I do see myself as being at the "coalface" of care, yet I can never recall anyone actually asking me , (or my colleagues), what we need from a system.
Valid point, and a major problem in terms of specifying and developing any system. The larger the organisation the bigger the problem (generally).
But not the point being raised, I think.
One can (and should) separate WHAT is being done from HOW (and how reliably) it is being done.
SD