Thanks for asking this extremely important question. In fact, it’s one of the most important questions we must resolve if the OpenMRS Community is going to remain relevant and a reliable source of software & services for our customers.
The great news, as seen above, is that @janflowers is doing a lot of thinking on these topics, which is key to our long-term viability & growth. We should all do whatever we can to support her efforts, and to find people to help in the cause.
The other good news is that requirements management is a practice that is well-documented and well-understood in the software engineering world; so we don’t have to re-invent the wheel, we just have to make it work for us. 
I would recommend that with Jan’s leadership, we assemble a team of people to focus on understanding what the 5 stages of Investigation, Feasibility, Design, Construction and Test, and Release mean to us. We already do some minimal/basic process in the Design and Release phases, but importantly, we don’t have a documented process about how to pass feedback in the Release phase back to the earlier phases of a subsequent release. (This is in part what Ada mentioned above.)
I believe we also need to do much better with traceability as described in the Wikipedia article above. If our customers don’t understand how and when their ideas are getting implemented (or not!) in a particular release, we will appear as non-responsive to their needs.
Finally, I also strongly support the idea from @sunbiz about co-locating developers with implementations for extended periods of time. Those co-placements should also rotate – in other words, a “serious” (high commitment) developer-contributor should have exposure to as many different settings as possible. I realize not all of our contributors will be able to accept this opportunity, but I think we’ll be surprised at the numbers willing to take on the challenge. I hope the engineering teams will include this idea in their requests for funding to our fiscal sponsor(s) as we get more formalized about the fundraising process in 2016.
- We need lots of people to do this work! If this kind of stuff is interesting to you, please speak up and make yourself known to @janflowers, or to me!
- We also need many more ideas, so please continue to reply to this topic with your thoughts … we want to hear from both engineers with experience in these areas, as well as hear from our implementing customers who have good ideas to share about making our software releases more valuable for them.
Thanks everyone for the continued discussion!