The episode traces the evolution of the Kaiser Permanente orthopedic registries, from an early ambition to match academic output to a sophisticated data platform spanning hip, knee, shoulder, ACL, and hip fracture surgery. The guests describe how minimal-burden data entry, long-term follow-up, and partnership with skilled epidemiologists enabled high-quality observational research capable of influencing practice—such as shifting hemiarthroplasty fixation toward cementation. They emphasize the cultural conditions allowing unbiased inquiry, the complementarity between registries and randomized trials, and the ongoing need to elevate registry science within evidence hierarchies to accelerate meaningful, system-wide change.