Should accessibility be made a requirement?

Yes. Wheelchair access should be the norm these days...
Not quite so sure about those people who need a crane to move 'em about tho' .

Del

Be more specific.

A little more specificity. My main area of interest is with medical device design. An important area but yet not reviewed or discussed much. Right from simple devices like thermometers to more advanced complex designs like MRI scanning machines. For example, a regular thermometer cannot be used by someone who is blind, and a talking thermometer is not very common and also more expensive than regular thermometer. So if a person is blind, not only does he have to search a little more to find a thermometer but also has to pay more. This is a crude basic example but I can see the problem being more significant in case of certain devices especially scanning devices. Should there is such cases be a requirement for medical devices during the design stages to be evaluated for accessibility?

Well using the home use thermometer example, it just basically boils down to supply and demand. Not much demand for one so there aren't many manufacturers that would produce one.

I'm guessing that you are more referring to the home-use area of medical devices? Because in a hospital or clinic all of the equipment is operated for the patient, there is no need for those type of evaluations. The only real changes medical manufacturers are more focusing on now in equipment function and accessibility is the size of patient the equipment is being used on (it's either the equipment is getting smaller or the patients are getting bigger, I haven't figured out which yet).

The manufacturers are very tight lipped about any new technologies they are coming out with and there have been some major lawsuits filed over patent infringement over just the past few years.

What's the question? Are you asking about patients being able to get any sort of medical care anywhere in the US or are you asking about disabled patients getting the same care as others? Not sure what you are trying to articulate.

Whats the point? The disabled person is more likely to use medical test equipment more often, so why wouldn't accessibility be built into the design. Sometime illness make a person temporarily disabled, also when one is hospitalized.

The question you ask is like asking if hospitals should be designed for the sick.

I actually completely agree. Though the question was raised mainly because I have been reading a lot of literature lately where it is found that people with disabilities actually do not access healthcare because they cannot use medical equipment. Common examples are mammography equipment which requires you to stand up to get scanned so women in wheelchairs cannot use them. MRI scanning machines which require a person to be completely still so people with tremors have problems using them. I don't know if the issue is brought up among medical equipment designers and that why I raised the issue in this forum. No one at this point is really doing anything about it and I think sometimes there needs to be a lot of expertise on the part of the designer about disabilities which is sometimes lacking.

So if a person has tremors or is too large to fit in an MRI machine what are you suggesting we do to accomodate all such cases. The MRI is dependant upon a person remain still, as you indicated, people with tremors do not get the same access to medical aid as other people because they can not remian still during the test. Thus the only way to make the access to medical aid equivalent for all would be to remove the MRI for testing people who can remain still during the test. Is this what you would suggest for people because a few people have special needs that vastly exceed the norm? Just throw away the testing equipment and medical support that does not benefit all equally. To the example of a blind person, it again sound like you are implying that we must do away with all standard thermometers because some people can not use them themselves, medical professionals can still read the thermometer, so they wont need a speaking thermometer to test blind people, the blind only need it for self testing. How about the quadrplegic should we have to consider equipment they can use to self test also, so now we need fully automated robotic thermometers, and this would be all that people are allowed to use to make medical treatment equivalent for all. Most people who are limited in access to medical treatment are so limited because their condition is so extreme. I believe you should try to make medicine available, but not that equivalent testing should necessarily be available to all no matter their condition unless it incurs insignificant additional costs. Thjis is also a problem i have with wheel chair access, it does incur a significant and substantial cost that frequently halts municipal public works progress. Sometimes it is cheaper to not repair a sidewalk or install a cross walk for children than to make such changes. Given some poor communities limited municipal budgets, you end up not trying to promote children safety, because of all the other things you now have to do to develop accessibility. This is the same for medicine, if you drive the cost up trying to accomodate everyone, it will become so expensive no one can afford it. I believe that acess to medical facilities is not the primary concern that casues most people to receive substandard care, but rather cost. While I understand that the governments in many nations pay for treatment for severely impaired persons and their main concern is access, the vast majority of the non-impaired public pays a large portion of the medical cost themselves out of pocket, and poor children do not get adequate medical care because of this. So I guess the cost to society is balancing the benefits to the impaired against the cost to children and economically disadvantaged who are not identified as impaired and supported by government health care. Given the limited funding available, we could devote a large portion of it to a few impaired persons or the same could be devoted to the health and welfare of many-many children and poor. Now if we could offer the same care without any added cost to the general public, then I would think it would be reasonable. (However, I do think it is the responsibility of the government and the people to offer the equivalent level of treatment to soldiers, since they were directly impaired in the service of the country,but there are specialized medical facilities devoted to them.)

