In addition to challenges related to comparing studies done in different
cultural contexts, another challenge is that formal experiments
comparing different methods for gaining user input are very difficult
to perform in a real workplace context [19]. This study is thus
notable in that it reports on failed and successful design processes
at the same hospital, and also in that the data was collected, and is
being reported by, outsiders not involved in the design process.
The second version of the EMR system was designed by an
experienced consultancy firm that gained input from key personnel
at SN. The design team still did not manage to create an acceptable
design with this process however. Considering the hierarchical nature of SN, and lack of existing structures such as labor unions that could be used for interacting with different user groups, it is not surprising that the initial participatory design strategy did not directly involve users of the system beyond the management level. User input from a few managers during the initial phase of software development deemed to be inadequate however.