In my work I used AutoHotKey and a USB numpad to turn button presses into clicks and routines in an old piece of software in order to set up a machine
I run out of buttons so I was inspired by Adafruits MacroPad RP2040. While conceptually similar I started from scratch with the following design decisions:
Pi Pico soldered to the board instead of discrete RP2040 and support components.
Change to a 240x135 TFT so I could have icons that matched colour with the keys.
Change from a 3x4 layout to 4x3, helps make the PCB within PCBway's 100x100 pricing
Use a matrix for the keys (Diode per key) to free up IO for a hat and thumb switch)
CircuitPython pretends to be a USB joystick, AutoHotkey on the device handles what happens when a key is pressed on each page.