Epic Fail

Atul Gawande describes the Epic software system being rolled out in America’s hospitals.

It reads like a  potpourri of everything bad about enterprise IT. Standardize on endpoints instead of interoperability, Big Bang changes instead of incremental improvements, and failure to adhere to the simplest principles of usability.

The sad thing is that the litany of horrors in this article are all solved problems. Unfortunately, it seems that in the process of “professionalizing” usability, the discipline has lost its way.

Reading through the article, you can just tally up the violations of my proposed Usability Heuristics, and there’s very few issues described in the article that would not be eliminated by applying one of them.

The others would fall to simple principles like using battle-tested standards (ISO timestamps anyone?) and picking the right level of database normalization (it should be difficult or impossible to enter different variations of the same problem in “problem lists”, and easier to elaborate on existing problems).

There was a column of thirteen tabs on the left side of my screen, crowded with nearly identical terms: “chart review,” “results review,” “review flowsheet.”

I’m sure the tabs LOOKED nice, though. (Hint: maximize generality, minimize steps, progressive disclosure, viability.)

“Ordering a mammogram used to be one click,” she said. “Now I spend three extra clicks to put in a diagnosis. When I do a Pap smear, I have eleven clicks. It’s ‘Oh, who did it?’ Why not, by default, think that I did it?” She was almost shouting now. “I’m the one putting the order in. Why is it asking me what date, if the patient is in the office today? When do you think this actually happened? It is incredible!”

Sensible defaults can be helpful?! Who knew? (Hint: sensible defaults, minimize steps.)

This is probably my favorite (even though it’s not usability-related):

Last fall, the night before daylight-saving time ended, an all-user e-mail alert went out. The system did not have a way to record information when the hour from 1 a.m. to 1:59 a.m. repeated in the night. This was, for the system, a surprise event.

Face meet palm.

Date-and-time is a fundamental issue with all software and the layers of stupidity that must have signed off on a system that couldn’t cope with Daylight Savings boggles my mind.

A former colleague of mine linked to US Web Design System as if this were some kind of intrinsically Good Thing. Hilariously, the site itself does not appear to have been designed for accessibility or even decent semantic web, and blocks robots.

Even if the site itself were perfect, the bigger problems are that (a) there are plenty of similar open source projects, they could have just blessed one; (b) it’s a cosmetic standard, and (c) there’s pretty much no emphasis on the conceptual side of usability. So, at best it helps make government websites look nice and consistent.

(To be continued…)

Lost Productivity

A couple of months ago I listened to a Planet Money podcast discussing the mysterious slowdown in US productivity growth (the link is to one of several podcasts on this topic). Like most NPR content, the story got recycled through a number of different programs, such as Morning Edition.

The upshot was, that productivity — which is essentially GDP/work — has stalled since the — I dunno — 90s, and it doesn’t make sense given the apparent revolutions in technology — faster computers, better networks, etc.

Anyway, the upshot — and I’m basing this on memory because I can’t find the exact transcript — is that there’s a mysterious hole in productivity growth which, if it were filled, would add up to several trillion dollars worth of lost value added.

Well, I think it’s there to be found, because Free Open Source Software on its own adds up to several trillion dollars worth of stuff that hasn’t been measured by GDP.

Consider the dominant tech platforms of our time — Android and iOS. Both are fundamentally built on Open Source. If it weren’t for Open Source, iOS at minimum would have been significantly altered (let’s assume NeXTStep would have had a fully proprietary, but still fundamentally POSIX base) and Android could not have existed at all. Whatever was in their place would have had to pay trillions in licenses.

On a micro level, having worked through a series of tech booms from 1990 to the present — in the 90s, to do my job my employer or I had to spend about $2000-5000 for software licenses every year just to keep up-to-date with Photoshop, Director, Illustrator, Acrobat, Strata 3d, 3dsmax, Form*Z, and so on and so forth. By the mid aughts it was maybe $1000 per year and the software was So. Much. Better. Today, it’s probably down to less than $500.

And, in this same period, the number of people doing the kind of work I do, is done by far more people.

That’s just software. This phenomenon is also affecting hardware.

The big problem with this “lost productivity” is that the benefits are chiefly being reaped by billionaires.

Fixing Healthcare.gov

healthcare.gov sign in page

On my way into work today I heard various pretty intelligent critiques of healthcare.gov and realized that the fix is easier (and the existing site stupider) than I ever expected.

The key points are:

  • The IRS provides a service for verifying a person’s income to mortgage vendors.
  • The actual signup for a plan is (I assume) in fact a transaction between a person and a private company that presumably has a website (or phone number) for signing you up, handling security, etc.
  • So the only job healthcare.gov has to do is tell you what products are available to you and how much they cost. And, modulo disclaimers, it probably doesn’t even have to be right.

As someone on NPR pointed out, the job is very similar to selling mortgages through a site like Lending Tree or Quicken Loans. You enter the value of your house, the amount you owe, and your credit score, and you get given an estimate whose accuracy depends on the accuracy of what you put in. If you close the deal, the figures you enter are verified by the actual lender.