I forgot to log in. I have had several surgeries and on occassion I have had to have test while in the hospital, even though I wasn't paralysed, I could not stand or use my legs. In that instant I am a patient in need of care so why is designing a machine that a paraplegic could have access a burden in cost for the hospital. The hospital would use the machine with other patient who would not be described as disabled, but at the time would have a disability.

Well. if accessibility was a requirement that they must comply with, the Hospitals would have to either stop using non-compliant equipment all together or upgrade. How much would that cost? How do they pay for the cost? Who should pay for this cost? Do they charge a additional fee for using this upgrade in service to those who needed it? Do they just charge everyone who uses the MRI and spread the cost out to all MRI users or all medical services, even though many did not need it? If so you would then be discussing increasing the cost of medical service for the majority of the people, to provide service for a few who have this special need. As I understand it the cost of medical service is a concern for children receiving adequate care as it is. It is just like a car, if you want the bells and whistles someone has to pay for it, so poorer people do not own ferraris, however where would we be if you required everyone to own a ferrari or better.

I like the open question. Means that our opinions are valued.

I am CERTAIN that every designer of medical equipment considers the question of accessibility for their equipment for potential patients.

They are in BUSINESS and if their equipment is difficult to use, cannot fit patients into required positions or is unsuitable for use, then they will not be able to sell any and they will go broke.

You mention mamagram testing (for instance) the device at the local hospital has height adjustment and can be lowered into position for very short individuals, but I've also noticed a "lifting chair" in the ward that could be used for immobile patients to raise them to the necessary level.

You mention people with tremmors. Regardless of how well they can access the equipment, they will still need to be "still" for the measurements to be made. (Implied maybe necessary for restraints to be used as happened with a friend of mine. He understood the need.)

The trained operators and technicians are skilled in bridging the function of the machine to the needs of diagnosis. Even the best designed car still needs a driver to get to work and back home.

Home care material (like diabetes injection devices) are evolving at tremendous rates, with selected patients "sampling" the new designs and giving feedback. In five years, I've seen insulin injections move from individually filled disposable syringes to multi dose "pens" with adjustabel dose, variable speed, self injecting devices that fit into your pocket.

they are professional companies out to maximize their profits and the only way to do that is to design for the customer.

There are cost-benefits to consider, larger more complicated equipment cost more, requires more floor space, utilizes more energy (even if just from the A/C & heating of additional floor space), it tends to break more often requiring greater maintenance and replacement cost. So they have to balance total cost to the benefits. I am not sure that it is in a hospital's best interest to reduce funding to prenatal care so they can afford an oversize MRI to accomodate the 600 lbs man who happens to live within 100 miles of them. Any money to provide specialized access to impaired persons to provide equivalent care, must be taken from some other program. So the question is always, who do we reduce care to, in order to provide the special access to facilities. I suspect if this specialized access to equivalent care cost more to the impaired they would receive even less care then they currently do, so it is unlikely that they would pay for it.

Good question, but I'm not quite clear on the scope of the issue.

First, as another has mentioned, there are 'consumer-usable' devices and equipment, and there are devices only to be used by trained professionals. I will assume, for the sake of this discussion, we are talking about consumer-usable products.

Secondly, one has to clearly define what is a handicap or disability (and once any government gets involved with that, it will be a 300-page document). The problem will be, if legislation is at the helm of this 'accessibility' issue, to discern who is and who is not 'legally' disabled.

[case in point ... years ago in California, one of my work associate suffered a very severe compound leg fracture, and was in a cast for about 6 months. He was able to get his car fitted with attachments allowing him to drive (his own money and effort), but was denied a 'handicapped parking permit', because his disability was 'temporary'.]

If accessibility is defined as "I need one but can't afford one so you gotta give me one", that will become an issue of who is and who does not qualify for this benefit, who pays for the benefit, and how it will be regulated. Quite a mess.

If accessibility is defined as 'I have [this] condition, and I need the ability to do [that]', the problem will be to define if or if not a technology or technique is or is not readily available to meet that demand. In that case, I think the burden will be on a manufacturer or brand to consistently offer all that is 'available', but not to try to meet every contingency. There's no way to meet every contingency.

[I'm diabetic, and occasionally have to give myself injections ... if I had no hands, is the company who makes the insulin pen liable to create some method for me to still give myself injections? I can't see how that would be the case ... however, making a braille manual available, putting braille markings on devices, making a glucose meter that 'talks', and so on ... I can understand that.]

