In what was heralded as a watershed moment in the movement for greater and more meaningful web access for those with disabilities, last April, Staples, the world’s largest office supply company, entered into an agreement with several advocacy groups for those with disabilities to make improvements to its website that will benefit people with disabilities—chiefly of the visual sort. According to the terms of the settlement, in addition to making several enhancements to their brick-and-mortar stores in order to accommodate shoppers with certain disabilities, Staples agreed to bind, more or less, the development of its website, www.staples.com, to the Web Content Accessibility Guidelines put forth by the World Wide Web Consortium (W3C). Staples agreed to have in place the checkpoint one and checkpoint two guidelines by June 2009, and to ensure that going forward, any changes or enhancements made to the site would comply with W3C accessibility guidelines.

In the brick-and-mortar world, the need to provide equitable and unfettered access to those with disabilities is a bit more obvious than it is in the virtual world; after all, the virtual world is principally a visual medium—to a lesser extent an aural one, and to an even lesser extent a tactile one. As a natural extension of its native environment, the web-based world is a virtual Valhalla for visual designers; arguably, the best of the breed now do their best and most revolutionary work within the borders of a browser. From a facile standpoint, it may seem to the casual observer that strict adherence to accessibility guidelines might only hobble visual designers and prevent the best work from being done. But after careful consideration, it soon becomes apparent that this is not the case, and that adhering to accessibility standards actually makes good visual design even better. Throw in the notion that accessibility standards also strengthen the code and provide some business benefits as well, and suddenly it makes little sense not to design with accessibility in mind.

From an information architecture standpoint, you can go a long way towards meeting a good portion of the W3C accessibility guidelines by designing with screen readers in mind. A screen reader, like JAWS, paints an audio version of a web site for those with visual impairments. Because a screen reader concocts things like navigation schemes based on words rather than pictures, it’s incumbent on the designer to supply good content—and well-ordered content—in order to provide the screen reader with the fodder it needs to construct a website’s framework for visually-challenged users. While a quick visual scan can tell most sighted users how good or how bad an information architecture has been constructed, a quick aural scan goes one step further by eliminating things that sighed users take for granted—like page placement and visual patterns—to see if the information architecture still sticks together. If it does, through a screen reader, the web page sounds like a concise, non-repetitive, well-ordered entity. If it does not, through a screen reader, the web page sounds like a cluttered, repetitive mess.

Coding for accessibility standards largely means going back to basics: things like closing all tags, stripping formatting elements from the code and putting them in a CSS file instead, and providing meaningful ALT tags for all images—religiously. Dovetailing onto this notion, coding for accessibility makes great business sense, for it also has the added benefit of providing better search engine optimization. When you think about it, this makes perfect sense. Accessibility standards attempt to open the web up to users who are encumbered by physical or technological standards; a search engine processing algorithm is much the same thing. It cannot “see” visual media, it cannot “hear” audio media, it cannot comprehend clips of code. Therefore, by providing ALT tags for visual and audio media—especially meaningful tags that truly represent the media and the reason it’s included in the design—coders and designers can give search engine algorithms the sort of understanding and context it needs to index a site correctly, thereby increasing the chance of the site popping up near the top of a set of search results. Thereby exposing a site to an even greater audience.

In essence, accessibility standards bolster standard good design practices, and almost invariably, good design practices leads to better business. Rather than encumber development and hobble creativity and innovation, accessibility standards provide the essential foundation and framework from which features and functionality can flourish to make the world a better place for all users, not merely those unencumbered by limitations of one sort or another.

One of the most critical stages of turning an idea—a figment of your imagination—into a real-world product or application is the prototyping stage. Here at Makibie, we typically create prototypes shortly after or sometimes even in parallel with the wireframing stage, as we employ a modified agile development process to get tangible ideas and working software in front of our clients as soon as possible.

Why do we do this? Because just like good authors know “showing” makes for better storytelling than, well, “telling,” conveying the merit of an idea or a concept is much easier and much more effective if the audience has something tangible in front of them that allows them to grasp, or visualize, the idea or concept wholly independent from your pitch. Think of the Socratic method: learning is much easier, and the concepts learned are more readily absorbed and remembered, if the teacher gently guides his or her students to the promised land rather than preaches to them or lectures to them. A good prototype does much the same thing: it sells the audience on your concept by immersing them into it, by allowing them to draw their own conclusions about it. The better the prototype, the better the impression your idea or concept will make on your audience.

You can get a good deal of mileage out of a good prototype. Essentially, a prototype serves three distinct purposes: two of them obvious, at least from the perspective of a design firm, and one of them too often overlooked, but essential if you want your idea or concept to succeed in the marketplace.

