BackgroundWith 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.MethodIn 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 mismatches.ResultsThe 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.ConclusionChoices 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.Electronic supplementary materialThe online version of this article (10.1186/s12911-018-0726-3) contains supplementary material, which is available to authorized users.

Axiomatic Design and Complexity Theory as described by Suh focus heavily on the coupling often found in functional requirements. This is so fundamental to the analysis of the design that it is the core of the Axiom of Independence which examines the coupling between functional requirements due to chosen design parameters. That said, the mapping between customer needs and functional requirements is often overlooked. In this paper we consider coupling, found due to this mapping, as a possible source of complexity in terms of a user interface to a designed product. We also re-examine the methodology of how customer needs are generated and translated into the other domains to understand how they can give further insight into the customer mindset. Based on this analysis, we believe customer domain complexity should always be examined in design that includes end-user interaction.