Design and implementation of an EMR-embedded integrated cardio-cerebrovascular registry platform

Fragmented registry systems and limited capture of patient-centered outcomes remain barriers to real-world evidence generation. We implemented an EMR-embedded integrated cardio-cerebrovascular registry platform at a tertiary referral center. The platform included 9 clinical areas and 27 disease- or procedure-specific registry modules, integrating EMR-based candidate event detection, structured data extraction, clinical confirmation workflows, harmonized variables, mobile patient-reported outcomes, cross-module event reuse, and planned administrative linkage. Implementation was evaluated using RE-AIM-informed metrics. Between January 1, 2014, and May 31, 2026, 2,890,478 outpatient or inpatient cases corresponding to 396,481 patients were recorded at the institute; 80,478 patients, corresponding to 97,584 screening cases, met module-specific EMR-based screening criteria. The registry platform included 2,633 operationally available variable rows from reviewed registry components, including 329 common variables applicable across modules. During PRO implementation, the PRO response rate was 48.8% (11,488 of 23,537 unique individuals). The platform was feasible within routine care and may support clinical monitoring, quality assessment, observational research, and future registry-embedded studies after further prospective evaluation. Clinical trial Registration: Clinicaltrials.gov; Registry name: PRIME (Precision Registry for Integrated cardio-cerebrovascular Medicine & Evidence); Registration Number: NCT07393412; Date of registration: 2026-01-30.