Okay, I've rambled on, and maybe confused others with my own confusion, but if we are talking about making readily available 'tools and equipment' more usable by more people, its a good idea.

Kind regards ...

I think the point of the original post was in regards to providing access to equivalent care for the disabled. I believe the underlying implication by mentioning the involvement of the federal government is that the access should not cost any additional cost to the impaired, but rather be provided as part of the regular cost of business. Such that all people pay the same for similar care. Specialized medical equipment does cost more, but, like diabetes, if their is enough buyer demand and the willingness to pay the cost, the medical devices become available and costs begin to drop as the market increases. Also some access can not be provided to give equivalent care, leaving only the prospect of limiting access to those whose impairments do not limit access. The example above of people with tremors and the MRI is a good example. If a few peoples impairments limits their access to equivalent care, would we then have to stop using the MRI? I have seen something similar happen with the ADA rules and public works projects. Sometimes because of the cost of implementing ADA requirements it is most cost effective not to modify facilities, even if this is typically done to benefit the general public or childrens safety and welfare. Just installing a simple crosswalk is now a seriously huge project. It used to involve just painting two white lines for about $1000. Now you have to install specialized ramps, demo existing sidewalks, close roads, modify gutters, remove and modify median islands, possibly installing the entire new sidewalks for many feet because of the width of older sidewalks does not accomodate the required ramp space, etc.. for $100,000. I just had a meeting with a City about this issue, they actually wanted to install a ramp to prvide access to a Doctor's office, at the Doctor''s request, but the ramp would have to be ADA, and the existing sidewalk, buildings and parking was built in the 1960's (so no additional space available). Since the ramp could not conform to ADA, and the City could not afford to remove limited parking spaces (it would have taken 3), remark the streets for parking and reduced driving lanes, reduce the width of the road to increase the sidewalk space to accomodate ADA ramps, etc.. They decided not to do the project. You just can not provide everyone with an equivalent ends, no matter the cost of the means.

I would think that a CT Scan would be recommended for a patient with tremors and that software rather than any mechanical modifications would be able to adjust to a still image. That would be an alternative to care. It would be an accommendation, so why would that stop the use of MRIs?

In the end it becomes an issue of who pays for the upgrades, and how do we offset the potential for a loss of service to the many financially limited to provide improved access to a few with special needs.

Are you proposing that the software, which would have to be intregrated into existing systems, would be compatible and free installation and upgrade for all the existing facilities? So who would develop software that they would lose money on?

If not how much would it cost to upgrade all the MRIs in the country and who pays for it? Maybe each hospital should wait for routine upgrades, depending on services agreements, whenever that may be and pay an upgrade fee (so a reduced service fee since service was already there no special travel). Should the government set a deadline for compliance, and force out all MRIs that do not comply in say 5 years? So a poorer hospital with second-hand equipment from a richer hospital would no longer be able to provide service in 5 years?

The other thing to keep in mind is that software is designed to compensate based on algorithms, so you can sometimes mask something or get a false image that is caused by software (not really there). So now you have limited the accuracy and/or precision of a scan. I guess you could design the software application to be switched on and off (then you would be able to identify who neeed it, and charge a special fee).

Also, this only addresses one very small community of impaired persons that could be resolved by confining them to limit movement. Since hospitals already have the facilities to confined people to severely limit any movement, for cases of spinal injury, they could utilize things like the head bracing and straps to resolve simple issues like tremors. However, this would do nothing for the others with special impairments who would want equal considerations implemented to accomodate their special needs. Setting a precedent for one minority group of users means you have to accomodate others sho then use the previous argument as a basis for expanding the scope to accomodate their own personal agenda.

I would suggest that, since facilities do exist, special needs should be accomodated at facilities set up just to accomodate these needs. Some large medical research universities can accomodate many of these special needs patients, or in some case university veternary hospitals facilities are used. Anything you require as an upgrade to basic facilities will cost money, and this would limit access to those poorer users not receiving government support, primarily impacting poor children and elderly who do not have such special needs but still need the CT scans (specialized software upgrades cost a few thousand $ at least). Additionally, many medical facilities would not upgrade their equipment by purchasing newer more expensive MRI equipment just because it is a little too expensive. So such medical facilities for the poor would not improve service as soon as they maybe could simply because the increase in expense was a bit too much at that time for their budget. Of course i guess they could just charge a special needs facilities fee on those patients who require the facilities modifications. This could work, but we would then be discussing why it cost more for someone with tremors to get a CT when the software already exist in the MRI and others, without such impairments, use the MRI without being billed this extra fee.

