Monitoring clinical performance: the role of software architecture.

Methods of assessing and monitoring the performance of clinicians have received a lot of publicity in recent years. We review the main methodologies concentrating on the distinction between monitoring individual performance and monitoring aggregated performance. We also highlight the importance and difficulties associated with incorporating and assessing risk factors into the process. We discuss how software architecture can be developed to implement these methodologies. We illustrate this development by a case study involving the creation of a software tool to produce funnel plots to analyse surgeon performance. We discuss how such tools are currently evaluated and propose that in future assessments of usability would benefit from an experimental study.