After much speculation and anticipation, Apple released iOS 7 on September 18, 2013. This new operating system is compatible with iPhone 4 and later, iPod touch 5, and iPad 2 and later.

This new operating system has many new features and some VoiceOver enhancements. Because it's impossible to discuss all of the many updates in just one article, there will be a list of additional resources at this article's conclusion.

The first change users will encounter is on the locked home screen. After pressing the "Home" button, iOS 7 does not play any sound, but VoiceOver announces the time. If you have a passcode, the keypad to enter it is at the top of the screen. If you don't have a passcode, there are two ways to unlock the phone: either tap above the "Home" button, and if necessary flick to the left until you reach the "Unlock" button, or flick three fingers to the right.

The Control Center

The Control Center is a new feature which puts frequently used items on the Locked Screen, the Home Screen, or on top of any open application. The Control Center is opened by first touching an item on the status bar (at the top of the screen), and then flicking up with three fingers.

The first few items in the Control Center are also found in the Settings menu and include Airplane Mode, Wi-Fi, and Bluetooth. Below these controls are controls for media. It is no longer necessary to go into the Music app to use the controls. There are buttons for "Previous Track," "Play," and "Next Track." There is also a volume control. In addition, information about whatever media you are listening to is also provided including title, elapsed time, and total time. Underneath these controls are icons for several apps including Clock, AirDrop, and Calculator. The Control Center can be dismissed by pressing the "Home" button or doing a two-finger scrub.

In the Settings menu there is an option for the Control Center. You can choose whether you want the Control Center to appear in the Locked Screen and/or allow access within apps. By default, both items are on. It is not possible to add or remove items from the Control Center.

The Notification Center

Apple has changed how the Notification Center is displayed. It is still activated by tapping an item on the status bar and then flicking down with three fingers. At the top of the screen are three tabs labeled Today, All, and Missed. By default, Day is selected. The All tab will display every event that hasn't been deleted from the Notifications Center. The Missed tab will display all missed notifications from the past 24 hours.

When the Notification Center is opened on the Today view, and there are multiple events on your calendar, VoiceOver just reads the first event. Instead, an hourly view of the Calendar is presented, making it necessary to go through hour by hour. There is no list view. At the end-of-the-day section is a heading for tomorrow's events. VoiceOver will again say how many events are scheduled and what time the first one starts. Selecting the All tab will present a listing similar to the Notification Center in iOS 6. Press the "Home" button or do a two-finger scrub to close the Notification Center.

As in previous versions, you can adjust which apps appear in the Notification Center and how each app performs an alert. Do Not Disturb has its own listing in Settings and is no longer in the Notification Center menu. There are also options to include Amber Alerts and Emergency Alerts in your Notification Center.

VoiceOver

There are some new features in VoiceOver. In iOS 7, the Accessibility menu item has been moved further up the screen in the General menu. In other words, to reach the Accessibility menu, go to Settings, then General, then Accessibility. Vision is the first heading and VoiceOver is the first option. Once in the VoiceOver settings, flick down to the rotor and double tap with one finger. There are two new additions to the VoiceOver rotor.

Containers

Containers is a new feature on the iPhone, but it has been previously available on the iPad. This is a useful feature in e-mail since it lets the reader quickly move from the heading to the message, and to the buttons for choosing an action for the email. Containers are useful in other applications because they move you easily from section to section.

Handwriting

Another new option in the rotor is Handwriting. It allows the user to write print letters on the screen using one finger. By default, Lower Case Letters is selected, but by flicking up with three fingers, the user can cycle through the other options: Upper Case, Numbers, and Punctuation. To add a space, swipe right with two fingers. Swipe left with two fingers to delete a letter. Swipe right with three fingers to add a line. If VoiceOver says an incorrect letter, flicking up or down with two fingers will present additional letter options. Double tap on the correct letter with one finger. The other option is to do a two-finger flick to the left to erase the incorrect letter. It does take some practice to use this feature, but it's fun to do.

Handwriting can be used for entering text in edit boxes, opening apps, performing single letter navigation in Safari,and entering a passcode on the Locked Screen. To open apps with the rotor set to Handwriting, start writing the name of the app. With each letter, VoiceOver will say how many apps have that letter. Keep writing letters until VoiceOver says the name of an app and then open it with a one finger double tap. When in Safari, writing the letter "H" and then flicking up or down with two fingers will move you by Headings. This works for every navigation unit in your rotor. Once you find what you want, take the rotor out of Handwriting mode and continue reading. Otherwise, as you move your fingers, VoiceOver will say that your movements are not recognized.

Copy and Paste

Another new feature lets the VoiceOver user copy the last thing VoiceOver said to the clipboard and then paste it somewhere else. This task is accomplished by tapping three fingers four times to copy the text and then repeating the gesture to paste it in a new location.

VoiceOver Help

It is no longer necessary to go into the VoiceOver settings to practice gestures. Do a four-finger double tap to bring up the Help screen. Be careful not to accidentally use three fingers as that will turn speech off. If this happens, do another three-finger double tap to turn the speech back on. Triple clicking the Home button will not work in this instance. When you're finished practicing VoiceOver gestures, perform another four-finger double tap and that will close the Help screen.

Premium Voices

You can now download more than one Premium Voice. By default, the US English voice is already installed. In the VoiceOver menu go to Languages and Dialects. If you're using more than one language, make sure to enable languages in the rotor.

Siri

Apple has made some major improvements to Siri. You now have a choice between a male or female voice. These are significantly better than Siri's previous female voice. Siri no longer repeats every instruction you say, and it is no longer necessary to hold down the Home button or tap the "Listen" button each time you give instructions during the same conversation. Hold down the "Home" button to bring up Siri, and continue your conversation.

Siri now has access to Wikipedia and will offer to read articles to you when it finds an answer to your query. For example, I asked Siri, "Who was Gary Carter?" Siri indicated that it found a Wikipedia article and asked if I wanted to have it read aloud to me.

Siri can now open some settings and perform actions within these settings. For example, Siri can open the Accessibility settings. VoiceOver can now be turned on and off using Siri. Siri will now read your e-mail. When dictating text with Siri, it's no longer necessary to find the "Dictate" button. Once an edit box is active, a two-finger double tap will start the dictation process, and performing this action again will stop dictation.

Apps and App Switcher

By default, your apps will now update automatically. The app switcher has undergone some changes. It is still activated by clicking the "Home" button twice. Apps will be displayed in a continuous row. Flick left or right to locate apps. When VoiceOver speaks an app name, it will also indicate if the app is running in the background by saying , "Running." Close an app by flicking up with three fingers. Double tapping with one finger will open it. Flicking up with one finger will present the option to close it and you'll need to double tap. Flicking down with one finger will present the option to activate it, and if this option is selected, you will then have to double tap. When finished using the App Switcher, press the "Home" button.

Folders

Folder structure in iOS 7 has undergone a change. Only nine apps can now go on one page in a folder. Each folder can now have up to 14 separate pages, which makes each folder able to accommodate 126 apps. To change the folder's page, you can either use the Picker or flick left or right with three fingers.

Find My iPhone

Apple has incorporated a new anti-theft mechanism into iOS 7. In order for it to work, you must have an active iCloud account. Information on iCloud can be found in the Settings menu. If your device is stolen, the thief will not be able to wipe or reset it. In order to perform these actions, the Apple ID and password must be entered.

E-mail

If you get an e-mail you don't want to read, flicking up with one finger will present the option to send the email directly to the Trash. Flicking down with one finger will present the option to activate the item. Double tapping with one finger will initiate the desired option. Flicking down again with one finger will cause VoiceOver to say, "More." Double tapping on this option will bring up a list of choices including Move Message and Forward. Flick up and down with one finger to review the list, and double tap on your selection. There is also an option to cancel the action.

iTunes Radio

iTunes radio is available on devices running iOS 7. It is also available for Macs and PCs running iTunes 11.1. iTunes radio is similar to apps such as Pandora or Slacker. It may not yet be available in all countries.

When the Music app is opened, there are now five tabs on the bottom of the screen. The first is Radio. Activating the tab will bring up two options, Learn More and Start Listening. When the "Start Listening" button is activated, the new screen has a list of pre-programmed stations spanning many genres. Double tapping on any of the stations will start the music playing.

While a song is playing, doing a one finger flick to the right will present several options including a button to buy the songs and an info button that presents more options. There's a button to like or dislike the song and a button to go to the next track. The song's artist and title are also on the page. There is a back button in the upper left corner.

Creating Your Own Stations

On iTunes radio it's easy to create your own stations. Activate the "New Station" button which is located near the bottom left of the Home screen. When the next page loads, there is an edit box to enter the name of an artist, genre, or song. When the search results are displayed, double tap on the one you want, and the music will start playing.

Another way to add a new station is to activate the "New Station" button and then choose from the genres presented. Once a genre is chosen, a more detailed list of song types within the genre will be presented. Double tap on the one you want. Brief song clips will start to play. If you like what you hear, activate the button to add the genre as a new station. To stop the song clips, press the "Audio Preview" button. All stations you add will be under the My Stations heading on the main screen.

In the upper left corner of the Home screen is a "History" button. This will bring up a list of the past few tracks that were played and an option to buy them.

Editing in iTunes Radio

Above the My Stations heading is an "Edit" button. Activating this button will bring up your station list. When you select a station, several options will be presented including adding an artist, song, or genre to the original station. This will help iTunes narrow down the music you want. Additional options include "Delete Station" and "Play More Like This."

Conclusion

iOS 7 has brought many enhancements to Apple devices. The positives far outweigh the negatives. For those familiar with using VoiceOver on Apple products, there is a learning curve, but it's not too steep. VoiceOver works extremely well, and the new VoiceOver features prove Apple's commitment to accessibility.

Resources

David Woodbridge's comprehensive podcast on iOS 7

How to Be Blind: tutorials and discussions on the new iOS7

AppleVis: podcasts about the new iOS7, blogs, and user forums

Fedora Outlier: "The Old Hat Guide to iPhone Accessibility, iOS7 Edition" ($4.99 if ordered by October 15^th, 2013)

National Braille Press

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The American Foundation for the Blind CareerConnect program staff has been extremely busy over the last year updating and adding new CareerConnect site features. In March 2012, AFB redesigned its website, and CareerConnect took this opportunity to reorganize and refresh its many layers of content to provide job seekers with vision loss even more information and resources. This article provides a tour of the website, and provides information on where CareerConnect is headed in the future.

Years ago, CareerConnect began simply as a database of successfully employed people with vision loss who could give advice on employment and technology. The program has since grown exponentially, and is now staffed by Joe Strechay and Detra Bannister, two professionals dedicated to creating robust and informative employment-related content, curricula, and resources for teens and adults.