First off, a good prototype is an essential element of a good design process, especially in the conceptual design phase and immediately thereafter. A good prototype is a workable, functional, clickable, hands-on, tangible thing that conveys your idea or concept so well that your audience can buy into it without having to guess at its finer points. Even if your prototype at this stage is nothing more than a series of clickable image maps, it’ll help you and your team shake out some of the finer points of the design, including all-important elements like workflows and processes. Though your prototype doesn’t have to be fully functional at this stage—in fact it would crazy to invest time into coding it from soup to nuts—it’s a very good idea to slice your prototype vertically and make certain parts of it, or certain workflows or processes, fully functional, especially if by doing so you can demonstrate a new and innovative use of technology. Especially if by doing so you can demonstrate a combination of data points or a streamlining of functionality that simplifies the information architecture, and can prove to the technical people that hurdles can be overcome.

Second, a good prototype is essential for usability testing. Usability testing, of course, is a vital element of the design process, as it validates or invalidates your idea’s or your concept’s design against the purpose it was designed to serve. The better your prototype, the better the results you’ll receive from usability testing.

Finally, the often-overlooked advantage of a good prototype: it serves as the foundation for a sales demo that you can use to validate your idea or your concept in the marketplace. As before, when you mold your prototype into sales demo form, it doesn’t have to be fully functional, but it should be functional enough to give your sales force the ammunition they’ll need to sell your concept in the marketplace, or at least test your idea or concept in the marketplace. After all, in addition to its primary purpose—selling—a sales demo serves as an unparalleled litmus test you can use to see how features and functionality resonate in the marketplace. Once you know which features and functionality the market really wants, you can make your idea or concept that much better.

If Google CEO Eric Schmidt’s crystal ball is good enough to predict the future five years out, here’s what we could be looking at, news delivery-wise, a scant half-decade from now. Cue the wavy lines.

You’ll be holding some sort of portable device in your hands—a tablet, a smart phone, some sort of hybrid—who knows? In any event, on this portable device, the great electronic volksgemeinschaft we call the internet will deliver to you, one story at a time, content from your favorite newspapers and magazines; the images crisp as if they were delivered to you in old fashioned tangible print, sans excessive load time. Not only that, since the device knows who you are, what you like, and what you’ve already read—or presumably viewed—it serves up, automatically, stories related to or pertaining to the one on which you’re currently grooving. You like the suggestion, you check the box, a la Pandora, and the magical newsreader in your excited little mitts learns and loves you just a bit more.

In Schmidt’s model, some of the content delivered to you is handled via a monthly subscription package, while other content consists of the pearls and cockleshells you discover on your own, perhaps through search engines like Schmidt’s own Google. Some of that content would be delivered to you free of charge, while some of it would cost pennies to purchase—the purchase, of course, would be handled seamlessly. And since there’s no such thing as a free lunch (the oldest saws are usually the truest ones), that free content will be delivered to you encased in a neat package of advertisements, albeit ads “tailored” just for you.

An aside: ads “tailored just for me?” I hate to break this to Mr. Schmidt, admittedly a more accomplished man than yours truly, but in all my years of consumer consumption, I’ve never once sought out an ad or appreciated it because I felt it was “tailored just for me.” I have always been somewhat resentful of advertisements, and I suspect I’m not in the minority. Advertisers may want to believe, deep in their hearts, that what they produce is appreciated by their audience—at least on some level—probably a very schlocky one. But let’s be honest: ads are rarely anything but unwelcomed interruptions. To pretend otherwise is to engage in the grandest of self-serving delusions.

Enough of my digression, and back to my main train of thought. The aforementioned waxing rhapsodic was brought to you by Eric Schmidt courtesy of an op ed piece published earlier this month in the Wall Street Journal; a bit of irony in and of itself in that the future of news found it fit to opine on the future of news using the industry’s horse-and-buggy as a delivery model. Schmidt’s piece came shortly after news broke that Google will make it easier for publishers like the Wall Street Journal to block their material from Google News automatically, simply by adding code to their websites instead of having to contact Google via an online form. Google also recently announced that it would allow publishers to set a daily limit on the number of articles users can read for free via the Google search engine.

Content publishers, in other words, feel that they’re being short-sheeted by Google News, and in some ways they have a point. If their content is scoped and presented in a forum other than the one in which it was produced to appear, is that not akin to stealing? Content, after all, is eyeball candy, and content producers are producing it, and Google is replicating it, for the same reason: to get eyeballs on advertisements, albeit in addition to the altruistic things that content does as well, i.e., inform the reader. Sure, Google may point readers to content they may not have discovered otherwise on their own, and thereby benefits content producers by giving them a larger pool of eyeballs, but that presumes the reader is not too lazy to click through to the content source—these days not a safe bet.

The whole conundrum reminds me of the Great Napster Wars of the earlier part of this decade and the latter part of the last. Before the masses caught up with the paradigm, an intrepid internet crawler could, basically, access virtually any bit of music that someone had taken the time to digitize and make available on his or her computer . . . the exchange was free, and the quality of the music was good enough to satisfy all but the biggest of audiophiles. But soon, the sweet set up hit a critical mass; critical enough to cause a sucking chest wound in the record industry, a wound from which they have yet to recover—and perhaps never will.

