Should Surgeons Have a Say in the Software They Use Daily?

The evolution of purchasing decisions in medical devices vs. clinical work software

Maya Ber Lerner
5 min readDec 6, 2022

Topics like preventing clinician burnout, replacing manual workflows and enabling new and flexible ways for clinicians to work are becoming a top priority for health-systems. A significant part of the technological innovation that will support this transformation will be software-based. This is a critical time to analyze software purchasing processes, and understand how they compare to other, more mature, health-system purchasing processes.

The surgeons’ work-tools market keeps growing

As long as there was surgery, surgeons have been coming up with tools to help them solve surgical problems and get their job done better, faster and safer. The surgeon’s work-tools market — surgical devices, robots, instruments — continues to grow, and the tools become more sophisticated. The global orthopedic devices market on its own is set to surpass $55 billion by 2025 (1). The global market for surgical robotics is expected to grow to $11.6 billion by 2025 (2).

Surgical Instruments from Ancient Rome (source: University of Virginia Historical Collections at the Claude Moore Health Sciences Library)

The surgeons decide what medical device is best for the job

It’s not surprising that surgeons often invent these medical devices. “Not only do they identify the clinical need for a new device or for improvements in existing devices, but they may also be the innovators and builders of the original prototype.” (3) It makes sense that there is a strong connection between clinicians and the medical device industry.

Who decides what medical device to use? Historically, the decision was made exclusively by the surgeon. It makes sense. As the captain of the ship, the surgeon is in the best position to determine the right tools for the job.

The evolution of medical device purchasing

With time, hospital economic and regulatory factors were increasingly considered, and administrators got involved in an attempt to optimize the process. The decision-making power started shifting. Nevertheless, it was always clear that the clinician’s input is a critical factor.

In 2018, the article ‘Surgeons and Purchasing Decisions: Their Power is Increasing’ looked at the increasing surgeons’ influence in medical device purchasing decisions made in hospitals. The article highlighted findings from the 2017 Bain & Company ‘Front-line of Healthcare Report’:

The article explained that while surgeons no longer had full control on medical device purchasing decisions, hospitals realized clinicians couldn’t be excluded from the decision making process. Healthcare systems that operated without clinician participation found that change was slow and new initiatives weren’t embraced. “Surgeons doubt the success of purchases made without them and in some cases blame poor patient outcomes on the devices bought without their input.” (4)

Today, the decision is usually made by a committee of clinicians and administrators. Still, the go-to-market of medical device companies typically starts from the surgeon-users.

Is software a work-tool?

What about software tools? The development of software in medicine took a very different path. The history of software in health systems obviously started much later than the history of medical devices. It was only in the 1950s that doctors and researchers started to explore the role that software could play in medicine (6). Initially, researchers looked at computers assisting with patient diagnosis, but the technology wasn’t there. At the time, computers couldn’t help with most healthcare problems. However, computers were able to make the management of patient records more efficient. The first electronic medical record system was created, and the rest is history (a while ago I summarized the history of electronic health records in the following diagram). (7)

The history of EHRs 1960–2021

The approach to software in health-systems is top-down

Unlike the bottom-up path of medical device development, software tools in healthcare were quickly established as IT/administration tools. Their development, selection process and implementation were top-down. Software development was expensive and complex, and the products were born into an already highly-regulated landscape. From the early days of software in healthcare, clinician-users were somewhat excluded from the decision making process. The consequences haunt us to this day: over fifty years of software that aims to solve more use-cases that any single product can successfully tackle, slow processes, and growing clinicians’ frustration.

Software in the hand of clinicians

As technology evolves, software can help clinicians solve challenges in surgery. Software products can complement medical devices and become daily work-tools for surgeons and surgical teams. But much like medical devices, for software products to be adopted and initiatives to be embraced, clinicians need to be at the helm.

Past constraints that dictated heavy and expensive software, and years-long implementation projects, are rapidly removed. Advancement in cloud technology, a brighter interoperability/integration horizon, and a new generation of iPhone-savvy clinicians — all create opportunities for secure, lower-cost, highly-scalable and self-service software. But none of this matters until the surgeons have a say in choosing the software tools they use daily.

Software purchase processing

What is the future of purchasing decisions in clinical work software? They will likely become more similar to purchasing decisions in the medical devices industry. Decisions on software used by clinicians in the surgical workflow will involve both clinical and operational functions. IT and administrators will partner with these stakeholders to oversee the selection process and assure that it is properly governed (security/privacy/compliance/economic factors). The clinicians‘ influence on the work-tools they use daily will significantly increase.

The result will be faster cycles, an easier path to innovation in surgical software tools, and a radically improved experience for clinicians.

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  1. Orthopedic Devices Market will reach $55bn by 2025, 2019.
  2. Medical Robotics and Computer-assisted Surgery: The Global Market, 2021.
  3. Technological Innovation: Comparing Development of Drugs, Devices, and Procedures in Medicine. Gelijns AC; Institute of Medicine (US) Committee on Technological Innovation in Medicine. Washington (DC): National Academies Press (US); 1989.
  4. Surgeons and Purchasing Decisions: Their Power is Increasing, 2018.
  5. Front Line of Healthcare Report 2017: Why involving doctors can help improve US healthcare, 2017.
  6. The History of Health Informatics, 2020.
  7. A Brief History of EHRs; Timeline of electronic health record systems in US Hospitals, 2021 The history of EHRs 1960–2021