The Centers for Medicare and Medicaid Services (CMS) is committed to ensuring that the Medicare and Medicaid Promoting Interoperability Program Registration and Attestation System (referred to as the Promoting Interoperability Program System in this Accessibility Statement) is accessible to the widest possible audience, regardless of technology or ability.
The Promoting Interoperability Program System aims to comply with §1194.21, §1194.22, §1194.31 and §1194.41 of the United States' 1998 Amendment to Section 508 of the Rehabilitation Act of 1973. These standards are intended to make web content and applications more accessible for people with disabilities.
CMS welcomes comments on how to improve the Promoting Interoperability Program System's accessibility for users with disabilities. If you have any questions or suggestions regarding the accessibility of the Promoting Interoperability Program System, or should you experience any difficulty in accessing this web application, please contact the Service Desk and provide:
- the URL (Web address) of the material you tried to access
- the problem you experienced
- the assistive technology (if any) you are using
- your contact information.
An Promoting Interoperability Program System representative will attempt to help you find the information you were seeking.
There are three objectives of Internet-based Registration and Attestation system: One is to allow Eligible Professionals and Eligible Hospitals to register for the Promoting Interoperability Program. The second is to attest and demonstrate meaningful use of certified EHR technology. The third objective is to provide a current and historic status of Registration(s), Attestation(s), and Payment(s) for the Promoting Interoperability Program.
Browser Settings and Features
A user may choose to change the accessibility options in their browser. Use the following links to learn more about the options Internet Explorer, Firefox, and Safari include to make things easier to see on the computer screen, or to adjust to your visual preferences:
- Internet Explorer 7 Accessibility Resources
- Internet Explorer 8 Accessibility Resources
- Firefox Accessibility Resources
- Safari Accessibility Resources
The Promoting Interoperability Program System interface is designed to promote usability and support the use of assistive technology. The following sections outline some specific design elements used throughout the web application.
Every Promoting Interoperability Program System page should be fully accessible with a keyboard; a mouse is not required. In other words, a user can use the keyboard to navigate through pages in the Promoting Interoperability Program System by selecting links, completing form controls, and using form buttons. The Promoting Interoperability Program System does not include any custom-defined access keys.
The Promoting Interoperability Program System uses only relative, scalable font sizes designed to work with a browser's text resizing options.
All primary pages in the Promoting Interoperability Program System have a consistent structure as follows (reading from top to bottom):
- "Skip to Main Content" link
- Global navigation area
- Heading at start of main content
- Global footer area
"Skip to Main Content" Link
The "Skip to Main Content" link provides a convenient shortcut to the main content of the page. The "Skip to Main Content" link allows users to bypass the global navigation links and quickly skip to the main content of the page. This feature may be helpful if you are a keyboard user, are using a screen reader or screen magnifier, or are viewing the site on a small screen. For example, this shortcut saves a keyboard user from having to tab through the global navigation links before they get to the core information (content) on the page. Similarly, screen reader users can jump their screen reader software to the start of the content without having to listen to the global navigation area on each page.
The "Skip to Main Content" link is hidden as the first link on Promoting Interoperability Program System pages that are displayed after the user logs into the application. When keyboard focus is concentrated on the link, the "Skip to Main Content" link text is visible to the left of the Medicare and Medicaid Promoting Interoperability Program Registration and Attestation System banner. Once the user tabs away from the link, the link text once again becomes hidden. Activating the "Skip to Main Content" link navigates the user to the heading for the main content.
Global Navigation Area
The global navigation area provides access to the Promoting Interoperability Program System Home page, Help page, and Logoff dialog box from any page within the Promoting Interoperability Program System application. The global navigation also includes a series of five tabs that allows the user to navigate between different components of the application.
Heading at Start of Main Content Area
Every Promoting Interoperability Program System page has a heading at the start of the main content of the page. This heading is always the first heading on the page. Additional subsection headings are also defined when there are multiple topics within the main content area. Any text visually distinguished as a section heading is also programmatically defined as such to help blind and low-vision users understand the structure of the page, and facilitate quicker navigation and understanding of the application.