The blow to the industry was cataclysmic enough for Apple to enter, stage left, and change the paradigm forever with its iTunes service. By componentizing music into a basic, bite-sized, consumer-friendly piece—the individual song—and by selling that piece at a reasonable price, iTunes changed, permanently, the way in which people buy music. No longer are consumers forced to buy the whole enchilada—we buy what we want, and no more than what we want. Unless we are dumb.

Something very, very similar to what happened to the music industry is going to happen to the news industry, and the iTunes model presents an interesting take. One can easily foresee a time where news content is provided on a subscription model, albeit one where the individual, consumable pieces of news—perhaps componentized into a “story” of a thousand words or less (like this piece)—costs far less per bite than Apple’s $0.99, because a news story is not something the average consumer goes back to time and time again, like a song. The subscription model may very well be like Napster or Rhapsody’s model: pay a set price per month and get unlimited access to a pre-defined set of content.

So Schmidt’s crystal ball, friends and neighbors, is probably precisely right. But that should scare him, and perhaps that’s why Google made concessions to content producers earlier this month. For if Schmidt’s right, and the people of the future are willing to pay subscriptions to access good content, their need for Google as a discoverer of news content goes right out the window. For, as Richard MacManus writes in a brilliant piece for ReadWriteWeb, Google’s being infiltrated on a vast scale by content farms. And that’s precisely the seaweed that will foul their screws if they allow it to continue for much longer.

Web 2.0, a term coined by Darcy DiNucci in her 1999 article “Fragmented Future,” describes the then-nascent rumblings of an internet disconnected from screenfuls of text and graphics loaded into a browser into an interconnected transport mechanism where all sorts of interactivity takes place—on the computer screen, the television set, the car dashboard, the cell phone, the hand-held gaming device—basically anywhere. Since the term was coined a decade ago, Web 2.0 has emerged as a sort of connectivity paradigm based on social networking, information sharing, interoperability, user-centered design, and collaboration.

Web 2.0 revolution was slow to gain a foothold in the world of enterprise software, for enterprise software, after all, is based, traditionally, on a paradigm of centralization and control—the very paradigm Web 2.0 tears down in all its Wild West glory. As Web 2.0 emerged from the grand world wide web proving grounds as the standard-bearer for software development, in the enterprise space there emerged a dialectic of Hegelian proportions: a thesis of centralized, control-based enterprise software challenged by an antithesis of Web 2.0 decentralization and sharing. From the clash has emerged the synthesis we now call Enterprise 2.0.

Enterprise 2.0 applications—the next generation of enterprise software development—represent a great leap forward for the enterprise in terms of scalability, modularity, interoperability, user productivity, and enjoyment. But what makes an application an Enterprise 2.0 application? Here’s our take.

An Enterprise 2.0 application is 100% web-based. It has a properly-modeled object-oriented design and architecture, and is multi-tenant and multi-client. An Enterprise 2.0 app has easy, robust configurability, and a rich toolset associated with it that makes administration and management easy. An Enterprise 2.0 app is measurement-ready, because metering and analytics are built into its DNA. An Enterprise 2.0 app is role-based, secure, and offers a persona, private experience for each user. It’s compliant with modern integration standards, and has documented, re-usable APIs and web services that make third-party integration a snap.

In terms of design, an Enterprise 2.0 app is crafted to take advantage of all appropriate business channels, including—but not limited to—the web, the phone center, advisors, devices, and brick-and-mortar establishments. An Enterprise 2.0 app requires no training because it’s simply usable right out of the box. It has a flat, interactive information architecture that’s designed with a customer-centered focus for all types of people.

But what’s customer experienced-centered design? It’s customer-focused, of course, but it goes several steps further to consider the entire customer experience as a whole. It’s based on real-world user scenarios and goals, not a laundry list of features and functionality concocted in a board room or a focus group. Car owners, for example, love cup holders, so car manufacturers typically build cup holders into every nook and cranny of a car’s interior. But just because car owners love cup holders doesn’t mean they’re looking for cup holders in the trunk.

Customer experience-centered design meets business goals because the criteria for success, and the means to measure it, were determined up front, before anything was wireframed or coded. And that makes the CFO happy, because customer experienced-centered designs are feasible, supportable, and implementable. They delight customers because they predict which way the market is going, then deliver on market expectations in an elegantly simple way. They are intuitively usable because their engagement model is flat, fluid, and based on warm, two-way interactions between the interface and the user.

What does Enterprise 2.0 and customer experience-centered design mean for business? At Makibie, we’re excited to be on the bleeding edge of Enterprise 2.0 and customer experience-centered design because it allows us to deliver real business value up front—and quickly at that. After all, in an increasingly-crowded marketplace with little differentiation in service models, features, and functionality, applications that make doing business easier for enterprises and customers alike can lead to real competitive differentiators that can transform a company into a real market leader and innovator . . . not just another dog in the pack.