Explore Careers

When thinking about your future work, one of the first steps is exploring career possibilities. The Explore Careers section of the CareerConnect site is a great place to begin this process.

There are many benefits to doing a thorough career exploration before you start your job search. Job seeking can be a long and challenging process, so it's important that you've done the research to ensure that the positions you do pursue are right for you, your background, and your interests. Career exploration will help you avoid:

• Applying for jobs for which you don't meet minimum training or education requirements
• Pursuing positions in a profession, field, or work environment not suited to your personality, values, or lifestyle
• Going for jobs where the average salary and/or opportunities for promotion do not match your career plan
• Ending up in a position where the reality of the work is not what you thought it would be

The Explore Careers section has two robust tools to offer to people preparing for employment: The Jobseeker's Tool Kit and Career Clusters.

Job Seeker's Toolkit

The Job Seeker's Toolkit is a self-paced, online course about navigating the employment process as a person who is blind or visually impaired. The course guides participants through thirty-three lessons and assignments. The tool allows users to save their assignments and associate a mentor to their profile. The Jobseeker's Toolkit has been very successful and is accessed by over 1,000 visually impaired jobseekers each year.

Career Clusters

Career Clusters is made up of groupings of types of jobs or career fields. Visitors to the site can navigate through a cluster to see a list of jobs in the field, with related descriptions and career profiles. Career Clusters currently encompasses the fields of Law, Education, Counseling, and Healthcare, with more fields to be added soon. Each Career Cluster also has an associated message board where questions can be asked to professionals working in that field.

When site visitors Explore by Career Clusters, they can do an advanced keyword search through careers to find detailed information. Based on the O-Net Online database, the information provided has been customized for CareerConnect users. This database provides information about educational requirements and job duties.

Make Connections

From networking to guidance seeking, having a successful job search often depends on forming relationships with other people. The Make Connections section of CareerConnect offers ways to interact with others who can assist you in the job search process. CareerConnect offers a few ways to help you meet people who might prove to be important to your employment process.

The CareerConnect Mentor Program

With mentors from the US, Canada, and the United Kingdom, the CareerConnect Mentor Program puts you directly in touch with a mentor in your field of interest. Mentors are professionals with vision loss who have volunteered their time and expertise to the AFB community and are available to answer questions and provide advice to job seekers about employer expectations; job requirements, education, and training; salaries; and the future prospects of their field.

Since our mentors all have some level of vision impairment, they are fantastic sources of firsthand information about workplace accommodations, access technologies, the disclosure process, the pitfalls and triumphs associated with the social aspects of working, and any other questions you might have about entering the workforce or changing careers as a person with vision loss.

CareerConnect Message Boards

Ask and answer employment-related questions on the CareerConnect message boards. Share information and experiences on a variety of topics with people with vision loss who are working or are in the midst of the employment process. You'll need to register to post to the boards, so if you haven't already, set up an account today.

Find a Job

The Find a Job section of CareerConnect offers some great resources for a high-quality job search. There is a link to Job Search Preparation which contains articles about conducting an effective job search. In this section you will find Ten Steps to Starting a Job Search, which provides advice as you begin the search and contemplate the future. You will find other articles about organizing your time and work space, finding job leads, and doing research on employers.

Getting Hired

In the Getting Hired part of the Find a Job section, you also will find valuable information on negotiating assistance, disclosing your disability, answering interview questions, and preparing a résumé. All people with disabilities wrestle with disclosure, and this resource provides positives and negatives of disclosure at specific times during the employment process.

Succeed at Work

The Succeed at Work section of CareerConnect offers articles and videos specific to maintaining employment. Here you can also find the ever-popular Aaron's Adventures in Employment videos and other teen related multimedia on this topic. Virtual Worksites give you examples of how employees with vision loss can perform their duties in a variety of work environments. Due to differences in visual functioning and job responsibilities, not all workers who are blind or visually impaired will need or use the same accommodations. The virtual worksites graphically demonstrate the range of tools and equipment that might be helpful to an employee who is blind or has low vision. Each page contains a graphic with embedded links that connect you to detailed information about the accommodations, including product reviews, product evaluations, and, in some instances, videos of the products in use.

Our Stories

During the past year, Detra Bannister has been working busily to reorganize the ever popular Our Stories section, formerly called Success Stories, to follow the Career Clusters structure more closely. The feedback about this reorganization has been quite positive. The section includes written and audio pieces that highlight our mentors and other successful people who are blind or visually impaired.

Lesson Plans for Professionals and Teachers

For quite some time, professionals in the field have been asking for ideas and assistance with lesson plans, and CareerConnect has been listening. The newest section of CareerConnect, Lesson Plans for Teachers and Professionals, offers lesson plans structured around transition activities created by AFB's good friend, Shannon Carollo. The first set of lessons is built around preparation for work. Over the next year, we hope to develop100 additional lesson plans.

Featured Areas

CareerConnect also offers featured areas that provide informative information and linkages to other resources.

NIB CareersWithVision

National Industries for the Blind (NIB) partnered with CareerConnect to offer the opportunity to search job openings from the associated industries for the blind programs around the United States through the NIB CareersWithVision website. This resource also allows a job-seeker to submit a generated résumé from the user's My CareerConnect profile for a specific position in the NIB database.

CareerConnect Blog

In July of this year, CareerConnect launched its own blog, where you'll find posts each week from Joe Strechay, Detra Bannister, mentors, and professionals from the field. The blog creates the opportunity to provide users with relevant and timely information, advice, and updates on employment issues. Specifically, you will find information about traveling independently, dressing for success, and even a little about Christine Ha (winner of "Master Chef," Season 3) and her cookbook.

Job Listings

The Job Listings section on CareerConnect offers a variety of jobs posted by friends of AFB.

Resources for Employers

The Resources for Employers section is designed to be a practical guide for employers, providing useful information about hiring, and working with, blind or visually impaired workers. The myths surrounding blindness that may raise concerns for employers are discussed, as well as the benefits that can result when employers hire or train an employee with vision loss.

The topics in this section will provide answers to questions and give you the information and resources you need given your work situation.

CareerConnect Canada

AFB partnered with the Canadian National Institute for the Blind (CNIB) to create a section called CareerConnect Canada) which allows Canadian users an experience more specific to their geographical location.

Looking to the Future

In the coming year, CareerConnect will be adding many new features. Thanks to grant-funded projects, we will be adding more new content and features, including the development of a social networking, Facebook-like profile platform located within the My CareerConnect area for registered users. This new platform will allow for a more unique and lasting mentoring experience through the Web. With this new platform, users will be able to post questions to mentors' profiles and even more easily connect with them.

Another exciting feature will be the new CareerConnect iOS app, which will provide some of the program's popular content. CareerConnect is following in AccessWorld's footsteps to bring you an easier mobile access point to the Our Stories and the Lesson Plans for Teachers and Professionals sections. In addition, be on the lookout for other CareerConnect apps specific to other popular content, such as the Job Seeker's Toolkit.

We invite you, your friends, family, students, and colleagues with vision loss to visit CareerConnect and see firsthand how its resources can be of benefit on the job hunt.

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National Disability Employment Awareness Month kicks off with some uplifting information about employment for people with disabilities.

Federal Efforts

In response to President Obama signing a 2010 Executive Order to increase federal employment of individuals with disabilities, the US Department of Labor Office of Disability Employment Policy worked with the Office of Personnel Management (OPM), which, in turn, worked with federal agencies to create plans for hiring people with disabilities. This federal initiative is intended to provide a model for industries to follow in their own hiring practices.

Not all of the agencies are equally effective, and not all people with disabilities or vision loss have had easy transitions into federal positions. There are numerous success stories and a few not-so-positive examples of how these processes have worked for people with vision loss. That said, 200,000 people with disabilities now work for the federal government, the most in 20 years, and the rate of new hires with disabilities has increased.

The US Department of Labor is working on a rule that would require government subcontractors to follow similar steps for employing people with disabilities and veterans. The language of the rule is under some debate: some are concerned that the wording is not specific enough, while others feel that the government shouldn't create these types of regulations in the first place.

Add Your Voice to Private Sector Conversations about Employment

Many mainstream corporations and industries have realized that people with disabilities are an untapped resource. As groups like the United States Business Leadership Network work to improve opportunities for people with disabilities, the blindness community has to make sure that its voice is part of the discussion. There are local business leadership networks in states and communities. Let them know that the vision loss community wants to participate and has a lot to offer.

Technology and the Employment Process: Benefits and Challenges

The employment process includes training, researching, applying, interviewing, getting hired, starting a job, and maintaining employment. Over the last 15 years in the US, much of the initial phases of the employment process have moved online, meaning job seekers must have computer and Internet access in order to research, find, and act upon the largest number of employment opportunities. Libraries can be an option for those who do not have Internet access at home, though not all libraries have screen access software available. In addition, due to budget and staff limitations, many libraries have trouble maintaining the access technology they do have.

The move toward online applications has some benefits, such as the ability to quickly apply for a job in any location. A job seeker can apply for a job listing directly from a smartphone via the Web or an app, which can be convenient and fast. A negative aspect of searching for employment online is the proliferation of scams that offer work in exchange for a small investment or those that claim to offer an "easy, work-from-home opportunity."

The ability to network online and connect with people who may be working in the same field is a major benefit of using technology in the employment process. Along with this benefit comes the challenge of ensuring that the people you meet online are honestly representing themselves. There are also accessibility issues with social networking platforms, as access can be limited due to insufficient labeling and other barriers.

Another positive aspect of today's job search is that there are many easily accessible sources for job listings. Online newspaper classified ads, corporate and business websites, job search websites, job announcement boards, and online list services allow for more and faster access to opportunities. On the other hand, with these opportunities comes the increase in effort required to search through jobs that may not relate to your interests.

Technology has also changed the work environment in a profound way. Working from home has become a more accepted practice now that the office is only a call, chat, e-mail, or text away.

Employment Resources

The Equal Employment Opportunity Commission

Everyone is afforded equal opportunity and access to the employment process under the Americans with Disabilities Act (ADA), Civil Rights Act, Rehabilitation Act, Age Discrimination Act, and Genetic Information Discrimination Act. Employers are not able to ask prospective employees about their disabilities, so people with disabilities have to be prepared to bring up the topic creatively in order to answer unasked questions related to their ability to perform job requirements. The US Equal Employment Opportunity Commission (EEOC) provides oversight to the laws relating to employment and preventing discrimination during the employment process. Over the past year, the EEOC has been revitalized with a lot of new staff and improved focus.