If errors are found when you submit a data entry form, you will be taken back to the same page. A new messages section will appear at the start of the main content area. The section will be marked with the text "You must resolve the following error(s) to continue" and a list of error messages applicable to the page will follow.
In general, mandatory fields within a Promoting Interoperability Program System data entry form are indicated by an asterisk (*) at the beginning of the field label. Each page containing mandatory fields also has an explanation at the beginning of the main content area stating that "(*) Red asterisk indicates a required field."
Global Footer Area
The global footer area provides the user with links to the Web Policies and Important Links, Department of Health & Human Services (HHS) website, CMS website, and the Promoting Interoperability Program System Accessibility Statement. It also provides the address for the Centers for Medicare and Medicaid Services.
Text equivalents are provided for all images to aid users who listen to the content of the system by using a screen reader or Braille display, rather than reading the site. Text equivalents also benefit users who, due to slow download speeds or security concerns, choose to disable the display of images in their browser.
Use of Cascading Style Sheets (CSS)
CSS is used to control some visual formatting and presentation in the Promoting Interoperability Program System. Promoting Interoperability Program System pages are not designed to interfere with user-defined style sheets. Moreover, if your browser or browsing device does not support style sheets at all, Promoting Interoperability Program System pages are readable and understandable (i.e., no content is lost) when the associated style sheet is turned off. A screen reader can read the page content.
Use of Tables
The Promoting Interoperability Program System uses some "layout tables" to control the visual layout of the pages. As a result of the table-based layouts, non-JAWS screen reader users may have to listen to their screen reader detect this information. However, screen reader users can distinguish between the presence of actual data tables used for presenting and tabulating data versus layout tables. For actual data tables, summary text descriptions and table column headers are used to help screen readers make sense of table structures. For layout tables, neither summary text nor table headers are provided.
Links That Open a New Browser Window
On some pages, text links or graphic links will trigger a new browser window to open. Text links that open a new browser window are denoted as follows:
- A small icon ( ) appears after the link text to indicate that the link will open in a new browser window.
- The icon's alternative text is defined as the phrase "Opens new browser window".
For security purposes, the Promoting Interoperability Program System times out after 30 minutes of inactivity. Once the session has been inactive for 25 minutes, a dialog box displays to notify the user that they are about to be timed out. The dialog box states "Your user session is about to expire due to inactivity. Would you like to extend your session" The user should select the Yes button to extend their session. If the session inactivity reaches the 30 minute mark, the user is logged out and any unsaved data is lost.
JAWS Virtual Cursor
Text in a web page is very much like the static text in a Windows status message. The PC Cursor cannot move to this text as there is no insertion point. The JAWS Cursor can access this text, but this is not the most effective way to access larger documents such as those often found on the World Wide Web. When using Internet Explorer 5 or later (or programs that tie into the core components of Internet Explorer), JAWS provides the Virtual Cursor to simulate an insertion point. This provides you similar functionality to that found in any word processing document. Read text by word, line, sentence, or paragraph, or select and copy text to the Windows clipboard. The Virtual Cursor is active by default in applications that support it. If you switch to another cursor, press NUM PAD PLUS to make the Virtual Cursor active again. You can turn the Virtual Cursor off entirely, but this seriously limits functionality. Toggle the Virtual Cursor on and off by pressing INSERT+Z.
Routing the Virtual Cursor to the PC Cursor
Press INSERT+DELETE to route the Virtual Cursor to the PC Cursor. Using this command moves the Virtual Cursor to the current location of the PC Cursor. This makes using Web forms easier, and is also useful on pages where a form control is automatically made active when the page loads.
Routing the PC Cursor to the Virtual Cursor
You can press CTRL+INSERT+DELETE to route the PC Cursor to the Virtual Cursor. Using this command moves the PC Cursor (and the application focus) to the current location of the Virtual Cursor. Visually, the page will scroll so that the area containing Virtual Cursor is visible on the screen. This command is the opposite of the Route Virtual to PC Cursor command (INSERT+DELETE).
Routing the Virtual Cursor to the JAWS Cursor
You can press INSERT+NUM PAD PLUS to route the Virtual Cursor to the JAWS Cursor. Using this command moves the Virtual Cursor to the current location of the mouse pointer and can help sighted users navigate Web pages.