In a recent interview with Healthcare Informatics Editor in Chief Anthony Guerra, Jeff Cash, CIO of Mercy Medical Center in Iowa, presented an interesting conundrum vis-à-vis the American Recovery and Reinvestment Act of 2009 (ARRA) and its push to drive American hospitals towards Computer Physician Order Entry (CPOE) systems. The conundrum is particularly interesting because it illustrates, yet again, how the Federal government’s favorite go-to solution—throwing cash at a problem—often leads to unintended consequences.

In a nutshell, the Federal government wants to encourage hospitals to use CPOE systems because let’s face it: digitization is the wave of the future, and in the long run, it’s probably best if we all get used to it sooner rather than later. To encourage hospitals to adopt CPOE, the Feds made available dump truck loads of ARRA cash (i.e., American taxpayer money) to those hospitals that mandate CPOE. To punish hospitals that didn’t mandate CPOE, the Feds degraded the Medicare payments that hospital would receive. In other words, go CPOE and we’ll give you stimulus money; forego CPOE and we’ll slash your Medicare payments.

Mandating CPOE, therefore, seems like a no-brainer. As always, however, when things seem the simplest, therein lies the rub. CPOE, as it turns out, is extremely difficult to implement for a host of different reasons, many of which are familiar bug-a-boos in the IT world: costly hardware, scalability and infrastructure issues, cumbersome interaction models, proprietary systems that limit interoperability, and unintuitive user interfaces. Let’s not forget well-meaning but hand-cuffing regulatory pressure as well, for example a regulation that an actual physician, and no one else, be the one to enter data into the front end of a CPOE and “click the button” to make it official. The regulation seems well-intentioned, of course: you wouldn’t want an order enacted that wasn’t checked, double-checked, blessed, and Amened by a physician, for if it were otherwise, the whole system would be ripe for all sorts of exploitation, nefarious and otherwise. But couldn’t a qualified and certified medical assistant do 99% of the legwork, and then just have it approved by the physician?

Precisely at this juncture is where Cash has the gall to mention the 800 pound gorilla sitting directly in the middle of the room, and it goes something like this. A certain demographic of physician, particular the senior set, is never going to be comfortable with CPOE. Neither is the demographic that simply won’t adapt to CPOE because the systems themselves are too much of a hassle. What are the anti-CPOE physicians going to do? They’re going to affiliate themselves with hospitals that don’t mandate CPOE. And that means that the hospitals to which they were formerly affiliated lose the revenue those physicians used to bring to the table.

For a hospital, therefore, it becomes a matter of ROI. Do you accept the Federal government’s 40 acres and a mule, agree to abide by their current standards and requirements, and watch a chunk of your physicians walk leave to practice elsewhere? Or do you tell the government thanks but no thanks, lose out on the ARRA infusion and suffer under devalued Medicare reimbursements, but maintain that chunk of physicians whose walk-out would have otherwise affected the bottom line? Arriving at that equilibrium point—where you’re not shooting yourself in the foot fiscally—is really an exercise in accommodation, where you settle on a solution not by striving for what’s best for physicians, hospitals, and patients alike, but by settling for the lowest common denominator.

An environment that fosters lowest common denominator solutions is deadly to innovation. The Federal government and the health care industry need to level set the playing field so that financial rewards—and financial penalties—aren’t tied to things that could inhibit innovation; things like regulations that require behaviors or workflows that simply make no real-world sense. Or things like regulations that require CPOE systems to be certified, even though certification is possible only via tools or components with known usability or interoperability issues. Federal regulations should set standards and provide the basic rules for the marketplace, not limit solution alternatives to a specific subset of applications or interfaces. If there’s a better way to build the mousetrap, let private industry build it, and let the chips fall where they may.

“WTF” scream-asks a sub-head on the cover of Esquire magazine’s December 2009 issue, and while you may think the question is being posed about actor Robert Downey Jr.’s somewhat déclassé spread-eagled pose on the cover, what really garners the WTF is the cryptic box upon which Downey is sitting. Because it looks like a black-and-white alien icon from a 1980s-era Atari video game.

But hold that pixilated black-and-white box to a web camera, and prepare to be amazed. On the web camera’s display screen, a 3-D Robert Downey Jr. springs to life, offering, as Associated Press’ Andrew Vanacore put it, a “half-improvised shtick on Esquire’s latest high-tech experiment for keeping print magazines relevant amid the digital onslaught.”

Welcome to the brave new world of augmented reality, print magazine style.