AFB CareerConnect

The CareerConnect website is a fully accessible AFB sub-site dedicated to promoting the employment of people with vision loss. CareerConnect boasts a number of helpful resources, such as articles about the employment process, stories from successfully employed people with vision loss, and connections to mentors who are blind or visually impaired and employed in many fields. These mentors are great resources for career-specific questions, information about job accommodations, and more. CareerConnect also offers useful links for job seekers, career exploration, and resume development tools. In addition, CareerConnect provides useful tools and activities for professionals working with clients who are blind or visually impaired.

Career Clusters

AFB CareerConnect offers Career Clusters, an easier way to navigate government data on popular job fields. The Career Clusters message boards facilitate connecting with mentors in specific work fields.

Currently, the Career Clusters site covers Law, Education, Counseling, and Healthcare with more fields, including Entertainment, Communications, Business, Science, Technology, Engineering, and Mathematics (STEM), and others, to launch during the coming year. Users can build a network through field-related message boards and profile pages within the CareerConnect program.

The Job Seeker's Toolkit

The CareerConnect Job Seeker's Toolkit, launched in the fall of 2010, is a free, self-paced online course aimed at people who are new to the employment process. The Toolkit consists of a series of lessons and assignments that cover self-awareness, career exploration, job seeking tools, pre-interview and interview skills, and job maintenance. As you work your way through the Toolkit, you can save your assignments (ranging from your network contacts, to your resume and cover letter, to a list of job leads, to your My CareerConnect portfolio) so they can be accessed for future use.

Working with Job Seekers who are Blind or Visually Impaired

Last year, CareerConnect worked with the American Foundation for the Blind eLearning Center to create groups of lessons aimed at increasing awareness among employers of the types of job accommodations needed by people with vision loss.

All of the lessons contain sections with detailed content that will be useful for vocational rehabilitation staff, transition specialists, and other professionals looking to learn more about job accommodations, processes, and resources. Visit the AFB eLearning Center for more information on these offerings.

National Industries for the Blind

Two years ago, the National Industries for the Blind (NIB) brought a new spin to their employment training programs by adding management tracks. The NIB now offers a contract management training program in connection with a federal government university program. The NIB member organizations hold a number of federal contracts, and the program provides the opportunity to train people to manage those contracts. Contract management is a marketable skill that can be taken to other organizations, governmental agencies, and the public sector. This is also notable as government contractors aim to hire more people with disabilities, which means more possibilities for qualified people with vision loss who have this type of training.

Over the past two years, the NIB Networking Group has worked to provide great online and offline networking opportunities in the Washington DC area and has added New York City to the list of networking groups. Since the networking groups have been popular and growing, NIB is interested in starting networking groups in other metropolitan areas.

NIB CareersWithVision

The NIB CareersWithVision website is the result of a collaboration between AFB CareerConnect and the NIB. The NIB has compiled a large list of jobs from around the US in organizations that do work in fields related to blindness, or that have hired people with visual impairments. A unique feature of the site is that you can submit your CareerConnect resume to participating organizations in order to apply for jobs. This service requires you to create a free CareerConnect user profile to search the job board, develop a resume, and apply to job announcements.

Hadley School for the Blind

The Hadley School for the Blind offers online and correspondence courses for people with vision loss in subjects related to blindness skills, business writing, employment, and more. Hadley's exciting program, the Forsythe Center for Entrepreneurship, offers in-depth information and training for entrepreneurs who are blind or visually impaired and who want to start their own businesses. This resource has seen growth and innovation through partnerships with groups including the Veteran's Administration and others.

Accessing Federal Jobs

Federal agencies have two job application methods available for people with disabilities: competitive and non-competitive placements. Job applicants must meet specified qualifications and be able to perform essential job duties related to any position with reasonable accommodations.

Jobs that are filled competitively are advertised on USAJOBS, the official job-posting site used by the United States government. There are approximately 16,000 jobs available on the site each day. Once you register on the site, you can set up notifications for job advertisements related to selected keywords. Jobs filled non-competitively are available to those with mental, severe physical, or psychiatric disabilities who have appropriate documentation as specified by the US Office of Personnel Management.

The US Department of Labor Office of Disability Employment Policy (ODEP) offers useful connections to resources for self-employment, youth employment, employer advisement, the latest disability policies, and more. This office advises the US Department of Labor and other government agencies on employment issues regarding people with disabilities.

GettingHired

GettingHired, LLC offers training courses, opportunities to connect with employers, career personality assessments, and other employment resources for people with disabilities. GettingHired has recently announced a partnership with HirePotential, Inc., which will provide specialized training courses for national employers on the job accommodation process, disability etiquette training, Office of Federal Contract Compliance Programs compliance, tax credit utilization, and disability awareness training for recruiters and hiring managers.

Job Accommodation Network

The Job Accommodation Network (JAN) is an online resource for accommodation advice for all disabilities. The website also allows users to submit questions regarding special accommodations and ADA issues in the workplace. JAN hosts webcasts, accessible through their website, on the provision of job accommodations, along with a ton of great resources and webinars.

Career One Stop

Career One Stop is a free resource provided by the US Department of Labor that allows you to search state job bank databases.

Career Centers

Career centers help people perform research to support professional goals. Colleges, universities, and post-secondary and vocational schools often have career centers, and many are available to the public. You may have to visit, call, or do some online research to find out what is available to you locally. Keep in mind that many career centers maintain robust websites accessible to anyone with an Internet connection, and these sites may offer many free resources and materials. Career centers are often underutilized, and most are eager to have visitors. Some receive grant money to offer services to the community or state, and some actively recruit people with disabilities to their centers.

Vocational Rehabilitation Agencies

Vocational rehabilitation helps people with disabilities prepare for entry or re-entry into the workforce. Your local vocational rehabilitation agency will offer a range of programs, resources, and services to help you prepare for and find work. The range of programs offered by these agencies varies from state to state, so research your local vocational rehabilitation agency, determine what programs and services you are eligible for, and register.

In most cases, these organizations exist to help you become job-ready and find employment. Some may also train you in independent daily living, orientation and mobility, and access technology. These organizations will also know about other available resources in your community and state. To find a local or state agency near you, use the AFB Directory of Services.

New Resources

There are several organizations, such as recruitment consulting firms and job boards, making an effort to find talented people to fill jobs and create careers. The following organizations are just a few standouts.

Stephen-Bradford Search

Stephen-Bradford Search is an executive consultant search firm that looks to connect the right person with the right job. Their motivation and passion explodes through the phone when you speak with a representative. Their core values are accountability, growth, integrity, positive culture, and respect.

The firm is dedicated to improving people's lives by identifying talented individuals, and is known as a forward-thinking, highly ethical search firm. Its expertise is in marketing, sales, business development, account management, and operations across many industries, including: advertising, beauty/luxury, consumer goods, digital/social media, emerging technologies, and market research for nonprofit organizations. The management and recruiters come from the industries for which they recruit, and they are dedicated to helping clients build their business with people who drive growth and results.

Stephen-Bradford Search is not an organization that specifically aims at the recruitment of people with vision loss. It aims to find talented people who are qualified individuals and can get the job done. That said, the firm does have personnel who are visually impaired, and if you are working in any of the fields listed, this is a recommended organization to contact.

Big Tent Jobs

Big Tent Jobs is a national recruiting firm based in Michigan that places professionals with and without disabilities in career positions at leading companies. With a focus on Information Technology, Big Tent Jobs has openings in computer programming, systems administration, software development, and much more.

Big Tent Jobs works at a high level with each candidate to make sure he or she is appropriately qualified and prepared to ace an interview and receive a job offer. Big Tent Jobs offers opportunities with successful corporations looking to hire quality personnel.

At the Big Tent Jobs website, you can search through available job listings and connect with an experienced and eager recruiter to find out how he or she can help connect you to your next big job. Big Tent Jobs works with candidates who are blind or visually impaired or who have other kinds of disabilities or chronic conditions.

disABLED Person, Inc.

disABLEDperson, Inc. is a non-profit public foundation with the mission to reduce the extremely high unemployment rate among the disabled by providing online recruitment solutions as well as program initiatives. A primary goal associated with this mission is to connect individuals and veterans who have disabilities with employers who are proactive in hiring them. It accomplishes this goal through their disability job matching system.

Another goal is to assist its community members in gaining marketable job skills that will translate into sustainable employment, accomplished through their Microsoft IT Academy program. Recently, the organization has created a partnership with the Council of State Administrators of Vocational Rehabilitation and an alliance with the United States Business Leadership Network. You can visit the Web portals at the disABLEDperson, Inc. website or the Job Opportunities for Disabled American Veterans (JOFDAV) website.

Seattle Lighthouse for the Blind

Seattle Lighthouse for the Blind, a member organization of the NIB, is blazing the path to successful employment for people with visual impairments. This past year, Seattle Lighthouse for the Blind began an initiative to create and fill 500 living wage jobs over the next number of years for people who are blind, visually impaired, or deaf-blind. The organization doesn't just want these jobs to be within their industry's sector but throughout the organization. Kevin Daniel, Sr. Director of Strategic Recruiting, searches out talented people who are blind with positive attitudes. He feels that if he can find a talented worker, he can find the right position within the organization. Mr. Daniel is also a person with vision loss and believes that there needs to be more people with vision loss and deaf-blindness in executive roles and that these individuals should be committed to the hiring and mentoring of other individuals who have visual impairments.

Texas School for the Blind and Visually Impaired

The Texas School for the Blind and Visually Impaired should be recognized for its efforts to be creative and change how employment preparation is being done at schools for the blind and visually impaired. The organization is revamping internal training programs, beginning with a hospitality training program that will prepare appropriate students for careers in this multi-faceted field.

Chicago Lighthouse for the Blind

The Chicago Lighthouse for the Blind, another NIB member organization, has developed a number of programs specific to employment. They have a call center training program and an internal call center that has contracts with businesses. The organization recently obtained a large industries contract, which means the hiring of around 300 new employees.

Winston-Salem Industries for the Blind

Another organization that is on the move, Winston-Salem Industries for the Blind has developed a call center training program, call center, and technology advisory programs. They are continually developing new opportunities for people who are blind or visually impaired, including regularly posting new job openings.

Final Thoughts

During National Disability Employment Awareness Month and beyond, take the time to spread the message that qualified individuals with disabilities can be great employees. If you're in a position to do so, open some employment doors for a qualified person with a disability. Contact your local state agency for people with disabilities to find out about any awareness activities planned this month. Your local state vocational rehabilitation agency, blind services, or community rehabilitation provider would be a good place to start.

Create your own opportunity to expand awareness and education of the public through offering presentations to your local schools and community organizations. You may just create an opportunity for employment for others in the future.

Comment on this article.

