Physician, heal thyself

This article first appeared on IBM developerWorks.

Health care Web sites that could use a thorough exam

Peter Seebach (

November 2001

Health care Web sites show a stunning failure to consider goals and target audiences. Their lack of accessibility results in high costs and frustration. This is particularly disturbing when you consider the material covered.

Who are you guarding, anyway?

Once upon a time, I received health coverage through an insurance company called "The Guardian." I called to ask how I could obtain a doctor. I was told to use their Web page.

Ahh, the Web page. A large blank blue field. The source code included a JavaScript hack that redirected me to a different page, as well as an image I could click on to get into their home page -- but the image file didn't exist, so all I saw was a blank blue page.

The page I was redirected to is a blank white page -- the only indication that I'd gotten anywhere was this background change. In this case, it was a totally defective attempt at specifying frames -- with no frameset. Why? Because the opening tag for the frameset was in some JavaScript that required that I use either IE 4 or Netscape 4. There was no provision for any other browsers, let alone browsers without JavaScript or frames capability.

After about half an hour of futile attempts to get the page to work, and a number of wacky high jinks, I called back in. They agreed to send me a list of doctors, so a few days later I received a large paper book.

Net cost to them: at least 20 minutes of phone rep time, plus shipping, plus books, plus an annoyed customer. Net cost to me: probably an hour or so, although I grudgingly admit that after a while it got to be sort of like a game.

At that point, I thought about writing about this column, but thought "Why bother? It's just one company."

Inaccessibility epidemic

A few weeks ago, a friend of mine mentioned in passing that his company health care site used a Flash intro, and you couldn't enter the site unless you had the Flash plug-in installed. He eventually managed to get around that, and found the rest of the site to be deeply challenging. He mentioned it to me after telling me that he'd written them to complain.

I started thinking about the column again.

Last week, I tried to find a dentist. It turns out that my current health care company (Cigna) has the "blank page" problem, too -- JavaScript-only redirect and everything. Pages and pages of links with HREF="#". Form submit buttons that don't work. My particular favorite is the "contact form" which instructs me to use the links on the left to send e-mails; unfortunately, on my system the box on the left side of the page only contains the message "Your browser does not support JavaScript."

I started taking notes for the column.

Accessible health care

What, exactly, are these people thinking? If you publish an online comic, I could see not worrying whether your site is accessible to people who can't load images; after all, they can't possibly see the comic. However, health care providers are a different story. Everyone gets sick. The process of trying to find a doctor who is legally allowed to talk to you is harrowing enough as it is; why is it being made so much worse?

There is no compelling reason why a list of doctors within 20 miles of a given zip code should require plug-ins. You need about 30 lines of Perl, a decent database, and an hour's time to do this. The user's browser can be presented with convenient lists. You don't need to use JavaScript to make a form submit button. You don't need Flash to display the first 10 search results and provide a button to show the next 10. You don't need a splash screen at all!

Indeed, if anything, this is an example of an arena where most users have no interest in flashy, exciting pages. Users come to a site looking for a doctor because they are in need of medical attention; they want to find out if they have a serious condition, not watch your logo spin for five minutes.

The end result of this is that I don't use the company Web page -- I call in. Every time. If I want to find a doctor, I call in. If I want to find a dentist, I call in. If I want to know which plan I'm on, I call in. Any time I have any question, no matter how trivial, I call in; I know I will get an answer sooner. I don't know how much that costs, but it's probably a lot; it seems like the company would get a better return on investment by doing a simpler site.

There is hope

As I mentioned, my friend wrote his health care provider (Blue Cross & Blue Shield of Minnesota) to complain. Their response was good: They admitted the site had problems, and said they were working on it. My friend forwarded me the letter, so I wrote them to ask if I could ask a few questions.

I got a response from Vincent Hopwood, a communications consultant at BCBS, who graciously answered my questions about how their Web page came to be difficult to use, and where they're going with it.

They are planning to scale back the use of "non-HTML" technologies, improve search functionality, and improve navigation. They have been paying attention to user feedback, and they are trying to adapt the site to the needs of their users. They believe it is important that the people who rely on them for health care be able to use their Web page.

The most important thing, of course, is that they are concerned with the accessibility of their page. Instead of telling users to "upgrade your browser," they're saying "we should upgrade our site." While there may be problems in days to come, they have cleared the first hurdle -- recognizing that their page exists to provide services to their customers.

Cigna hasn't given me any such assurances. They said my comments would be forwarded to the Web design team (I couldn't write those people directly, because no e-mail address for them was posted; indeed, it wasn't clear whether the form I had to use would send anything to anyone!), but I haven't heard back, and I'm afraid I don't really expect to. Maybe someday they'll spontaneously fix the page.

In the meantime, I can always call in and ask them to mail me a list of doctors.

This week's action item: Find someone on the same health plan you're on (if you're on one). Pick a question, such as "Which plan doctor is closest to the office we work in?" Have one person send the question via the provider's Web site, and have another call in. Which person gets the answer first? If it's the person calling, what does this tell you about the cost, to the health care provider, of not having a more accessible page? Of course, if you run into this problem, complain to your health care provider and the division of insurance in your state or province.


About the author

Peter Seebach has been having trouble navigating through badly designed pages since before frames and JavaScript existed. He continues to believe that, some day, pages will be designed to be usable, rather than being designed to look impressive. You can reach him at