Evaluating accessibility in telehealth platforms using heuristic review: A case study of the pathways application

As telehealth platforms become essential in healthcare delivery, ensuring accessibility for individuals with disabilities is critical. However, existing digital accessibility standards such as WCAG 2.0 and Section 508 are often difficult to apply and insufficiently enforced, particularly in real-world healthcare applications. This study evaluates the effectiveness of a newly developed set of ADA-aligned accessibility heuristics by applying them to the Pathways telehealth platform to identify usability barriers for people with disabilities. A heuristic evaluation methodology was employed using five trained subject matter experts (SMEs) in human factors and accessibility. SMEs independently evaluated the Pathways platform using custom heuristics organized under the POUR framework (POUR stands for Perceivable, Operable, Understandable, and Robust) (W3C, 2025). Each SME assessed both patient and provider interfaces, using screen readers and varied hardware/software configurations. Accessibility issues were rated by severity and analyzed qualitatively. The evaluation identified 44 unique accessibility issues: 38% rated as Critical, 31% as Major, 22% as Minor, and 6% as Minimal. Key barriers included unlabeled buttons, inaccessible navigation menus, improperly tagged content, and lack of alternative formats for audio and visual information. Most issues impaired screen reader usability and keyboard navigation. The findings confirm that heuristic-based evaluations are effective for identifying critical accessibility gaps in telehealth platforms. The results offer actionable recommendations and highlight the need for inclusive design practices in digital healthcare tools. These heuristics can serve as a practical and scalable model for improving ADA compliance across telemedicine systems.