Some of the comments made about cost, is as if medical equipment is cheap.

When even a small hospital has thirty million flow through it in a year, a couple hundred thousand is just a drop in the bucket.

It's just being looked at in perspective, no one is dumb enough to believe (good) healthcare is cheap.

The original post was regarding the government requiring equivalent access be provided to a few severely impaired individuals that the current facilities are not designed to accomodate. So we are not discussing improving health care for the vast majority of the productive populus. We are discussing improving health care access for the limited minority of impaired individuals that could benefit from such modifications. This may not be "good" Health Care if it reduces the affordability of health care to the poor and children in order to benefit a very few individuals. The question is what defines good health care. Every cost increase effects some fee increase or loss of wages somewhere else. Who will pay or absorb that loss of wages? Even with all those millions in the (non-elective) health care facilities, much of it goes to unionized labor. This is leading to a slow drain in the number of MDs since they slowly are earning less to provide (non-elective) health care (in many cases after all the insurance and other costs, earning less than an RN for more hours of labor). The budgets are tight for health care with all the support staff leaching the process. This is just an added cost to be absorbed by the industry, and as a professional I realize that whenever an industry full of unionized labor pseudoprofessionals has to absorb more costs, it will not come from managements wages, but rather the scientific/technical professional staff wages and/or increases in medical care. Neither of which are beneficial to the vast majority of the population.

Added cost starts to exclude the less financial able sectors of society from service, along with their children. I am not sure that it is in anyone interest to start children off on a path toward adult disabilities and health problems when we could have addressed the issues early on for substantially less investment (while gaining a potential future productive member of society).

The continued process of declining MDs (in non-elective surgical specialties) leads towards a downward spiral in quality of service (as we have seen developing in health care for the last 30 years) as fewer people go into the professions, as they would rather have less time and cost in education and work effort to become qualified and licensed when they can earn more money for less working effort and education. Soon you have a lot of LVNs and no MDs (or nearly none, except the plastic surgeons specialized in boobs jobs for hollywood or face lifts for NYC women). I suspect the quality of care would decline in general as access to fewer and fewer Doctors becomes available to the majority of the population. Most people complain about the limitations on the availability of Doctors to provide service as is, (they like the nurse and the attention, but when a person thinks he needs medical attention he wants to see a Doctor, no matter how trivial their medical needs are always very critical to them).

The original post was regarding the government requiring equivalent access be provided to a few severely impaired individuals that the current facilities are not designed to accomodate Objection your honor! Here say! You can assume the direction of the original post, but sticking up for Doctors not making enough money? That's near lunacy.

And you keep going on about how the money draw is at the facility, but the manufacturer is one of the biggest money pits in healthcare, period. The equipment is overpriced when purchased. The parts are too expensive when the units break down (and all devices break down no matter what the sales guy tells you). And the cost for service from the manufacturer is enough to make a doctor jealous.

And another thing about Doctors, it used to be that people became a Dr. to help people and make a difference. Most now just are people with a high IQ (which is needed) and a greed that almost makes them bleed green. It might not be such a bad thing for people to become doctors not for the money, but then again, what do I know

First of all, the part and service for medical equipment is relatively specialized, materials used are rare, and there is huge liabilities attached (this is not like your X-box), therefore, you always expect it to be expensive. I would expect parts and service for active US fighter jets to be expensive too. When the equipment become more common worldwide, and demand increases costs decrease. Keep in mind that the vast majority of the worlds population does not have access nor uses MRIs.

As far as Doctors go, they have always been one of the better paid professions over the entire history of this Country. Pay has always ben a draw to becoming a Doctor, but it is too offset the huge amount of education required (even when it wasn't all that much education in the 1800's it was still huge compared to most people). Doctors bills can be high, yes. However, you muct factor in their costs also. RNs as it stands now earn a similar or higher wage than a Doctor, with far far less education or medical skill. The bill for a Doctors services has to account for all the office overhead for billing personnel to help you figure out how your insurance works, nurses, technicians, accounting personnel to try and collect your fees, collections for all the people who do not pay their bills on time, etc.. As the unionize labor and equipment cost increase, so does the labor overhead, insurance, loans to keep their practices a float, etc.. Plus as people tend to blow off things like medical bills in favor of car payments, the cost of carrying all those unpaid services but still paying out for labor gets expensive. (I guess Doctors could get collections similar to cars and homes, send out Dogg to repossess your hip). It is quite simple really, most people will not go into a profession where they earn less than their subordinates for much more education, work effort, and all the legal liability on their part. The Doctors who really want to help people have no need to help you, you have minor nuissance issues of your own doing. Such Doctors tend to join Doctors without borders, and go to Guatemala or Sudan where many people have serious health needs caused by circumstance, not people whose injuries are solely due to their own dumb attempts at rock climbing without a safety rope or such. However, if you believe Doctors are paid fairly for their service, then you should be happy with what you get from them, unless you want to pay more, or stop using their service. There is always alternative medicine, and some people believe very strongly in it (right up until they get really sick). I am sure that you, however, would be just as well off to refuse any medical attention from a doctor in the future (this would certainly keep you from having to pay these greedy hacks).

