Digital health solutions are routinely promoted as catalysts for safer care, streamlined workflows, and improved patient outcomes. Yet for many clinicians, the lived experience is far more complex. Instead of enabling better practice, digital systems often constrain it, by locking clinicians into rigid workflows, delaying essential changes, and quietly drifting out of alignment with how care is actually delivered.
Over time, this misalignment creates a cascade of consequences: inefficient workarounds, outdated practices embedded in software, erosion of trust in digital vendors, and a growing sense of frustration among clinicians who are expected to deliver modern care using inflexible tools. From a clinician’s perspective, this is no longer a minor inconvenience, it is a structural problem that directly impacts care quality, workforce wellbeing, and the sustainability of digital transformation efforts.
The Configurability Conundrum
Healthcare is dynamic by nature. Clinical guidelines evolve, service models shift, and patient needs change. Digital systems operating in this environment must be adaptable. Yet many platforms remain rigid, offering limited configurability and forcing clinicians to work around predefined workflows that reflect how care once operated, rather than how it operates today.
Too often, “configurable” in healthcare IT still means configurable by the vendor, not by the health service itself. Changes require formal requests, vendor involvement, and long lead times – even when the change is operationally minor or clinically obvious. In practice, this places day-to-day control of clinical workflows outside the hands of those delivering care.
When systems cannot be adjusted to suit real-world practice, clinicians absorb the burden. Extra documentation steps appear. Parallel paper or spreadsheet systems emerge. Informal workarounds become normalised. Instead of reducing cognitive load, digital tools add to it by diverting time and attention away from patients and toward managing the system itself.
Crucially, these inefficiencies are often invisible at an organisational level. Dashboards still populate. Tasks are still completed. The cost is paid quietly through clinician time, mental effort, and frustration.
A Historical Pattern We Rarely Acknowledge
To understand how we arrived here, it’s worth examining a long-standing assumption in healthcare IT: that clinicians must adapt their workflows to fit the software.
Historically, this was understandable. Early clinical systems were expensive, bespoke, and difficult to modify. Change was slow by necessity. Over time, however, this constraint hardened into a norm. Even as modern platforms became technically capable of rapid configuration, many business models and implementation approaches remained rooted in rigidity.
In practice, this has meant that:
- Clinicians are discouraged from requesting change
- Configuration is restricted or monetised through formal change requests
- Updates are slow, deprioritised, or bundled into distant upgrade cycles
What follows is predictable. Local workarounds proliferate. Systems drift further from clinical reality. Eventually, the platform is labelled a “poor fit” and quietly endured until a long-term contract expires, at which point a new system is trialled, often repeating the same cycle under a different name.
This is not resistance to digital health. It is the predictable outcome of designing systems that cannot evolve alongside care.
What is rarely challenged is the underlying model itself: that configuration is something done to for a health service, rather than by it. This vendor-centric approach may protect platforms from variability, but it does so at the expense of clinical agility and local accountability.
The Hidden Cost of Waiting
Delays in system change are often framed as an operational inconvenience. In reality, their impact is far broader and more serious.
Outdated Practice Embedded in Software
Clinical guidelines evolve rapidly. When digital systems fail to keep pace, outdated pathways and assumptions become embedded in everyday practice. Clinicians may recognise the discrepancy, but the system continues to guide behaviour – subtly shaping care in ways that no longer reflect best evidence.
Burnout and Digital Learned Helplessness
Repeated experiences of ignored requests or delayed updates teach clinicians that change is futile. Over time, they stop asking. This “digital learned helplessness” quietly undermines innovation culture and disengages the very workforce digital transformation is meant to support.
Invisible Risk and Cognitive Load
Workarounds shift responsibility from systems to people. Safety is maintained not because the system supports clinicians, but because clinicians compensate for its limitations. This creates hidden risk, resilience that depends on individual effort rather than reliable design.
Erosion of Trust
Clinicians rely on vendors not just for functionality, but for partnership. When responsiveness falters, confidence erodes. Future digital initiatives are met with scepticism, not because clinicians oppose technology, but because experience has taught them to expect disappointment..
Ultimately, patients feel the impact. Delayed updates, fragmented systems, and manual data transfers increase the likelihood of miscommunication, delays, and errors – none of which are visible in procurement reports or vendor dashboards.
Configurability Does Not Mean Chaos
A common concern is that increased configurability introduces risk, inconsistency, or governance challenges. This is a false dichotomy.
Configurability does not mean uncontrolled change. It means:
- Clear guardrails rather than hard-coded barriers
- Role-based configuration aligned with governance frameworks
- The ability to adapt workflows within safe, approved boundaries
Well-designed configurability allows systems to support optimal practice without undermining safety or standardisation. In fact, it strengthens governance by ensuring digital workflows reflect current, approved models of care rather than outdated assumptions. Health services routinely manage clinical risk, variation and approval processes – digital workflows should be no different.
What Clinicians Are Actually Asking For
Clinicians are not seeking constant reinvention or bespoke systems for every preference. They are asking for:
- The ability to adapt workflows as practice evolves
- Changes measured in days or weeks, not years
- Transparency about what can and cannot be configured
- Genuine partnership rather than transactional ticketing systems
At its core, this is a request for ownership. Clinicians and health services are asking to manage and evolve their own digital workflows, rather than relying on vendor-mediated change for routine operational and clinical adjustments.
Conclusion: A Call for a Different Approach
Healthcare cannot afford to continue waiting for digital systems to catch up with clinical reality. The cost of poor configurability and delayed support is not theoretical, it is paid daily through inefficiency, frustration, risk, and disengagement.
Digital health vendors must move beyond rigid, provider-dictated models and embrace adaptability, co-design, and responsiveness as core principles, not optional extras.
Until configurability is genuinely client-side – supported, not controlled, by vendors – digital systems will continue to lag behind clinical reality. Empowering health services to safely configure and evolve workflows is not a technical challenge; it is a design and governance choice.
The future of digital health depends not on more technology, but on better alignment between systems and the clinicians who use them. It is time to break the cycle and design digital solutions that evolve at the same pace as care itself.