The blending of two seemingly disparate mediums—static print and vibrant video—is nothing new for the Hearst-owned Esquire, who experimented last year with static print mobility on the cover of its 75^th anniversary issue via E Ink, the same technology that powers Amazon’s Kindle e-reader device. Though internet wags almost universally declared the stunt a flop—from the wow-factor perspective—it nonetheless proved that Esquire, and Hearst, was not about to let the once-vibrant magazine industry go quietly into its grave in the age of the internet. Hey, at least they’re trying.

And innovating in the process. Sprinkled about the December issue are several augmented reality icons, and when held up to a web camera, different things appear to delight and engage the reader. According to the Wall Street Journal, an interior fashion spread about dressing in layers features actor Jeremy Renner shedding his coat and sweater as weather conditions dictate. Turning the magazine in a certain way in front of the camera triggers an on-screen snow flurry; Renner dons more clothing layers and chucks snowballs at the reader . . . or the viewer. Luxury car maker Lexus features an augmented reality ad inside the magazine’s covers promoting a new technology that uses radar to keep errant or dozing drivers in the correct lane. An augmented reality-enhanced “Funny Joke from a Beautiful Woman” features actress Gillian Jacobs delivering a joke in a gray nighty, and should the reader-viewer activate the augmented reality feature after midnight, she tells a second joke—this time a dirtier one.

Esquire’s honchos plainly cop to AR being a publicity stunt, but one that will still generate enthusiasm for the struggling magazine industry, according to the Wall Street Journal. “It is a gimmick, but we’re an entertainment medium,” said Esquire editor-in-chief David Granger, as quoted by the Journal. The technology for this issue reportedly cost the magazine “in the six figures.”

Esquire, once known as a bastion for cutting-edge literature and journalism from literary luminaries like Norman Mailer, clearly needs a shot in the arm in order to survive in the digital age. According to the Associated Press, citing numbers from the Publishers Information Bureau, Esquire’s ad pages dropped 26% over the past year, down to 319 from 431. That said, according to the AP, citing figures from the Audit Bureau of Circulations, Esquire has seen its print circulation grow by 38,000 copies in the past ten years, and now has a circulation of 718,000.

The yin-yang relationship between business and design is a long and storied one, and the crux of the complex relationship, at least from the design perspective, is summarized rather nicely by Phil Goddard of Human Factors International, one of the largest and most respected user-centered design firms in the world:

“A big part of the job of a good UX professional is being an effective critic. Our job is to research, quantify, and articulate the strengths and weaknesses of the ‘experience’ of a design—much like the critic of a movie.”

A movie critic, however, has a much simpler task than a user experience professional. The entity a movie critic assesses—a movie—is always assessed in purely subjective terms. No consumer of a movie critic’s wares would expect otherwise. When we read movie reviews, we judge the merit of the review chiefly on the qualifications of the reviewer, and whether or not we’ve agreed or disagreed with his or her reviews of other movies in the past. If a movie review doesn’t share our taste in movies, we move on to a reviewer who does. That’s why movie critics are a dime a gross: there are as many opinions about movies as there are people in the universe, and each one of those opinions, fundamentally, is correct. Star ratings, rotten tomatoes, or thumbs-up/thumbs-down grades attempt to quantify movie reviews, but these, really, can’t stand up to vigorous quantitative analysis.

In a recent white paper titled Connecting UI Design and Business, Goddard, a PhD in cognitive psychology, suggests that the qualitative aspects of user experience design can be mitigated by breaking down the analysis of a website itself into a scorecard in which user experience experts “grade” a website according to five accepted dimensions of good design practice: navigation, content, presentation, interaction, and value and usefulness. Each dimension becomes a section of the scorecard, and the dimensions themselves are sub-divided into a series of posits, like “navigation options are visible and clear,” or “labels are distinctive and descriptive.” The reviewer then assigns each posit a grade from 1 to 5, and the results for each section are then tallied and presented as a percentage—just the sort of thing you would see on a college exam. While the posits themselves surely lend themselves to the whims and whimsies of subjectivity, the composite scores, nevertheless, provide plenty of fodder for design and business professionals alike to evaluate the effectiveness, usefulness, and overall “success” of a website’s design. Even further, these scores give business owners good benchmarking data, and give design professionals the direction they need for improving design in future iterations.

Though the scorecards are fairly effective, they have one serious disadvantage: they’re being filled out by user experience professionals performing evaluations, not by real users completing business-oriented tasks. But Goddard has a solution for this, and it’s something we’ve been doing at Makibie for years: evaluating designs from a user’s perspective through the use of personas and user scenarios.

Simply put, a persona is an archetype of a website’s intended user. Each potential user archetype has a unique persona; for one website, therefore, there may be several personas. A user scenario, simply put, is a task a persona would want to accomplish on a website—get information, make a purchase, watch a video, interact with a friend. Just as there may be several personas for a website, typically there are dozens of user scenarios. Designers, therefore, typically design towards the most important user scenarios. Which user scenarios are the most important? Herein lies the link between business and design: the most important user scenarios are the ones that provide the most business value.