So, healthcare.gov basically needs to know the price structure of the plans it is dealing with (this presumably is quite complicated, but not hideously so), and the location of the applicant. It can work with guesstimates of everything else (but there’s an existing IRS service to provide exact figures if needed). So you need a couple of simple web pages that ask the following questions:

  1. Where do you live?
  2. How much do you (and your spouse) make?
  3. How many people do you want to cover?
  4. Do you get health insurance through your employer?
  5. Based on the answers, here’s a list of available plans and their prices.
  6. Click on a button to apply for a specific plan (handed off to vendor website).

This is a little oversimplified, but only a little. (I’ve implemented life insurance application processes — and most of the things that feed into those calculations are expressly not factored into Obamacare health plans — Life Insurance is all about discriminating on the basis of pre-existing conditions.) Without income verification, this could all run client-side from static HTML. It would be technically simpler than the sign-in page shown above. Fixing this fiasco in a few weeks with a team of a dozen people is actually perfectly realistic. Fixing it with hundreds of the “best and brightest”, however, suggests that the wrong approach is being taken to the wrong problem.

It’s time for a change: Adobe jumps the shark

Grant will get you one month of Adobe Creative Cloud with an annual commitment
Grant will get you one month of Adobe Creative Cloud with an annual commitment

I love Adobe and its products, despite their eccentric UIs, awful installers, and the mystery that is Bridge. The fact is Adobe knows its shit and does it better than anyone else. However, while for many years I considered myself a “power user” of Photoshop and competent enough with Illustrator, the capabilities of Photoshop have long outstripped my needs, and Adobe’s marketing team has done a remarkable job of alienating me with pricing shenanigans.

My first experience with Adobe Software was learning to use Illustrator 88 in a production environment — mainly tracing logos. I was introduced to Barneyscan (the program that became Photoshop) when the multimedia startup I joined acquired a Barneyscan Slide Scanner. We soon discovered that Barneyscan was actually a very capable graphics program that was better for handling 24-bit color images such as scanned photographs than anything else on the market.

Then Fractal Painter and Color Studio came out and, briefly, it was a three horse race. When Photoshop introduced, in quick succession, a better implementation of Painter’s layers and editable text layers, the competition fell by the wayside. Other competitors, e.g. Macromedia’s ill-fated xRes, the amazing Live Picture, and Microsoft’s Expression Studio, came and went.

Despite its many virtues, I couldn’t justify buying my own copy of Photoshop until it started being bundled with scanners. I literally paid $500 for a scanner and didn’t use the scanner in order to get Photoshop 4. Adobe’s upgrade pricing led to my upgrading Photoshop as each new version came out until Adobe got me to upgrade to Creative Suite for not much more than the cost of just upgrading Photoshop, but then made further upgrades horribly expensive (and also made skipping versions very expensive). My last CS purchase was CS4 Web Pro academic (I was working for a University at the time) just after Adobe announced that anyone buying CS4 would receive a free CS5 upgrade.

Over the years, Adobe’s other applications rose and fell in my esteem. I used Premiere for years, and once found After Effects to be an unbeatable combination of power and usability — I haven’t touched either in years, and Apple’s $50 Motion does everything I need. (Indeed, I don’t have any use for Final Cut Pro, either.)

Now Adobe is essentially offering us three options: pay $50/month to get access to all Adobe software, pay $20/month to get access to Photoshop (both require one year commitments, it’s higher if you go month-to-month), or somehow get academic pricing for $20/month to get everything. The plans also come with 100GB of cloud storage (which would cost you $10/month on its own from Dropbox — of course Dropbox’s 100GB is a lot more flexible).

So for me, that means it’s time to kiss Adobe good-bye. (Except for Adobe Ideas of course — I love Adobe Ideas.)

Alternatives to Adobe’s key products

  • Photoshop: Acorn (Mac), Photoline (Mac/Windows), Pixelmator (Mac), Paintshop Pro (Windows), Painter (Mac/Windows)
  • Illustrator: Inkscape (Mac/Windows/Linux), iDraw (Mac), CorelDRAW (Windows), Intaglio (Mac), Lineform (Mac), Artboard (Mac), ZeusDraw (Mac), EasyDraw (Mac)
  • Dreamweaver: a good text editor (e.g. BBEdit (Mac), Sublime Text (Mac/Windows), Vim) or web-centric IDE (e.g. Webstorm (Mac/Windows), Coda(Mac))
  • Fireworks: no direct replacements that I know of, but UI-oriented graphics apps like Sketch (Mac) seem like replacements to me.
  • InDesign: Pages (Mac), TeX or Latex (Mac/Windows/*nix) or even Quark XPress (Mac/Win).
  • After Effects: Motion (Mac), or one of the fire-related products (Inferno, Flame, Flint, Combustion, Smoke, etc.)
  • Edge: haven’t used it, but I’m guessing something like Hype (Mac) or learn to use CSS and jQuery.

