Though I’m an advocate of both conventional (Gane/Sarson) and more current UML methodologies with respect to system/software development and business process re-engineering, ten years of professional practice as a business systems analyst has demonstrated that the majority of organizations will not pay for the professionals and the Computer Aided Software Engineering (CASE) tools needed to support modern-day structured analysis and development.
Those organizations that do fund a structured approach like UML have a tough-time suffering the time frames needed to gather requirements, analyze needs and document the results, before beginning to develop and implement a new design. This is true even for executives and managers who understand the long-term benefits of this approach over conventional analysis and development methodologies.
Extreme programming/data modeling, and even a condensed UML approach (Extreme UML) are in the works by some advocates, in an attempt to shorten the lifecycle of a structured analysis and design project. If these efforts are successful, one expected result would be that more organizations would adopt and fund a structured analysis and development approach, as opposed to hacking away endlessly trying to bring an organization into compliance with HIPAA.