The analysis of recurring concepts in the interviews focus on five central themes: stakeholders have substantial expectations for CER using ECD, both with respect to addressing the limitations of traditional research studies, and generating meaningful evidence for decision-making and improving patient outcomes; stakeholders are aware of many challenges related to implementing CER with ECD, including the need to develop appropriate governance, assess and manage data quality, and develop methods to address confounding in observational data; stakeholders continue to struggle to define 'patient-centeredness' in CER using ECD, adding complexity to attaining this goal; stakeholders express that improving translation and dissemination of CER, and how research can be 'useful' at the point of care, can help mitigate negative perceptions of the CER 'brand'; and stakeholders perceive a need for a substantial 'culture shift' to facilitate collaborative science and new ways of conducting biomedical and outcomes research. Many stakeholders proposed approaches or solutions they felt might address the challenges identified.

Each week, half a million readers access the Journal electronically, and our content is now seen online by about four times as many people as those who see the print edition. This mode of information delivery has expanded tremendously since the Journal first went online in 1996.(1) Not so long ago, electronic publishing was viewed as secondary to print publication, basically as a convenient way to deliver the print version of an article. Today, the electronic presentation of scientific articles has become the version of record, with print becoming only one part of the complete publication, which may include video, . . .

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