A Multi-Tier Accessibility Evaluation Architecture for Healthcare Web Portals

Healthcare web portals have become essential platforms for appointment scheduling, medical record access, prescription management, and patient-provider communication. Despite their growing role in digital healthcare delivery, many portals continue to present significant accessibility challenges for users with disabilities. This paper presents a multi-tier accessibility evaluation architecture for assessing WCAG 2.1 compliance across sixty healthcare patient portals from major health systems in the United States, United Kingdom, and Australia. The proposed architecture combines automated accessibility scanning, keyboard-based workflow analysis, and expert manual inspection to identify usability barriers affecting visually impaired, motor-impaired, and cognitively challenged users. To quantify accessibility impact, the study introduces the Accessibility Barrier Index (ABI), a weighted metric that measures the severity and functional effect of WCAG violations across healthcare workflows. Experimental analysis reveals that 91.7% of evaluated portals contain at least one Level A accessibility violation, with missing form labels, insufficient color contrast, and keyboard navigation failures representing the most common issues. Results further demonstrate that automated tools alone fail to detect a substantial portion of workflow-specific accessibility barriers, highlighting the necessity of hybrid evaluation strategies. The proposed WCAG-Health Audit Protocol (WHAP) provides a scalable and repeatable framework for continuous accessibility monitoring and remediation planning in digital healthcare environments. The findings emphasize the importance of accessibility-centered healthcare architectures to improve digital health equity, regulatory compliance, and inclusive patient engagement.