What exactly do you mean by commercial counterparts? Are you talking about replacement parts or like home NIBP vs Hospital grade NIBP?

I was speaking of the electronics and sensors used. I am familiar with medical equipment only as a user. I first saw some similarity when in labor and they attached a fetal monitor to my abdomen. Which picked up small electric pulses and sound. Then thinking how similar it was to an oscilloscope, only with an audio amplifier, which made my son's heartbeat sound like an elephant's on speed.

We may not be speaking about the same thing and I have no idea what your acronyms mean. I didn't ask any of these questions as an expert, but I thought I knew enough about some sensor technology, electronics and the use of software to think that cost must not be a consideration when designing medical equipment. I also know that most companies that get military or government contracts see the Golden Goose. Quality assurance may increase the cost, but modern techniques of QA should reduce that to a reasonable amount.

I do understand that demand defines price, so I understand that medical equipment cost will be higher, but I still don't see how RCE's argument has anything to do with the question you (BiomedWV) and Access asked.

Having workked on some of those government contracts for a large international engineering corporation, I know it is not exactly the golden goose. The government has so many specific requirements, regulations, procedure, etc.. that you must follow. You spend most of your budget trying to do everything on their schedule and in accordance with these governement red tape. Governemnt work doesn't pay off in necessarily highly profitable work, it pays off in a lot of billable hours with little outside (non-billable) overhead, like marketing. The governement work keeps people busy filing paperwork and communicationg information to every bureaucrat they can think of having involved. Additionally, the government pays their bills on their own schedule, so you have to hold the labor and materials cost for 90 days. And if there is any miniscule typo, you probably will get your invoices kicked back to you and have a ton of new paperwork to file. Government work is an accountant (or project managers) wet dream, but many engineers find it is their nightmare.

Regarding the cost issue of QA, there is also the process of upgrading manufacturing to provide proper QC. Not every industrial process requires a sterile environment, and compliance certification; accredited personnel training; compliance many times unrelated to the quality of the product like health and safety procedures; and additional staff to verify compliance, processing of paperwork, and managing the implementation of additional compliance measures. All these costs add up fast. Also, the brueaucracy of the process tends to limit the number of manufacturers that are willing to make such specialized porducts for such a small market, further increasing the cost.

We are speaking on the same thing, and sorry about the acronyms it's just something I'm used to. NIBP stands for Non-Invasive Blood Pressure, like a standard blood pressure cuff that staff puts on your arm, pumps up and takes a measurement with. You can buy those in home or hospital grades.

As far as you were talking with the fetal monitor, you are pretty close with your analysis. There are a few more safety things built in to isolate the patient from the circuitry, but a capacitor or resistor that you find in a fetal monitor is the same one you can buy from Newark electronics. Yes there are some things with the units that are specialized for just that make and model unit, but that is most often software or the sensors like the ultrasound transducer that they had strapped across your belly that are used on the specific unit.

Quality assurance may increase the cost, but modern techniques of QA should reduce that to a reasonable amount. You are correct that modern QA techniques have taken a lot of failures out of components so the FDA lets medical manufacturers use regular old caps, relays and transistors though now most are surface mount.

This has kind of gotten off topic but manufacturers generally try to make their equipment to suit the public that will be using it. The trend of people weighing more has driven the weight limit on patient beds and x-ray tables to be much more than they used to be, from 250lb to 450-500lb. As far as the examples of tremor patients in MRI and other examples, there are just some things that won't work with some people. Just like two different people having high cholesterol, they both start taking the same meds, but one med gives patient A a bad reaction, what do they do? They start him on something else. If a patient can't have one type of test done, there are other types of tests that can be done and that type of thing is actually quite common.