By completing user experience scorecards designed from the viewpoint of personas and user scenarios, user experience experts can provide their business counterparts with useful, usable quantifiable data on the design elements that matter most: those that directly impact business value. On a typical e-commerce site, for example, if the design intrudes upon a user’s ability to place items in a shopping cart and check out, a persona/user scenario based user experience scorecard will point that out in a direct and actionable manner, giving the business people the fodder they need to secure funding to make design improvements, and giving design people the fodder they need to know where to begin to make improvements in the design. Neither the business team or the design team needs to fumble about through the fog.

But why stop here? Sure, such a paradigm is powerful, but even more powerful would be such a paradigm coupled with real, hardcore, scientific web analytics. The challenge of getting here, of course, is the task of linking user scenarios with the web analytics that best describe them. For the more obvious user scenarios, the web analytic that best describes it might be obvious: to measure the amount of transactions completed successfully, you could divide the number of times a transaction start button was clicked by the number of times the confirmation message for that transaction was served. For the more esoteric user scenarios, coming up with a web analytic that best describes them might be more complex or convoluted, but the beauty of user scenarios is that they can almost always be analyzed by one quantifiable metric or another. User scenarios are, after all, most likely business goals, and business goals are almost always quantifiable.

And business goals are almost always measurable, directly, via web analytics—if they weren’t, hundreds of business dashboard RIA developers would have gone out of business years ago. The logical next step, therefore, is to combine the notion of a persona and user scenario-based user experience scorecard with web analytics that measure business goals into a user experience RIA dashboard that aggregates subjective, yet quantifiable, user experience data with hardcore web analytics to measure the total user experience of a website in a meaningful and actionable way. Such a user experience dashboard would be a Rosetta Stone, of sorts; allowing business teams and design teams not only to understand each other, but giving them the power to speak exactly the same language.

October 2009 is shaping up to be a company-defining month for Microsoft. On October 22, Microsoft is poised to launch Windows 7, the latest version of its ubiquitous Windows operating system. Plenty of ink and electrons have been sacrificed to the god of Muse in the course of explaining how important this Windows release is to Microsoft: it has to, after all, bang the final nail into the coffin of the disaster that was Windows Vista, just like Windows XP was the sweet mint that cleansed one’s palate after dining on that scatological sandwich that was Windows ME, arguably one of the worst operating systems ever developed. But Windows 7 is not all for this October, not by a long shot. Also coming this month? Microsoft’s very first retail store.

The Wall Street Journal reports that Microsoft is currently putting the finishing touches on its first retail store, which will be located in the Scottsdale Fashion Square mall in Scottsdale, AZ. The store, which, according to the Journal, may or may have been planned, designed, or conceived with the help of former Apple executive George Blankenship—who helped Apple launch its own retail stores—will showcase laptops that run Windows 7, mobile phones that run Windows Mobile, Zunes, and xBox 360 game consoles. Customers will be able to play xBox games on a 94-inch TV screen inside the store. The Microsoft stores will even feature a counter for technical support—in other words, the Apple Genius Bar.

Apparently, then, for Microsoft, innovating these days means copying anything and everything that Apple has done successfully. The truly off-putting thing for Microsoft, however, has been their failure to execute on this strategy, even though Apple practically lays the blueprint for success in their laps directly. And there’s no reason to think that the Microsoft Store won’t go the way of the Zune or Windows Vista, either.

Why?

Well, for one thing, except for gaming consoles, Microsoft’s success as a hardware, device, or gadget maker has been limited, and some of their forays into the space have been downright dismal—see the aforementioned Zune. Microsoft’s formidable success has come chiefly from the software space, but these days, consumers may be reluctant to travel to a brick-and-mortar store to purchase software when more and more, they also have the choice of purchasing immediately-downloadable and useable software online.

Exactly what sort of hardware products are going to line the shelves of a Microsoft retail store? Again, Microsoft is not primarily a hardware, device, or gadget maker. Whose laptops are going to feature that Windows 7 operating system? Whose smart phones are going to show of Windows Mobile? And why would anyone go to the Microsoft store to purchase a Zune, when Zunes aren’t flying off the shelves of any store on planet Earth? Undoubtedly, the products that line the shelves of the Microsoft store will come from the legions of Microsoft hardware partners, but just which partners are featured, and which aren’t, is sure to cause dissention in the ranks.

When all is said and done, however, the ugly truth, real or not, is this: Microsoft really is the nerdy uptight business guy in the brown suit, and Apple really is the trendy mellow hipster in a black shirt and blue jeans. This is qualified as real or not, of course, because that’s how Apple sees things, not how Microsoft sees things. Unfortunately for Microsoft, those Apple commercials, coming as they did during a period of time where Microsoft was struggling mightily with Windows Vista, have solidified the public perception of both companies. And unfortunately for Microsoft, coolness factor plays a major role in retail. Simply put, nobody’s going to flock to and pay retail prices at a store where the nerdy, uptight business guy in a brown suit does his shopping.