Dear AccessWorld Editor,

I use AFB's note-taking app, AccessNote, quite a bit. I am wondering if the developers can add a Folders option, so app users can organize notes by Folders/Categories?

Thank you so much for taking my suggestion under consideration.

Alvaro Alvarito

Response from Darren Burton, Director, AFB Tech

Hello Alvaro,

Thank you for using AccessNote and for your suggestion. Adding a Folders option is on our to-do list for a future upgrade. It won't be ready in time for our next upgrade this Fall, but we hope to add folder functionality this winter.

Dear AccessWorld Editor,

I always look forward to reading each issue of AccessWorld. I loved last month's vision research article by Bill Holton, Four Emerging Vision-Enhancing Technologies: the Implantable Miniature Telescope, the Telescopic Contact Lens, the Argus II Retinal Prosthesis, and the Artificial Silicon Retina, and I hope AccessWorld will continue to update that important research.

I also agree with a fellow reader who wrote in concerning the important issue of online learning access. I am employed fulltime and constantly deal with access issues at work, but I want to pursue online graduate courses. After looking at a sample of the courses interface, I decided I couldn't voluntarily tackle another computer environment which may or may not be able to provide me the support that I would need to deal with each access issue. It is unfortunate that those of us who use access technology are forced to be much more than mere "point and click" users just to survive much less thrive.

Best regards,

Pshon Barrett

Dear AccessWorld Editor,

I live in Wangaratta, Victoria, Australia.

I just read Deborah Kendrick's September article, An Evaluation of the I.D. Mate Quest Talking Bar Code Scanner from Envision America, and I liked everything I read!

As soon as I saw the "Comment on this article" link at the bottom of the review, I jumped at the chance for one reason and one reason only. I received that very product just a week ago today.

The only down side is it will only recognize barcodes on Kohl's and Woolworths products; nothing from Aldi, but I can very easily record any codes for those products.

Great review!

Kyle Cogan

Dear AccessWorld Editor,

I am a blind IT professional and I had been a JAWS user since the 1970s.

Approximately 18 months ago my PC, running Windows XP with JAWS crashed and I had to purchase a new one. The new PC came with Windows 7 preinstalled, and this meant that my current version of JAWS would not work. I contacted the Freedom Scientific sales folks and found out that it was going to cost me about $1,000 for the Windows 7 version.

Given this information, I started to look for a suitable alternative.

Much to my sheer delight, I came across the NVDA screen reader, and WOW! Not only is this software FREE it actually performs every function that is required for me to perform my daily duties and for just having fun. I am currently running the latest version and everything is running extremely smoothly. Everything I encountered from the initial download to customizing the readers preferences is very clear and concise.

More information is available at [the nvaccess website.]

One of the features that is an absolute must for me is the ability to create a portable version on a thumb drive (USB) where you can carry the reader from PC to PC. My wife has a laptop, and she needed some help last month. I was able to get the problem resolved by bringing her machine up using NVDA from the USB drive, therefore not having to load the software on her machine. WOW!

Lee O'Neill, Jr.

Dear AccessWorld Editor,

I am blind and using the AccessNote app for iPhone.

I have some wishes for the upcoming versions, and hope there is a possibility to consider it.

It would be nice, if there were a possibility to synchronize the app direct with the iPhone via iTunes, and not only via Dropbox. And, it would be great, if the app could work with RTF files.

AccessNote is a very useable tool for people with vision loss, and I am looking forward to upcoming improvements.

Thanks a lot, and excuse my English, I am Austrian :-).

Thomas Hill

Dear AccessWorld Editor,

Lately I've been hearing little bits about two new devices for the blind. One is called Orcam and the other is called Visus. They sound fascinating and I'd dearly love to see in-depth articles about them in Access World.

Sincerely,

Linda Vos

Dear AccessWorld readers,

October is Disability Employment Awareness Month and we at AccessWorld have taken this opportunity to focus on employment with articles that provide strategies, insider perspectives, and information about employment resources.

October is a time to celebrate the skills and accomplishments of American workers with disabilities. Further, it's a time to illuminate and discuss the employment barriers that still exist and, with renewed vigor, pursue their removal.

The effort to educate the American public about issues related to disability and employment began in 1945 when Congress enacted a law declaring the first week in October as National Employ the Physically Handicapped Week. In 1962, the word "physically" was removed to acknowledge the employment needs and contributions of individuals with all types of disabilities. In 1988, Congress expanded the week to a month and changed the name to National Disability Employment Awareness Month.

In observance of this month-long celebration, CareerConnect Program Manager and AccessWorld writer, Joe Strechay, developed three employment-related articles, each providing an important perspective on the employment of people with vision loss.

This month I am also sharing the Editor's Page with Joe to bring you his unique personal perspective on the employment of people with vision loss. He writes:

Having traveled extensively around the United States and met with professionals, job seekers, teenagers, and adults who are blind or visually impaired, I have had the opportunity to learn about employment issues from all sides. Much of my job pertains to analyzing employment issues and creating resources to assist people with vision loss in becoming career ready.

In that vein, I am often asked the question, "What is the major factor affecting whether or not a person with vision loss is or is not employed?" Too often, I feel, people want to highlight a single reason as the major cause for the differential between being employed or being unemployed. Instead of offering one reason, I assert that the underlying factor is that there is such inconsistency around the United States in the training and preparation of people with vision loss from an early age to later in life. Neither public nor private services are created equally, and for that matter, no government or private entity offers those services in the same manner. This issue is larger than just vocational rehabilitation. It includes preparation in the schools, non-profits, various state agencies and services, and other important variables including family involvement. There are a lot of fantastic programs and services available, but any given area may be great in one service and lacking in another. I know this is obvious, but it needs to be said openly. Our field needs address our weaknesses and diligently work to make improvements.

Each job seeker with vision loss has his or her own challenges. Unfortunately, I still see a level of learned helplessness among young people with disabilities, even among the brightest. Learned helplessness refers to an individual being taught that things will be done for them, which allows them to not attempt to initiate or do things on their own.

This type of thinking sometimes extends to the perception of job seekers that vocational rehabilitation is designed to find them jobs, but really that is not the purpose. Vocational rehabilitation specialists definitely can help and guide, but they are not job placement professionals. Job placement is an art; it is a mix of sales, community relations, and having a well-defined pool of applicants.

Job seekers battle the perceptions of employers about vision loss and their own perceptions about navigating the employment process. At the same time, the technology divide between those who have appropriate access and mainstream technology and those who have orientation and mobility training, and those who do not, is apparent. Those with O&M training and technology skills have a better chance at finding, obtaining, and maintaining successful employment. In addition, job seekers are all individuals with strengths, skills, and weaknesses. All individuals have limitations, and not every job seeker is going to be a computer programmer, accountant, teacher, mechanic, or maintenance worker. The common thread typically is they want to be a productive and employed citizen.

I encourage everyone with vision loss to pursue every avenue of education and training possible. I encourage you to embrace and learn to skillfully use technology. Take it upon yourself to seek out resources such as CareerConnect to assist you with career readiness. Ultimately, it is your life and your career, and you are responsible for it. Take action! By working hard, obtaining education and skills, and seeking out and using resources available to you, you can find the job that's meant for you!

Joe Strechay

This October also marks the two year anniversary of the AccessWorld app. I'm very excited to announce that the app has been downloaded nearly 2,500 times. If you have an iPhone and haven't yet downloaded the app, I encourage you to read Ricky Kirkendall and Darren Burton's article to learn how you can have AccessWorld on your iPhone!

I hope you enjoy this issue and will join AccessWorld in recognizing and celebrating the inroads individuals with vision loss, and all types of disabilities, have made in the world of employment.

Sincerely,
Lee Huffman
AccessWorld Editor-in-Chief
American Foundation for the Blind

Mark Your Calendars for the 2014 AFB Leadership Conference in New York City

The 2014 American Foundation for the Blind Leadership Conference (AFBLC) is scheduled for February 27–March 1 at the Brooklyn Bridge Marriott. Conference attendees can take advantage of a low group rate at the centrally-located, luxury hotel and join colleagues new and old for three days of informative and thought-provoking sessions led by leaders in the field. Visit the American Foundation for the Blind Leadership Conference page for the latest information on this conference that draws hundreds of professionals from across the country and around the world.

Survey Announcement: Accessibility of VoIP Systems

The American Foundation for the Blind (AFB) is seeking blind and visually impaired adults who have had experience using Voice-over Internet Protocol (VoIP) systems to participate in an online survey. VoIP is technology that allows telephone calls to be made over the Internet rather than via traditional telephone systems, and often includes features such as caller ID, call forwarding, creation of answering rules, and maintaining a contact list with phone numbers.

You must be 18 years of age or older to participate in this survey, and you must reside in the United States or Canada. The survey will take approximately 30 minutes to complete. Those who complete the survey will be given a small monetary payment as a thank-you for your time and participation.

If you have used a VoIP system and want to take the survey, please choose the link below that best describes your primary method of reading:

You use your remaining vision and/or magnification tools to read.

You primarily use speech output and/or braille to read.

If you have any questions about this survey, please contact Darren Burton.

Library of Congress Braille and Talking-Book Program Releases Book Download App through Apple

People who are blind, visually impaired, or have a physical disability may now download audio and braille books to their iPhone, iPad, or iPod touch if they are registered with the National Library Service for the Blind and Physically Handicapped (NLS) in the Library of Congress.

The Braille and Audio Reading Download (BARD) Mobile app is now available through the Apple App Store. The app, which is free, allows readers to download audio and braille books from their NLS BARD accounts. Access to BARD is provided through local cooperating libraries. BARD contains nearly 50,000 books, magazines, and music scores in audio and braille formats, with new selections added daily.

NLS Director, Karen Keninger, said, "The BARD Mobile app allows searching, downloading, and reading braille and talking books and magazines on one fully accessible, mainstream device. It's a library in your pocket."

She explained, "With BARD Mobile, patrons can play talking books and magazines on their iOS devices. Patrons may also read electronic braille books, magazines, and music scores using a refreshable braille display connected to their iPhone, iPad, or iPod touch through Bluetooth. " Patrons will be able to receive their reading materials faster and won't have to be weighted down with bulky volumes or playback equipment.

NLS has provided free library service for people who have visual disabilities for more than 80 years and for people with physical disabilities since 1966. Best known as the talking-book program, NLS upgraded its analog program to digital in 2009.

"Audiobooks are provided on cartridges for use with digital playback equipment that provides high-level navigation capability, high-quality sound and other features, which are provided without cost to the reader," Keninger said. "Around the same time, NLS launched BARD, which permitted patrons who had access to high-speed Internet to download their audiobooks, as braille readers had been doing with the Web-Braille system since 1999. BARD now merges the two systems.

