Health and care services need to be optimised to meet the future demand that will be placed on them. This will require a closer coupling of service and research, whereby innovations in services can be rapidly tested and evaluated, and feed back into a continual process of service optimisation. The timely delivery of information from services into research is critical to this cycle. However, there are serious problems with the evidence on which healthcare and public health practice is based: it is expensive to produce; it takes a long time to produce; it takes a long time to influence professional practice; it is crude, relating to the average participant and simple treatment definitions under ideal conditions. In other words, it gives a low-resolution picture of how a patient might respond to treatment or a how a sub-group of the community might respond to a public health intervention. This work is an exploration of informatics solutions to these problems with an aim to re-engineer health care systems to make best use of the evidence available.