Somebody high up in the food chain over in Redmond, Washington, would be well-advised to remember that innovation means exploring and expanding into areas where nobody else has gone before, not following in someone else’s footsteps. Instead of trying—and failing—to replicate Apple’s successes, why not use a little imagination to show us all where we’re going next?

The First Amendment to the Constitution of the United States, arguably the marquee amendment of the Bill of Rights, guarantees a free, uncensored, and theoretically unbounded marketplace of ideas by prohibiting the US Congress from making laws that infringe on the freedom of speech and the freedom of the press. Though virtually all forms of speech and expression enjoy First Amendment protection, the Founders were undoubtedly most concerned with providing an open marketplace of ideas for political speech and political expression, the idea being that the people, via the press, would use this open marketplace to provide the ultimate “check” against government, both federal and state. Ours, after all, is a system built on checks and balances, and for the people to provide this ultimate check on federal and state power, the people need free and unfettered access to the information that helps them make better decisions about their government. And what better way to eliminate government incompetence, fraud, or corruption than to shine a light on it—to expose it?

Take the same concept and apply it to health care. What better way to improve the quality of health care than by making public and exposing to the light of day the aspects of health care that can be measured to improve quality, and let the chips fall where they may? Why not empower the consumers of health care to make decisions based on cost and quality, the same way consumers are empowered when they make purchase decisions in other markets, whether shopping for a new car, a cart of groceries, or a new leather jacket?

Makes perfect sense, yes? And the chief side effect of this health care open market just may be the Holy Grail for the health care industry and its consumers: lower costs.

According to the Wall Street Journal, for the past two decades, the Pennsylvania Health Care Cost Containment Council (PHC4),  a independent Pennsylvanian state agency, has collected and published “medical outcomes” for more than 50 types of treatments and surgeries at Pennsylvania hospitals, and what they’ve discovered is that publishing the report not only encourages hospitals to improve their scores and offer patients a higher quality of care, but that higher quality care actually costs less than poorer quality care.

“High-quality care costs less—always,” said David B. Nash, a medical quality expert and dean at Thomas Jefferson University’s School of Population Health in Philadelphia, as quoted by the Wall Street Journal. “If the federal government could behave like a savvy shopper, that would change the health-cost game overnight. But the government is a bill payer, not a savvy shopper.”

According to Thomas Burton, writing in the Wall Street Journal, “the theory underlying the Pennsylvania program is that to create a truly competitive healthcare market, consumers need hard information showing which hospitals perform better.” This hard information empowers Pennsylvanian health care shoppers to be savvy shoppers. They, in turn, give their business to the hospitals they feel are most qualified to serve them, and the hospitals left out of the mix are forced to improve in order to win back more health care consumers.

Consider, for example, preventable infections that arise from intravenous catheters and tubes left in a patient for too long. Three years ago, according to the Wall Street Journal, Pennsylvania first published numbers for these preventable infections. The following year, by responding with measures designed to lower these infections, Pennsylvania hospitals were able to reduce the rate by 7.8%. That translates to real savings across the board, as the average payment in 2006 for a patient who acquired one of these infections was $53,915. With no infection, the average payment fell to $8,311, according to state reports. In fact, the Philadelphia police health fund benefit management company, which covers 26,000 people, has saved as much as $5 million a year simply by adopting a plan pegged to Pennsylvania’s hospital quality reports.

Of course, raw numbers alone rarely paint a completely accurate picture, and the data obtained and reported still has to be massaged to tell the real story. For example, university or teaching hospitals typically take on the most severe cases, and therefore typically have higher mortality rates than hospitals that tend to treat less severe cases. Thus, quality of care at a university or teaching hospital might be very high, even though their mortality rates are relatively high as well. But this only means that the algorithms for gathering, aggregating, and reporting the data have to become more precise—as well as the metrics used for benchmarking purposes. As long as the data is completely transparent to the consumer, everyone will benefit in the end.

Health care industry experts and officials believe that publishing measurement information, including medical outcome information, is part of the White House’s overall plan for overhauling the health care industry, and the Senate Finance Committee is expected to vote in the near future on a sweeping health bill that would make $75 million available annually for the US Department of Health and Human Services to develop methods of improving quality, including, potentially, publishing outcomes. In light of Pennsylvania’s experiences, this seems to make perfect sense; the ability to measure quality of care quantifiably and objectively not only should be a part of health care reform, it must be a part of it.

After all, as the First Amendment proves, what better way to eliminate waste, fraud, corruption, and incompetence than by exposing quality of care to the light of day?

