Background: With the growing shortage of nurses, labor-saving technology has become more important. In health
care practice, however, the fit with innovations is not easy. The aim of this study is to analyze the development of
a mobile input device for electronic medical records (MEMR), a potentially labor-saving application supported by
nurses, that failed to meet the needs of nurses after development.
Method: In a case study, we used an axiomatic design framework as an evaluation tool to visualize the mismatches
between customer needs and the design parameters of the MEMR, and trace these mismatches back to
(preliminary) decisions in the development process. We applied a mixed-method research design that consisted of
analyzing of 118 external and internal files and working documents, 29 interviews and shorter inquiries, a user test,
and an observation of use. By factoring and grouping the findings, we analyzed the relevant categories of
Results: The involvement of nurses during the development was extensive, but not all feedback was, or could not
be, used effectively to improve the MEMR. The mismatches with the most impact were found to be: (1) suboptimal
supportive technology, (2) limited functionality of the app and input device, and (3) disruption of nurses’ workflow.
Most mismatches were known by the IT department when the MEMR was offered to the units as a product.
Development of the MEMR came to a halt because of limited use.
Conclusion: Choices for design parameters, made during the development of labor-saving technology for nurses,
may conflict with the customer needs of nurses. Even though the causes of mismatches were mentioned by the
IT department, the nurse managers acquired the MEMR based on the idea behind the app. The effects of the
chosen design parameters should not only be compared to the customer needs, but also be assessed with nurses
and nurse managers for the expected effect on the workflow.