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Even though medical expert systems have been one of the earliest and prototypical applications of expert system technology, progress in the field has been disappointingly slow. Medical expert system developers face a number of difficult challenges, in part because the process of expert system development is poorly understood (c.f. developments in software engineering), resulting in a paucity of applicable process models and methodologies. In this paper the challenges encountered by medical expert system developers are conceptualised into a three-layer model, and strategies devised to overcome the above challenges are arranged into a software process model suitable for medical expert system development.