The National Surgical Quality Improvement Program (NSQIP) has achieved remarkable success over the 15 years of its existence, initially in the Veterans Health Administration and more recently in private and US Department of Defense hospitals. However, the NSQIP is at a critical juncture because of the cost and other limitations of data collection largely by manual chart abstraction. A potential solution is the documentation of care by surgical teams using the NSQIP data set as the foundation for standardized data that can be reused electronically for multiple other purposes, such as discharge abstracts, billing, and other Centers for Medicare and Medicaid Services and insurer requirements for data. It is likely that the innovative design of portions of the electronic medical record will be time efficient and acceptable to surgical care providers once they experience its advantages.