The Multicenter Perioperative Outcomes Group (MPOG) was formed in 2008 to develop the necessary policies, procedures, and technical infrastructure required for multicenter perioperative outcomes research. We are a non-profit, self-funded academic consortium seeking to improve patient care using data. Currently, MPOG is a consortium of 56 medical centers aggregating large volumes of observational inpatient electronic health record (EHR) data, patient reported outcomes, and long term administrative outcomes. MPOG has already extracted, transformed, and semantically mapped more than 4.5 million cases with 3 million distinct patient records from 28 different medical centers across the US and Europe using distinct EHR products. We have overcome the regulatory, political, and technical challenges encountered by most attempts at robust multicenter research. It has now moved into the knowledge creation phase, publishing data in high impact clinical journals and informatics forums such as the electronic data methods forum sponsored by the Agency for Healthcare Research and Quality.