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Now merged into Siemens Medical Solutions Health Services, our company, formerly called Shared Medical Systems, creates clinical, financial, and administrative software for the healthcare industry. Like other medium to large companies, SMS had reached a scale and maturity level that required the development process to be documented, predictable, repeatable, measurable, and usable by the development groups. After much study and consideration, senior management committed to implementing a universal OO development methodology. Senior management recognized the need to improve customer satisfaction, which had always been high but needed to he better in an increasingly competitive market. Management saw the introduction of usability practices as a prime means to achieve this objective. So they began to place greater emphasis on usability-even to the point of building and staffing dual state-of-the-art usability labs. Our goal throughout the projects we describe was to combine the best OO analysis and design practices and usability techniques to create a powerful, unified way to develop software.