Home » Time Capsule » Currently Reading:

Time Capsule: Incompetence by Committee: How Customers Dumb Down Vendor Software

May 18, 2012 Time Capsule 2 Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in May 2007.

Incompetence by Committee: How Customers Dumb Down Vendor Software
By Mr. HIStalk


We software customers often complain that our vendors lack vision. Maybe so, but what goes unsaid is that we ourselves are largely responsible.

Many or most vendors do their best work before their second customer comes on board. Their bright and dedicated employees, along with perhaps a development site’s subject matter experts, work from a blank slate and do some really innovative work.

Once customers sign up, however, the once-fresh product is dumbed down. Every new customer has their list of must-have enhancements, almost entirely (a) a smorgasbord of unrelated bells and whistles they saw in some other vendor’s demo; or (b) a feature of questionable necessity that exists only in the product they’re replacing. Consider the irony in either case.

That’s why software turns into a crazy quilt of unrelated and immature ideas. Too many customers come up with lame ideas that vendors are scared to ignore.

Customers, you see, are terrible visionaries. They always have a punch list of minor productivity tweaks and site-specific changes that move the product sideways at best. Vendors who ignore these suggestions, often with good reason, are considered unresponsive.

No wonder quality assurance, product documentation, and integration are so bad in healthcare software. Applications aren’t an integrated software platform with a clear focus – they’re a collection of unrelated product features and emergency tweaks held loosely together with the unreliable glue of a common user interface, customization switches, and a single database, all voted on by committees of self-interest.

Too many cooks in the kitchen indeed. We blame customers or poor training when only 20% of software capabilities are used. Maybe it’s because only 20% of a scattershot of functionality applies to a given site.

The enhancement process encourages this. A bunch of customers – heavily overweighted by those from big hospitals with travel money – sit in a room and vote on enhancement ideas. What’s wrong with that democratic approach?

  • The larger the committee, the less likely anything bold or innovative will result.
  • The voting process ensures that only safe, universally acceptable enhancements will be chosen. Products that were created through risk-taking and creativity get watered down by dull, uninspired changes that neither enrage nor delight anyone.
  • Small, obviously beneficial changes never get done. Why waste your user vote on something less than a sweeping change that no one else wants?
  • Customers have no idea what they want or need. They’re also unwilling to expend any more effort than to toss out off-the-wall suggestions.
  • Customers will provide crudely drawn screen mockups (users think only in terms of screens). They don’t employee critical thinking skills until the enhancement arrives on their doorsteps, at which time they suddenly get engaged and loudly proclaim its imperfection and refuse to use it.

Ample evidence exists that hospitals have few original thoughts and little ability to think strategically. Putting hospital staff in charge of product design and strategic direction is a bad idea.

Once a product has evolved into a Frankenstein-like set of unrelated product appendages, testing and integration get geometrically more difficult. A great niche product with a fanatically loyal customer base becomes an unwieldy fibrillation of disjointed ideas with an indifferent audience and mediocre KLAS scores (sound like anybody you know?)

Vendors don’t help. Is the intended product audience a 50-bed rural hospital, a 1000-bed academic medical center, or an IDN with a big ambulatory business? "Yes!! We want a product that is universally cherished and appreciated." Fat chance.

I see nothing to challenge the basic premise that innovation will come only from small, cheeky vendors willing to break the rules and provide leadership, not contract programming to customer specs. At the other end of the product life cycle is the elephant graveyard, those publicly traded vendors and multi-industry conglomerates where once-interesting products go to die slowly and painfully.

What happens in between is up to us customers.

HIStalk Featured Sponsors


Currently there are "2 comments" on this Article:

  1. Clairvoyant piece. Eureka!! Now I understand why thoughtful creative doctors find EHR and CPOE abhorrent. The committees comprised of customer do-good ears muck up an already mucked up user unfriendly device that cognitively disrupts and radically degenerates workflow.

  2. You can get an amen!

    Personal experience has proven this all too true. I’ve seen some brilliant ideas/designs from talented programmers get tossed out the window because somebody didn’t know exactly where to click within 2 seconds of seeing a screen. Sad that interface design always seem to be drug back down to the least common denominator.

Founding Sponsors


Platinum Sponsors




























































Gold Sponsors











Reader Comments

  • Eddie T. Head: Re: Cerner subreddit - the subreddit became private over the weekend. No more leaks, I guess....
  • IANAL: How many virtual primary care startups can the market support?...
  • Ernie Riddle: Good insight and a note that there is a lot of change ahead. Many technology platforms are active in Healthcare and the...
  • Quynh Tran: Appreciate the shift in language from "follow the science" to "evidenced-based." The latter may be less intimidating a...
  • Matthew Holt: I'm at HLTH The testing on site was smooth--once you go into it. The Clear app to get into the testing was not.... ...

Sponsor Quick Links