I am wondering if your institution is using an automated document conversion to alternate format system/service such as Blackboard Ally or SensusAccess.
I am not sure what other systems are available but would love to hear:
What document system or service you use.
Does it integrate with your LMS?
Is it also available to staff outside of the LMS?
Are there any pros or cons you would like to share?
Also, D2L, do you have an integration with SensusAccess? I think you were looking at this at one point.