Rove, apparently, then crunched the numbers and determined that two thirds of President Obama’s current health care proposals amounted to a cool $662 billion. If, posited Rove, as President Obama claimed, a sum of money this lofty is “just being spent badly,” why, then, doesn’t President Obama “flip the health care debate to his advantage” by offering a stand-alone bill that would cut $662 billion in waste from Medicare and Medicaid?  Wouldn’t a bill of that nature show the American public that President Obama means what he says when he says overhauling health care will be painless?

Advantage Rove.  But this, however, is where Rove over-reaches.  Overhauling health care won’t be painless.  Rove knows it, President Obama knows it, the middle-class family that pays for health insurance out of pocket knows it, the working-class family forgoing health insurance for financial reasons knows it, and the general practitioner knows it . . . in fact, the general practitioner knows it only too well.  That’s because talk is cheap.  Subjectivity is easy; show me a secular system that’s based on faith and I’ll show you a secular system that’s bound to fail.  Objectivity, on the other hand, is tough.  Making the hard choices is tough.  But making those hard choices is the only thing that is going to reform health care in any meaningful way.

The fact of the matter, however, is that when it comes to health care, Americans aren’t skin flints.  Americans don’t want cheap health care; they want good health care.  When it comes to health care, Americans, as a whole, are willing to pay the price that needs to be paid, so long as they get real value for their money.  The waste:  that’s what gets the American dander up.  To be meaningful, then, any sort of health care reform, any sort of health care overhaul, should not focus purely on dollars and cents, but on quality of care.  After all, doesn’t John Glenn’s old saw apply here as well?  When your life is on the line, are you really going to feel comfortable knowing you’re being treated by not the best physicians and hospitals available, but by the lowest bidders?

At first blush, “quality of care” seems to be one of those esoteric notions best relegated to the realm of the subjective, but if you think about it for a moment, such is really not the case.  The same tools, principles, theories, and methodologies used to measure the more subjective elements of software design—things like usability and the customer experience—can be used to measure quality of care.  What remains to be done, then, is to attack the problem like any good engineer would: break it down into its simplest elements, and then work the problem from a solution-agnostic standpoint.

We begin, naturally, in the realm of the objective:  we cannot determine the success of anything without the means to measure success.  The means has at least three dimensions:  a scale, a benchmark, and a measurement tool.  When developing business software, the dimensions that make up measurement come relatively easy:  our scale is made up of business metrics, our benchmarks are our business goals, and our measurement tools are the software and hardware we use to collect, analyze, and report application performance.

Why not apply the exact same principles to health care?

Instead of business metrics, let’s substitute quality of care metrics.  Mortality rate.  Morbidity rate.  Ability to cure.  Patient satisfaction.  Reams and reams of efficacy measurement points, both dollar-based and non-dollar-based.  A good metric, however, is not merely something that can be measured, but something meaningful that can be measured; something that can be modified by proactive process improvements—whether for the better or the worse.

That latter point takes the whole paradigm between business measurement and health care measurement further still, because it adds to it the element of efficiency—the Rovian mandate to eliminate waste.  But when it comes to quality of care, what’s waste and what’s not?  What, even, makes up quality of care? Can something that subjective be made measurable?

Web advertisers believe so, and they back up their beliefs with real money, so spending those dollars wisely is key.  The same measurement tools and analytical methods that help advertisers spend their money most efficiently on the web can be used to determine whether health care dollars are being spent efficiently as well.  A practice, for example, that determined an overall quality of care metric based on an array of sub-metrics—easily measurable and trackable—could use a simple dashboard to measure, by any number of splits, how efficiently they spend their dollars, and how those expenditures affect the quality of care metric.  Everyone stands to win:  the practice gains a competitive advantage by being able to identify and eliminate waste, and the patient gets a better quality of care.

This is all predicated on the ability to extract real meaningful measurements, and these days, pretty much anything that takes place electronically can be measured effectively, often in real time.  Powerful, versatile, online measurement and performance analysis tools like the Makibie Connect Suite can, in many cases, leverage existing databases to extract information in order to help organizations of all types analyze what to measure, how to measure it, and how to use those measurements to achieve success—whether in business or in health care.  The Connect Suite does this by aggregating data and presenting it via easy-to-use analytical tools that help organizations see the health of their operations based on objective data, thereby getting the information they need to make proactive improvements, incrementally, and always informed by hard data.

In essence, for physicians and medical practices in the digital age, keeping a finger on the pulse of quality of care doesn’t need to be any more difficult than taking the pulse of a patient.  All it takes is the right set of tools, the right mix of analysis, and the audacity to believe that when it comes to health care, delivering quality of care isn’t just about spending a certain amount of dollars—it’s about spending wisely, on the sort of things that truly drive quality of care.  That, more than finding another way to spend the $662 billion Karl Rove seemed to find in between the cushions of President Obama’s couch, will foment true health care reform.  And it’s not a Democrat or a Republican thing:  it’s a good old-fashioned common sense thing. American ingenuity at work.