"BARD Mobile is another benchmark in our use of technology to enhance the delivery and reading experience of NLS patrons," Keninger said. "NLS developed the BARD Mobile app in response to demand from our borrowers. Blind and disabled Americans are as keen as everyone else to use mobile devices. Our younger patrons are particularly eager to use the same gadgets as their peers."

BARD Mobile will make reading not only more accessible, but more portable. "We anticipate that significant numbers of readers will adopt the app as their primary reading device," Keninger said. "As a growing percentage of blind and disabled Americans adopt mobile devices, the app will provide a highly valued avenue to NLS materials."

Eligible users may even find the free braille and talking-book program more attractive. Keninger explained, "This new, instant, and convenient package will increase the appeal of audio and braille reading."

NLS is also working on an app for Android devices.

NLS, which is part of the Library of Congress, administers the braille and talking-book program, a free library service available to residents of the United States and its territories and American citizens living abroad whose low vision, blindness or physical disability makes reading regular print difficult. Through its national network of cooperating libraries, NLS mails digital audio players and books and magazines—in audio and in braille—directly to enrollees at no cost. Music instructional materials are available in large-print, braille, and recorded formats. Select materials are also available online for download. To learn more, call 1-888-NLS-READ or visit the Library of Congress website.

The Web is a starting point for gathering information on every topic imaginable, including health care and disease. Websites offering information about health issues are popular among the general public. For people with vision loss, easy access to health information over the Internet may be especially important in overcoming difficulties accessing standard print information and traveling to health appointments. To examine the use and accessibility of health care websites, the American Foundation for the Blind (AFB) conducted a national survey of individuals with vision loss and analyzed the accessibility of key health-related websites. As the Affordable Care Act (popularly known as "Obamacare") goes into effect this month, it's a good time to look at what we found.

Survey Results Related to Accessibility of Health-Related Websites

In 2012, AFB conducted a national telephone survey of 400 adults with vision loss that focused on use of and satisfaction with health-related websites. Survey participants were also asked about importance of features such as text size, color contrast, labeled images, and search functions, and about the tools or methods they use to make websites more accessible and usable.

For the survey, health-related websites were put into three categories: general health information websites, drugstore or medical supply websites, and health insurance websites. More than three quarters (78 percent) of survey participants use health-related websites. Of those who used the websites, 80 percent reported using general health websites, one-third (32 percent) indicated using drugstore or medical supply websites, and only one-fifth (19 percent) of health website users said they visit insurance websites. Furthermore, the survey revealed that 75 percent of respondents reported being either satisfied or somewhat satisfied with general health websites and drugstore or medical supply websites. Insurance websites had the lowest satisfaction rating with 62 percent of users satisfied.

Slightly less than half of survey participants (45 percent) said they used tools or techniques to make information on the Internet more accessible. Among those who do, about a third (34 percent) said they used settings adjustment and about one-quarter (27 percent) used screen magnifiers. Other tools included glasses, the assistance of another person, screen readers, large monitors, and magnifying glasses. There were no participants who mentioned the use of braille and only five respondents (3 percent) reported using screen readers. This last statistic reveals that the results are strongly skewed towards the problems that individuals with some usable vision will face using a website as opposed to an individual accessing the site with a screen reader. Either our sample consisted mostly of individuals with very mild vision loss, or many respondents did not use access technology for some other reason. The respondents had difficulty naming a tool or technology that could improve their experience, so we believe that lack of information about access technology is a major contributing factor to the inaccessibility of health websites.

Website Evaluations

The second phase of the study was to perform a technical evaluation of the most commonly visited health websites according to the survey. This review of each website was carried out using the Web Content Accessibility Guidelines (WCAG 2.0), published by the Web Accessibility Initiative (WAI) overseen by the World Wide Web Consortium (W3C). This review was intended to determine the types of accessibility barriers that were present on each of the websites. The latest available version of Mozilla Firefox (version 20) and NVDA (version 2012.3) were used for evaluation. These programs were chosen because they are free and open source and because they tend to comply with Web standards.

The following websites were tested:

• General Health Information
  • WebMD
  • Mayo Clinic
• Online Drugstores
  • CVS
  • Walgreens
• Health Insurance
  • BlueCross BlueShield
  • United Health Care
  • Humana
  • Aetna
• State Health Exchanges
  • Mahealthcareconnector (Massachusetts)
  • Avenue H (Utah)

What Makes a Website Accessible?

According to the WCAG 2.0 an accessible website should be "Perceivable," "Operable," "Understandable," and "Robust." We will quickly review what each of these means and point out major shortcomings that were noted on the evaluated websites.

Perceivability

A website should be universally perceivable to all of its visitors. This means that the important information that is available to one user should be available to another user whether they're using a PC or Mac running Firefox, Safari with a screen reader, a magnifier, or any other compliant browser/operating system combination (called a user agent). This is specifically important to users who don't use vision to access a website but, instead, rely on a screen reader to interpret the underlying HTML. Problems arise when the Web developer, who uses his or her vision to access websites, creates a page that looks good visually but doesn't follow all design standards. Here is a representative list of some of the major issues that websites have with perceivability:

• No alternative text for non-text elements. It's obvious that a screen reader will not be able to interpret an image without alternative text, but there are other less obvious (to non-screen reader users) elements that need to be tagged as well. Input fields for forms is one example that causes major problems. A field can be "labelled" by visually placing text near a field, but if that label is not associated properly behind the scenes, the screen reader will not be able to make a connection between label and field. Videos and other time based media ideally should be transcribed and described for people who are hard of hearing or visually impaired.
• Low contrast text and other visual elements. The WCAG 2.0 guidelines have specific thresholds for different sizes of text and icons. In general, smaller text needs to be higher contrast, and there is a minimum contrast level for all visual elements no matter the size.
• Text within images. Websites are frequently designed with buttons, labels, headings, and other structural elements that include text in an image format, but this causes problems for both screen readers and screen magnification users. Oftentimes, these text images are not labeled, which is a problem for screen readers, but this convention also impacts screen magnification users because the image becomes pixelated when magnified while the text gets redrawn on the screen at high resolution.

The Perceivability standards are those that get violated most. Following the Perceivability guidelines of the WCAG 2.0 standards will fix most of the problems for screen reader and screen magnification.

Operability

This principle of the WCAG 2.0 guidelines focuses on the way that user agents interact with a website. Whether using a combination of keyboard and mouse, or only a keyboard or touchscreen, all ways of operating a computer should have the same access to a webpage. Here are a few common issues we found:

• Headings not used or used inappropriately. Headings are a very important navigation tool for screen reader users, and when implemented improperly (or not at all), it causes problems. There is a very specific set of guidelines for using headings, but in general there should be one top level heading, which tells you what the page is about, and, then, lower level nested headings used logically to indicate new parts of the webpage. Heading levels should be used sequentially and not be skipped.
• Multiple links with the same text but with different targets, e.g., "Click Here" links are a problem. The user has no idea what clicking there will do. Screen reader users frequently bring up a list of links on the page to make navigation easier. A list of "Click Here" links is not helpful.
• Keyboard traps. Sometimes a website will implement JavaScript (or another scripting technology), which moves keyboard focus around on the screen. Some implementations will actually trap the keyboard focus and not let you back on the main part of the screen. This is usually a bug, and it can require refreshing the page or leaving the page altogether to fix. This is annoying, and it also can make it impossible to complete certain tasks on the page.
• Illogical tab order. The focus should move in a logical fashion when a user tabs through the page. Sometimes the focus will jump across the page and skip over the content that is expected next.
• Mouseover events not occurring with the keyboard. When an element (like a drop down navigation menu) receives keyboard focus, the mouseover events should be registered so that the drop down actually occurs.

Forms, in particular, require a significant amount of interaction and can be a significant barrier to different users if not implemented using the Operability rules.

Understandability

A website can be perfectly perceivable and operable and still be inaccessible. A more human principle of the guidelines focuses on how understandable the content is to a person. In general, a website should use clear language, predictable navigation, and present the information that it's trying to convey in an understandable way. A few problems that we noticed on the websites surveyed are the following:

• Unpredictable navigation. A website should choose a convention and maintain it throughout the site. On some websites the navigation menu changes along with other conventions, such as calling the home page "Home" and, then, switching to "Main" on another page.
• Context changes upon interaction. A website with dynamic content should make it clear that the content will be changing. One example is a form that a user has to fill out that changes based on input from a field without informing the user. This can be confusing, especially for a screen reader user who will only become aware of the change after going back through the form.
• Poorly implemented input assistance. Sometimes a field will try to guess what you are entering and automatically complete the word. This is good if implemented properly but can cause confusion if abused. Auto complete and search-while-typing features can be cumbersome and problematic for screen reader users.

Robust

This principle states that the experience should be consistent for users across browsers and operating systems. The main point for this principle is that the HTML behind the webpage needs to conform to the HTML standards. There are some additional rules for how the browser should interact with technologies, such as Adobe Flash.

Summary of Results: Healthcare Website Accessibility Evaluations

The level of accessibility varied significantly across the websites that were evaluated. None of the websites evaluated could be considered fully accessible to screen reader users, and many of the sites do not work well for screen magnification users as well. Each site was tested with a markup validator. Essentially, this program looks over the code that makes up a website, and points out any inconsistencies with the standards. None of the websites we tested passed this validation, which is usually a strong indicator of poor accessibility. Five of the ten websites we looked at use the new HTML 5 standard.

Of the websites we evaluated, the Mayo Clinic, Humana, and Avenue H websites are the most accessible for both screen magnification and screen reader users. There are issues with each of the sites, but the solutions to these issues are simple to implement. There are no major issues that rendered these sites unusable.

CVS.com, Walgreens, mahealthconnector.org, and WebMD were mostly accessible but had some significant barriers to accessibility for some of the features of the sites. The major problem with the drugstore sites is their level of complexity. The main page, though technically accessible, is cluttered with so much information that it's very difficult to wade through. In addition, product listings in the store pages frequently had no alternative text or had repetitive links to the same information. WebMD is accessible in most places of the site except for the symptom checker tool, which is implemented in Flash and therefore is completely inaccessible to screen reader users. Finally, mahealthconnector.org is easy to use with a screen reader, but the use of text images for navigation links on the page make it difficult to use with screen magnification software. The images are labeled so that they are accessible to screen readers, but images of text should always be avoided because the quality of text in an image significantly degrades for screen magnification users.

BlueCross BlueShield, Aetna, and United Health Care all had significant accessibility issues with their websites at the time of evaluation.

Conclusions

As access to health information and healthcare is increasingly dependent on the Internet, it is critically important that these websites and information systems are made accessible to everyone regardless of the technology used to access them. Unfortunately, we have found that this is not the case thus far.

