

A glimpse of what is possible

From face to face physician-patient interaction in the United States to crisis response in the former Soviet Union, it is encouraging to see innovators establishing approaches and technologies that are breaking down barriers and achieving successful multi-language healthcare engagement. There is much still to be achieved, yet the examples here provide a hopeful glimpse of what is possible.

I am grateful to TAUS for their support in researching this report. My thanks are also due to the following:

Health Connections International
Molina Healthcare]
SpeakLike
Spoken Translation

Some years ago the importance of website accessibility came to the forefront when the Target corporation of the United States of America was sued by the US National Federation for the Blind (NFB). The issue was not that the website failed accessible standards, but that no significant progress towards accessibility had been made on the website’s accessible features following complaints raised twelve months earlier.

Accessibility is not just about anti-discrimination law

Whilst maintaining a compliant site means avoiding unnecessary litigation, there are so many other advantages for keeping up with the latest standards of accessibility. The “Guide to good practice in commissioning accessible websites” (British Standards Institute 2006, ISBN 0 580 46567 5) raised a few interesting commercial points about the need for accessibility in the United Kingdom:

• The Family Resources Survey [2] found that there are almost 10 million disabled people in the UK with a combined spending power in the region of 80 billion pounds per annum. Furthermore there are millions of other individuals that are affected by sensory, physical and/or cognitive impairments, including those resulting from the ageing process.

• Research undertaken by the DRC “The Web: Access and inclusion for disabled people” [3] has confirmed that people without disabilities are also able to use websites that are optimised for accessibility more effectively and more successfully.

• Content developed upholding World Wide Web Consortium (W3C) guidelines and specifications can be more easily transferred to other media, such as interactive TV, mobile phones and handheld computers.

• Accessible content, for example where a text equivalent is provided for graphical elements, is highly visible to search engines, often leading to higher rankings.

New standards are on the way

As technologies and techniques change, so does hardware and software. Naturally the standards that made a website accessible several years ago will be showing their inadequacies as vendors try to deliver solutions that take users of the Internet into the future.

It is for this very reason that the Website Content Accessibility Group is recommending a new set of standards to build on the existing framework. Web Content Accessibility Guidelines 2.0 (WCAG 2.0) have been in development for some time, and will inevitably become a standard in the near future.

The same questions that were asked by marketing departments and executives are likely to surface again: “Do we have to do it, and how much will it cost?”. Not that executives or marketers are in any way discriminating, but that it can seem like a forced expense that may be unbudgeted.

A new opportunity for a new generation

Rather than perceiving changing accessibility standards as a threat or weakness to the business, they actually present an opportunity to develop a new strength in the marketplace. Companies should enthusiastically embrace the opportunity to develop a fresh new site, build in some new and much needed functionality, and to capitalise on some of the trends in online social networking. All made possible by a change in accessibility standards.

Never forgetting those that actually use the site

An unfortunate aspect of some standards development processes is that although with best intentions, the standards do not always reflect the very real people that are using the Internet every day, despite needing various enabling technologies.

Real world accessibility is quite different to the tables that are spat out from automated accessibility validators. Interestingly many users simply ignore any part of the site that refers to ‘how to user this site’, or ‘Accessibility help’. Like any person browsing the Internet, they are not thinking about ‘how’ to use it, and especially not how they ‘should’ use a particular site: they simply get on and use it.

So in thinking about making a website accessible as new standards come into play, don’t simply accept the website designer or developer’s certificate’s of validity, rather make sure that some real world accessibility and usability workshops are held.

Creation Interactive has helped organisations such as the Royal London Society for the Blind to implement a website which the real world blind and visually impaired students enjoy its content every day.

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