  Standardisation of healthcare has been the focus of hospital management and
clinicians since the 1990's. Electronic health records were already intended to
provide clinicians with real-time access to clinical knowledge and care plans
while also recording and storing vast amounts of patient data. It took more
than three decades for electronic health records to start to become ubiquitous
in all aspects of healthcare. Learning health systems are the next stage in
health information systems whose potential benefits have been promoted for more
than a decade - yet few are seen in clinical practice. Clinical care process
specifications are a primary form of clinical documentation used in all aspects
of healthcare, but they lack standardisation. This thesis contends that this
lack of standardisation was inherited by electronic health records and that
this is a significant issue holding back the development and adoption of
learning health systems. Standardisation of clinical documents is used to
mitigate issues in electronic health records as a basis for enabling learning
health systems. One type of clinical document, the caremap, is standardised in
order to achieve an effective approach to containing resources and ensuring
consistency and quality. This led not only to improved clinicians'
comprehension and acceptance of the clinical document, but also to reduced time
expended in developing complicated learning health systems built using the
input of clinical experts.