The level of accessibility of the surveyed sites varies significantly from site to site. Additionally, the level of accessibility that each site offers visually impaired users who access the content visually varies from the accessibility of screen reader users. The health information websites tend to have relatively good navigation and accessibility of text articles, but significant portions of those websites have inaccessible multimedia. The pharmacy store sites are technically accessible to both groups, but the complexities of the sites and the dynamic nature of storefronts make it difficult to navigate successfully. The health insurance websites we tested were poorly organized, poorly executed, and, in some cases, totally inaccessible to individuals trying to find information about health insurance. Since our initial tests, however, Humana, BlueCross BlueShield, Aetna, and United Health Care have all made significant changes that may have improved accessibility. We will reevaluate these websites and provide an update in a future issue of AccessWorld.

We'd like to hear about your experiences using health-related websites. We'd be especially interested in your experiences accessing state-based websites offering health insurance under the Affordable Care Act. Visit the federal government website on the Affordable Care Act and the availability of health insurance for more information. In future issues, we'll take a look at the accessibility of some of the state and federal government sites.

Comment on this article.

Smith-Kettlewell Eye Research Institute is a scientific laboratory for projects and ideas that are aimed at making the world more accessible to people who are blind. It's a place where ideas are born and research is conducted. Under the best conditions, those ideas are brought into reality, but sometimes an idea is born, research carried out, a new project or reality conceived, and nothing ever comes of it. Once the research is completed the task of the laboratory is completed, too. Smith-Kettlewell is not in the business of manufacturing or distributing products or providing tech support for new products once they have been launched.

This article will feature one Smith-Kettlewell idea that, regrettably, is still waiting after a decade for an outside entity to polish, package, sell, and support it, and another project that found just such a brilliant collaborator and is taking off in countless directions.

Mapping It Out

Dr. Josh Miele, a principal investigator and research scientist at Smith-Kettlewell, has always loved maps. Because he happens to be blind, that means he is a lover of tactile maps. At the beginning of the 21st century, Yahoo and Google began making visual maps readily available to sighted people. With a few keystrokes, you could see the visual image of roads leading from you to a point across town or five states away. All the streets were there with all their beautifully and sometimes convoluted intersecting points and you could plan routes while sitting in your living room. Why, Miele wondered, couldn't such maps also be available to people who are blind? And how could a map be easily produced that would put a picture into the hands of a person who is blind?

Tactile maps are sometimes a point of controversy among those who work in the fields of education and orientation for the blind. Miele's belief is that the only reason blind people sometimes fail to make sense of tactile maps is that there is no consistent language of map-making or map-reading to guide users through the process.

The information included on a tactile map and how that information is conveyed are largely dictated by the whims of each developer. Labeling can lead to clutter so that there is too much information for the sense of touch to assemble into a meaningful picture. What if tactile maps could be produced inexpensively, easily, and with simple conventions—What if every tactile map was produced according to the same rules: using embossed lines to represent streets, each ending in a short braille abbreviation, and an accompanying automated key to those abbreviation?

Ten years ago, Tactile Map Automated Production (TMAP) was born in the Smith-Kettlewell lab. Josh Miele wrote the software himself and imported map data shared by Mike May of Sendero Group LLC. The idea was beautifully simple. Enter an address, such as 123 Main Street, Smalltown, USA, and TMAP generates an embossable map, 11 by 11 inches, with the given address at its center, and all streets radiating from that point clearly indicated with braille labels. A second page containing a key to those labels is also generated as part of the file.

TMAP Unveiled

At the 2004 California State University at Northridge Technology and Persons with Disabilities Conference (CSUN), Josh Miele introduced TMAP. At that conference, people who were interested in the concept gaveMielea familiar address to enter into the software. "More than one person cried," Miele recalls, "when a picture they could see with their hands was put before them." Here were the streets and intersections they knew well, but with relationships made clearer by an instantly readable tactile representation.

The problem with TMAP was that once it was in place, the work of Smith-Kettlewell was finished. The San Francisco Lighthouse has adopted use of the system, so that students receiving orientation and mobility training from the Lighthouse are often provided with tactile maps of environments of interest to them, but otherwise, the software remains pretty much neglected.

"The site is there and the system is free for anyone to use," Miele explains. But not everyone owns a braille embosser and it takes a bit of instruction to learn to produce the maps. Smith-Kettlewell is simply not in the business of providing technical support. Miele's initial expectation was that some other entity would take on the project, possibly teaching others to use it or offering to provide maps on demand, but that hasn't happened. He is still open to working with anyone interested in picking up this idea.

The Talking Tactile Tablet

Meanwhile, another innovative project for bringing maps to life for blind people was being launched by Steve Landau, president and founder of Touch Graphics, Inc., in New York. The Talking Tactile Tablet (TTT) combines tactile drawings, placed on a "tablet" platform. Connected to a computer running its software, the TTT makes it possible for a blind person to explore a tactile representation and then hear audio explanations of the image being explored.

With the TTT and the company's adaptation of the National Geographic Atlas, for example, a blind person can examine embossed textured representations and hear audio explanations regarding land mass, population, etc.

An Idea Twin

Miele and Landau describe meeting the other as the sparking an instant dynamic rapport. Their mutual regard and admiration for one another is palpable. Each refers to the other as a genius (a label clearly deserved in both cases) and each recalls with energy the thrill of pitching ideas to one another in a brainstorming frenzy. Landau refers to Miele as a "soul mate," while Miele's term for Landau is "idea twin." The result of their collaboration is a flurry of amazing projects with the potential of changing the ways people who are blind or visually impaired interact with and access visual information.

Touch Graphics is exactly the kind of commercial entity or, as Miele refers to it, "technology transfer partner" Smith-Kettlewell needs. Touch Graphics is positioned to take research conducted at Smith-Kettlewell, fine tune it, and turn it into a packaged product. In 2007, both organizations were headed in a new direction with Josh Miele's discovery of the potential of a particular mainstream product.

Through a contact at LeapFrog, a leading manufacturer of educational toys, Miele encountered Livescribe. Essentially, Livescribe is a computer in a pen-like device with audio output and remarkable recognition capabilities.

Landau recalls a "salon" of sorts assembled by Miele at an Orlando conference, where he invited a group of people, including Landau, to his suite to demonstrate Livescribe."He had a tactile map of North America and this pen," Landau says. When the pen touched various points on the map, instant audio feedback provided information. Here was a commercial product with limitless possibilities for those who are blind or have vision loss, and Landau recalls being immediately both thrilled and horrified. Thrilled, he explains, by the possibilities, and horrified because it might be the end of his own product!

It wasn't the end of his own product, after all, but it very definitely marked the beginning of several innovative breakthrough projects. With the Talking Tactile Pen and a collection of tactile images, a person who is blind can touch clearly defined tactile images and then tap with the pen for additional audio information. Landau has created several amazing projects using this technology, some of which will be discussed in a future article.

The STEM Binder

The STEM (science, technology, engineering, and mathematics) Binder, created by Touch Graphics in collaboration with Smith-Kettlewell and others, is a perfect introduction to the power of this audio-tactile combination.

The STEM Binderis a 3-ring binder filled with beautifully textured and colored representations of classic STEM images. The periodic table of elements, a human skeleton, a combustion engine, and several other images are ones familiar to sighted students of science and mathematics; they are also images that have been typically beyond the reach of students who are blind.

By tapping any point on an image with the Talking Tactile Pen, additional information is learned through audio output. Tap the textured image of one of the planets on the solar system page, for example, and the pen will announce in a clear male voice that this is Jupiter. Tap the image again, and you will hear that it is the fifth planet from the sun, the largest planet, and several other details. Tap it yet again, and you will hear how often it orbits the sun, its composition, and so on. A small chime is heard at the end of an audio explanation to indicate that there is another layer of information to be heard with another tap, and a kind of "clunk" sound indicates that you have now heard all the information available. In this way, an extensive amount of information can be provided to a student who is blind or visually impaired with a single tactile image. The pen has an internal speaker as well as a headphone jack, is charged via USB, and can be loaded with applications for use with other tactile images.

It is a truly amazing, portable, and powerful program that should be in any math or science classroom where a student who is blind studies.

BART Maps in San Francisco

One more project using this combination of tactile maps and audio output warrants mentioning. Smith-Kettlewell and the San Francisco Lighthouse have produced a collection of maps designed to familiarize residents and visitors with the 43 Bay Area Regional Transit (BART) stations. Each map consists of three pages, depicting the streets from which the station can be entered, the layout of the station itself, and the layout of the platforms where passengers board the trains. Details such as stairways, escalators, fare stations, and benches are included.

"There can be a lot of anxiety connected with planning a trip," Miele explains, "and these maps provide all the information necessary to do that."

Although the maps will be a fabulous orientation aid as stand-alone tactile images, additional information is available when used in conjunction with the talking pen.

With such projects under way and more to come, the research at Smith-Kettlewell is clearly mapping out a bright and amazing future for access to visual and graphical information for people who are blind.

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Odin Mobile, a nationwide provider of cellular service, has become the first cell phone company dedicated to serving people who are visually impaired. Odin sells phones and provides cellular service. Odin uses the T-Mobile network but they are a separate carrier. Anywhere T-Mobile has its network, Odin will have coverage. Odin does not provide service in areas where T-Mobile provides roaming coverage.

Robert Felgar, Odin General Manager, explained, "There really are two aspects to the service. One is the phones themselves and the other is the service that goes along with it." He added, "Right now we're launching with three phones, but we're looking to expand to five."

The company started taking orders on July 29, 2013, and planned to start shipping phones 4 to 6 weeks later.

The Odin Phones

The three phones that Odin is starting with are the Emporia Essence ($49), the Emporia Click ($73), and the Huawei Vision ($299; with RAY software installed).

The Emporia Essence

The Essence is manufactured by Emporia, an Austrian company that Felgar indicated was relatively new to the US. He said, "This is a great phone that is inexpensive and has been customized for blind users who just want to make calls. It is also great for low-vision users who want to send and receive text messages and access other functions because it has a high contrast screen and large font size and emphasizes simplicity and ease of use." Odin worked with the manufacturer so that the phone is useable right out of the box. The screen is set to the highest contrast and the font size is set to large.

Features

• Speaks the numbers when they are pressed
• Speaks "delete" when a number is deleted
• Speaks "calling" when a number is being called
• Speaks the battery level at the press of a button
• If the key lock feature is used, the phone will speak "key lock on" and "key lock off"
• Speaks "home" when the user is at the Home screen
• Speaks "menu" when the user has accessed a menu
• Speaks "call ended" at the end of each call
• Gives audio feedback when Bluetooth is activated and deactivated
• Allows for five speed-dial numbers
• Phone comes with desktop stand for charging
• Does not speak text messages

The Emporia Click

The Click is a clamshell phone designed for low vision users and users who have difficulty hearing. This phone does not have text-to-speech capability and therefore is not appropriate for someone who uses a screen reader.

