Glenn Fleishman over at TidBITS (no relation) recently published an interesting article about hand coding HTML/CSS versus using WYSIWYG editors, “Hand Coding HTML Is Still in Vogue”. To quote:

It’s therefore rather amusing to recognize that after 14 years of such editors - FrontPage, PageMill, GoLive, Dreamweaver, and many others, with few surviving the hecatomb - hand coding still rises to the top as the preferred method of building pages.

To build rich, complex sites with ever-changing and expanding content, you almost certainly need to get under the hood and get your fingers dirty with some sort of templating system.

Glenn’s basic point: since web sites are no longer static pages—instead they consist of idiosyncratic combinations of databases, templates, scripting, etc.—it’s much faster to simply code freehand because no WYSIWYG editor would be able to cope with the complexity of today’s sites.

A Different Point of View

I wholeheartedly agree with their opinion that hand coding always beats WYSIWYG, though I would qualify that it only does so if—and this is a big if—you have the technical chops and desire to do so. I’m good with HTML and CSS, so I write it by hand. However, you’re not going to find me trying to hand code Word documents any time soon. I don’t have the skills to do so, and although formatting can get very annoying and inconsistent from time to time, Word is a good enough WYSIWYG editor. Many people have the same attitude about HTML.

So, why aren’t more people using WYSIWYG editors to write web pages? Although I agree with Glenn’s points about the complexities of modern sites precluding the use of WYSIWYG editors, my take on it is that WYSIWYG editors failed to gain a hold with web developers for the following reasons:

1. When WYSIWYG editors first came out, they produced sloppy code
2. The sloppy code generated by these editors displayed inconsistently across browsers
3. As web developers eventually looked for ways to make their sites appear consistent across browsers, they learned about standards compliance
4. Web developers were able to switch to standards-compliant coding practices more quickly if they did so by hand than if they waited for the software companies to update their WYSIWYG editors
5. Web developers also realized that they had more control over the explicitness of their code if they wrote it by hand

WYWIWYG

There will always be demand for some form of WYSIWYG editor when it comes to producing web content, but if you regularly edit, build, or maintain web sites, it’s almost imperative that you have a decent level of experience writing code by hand. After all, hand coding is the only way you’ll know that what you write is what you’re going to get.

Sound off if you can think of other reasons why WYSIWYG editors are not the tools of choice.

Clinical user experience (UX) is a term we use to indicate the design and usability of software used in clinical health care settings. Makes sense, no? A few clarifications, though:

1. It isn’t limited to using software; we’re talking about the entire range of the software experience, from initial impressions to training to daily (and hopefully second-nature) use.
2. The “clinical” portion of this term is very important—it clarifies that we are only talking about software user experiences that relate specifically and directly to patient care.

Of course, along with internationalization, content management solutions, and Web 2.0, clinical UX is a big offering of ours, having worked with IDX / GE Healthcare, Partners, and others. So we have this experience, but we’ve been doing clinical design work for several years now; why are we making a push for clinical UX now?

Progression of Software Engineering Focus

Simply put, the timing is right for clinical UX because I believe the clinical software market is about to hit a key point in the progression of software engineering focus. This progression is actually something I’ve been thinking about for a while, but I originally thought of it in terms of Microsoft Office. I will tie the concept back to clinical UX in a bit.

At first, existing is enough. Microsoft created a suite of tools that allowed people to do things that they were unable to do in the past. It didn’t matter what the user interaction was like because the power of integrated office applications singularly made Office worth it. So long as people were empowered in ways they were not before, they were satisfied enough, even if it took a while to master and was unintuitive. There was little to no competition on the market. The fact that Office existed at all was enough for it to be successful.

Then, you must compete on features. As competitors see that there is a market for this product or technology, existing is no longer enough, especially if your market is getting crowded. So it went with Microsoft Office for over a decade. They consistently added more and more features to the suite until there were no more logical features to add. If everything up to Office 97 was the cake, Office 2000, XP, and 2003 were all just little dabs of icing here and there.

Finally, it’s all about the experience. So Microsoft had stuffed every conceivable feature into word processing, spreadsheets, presentations, and PIMs. That probably would have been fine. They had crushed all their commercial competitors, Office was a gigantic cash cow for them; what could go wrong? Try free, open source software like OpenOffice.org. Microsoft had actually made it easy for free office software to flourish because they, through all their releases, had basically written functional specifications anyone could use to roll their own software. Once free and paid software reach feature parity, what reason is there to pay? I believe Microsoft realized this and decided that their next release had to be all about the user experience. Whether or not they were successful remains to be seen, but if you read about why they came up with the UI, it sure seems like UX was the priority for Office 2007.

And this is related to clinical UX because…?

The timing is right for us to concentrate on clinical UX because I believe the major players in the EMR, PACS, HIS, and other health care IT markets are close to reaching that point of feature parity. Unlike Microsoft, we can’t let doctors, nurses, managers and support staff languish in a sea of lackluster software user experiences. It’s simply a matter of the work: every day thousands of health care staff have to deal with difficult and unclear UIs when they’re prescribing drugs, analyzing flowsheets, scheduling operations, and reading x-rays. Usability issues in those UIs have a much larger impact than issues in Office.

The fact of the matter is clinical software developers need to recognize the need for improved user experiences before their software becomes overcrowded with unusable features, and we’d like to help them get to that point. The opportunity is there for everyone. That’s why we’re making the push for clinical UX.

At the end of a recent trip to Austria, my family made a stop in Heidelberg, Germany for a night. We stayed at the Hotel Rose, which caters to the American military both in terms of its accommodations and its decor. One of the most fascinating decorations was this picture from 1911, featuring the river Neckar, the “Old Bridge,” and several important military types:

What I realized quickly after noticing it was the people clearly weren’t sitting on the bank of the river. In fact, it looks like this picture is actually composed of about 24 separate photographs taken in a studio, which led me to wonder just how the photographs were integrated into the obviously painted landscape. My guess: the photos were glued to a canvas, the canvas was photographed, then an artist painted the landscape on top of the composite photograph.

My theory of how this picture was created reminds me a lot of matte painting, a technique used in movies to create grandiose settings without having to physically build them. When was matte painting first used? 1911. So perhaps this picture used lessons learned from the early days of that technique.

Could we do something more convincing in Photoshop? Of course, but the stylization and attention to detail in this picture lends it a certain beauty that I don’t believe would be eclipsed by the realism of a Photoshop composite.