Chances are, if you’re a hardcore InDesign or After Effects user, you probably pay Adobe $600/year for the privilege and the new pricing policy doesn’t faze you. The problem you need to worry about is just how badly is Adobe going to hurt itself by its new pricing policy, because I suspect that the new pricing policy will convince a lot of people to live without Adobe for as long as possible, which will turn out to be forever.

Adobe is bucking a big trend — software is getting cheaper and more powerful — and a major perception issues — most people hate recurring expenses. See, I can splurge on a big software purchase because I’m flush with cash or have a big check coming in or some kind of weird justification. I don’t think of a $2000 camera purchase as, say, $55/month based on my using the camera for three years. No, I think of it as “can I afford a $2000 camera?” If you tried to sell me a camera that was just as good as my $2000 camera for $55/month with a one year commitment, I’d probably laugh at you. Do I need to pay as much for my camera as I do for cable internet? No way!

I strongly suspect this move by Adobe will be catastrophic. At this point in their old marketing cycle they’d be offering free upgrades to any new buyers of CS6 — instead they will at most be getting a few $50/month subscriptions. Next, they’d be offering time-windowed discounts on the new suite once it shipped. That’s not going to happen. So at best they get slightly more money than they’d have gotten with their old model, only spread out over twelve months. How likely does anyone think this is? I suspect they’ll instead get less money spread over a longer period. And they run the very significant risk of simply losing customers the way, say, Netflix did with its Quickster fiasco. My CS works fine, I’ll think about the Adobe cellphone plan when I need to. The difference here is that, as far as I can tell, time isn’t on Adobe’s side the way it, arguably, was with Netflix. Streaming video on demand is the way of the future, so Netflix (and Hulu) can probably afford to stumble. Adobe is the king of print media and web worst practices — it probably can’t afford too many mistakes.

Natural Justice and Patents

In Minority Report, Tom Cruise uses a multitouch interface that requires special gloves to operate, removable media to transfer data, and an elaborate two-handed gesture to zoom an image.

It’s pretty hard to find any vaguely balanced commentary on the outcome of the Apple v. Samsung trial that concluded yesterday. I agree with the verdict, so let’s get that out of the way. So don’t expect any vaguely balanced commentary here.

The general arguments I see in favor of Samsung / Android / Google are:

  • Apple’s patents are all trivial and shouldn’t be patents at all OR someone else invented them first (go check out the DiamondTouch video)
  • Apple is being anti-competitive and people will pay more for smartphones because of the decision
  • It’s bad for innovation because Apple will sue little guys who innovate

When Fingerworks patented a whole bunch of “trivial” multitouch technology Apple didn’t think it was too trivial to patent. It didn’t simply steal and imitate the ideas. It bought the company, hired its key people, and acquired its patents.

I remember back in the early days of the web when Amazon got the “one click purchase” patent. A lot of people (myself included) thought this was pretty ridiculous. By the time Amazon was awarded the patent, it seemed “obvious” — but bear in mind that Amazon had made it obvious with many smaller and less obvious innovations (e.g. when it asked you to provide credit card details there was a link with “click here to find out why this is safe” next to the field).

Apple’s reaction to the patent: it licensed it.

I have worked with touchscreens and stylus devices, on and off, for nearly twenty years before the iPhone came out. I can’t say that pinch-to-zoom was “obvious” to me. For that matter, Apple had been developing touch and multi-touch devices for, by all accounts, even longer and it didn’t occur to them until 2005. The fact it seems so obvious in retrospect just goes to show how valuable an idea it is. Of course you can’t patent “ideas”, but you can patent embodiments, and Apple did.

Similarly, Apple patented the rubbery spring-back effect. Not only is this not obvious (does anyone do it with their mousewheel drivers? Anyone? No) but there are perfectly satisfactory alternatives (the Nexus 7, by which I assume vanilla Android 4.1, has a page-curl and glow effect that communicates the same idea just as effectively; the Kindle Fire does something cruder along the same lines). Indeed, it looks like Samsung took an OS from Google that had a perfectly satisfactory and original mechanism for visually representing over scrolling and replaced it with a deliberate imitation of Apple’s mechanism.

Apple is being anticompetitive. It has invented a bunch of stuff and patented it. The patent system is designed to give inventors a temporary, unfair advantage in selling goods based on original inventions. This is not bad for innovation — without it there would be little incentive to innovate, and no incentive to publish innovations.

What the Apple-is-a-big-bully-I-love-Android (I think the acronym is NAMBLA) folk want is a free OS that has all the good things that Apple has invented in it, ideally in a device that looks a lot like an Apple device. They want these things but they don’t think they (or Google or Samsung) should have to pay for or license them or wait for the patents to expire because these inventions and designs are “obvious” and unworthy of patent protection. We can tell that Apple’s IP isn’t worthy of patent protection because the Android vendor which has gone the furthest in shamelessly copying it has done so poorly in the marketplace. Oh, wait.

Anyway, I think Apple should take its winnings (if it ever gets them) and donate them to a cause that solves real problems, like MSF. It might even help recover some of the goodwill it has burned through its lawsuits. (Heck, it’s how Bill Gates atoned for his behavior.)