Features

• Large keys
• High-contrast color display with adjustable font size
• Extra powerful speakers
• Ring tones can be adjusted to very high volumes
• High power vibrations when a call comes in
• Three speed-dial buttons
• Desktop stand charger
• Call for Care button (when pushed, five separately stored numbers are called in sequence until one answers; emergency SMS messages are also sent to emergency numbers)

The Huawei Vision

The Vision, manufactured by China-based company Huawei, is an Android phone that uses the Ice Cream Sandwich 4.0 operating system. RAY software makes this phone readily accessible and gives users with vision loss access to many important smart phone features. It was developed by Project RAY, an Israeli company. Although this software has previously been used in other countries, it's now making its debut in the US.

When explaining Ray software, Robert Felgar stated, "The RAY has a unique user interface designed from the ground up for eyes-free operation and every feature is accessible. It emphasizes simplicity and is an ideal phone for a user with vision loss who wants basic, and certain advanced, capabilities but does not need or want all of the functionality (or expense) of an iPhone."

Features

Felgar explained the software's features: "The RAY will include capabilities such as calling, text messaging, alarms, calendar, and managing contacts. The device has speech recognition to make calling and text messaging easier. It also offers more advanced capabilities, such as an easier-to-use GPS, voice recorder, money recognition and color recognition. Perhaps most importantly, it is a great device for accessing audio books, newspapers, and magazines. The Audible application is pre-loaded onto the RAY to give the user access to more than 100,000 audio books. In addition, we have plans to integrate the RAY with the NFB Newsline, the National Library Service and the Connecticut Radio Information System and we hope to integrate with additional organizations that can make available audio materials on the RAY. The objective is to make the RAY the best source for audio materials for visually impaired users in the market. Moreover, to make things easier, the user interface will be the same regardless of the source of the audio material so that the user has to learn only one system for accessing the materials. Also, the user or his or her family or friends will be able to go to a website to enter contacts for easy calling, or enter events on a calendar, and these will be automatically transferred to the RAY. The RAY facilitates remote access and screen sharing. What this means is that if the user needs help with his or her phone she can call customer support and Odin Mobile can see what is on the users screen and even take control of the screen and help the user through the problem."

He also indicated that over time the phone will have new features and capabilities. The user will not need to purchase another device because the phone will be updated automatically. The user will be able to exit the RAY mode and use standard Android functions on the phone. In addition, by the end of the year the RAY software will be added to another device which will run on the Jelly Bean operating system.

Phones in the Pipeline

Felgar was enthusiastic about some of the new phones that Odin will be adding in the future. He described two of them:

Alto II Manufactured by GoldGMT

"This phone is unique in the world in that it is a feature phone that is 100 percent accessible. It is designed to be a talking phone and allows the blind user to easily enter and use contacts, access a call log, create and listen to text messages, set alarms, and interact with the settings. Moreover, the buttons are extremely tactile and some have different shapes and colors to further enhance the experience. The phone will also speak the date and time, speak the battery strength, as well as the signal strength. It will retail for approximately $150. It is currently being sold in the UK by the Royal National Institute of Blind People and has been very well received. Odin hopes to be selling this phone no later than the end of November," Felgar explained.

NEXUS 4 Manufactured by LG

"Odin Mobile will sell the NEXUS 4 to provide blind users with the latest in Android accessibility on a high-end device. It operates on Android 4.3. While plans are not finalized, the device is likely to contain two customized features specifically tailored for the blind. First, it will support remote access and screen sharing to facilitate superior customer support. Second, it will include a widget on the home page that will allow users to easily download select applications, tailored to blind users, without going to the Google Play store."

Rates

Felgar said that Odin's rate plans were designed with lower income users in mind. The rate plans range anywhere from $10 to $45. The $10 plan allows for 150 minutes a month while for $45 you get 4000 minutes and 4000 texts. There are additional plans between those rates so the customer can select a more customized plan.

Data plans are also offered in various amounts. For example, The $5 plan allows up to 100MB usage and the $30 plan allows up to 2 GB. At the present time, only the Huawei Vision with RAY software supports data, but the additional smart phones Odin plans to offer in the future will also support data.

Customer Service

When a customer receives a newly purchased phone, all accessibility features are on by default. Regarding the Odincustomer service department, Felgar said, "We expect our customer service department to be busier than a normal customer service department. We are expecting many questions regarding Odin devices and how to use particular phone functions." He added that all customer service personnel have been trained on the accessibility features of the phones.

Additional Support for the Vision Phone

All users who purchase the Vision phone with the RAY software get an introductory training session with the phone at no extra charge. The session usually takes approximately one hour, but whatever length of time is needed is freely given. The training session will be conducted by a customer service representative who is blind. Primary tech support will also be provided by a representative who is blind. There are sighted representatives available who can provide remote assistance by seeing the customer's screen and, if necessary, take control of it. Similar support will be given for the Nexus 4 when it is released.

Giving Back

Odin Mobile will donate 2 percent of their talk and text revenue to organizations that assist the blind community.

Odin is also applying to the Federal Communications Commission to be part of its Lifeline Program. Felgar explained, "Lifeline is a government benefit program that provides discounts on monthly telephone service for eligible lower-income customers. To qualify, the customer must have an income less than 135 percent of the federal poverty guideline or participate in a federal program, such as Medicaid, SSI or Food Stamps. Once approved to participate in the program, Odin Mobile will offer qualifying customers a $10 monthly discount."

Advisory Board

Odin Mobile is creating an advisory board consisting of at least three people from the blind community. The purpose of the advisory board is to keep Odin Mobile connected to the needs of its customers. Specifically, the members will provide Odin Mobile with feedback regarding its existing services, as well as ideas on how better to meet customer needs in the future.

Contact

To learn more about Odin Mobile and the services it provides, visit the Odin Mobile website or call 800-826-0337.

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Over the years, the number of devices with built-in accessibility of some form has ballooned. Through advances in technology and decreased development costs, a range of electronics from smartphones to laptops have offered some form of access, often enabling the blind or visually impaired to use these devices independently. For a variety of reasons, televisions had not received this same treatment. Perhaps it was the prevailing notion that blind people don't have an interest in television due to its visual nature, or the apathy of manufacturers, or a combination that led to this reality.

Recent changes have resulted in some progress for those wishing to watch their favorite stars on the tube. The passage of The Twenty-First Century Communications and Video Accessibility Act has resulted in new rules and regulations that manufacturers of TVs and other set-top boxes must eventually follow. Meanwhile, the UK-based Royal National Institute of Blind People (RNIB) forged a partnership with Panasonic to create the first line of talking televisions in 2012. Panasonic is no stranger to creating accessible features on its products, and is widely known for an array of telephones that include talking caller ID. As for the TVs, voice guidance is included on over 30 high-end and mid-range models released by Panasonic to the United Kingdom. This means that users seeking audible feedback are not limited to a specific model, and that blind users can pay the same as anyone else for a new TV that happened to include accessibility features.

In 2013, Panasonic brought many of these features to other countries, including the United States and Australia, giving customers in these countries their first crack at buying an accessible television. We obtained a review unit from Panasonic to determine if its latest foray into accessibility was ready for primetime.

Overview

Panasonic's voice guidance features are available on a variety of Plasma and LED televisions released in 2013. These include the VIERA WT60, DT60, ET60, and E60 Series LED models and the VIERA ZT60 and VT60 Series, which are plasma TVs. An additional interactive voice recognition feature is available on all of the lines mentioned above except the ET60 and E60 series. We'll describe both of these features below.

These models encompass many of Panasonic's high-end releases for 2013, meaning that accessibility is not available for a smaller bedroom unit, for example. As of press time, the least expensive unit was the 42-inch E60, model TC-L42E60, currently selling for around $599.

Our review unit was the 55-inch DT-60 model, one of the TVs that included both Voice Guidance and Voice Interaction. The TV comes with two remote controls, the standard remote and a touch-screen control which is used for, among other things, the Voice Interaction features. On the TV, there are a variety of ports for connectivity including HDMI, USB, and an SD card slot. Six raised buttons are located on the back of the unit near the right side including an easily identified power button that is larger than the others. The unit was quite heavy, and it is recommended to have at least two people aid in its installation. Alternatively, one may often request or pay for professional installation services when purchasing a set.

Setting Up the TV

Panasonic provides a print manual in the box as well as electronic documentation in PDF format on its website. The actual user guide includes information on setting up your TV while the eHelp document includes the bulk of the instructions. While these instructions gave me basic information for understanding the TV, some of the descriptions were visual in nature, leaving one to wonder how exactly to operate the unit. For example, here's what the eHelp says about enabling voice guidance as interpreted by my screen reader:

1. Set Voice guidance to On
   MENU
   Menu > Sound > Voice guidance settings > Voice
   guidance
   Select the menu using
   /
   and press
   Then, switch to On
   using
   /
   and press

Since the eHelp was not getting us very far, we searched online and found a getting started guide from the RNIB (Microsoft Word format). This guide describes an accessible method for enabling Voice Guidance, but unfortunately additional roadblocks stood in the way.

When turning on the new TV for the first time, you are presented with a set-up wizard where the user language, wireless network, and other options are configured. There appears to be no way to accessibly set up the DT-60, an unfortunate oversight. It's kind of like signing the deed to a new house but not being given the keys. It's a bit troublesome that the set-up process is often ignored when creating an accessibility interface. Perhaps the assumption is that a sighted friend would be around to help enable the feature? In any case, it's a trend we hope does not continue.

Upon completing the set-up process, a tutorial is presented on the screen and is also spoken. This is the first time that any voice feedback is given to a user requiring voice output. We were instructed to press OK to continue through the tutorial, which encompasses several screens. Unfortunately, the content of the tutorial itself was not very useful and once completed, we were left with a silent TV with no apparent way to make it talk.

We turned to the RNIB help file, which describes the layout for the remote and an accessible method for turning on Voice Guidance. To do this, we pressed the Option key and then pressed Down Arrow until the Voice Guidance menu was indicated by a beep. After pressing OK, the Voice Guidance menu was then displayed and spoken, and the settings could be controlled independently.

A few basic settings are available including three different voice speeds, a verbosity level (beginner or advanced), and three volume levels for the speech. The default voice was from Nuance, familiar to anyone using VoiceOver on an iPhone. This menu and its settings were well-described with plenty of hints for the beginner user on how to navigate and change options.

