This short report shares learning from the research and development phase of the national decision support programme in NHS Scotland. It outlines how the programme has adopted an outcomes-focused approach which has guided critical decisions on solution design, engagement of policy sponsors, clinical and management leaders, implementation and evaluation approach, technical architecture and technology development. It discusses how this outcomes-led approach positions decision support as catalyst for a learning health and care system that continuously refreshes the healthcare knowledge base through new insights generated by evaluating impact and outcomes.