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Smart Watch It enables patients to track symptoms at home to identify early signs of increased disease activity, supporting them to coproduce better care with their clinicians.18 The practices participating in the registry have documented a 50% decrease in inflammatory activity among people with rheumatoid arthritis.19Model for coproduction of health, healthcare improvement, and researchThe growing emphasis on patient centredness in registries is consistent with the recognition of the importance of active partnerships between patients, clinicians, and health scientists to improve health, healthcare services, and research.20 21 Patient centred registries could help realise the vision for a learning health system articulated by the US Institute of Medicine as one where “knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” 22 In such a system, patient outcomes and experiences, as well as other valuable data, are continuously monitored and available in real time to both clinicians and patients to facilitate their joint work; importantly, the data are explicitly collected with a view to multiple uses and can be repurposed to support service improvement and scientific inquiry.Building on the structure and function of the registries described above, and the possibilities now offered by the rapid digitisation of healthcare, we have developed a generalisable model for a registry based, patient centred learning system for coproducing health improvement and research (box 1). A key feature of learning systems is that they are not simply a technical infrastructure: they are governed by strong values and a commitment to collective learning, not unlike Mintzberg and colleagues’ vision of a learning culture.23Box 1: Key features of registry based learning systemsSocial network of patients and families encouraged to engage in the patient’s healthcare and supported by tools that enable them to track their health outcomes and support self careCollaborative network of clinical teams that can provide care and who engage in a system providing longitudinal and comparative dataSharing of power and responsibility among patients, clinicians, and scientists for designing, governing, and evaluating services, improvement, and researchDigital collection and use of both clinical and patient reported outcomes to guide care and as a basis for improvement, research, and public health policyDemonstration of measurable improvement in individual and public health outcomes through improved adherence to current evidence and rigorous trials of new approachesOur model brings together patients and families with clinicians and care teams to form a partnership (fig 1). Box 2 shows the main mechanisms supporting the system Smart Watch.