That's where our success in setting up the TV ended, however. On the main screen, several options are presented including Clock, Notes, Apps, and Set-up. But choosing any of these options resulted in no speech whatsoever. This meant that basic functions such as performing a scan of available channels or toggling the setting for Audio Description were not accessible. Everything that was right about the Options screen and its accessibility was missing from virtually every other menu on the television, a rather frustrating conclusion.

What Does Work?

Sadly, this section of the article is going to be much shorter than I had hoped. While I didn't expect all of the apps or Internet-connected features to work, I did operate under the impression that I would be able to perform most basic commands with the help of Voice Guidance.

Most of the buttons on the remote don't give feedback when pressed. Among the few that work are the Volume Up and Volume Down buttons, which announce the new level as a number. The button to switch video source between TV, HDMI 1, 2, 3, and Video also generally indicates the current selection when pressed. But most other buttons either gave no audible feedback or provided just a tone indicating a menu had popped up on the screen. The Menu button itself gave an audio message that Voice Guidance was not supported on this screen and instructed me to press Exit to return to the TV.

We mentioned above a feature called Voice Interaction, where you can use your voice to enter commands. Aside from the set-up of the special voice remote being inaccessible, the feature likely won't be of huge value to a blind person. This is largely because the search results will either lead to an inaccessible screen or Web page. It's possible to speak websites by highlighting text, but the remote is touch-screen based and not designed to be accessible.

Modern televisions have evolved from a box that receives and displays pictures. For example, the Panasonic model we tested includes a music player, photo viewer, and support for Internet-connected services such as Netflix. None of these features appeared to work with Voice Guidance in our tests.

The Bigger Picture

American TV viewers face additional accessibility challenges that cannot be solved by access to the television alone. Perhaps the biggest draw of an accessible TV for users in other countries is the availability of a talking Electronic Program Guide. On the UK models, the current show, time, and description are spoken when changing channels, and one can browse the guide to learn of upcoming shows and set reminders. But in the US, it's common practice to use a set-top box to connect to cable or satellite services. So while access to TV features is definitely needed, this same level of access will also need to be included on a variety of devices that receive digital signals.

Comcast is one of the first US companies tackling this problem. A recent article in the Philadelphia Inquirer describes a pilot project that provided talking set-top boxes to 20 local cable users for testing. The features are expected to be available to Comcast customers in 2014 and could potentially be licensed to other cable operators. Beyond this, the Apple TV remains one of the few devices with accessibility features builtin, including an accessible set-up process. Other companies will eventually need to follow suit to remain compliant with the law, but it's too early to tell how willing they will be to do so.

Conclusion

There is still much work to be done to create a totally accessible television experience. Panasonic should be commended for being the first to propose a solution to a lingering problem, though it's far from a complete solution in reality. Currently, we couldn't recommend one of the 2013 Panasonic models with Voice Guidance based on accessibility alone.

We often focus on the negatives of products to encourage further innovation and development. The shortcomings we discussed are not insurmountable hurdles, and many could be corrected with firmware updates of existing models. And since the law is now on the side of those needing access to these devices, we expect this to be only one of many advancements in the world of accessible television. It's our job as blind and visually impaired consumers of these devices to give constructive feedback and help shape the future of television for all.

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The June 2013 issue of AccessWorld discussed the difficulty many individuals with visual impairments have accessing the information printed on their over-the-counter and prescription medicine containers. In that same issue, I reviewed the ScripTalk Station, a prescription label reader available on free long-term loan from En-Vision America.

Over the past few months there has been significant movement on the accessible prescription label front. In this article I'll discuss recently published best practices guidelines for pharmacists, and review an upcoming technology solution, the Audio Talking Label from AccessaMed.

The Access Board Stakeholder Working Group

On July 9, 2012, President Obama signed into law the Food and Drug Administration Safety and Innovation Act. Section 904 of the act authorized the US Access Board to convene a stakeholder working group to develop best practices for making information on prescription drug container labels accessible to "people who are blind or visually-impaired or who are elderly."

In October of 2012, the Access Board formed an 18-member working group composed of representatives from the American Foundation for the Blind, the American Council of the Blind, the American Association of Retired Persons, and other national advocacy organizations, along with representatives from industry groups, including Walgreens, Wal-Mart, Express Scripts, and Target. The goal was to create and publish best practices guidelines for accessible prescription drug container labels, including "guidance to pharmacies on how to provide accessible prescription drug container labels to patients with visual impairments to enable them to manage their medications independently and privately, and have the confidence that they are taking their medications safely, securely, and as prescribed."

The completed best practices guidelines were published on the Working Group's web site in July of 2013, and the National Council on Disability is preparing an awareness campaign to inform consumers and pharmacists of these best practices. Currently, these best practices guidelines are just that: guidelines without regulatory enforcement or penalties for non-compliance. But after 18 months the Government Accountability Office will undertake a review to assess the extent to which pharmacies are following the best practices and identify remaining barriers to information on prescription drug container labels.

The Audio Talking Label from AccessaMed

Just as these best practices guidelines are being rolled out, a new accessible prescription label option is also about to be released. The Audio Digital Label will be available in early 2014 from Seattle-based AccessaMed.

Description and Use

The Audio Digital Label is a device shaped like a chewing-gum package, measuring approximately 2 inches high by 1 inch wide by .5 inch thick, that is affixed by the pharmacist to the prescription container. The sample I received from the company came affixed with its long side running vertically against a standard-size child-proof prescription bottle. The Audio Digital Label is attached to the prescription bottle with special tape from 3M that is used in construction projects to replace nails and screws. I twisted and pulled, but the seal was so tight, I sensed either the bottle or the label itself would break before the seal would fail. The label is made of sturdy, putty-colored plastic, and there are only two visible features: A tiny speaker grille on the upper portion of the outward facing side, and a single button at the very center.

Accessing the prescription data could not be simpler. Press the button once to begin the voice announcement. Press the button again anytime during playback to silence the reading.

My sample label used the Microsoft US Zira female voice speaking at 350 words per minute. After conducting user testing, however, the company will be switching to the NeoSpeech Julie voice prior to production.

The speaker plays at 70 decibels. Holding the bottle at arm's length, the sound was a bit tinny but the information was clear and easy to understand. It was also easy to hold the speaker directly against my ear cupped in the fingers of one hand, which left my thumb free to press the button and start the voice playback, which at this point was painfully loud. Overall, the voice was loud enough to be understood easily but not so loud that the prescription information could be heard across a room.

The label begins by announcing the patient's name and the name of the medication, followed by the dosage instructions. My sample bottle contained M&Ms, and I was advised to take two tablets three times a day. (Full disclosure: I may have strayed just a bit from the prescribed dosage and frequency.)

The above information was followed in succession by the prescription number, the fill date, number of refills, and the quantity of pills contained in the prescription. Then there was something new: a description of the physical characteristics of the medication. Here the pharmacist can enter information such as "liquid gel capsules," or "oblong white pill, medium-size." This is an extremely useful feature, especially for those with a number of generic medications whose size and shape can vary between refills because the pharmacy has changed suppliers.

The label concluded by voicing the expiration date, the manufacturer's name, and the pharmacy name and phone number. The entire label took nearly 30 seconds to voice, however the information users will most often want, the patient name and medication name, are the very first to be spoken, so with two presses of the button, one to start speech and another to stop it, it only takes a few seconds to make sure you are about to swallow the right medication.

The law states that prescription containers cannot be reused, so the labels are one-time-use, after which they should be disposed of, or even better, recycled with other electronic components. The label's Coin/Button Lithium Manganese Dioxide Battery boasts a ten-year shelf life, which is far longer than any medication should ever be kept. But that's if the container sits unused on a shelf. In actual, day-to-day use the battery provides over 400 complete voicings, so even if you have a 90-day supply of a medication you can safely expect between four and five complete voicings per day for the life of that refill.

Programming the Audio Digital Label

To program the labels, participating pharmacists use a special AccessaMed docking station that attaches to their computer via a standard USB cable. The docking station costs $20 and labels run about $3 apiece, which compares more than favorably to $1,000 for the ScripTalk Programming unit and software, and $1 each for their Talking Labels.

When the docking station is connected the pharmacist is given the option to program the Audio Digital Label with the same information to be printed on the medication container. The pharmacist can also include the physical description of the pills or tablets, and choose whether to include a letter-by-letter spelling of the prescription name to be voiced immediately after the name is announced. This is a must-have feature, in my opinion. Many medicines have long and confusing names. Others may not voice properly because of unique spellings or quirks with the text-to-speech engine. There are also a number of medicines with names that sound alike, no matter how clearly they are spoken. You would not want to accidently take Xanax anti-anxiety medication when the pill you really mean to take is a Zantac to help lower stomach acid.

The "Spell" option is checked or unchecked by the pharmacist, but in my opinion it should be mandatory. Confusion over the name of a medication simply does not have to happen.

The pharmacist can change the voice speed before sending the information to the label and affixing it to the container. If the AccessaMed user picks up a prescription from the pharmacy there will be the opportunity to review the label with the pharmacist and make voice speed changes and add spelling, if necessary. But what if a family member picks up the prescription, or the medicine comes by way of one of the increasingly popular mail-order pharmacies? It would be much better if reading speed could be controlled by the use, but I'm not sure if the current hardware would allow this without cost-prohibitive modifications. Besides, offering this option would require at least one additional control, which would detract from the label's marquee feature: its utter simplicity and ease of use.

The Bottom Line

It's great to see a new player in the accessible prescription label arena. Competition leads to innovation, and it's always good to have choices.

The AccessaMed Audio Digital Labels cost three times as much as the ScripTalk Talking Labels: $3 each as opposed to $1 each, but the startup costs for AccessaMed is significantly lower: $20 versus $1,000. Smaller pharmacies that serve only a few visually impaired individuals will doubtlessly find AccessaMed the better solution. Larger chain pharmacies and mail order services may discover the ScripTalk will actually cost them less in the long run. With just twenty visually impaired customers each refilling two prescriptions per month, the extra costs of the ScripTalk solution disappears after just over one year, and after that the less expensive labels become a definite cost advantage.

People who are deaf-blind and others who rely on braille will prefer the ScripTalk solution, since it offers a computer interface. Myself, I prefer the AccessaMed solution. It's quick and easy, I can get the information I need in mere seconds, and best of all, I do not have to own and maintain yet another piece of single-purpose access equipment.

Contact Information

Currently, the company plans to begin production during the final quarter of calendar 2013, and begin shipping to participating pharmacies in early 2014.

AccessaMed Inc.
208 West 13th Street
Vancouver, Washington 98660
360-696-5955
Fax: 206-243-0380

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