JMIR Publications

ABSTRACT

Background:

User-centered design (UCD) processes often generate extensive lists of potential software features, necessitating effective prioritization methods to guide development. The MoSCoW method, categorizing features as Must Have, Should Have, Could Have, or Won’t Have, is widely used in software development for its simplicity and ease of adoption. Despite its popularity, limited evidence exists on its application within health informatics. The DEAN (Decision Aid Navigator) system, a clinical decision support tool, required prioritization of features for its administrative portal to ensure usability and alignment with health IT expert needs.

Objective:

To evaluate how health IT experts engaged with a MoSCoW-based prioritization process during the design of the DEAN Administrative Portal and to assess how discussion and interaction influenced feature prioritization outcomes.

Methods:

A 74 minute web-based group session included four health IT experts experienced in managing clinical decision support systems. Participants independently rated 30 proposed portal features using MoSCoW categories following brief discussions of each feature. Session transcripts, videos, and rating behaviors were analyzed using qualitative secondary analysis to identify themes describing how the MoSCoW process supported prioritization and expert engagement.

Results:

Participants rated 37% of features as Must Have, 13% as Should Have, 20% as Could Have, and none as Won’t Have. The remaining 30% showed distributed ratings without a clear majority. All participants adjusted their ratings, often prompted by group discussion or clarification from the technical lead. Qualitative analysis revealed four themes: (1) Interpretations of feature descriptions may vary; (2) Group discussion generated suggestions for alternative design solutions; (3) Group discussion identified implementation considerations; and (4) Participants considered differences in real world use vs. idealized use when ranking features.

Conclusions:

The MoSCoW method proved to be an efficient, intuitive, and engaging approach for prioritizing features in a UCD process for a clinical decision support system. Group discussion enriched the prioritization session by surfacing implementation insights and design refinements beyond numeric rankings alone. Findings support the use of MoSCoW as a practical tool for health informatics teams seeking structured yet flexible stakeholder engagement in software feature prioritization.