In the EHR space, all the CMO (chief medical officer) cares about is it helps keep them in compliance. Why should they care if it’s hard for their office staff to use?
So there were two sides, the engine optimizations to assure things like tab orders on a form, and the was the actually writing the form descriptions. In the first couple organizations that adopted it I wrote the forms and the engine in parallel adding feature flags/controls as needed to support the desired UI outcomes. Later after I quit, the lady who wrote much of the RFP responses started writing the actual form descriptions because it was just as easy as drawing them out in the (visio?) plugin she was using with MS word and doing screen captures for the RFP. Then I guess because she knew how to do it, was doing the "tuning" as well.