Why is medical software so hard?

Medical software is regarded as both a success and a risk factor for quality and efficiency of medical care. First, reasons are given in what respects the medical industry is special: it is highly complex and variable, exposed to risks of privacy/confidentiality but also of denied access to authorized personnel, and medical users are a highly qualified and demanding population. Then some software technology and engineering approaches are presented that partially master these challenges. They include various divide and conquer strategies, process and change management approaches and quality assurance approaches. Benchmark institutions and comprehensive solutions are also presented. Finally, some challenges are presented that call for approaches other than technical to achieve user "buy in", handle the outer limits of complexity, variability and change. Here, methods from psychology, economics and game theory complement domain knowledge and exploratory experimentation with new technologies.