Yes, users do know what they want from software. And developers must listen.

Benjamin Franklin said, "An ounce of prevention is worth a pound of cure." Then why is so much software rework done today, and why do so many software products fail to delight users?

In my view, it is because most companies don't understand or implement soft skills to develop great software.

In my career in the software business, I have experienced and/or led a number of interesting failed deployments. One effort involved software designed to help physicians enter orders. As homework, one tech person spoke to a physician and translated the physician's insights to an analyst, who wrote them up. An engineer then developed the solution and tested it for quality assurance, and the implementation team installed it.

But the receiving clinicians at another hospital wanted nothing to do with it, so it was back to the drawing board. The IT team went to fix it. Who got egg on their face? Development -- and not because of a lack of talented people. I strongly believe it is because the approach used old processes and an old mindset. We can do better.

Engineers, analysts, and others often believe they know what the user needs. A friend's teammate, who happened to be a trained physician but never practiced medicine, often said, "Users don't know what they want."

The fact is, he didn't know either. How could he? He may have studied and even practiced a little medicine. He may have done the job years before, but he was no longer involved in the medical field. A user may not know how to express what they need, but they certainly know, as Clay Christensen teaches, the job to be done. We can do better.

The first change we must make is to observe. We must do the contextual inquiry needed to understand why a user will "hire" the software. It must be done with a "customer empathy" mindset. Success stories achieved in other industries can show us the critical nature of this approach.

A good example is Huggies Pull-Ups. Parent company Kimberly-Clark created a whole new product line after spending time with parents and understanding that diapers are about the growth and development of babies. Another favorite example is the Oxo Good Grips measuring cup: After watching people crouch to see the lines in their measuring cups, Oxo designed its cups to be legible from any angle.

Agile, scrum, rapid cycle ... these are terms we are becoming more familiar with. They are often touted as the balm that will heal the wounds of bad software. So why do companies who get these theories right still build less-than-thrilling software? Are we focusing too much on the middle of the software information chain and on developing better engineering skills and capabilities?

We need to teach contextual inquiry skills to observation teams. Software, as innovation, is a collaborative team sport, yet we don't seem to collaborate around the context of the job we're doing. We still fail to think of software development as a team sport. What information does a developer need to do a great job? What information does a quality assurance person need to do a great job? The same question can be applied right through to the implementation consultant.

But it all starts with the user. In his famous article Integrating Around the Job to be Done, Clay Christensen asks: "Why would someone 'hire' a milkshake? What 'job' are they trying to get done?"

Many people talk about user-centered design, and I agree with that mindset. With a little creative license, I suggest that we should add "job-centered design" as well. We need to teach the mindset and skillset, and instantiate the toolset that enables great observation teams and outcomes.

Consider the concept of a "love metric." IT experts are familiar with the metrics of on time and on budget. However, these are entry-level expectations -- they are simply expected, but we are rarely rewarded in the long term for achieving them. Isn't our job really to help users get a job done?

If users want software to help them more easily record a patient note, or get paid faster, we must instrument our code and reviews to determine if the software delivers what users would love it to do. If they love it, we've succeeded.

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The owners of electronic health records aren't necessarily the patients. How much control should patients have? Electronic medical records contain highly personal information, from illnesses to family matters to emotional statuses. Yet those records don't necessarily belong to the patient. The question this raises in the digital age is: Just how much control should people have over their own records?

Electronic health records (EHRs) have become invaluable collections of information used by a diverse group ranging from government agencies and disease researchers to marketing firms and for-profit data brokers. Government and for-profit businesses have long collected, parsed, and used collective patient data to track the path of chronic conditions and contagious diseases, follow the success rates of new and old treatments, develop new cures, and improve the quality of providers' services. But because today's electronic records are easily shareable -- and hackable -- and have different rules depending on state and organization, some patients fear they have little to no control over the information that tracks their very personal health information.

"It's like we have a vacation home, and we've given out keys to 50 different people, and they all show up at the same time," says Chris Zannetos, CEO and founder of security developer Courion, which counts healthcare organizations as about one-third of its customers. In other words, as patients we want our data to be shared when needed, but then we're surprised at how quickly we lose control of how it's shared.

Consumers don't "own" their health records any more than they own the vast troves of data that retailers, financial institutions, and government agencies collect about them, says Dr. Josh Landy, a physician and co-founder of Figure 1, a text-messaging app for healthcare professionals. Instead of ownership, healthcare professionals and patients should discuss electronic patient data in terms of "stewardship," he says. Although the creator of the record -- such as a hospital or physician's practice -- controls the record and data, patient data has multiple stewards.

Complete records might well include a combination of handwritten medical notes scanned as PDFs into a patient's file; information manually or electronically entered from monitoring and collection tools such as stethoscopes and scales; and data entered directly into the EHR. And the picture is going to get more complex. Soon, electronic records might collect data from wearable devices -- purchased as consumer gadgets -- that gather health data around the clock.

In addition, consumers often see a variety of healthcare practitioners. Each one -- primary care doctor, orthopedic surgeon, hospital doctor, or psychiatrist -- typically uses the referring doctor's record and creates a copy appended to his own electronic health record for the individual.

With all this sharing, what if a patient has a diagnosis he doesn't agree with or doesn't want shared? Can he contest, say, a diagnosis of alcoholism?

"We have to give due course to the patient," says Richard Rosenhagen, assistant VP for EMR/HIM/CDIP at South Nassau Communities Hospital. "If you're not transparent, you're going to end up in a bad place." The hospital has a process for discussing such conflicts with patients and making their disagreement part of the record, though the diagnosis remains. "If they disagree with what's in there, they have a right to voice their opinion," he says. "That disagreement doesn't give them the right to amend the record."

Incorporating more patient-driven data changes will present a whole new set of challenges for health IT professionals.

One reason is that, as a rule, consumers are "horrible historians," says John Hoffstatter, a physician's assistant and delivery director of advisory services at CTG Health Solutions. People forget to bring in a list of current medications or don't know why they take a particular pill. Having patients read through their electronic record is essential to improve care and reduce costs, he says.