Do you ever look at the title of a book over and over? You know something is not right about it but you just cannot put your finger on it.

The book in question is titled Cost-Justifying Usability.

I sat.  And I puzzled until my puzzler was sore.

And then it hit me.  Nobody really needs to justify usability.  What needs to be justified is non-usability.  Non-usability must have a fairly substantial justification and ROI because most firms spend millions of dollars creating and maintaining non-usability in their systems and business processes.

Let us take for example one hospital (feel free to insert yours if the shoe fits) which spent more than one hundred million dollars on EHR—actually, they spent WAY more than that figure.

And, what did they get for all of their money?

One thing they did not get was usability.  If we define breakeven on usability to be the same level of productivity after implementing EHR that they had prior to implementing EHR, this hospital did not even breakeven on usability—they lost ground.  In the king’s vernacular this means that had the hospital spent no money on EHR it productivity would exceed its productivity with EHR.  It also begs the question of why, if the hospital spent nine figures and lost ground, heads are not rolling.

I may be guilty of oversimplification, but sometimes over simplifying a complex issue is the only way I know to shed light on something that may be being glossed over, the pay no attention to the man behind the curtain style of management.

How to put lipstick on the pig during your keynote address to the other members of the hospital’s C-Suite, “Our EHR productivity is only down twenty percent, an improvement of thirty-three percent from its prior low.”

Just how much does a point of productivity or a point of usability cost in real dollars in a real hospital?  We are using Roemer math in this example and all of the accounting knowledge I remember from my one accounting class.  Let us assume we are dealing with a hospital whose annual revenues are five hundred million dollars.  Let us also assume said hospital spent two hundred million dollars on its EHR system.  If the hospital’s margins were forty percent, which of course they are not, but if they were, a two hundred million dollar EHR would gobble up every dollar of margin for a year just to pay for itself.

Now in real life we know margins are probably one-tenth of forty percent which means if all of the hospital’s profits went towards paying for the EHR it would take ten years; also unrealistic.  Another rule of thumb regarding large IT systems is that they have a shelf life equal to that of a fruit fly. This means your hospital will be paying for your EHR long after it is dead and buried.

We have just shown that in a perfect world, EHR’s productivity and usability numbers will not have the CFO dancing a jig in the ER.  The great news is this drop in productivity and usability can be solved.  The bad news is that it cannot be solved by your hospital’s IT department or by your EHR vendor.

Design firms specialize in adding a human factor to the EHR interface and really can put the use back into your usability.