OPAL Rheumatology is an independent not-for-profit Australian clinical research organisation which aims to improve the health outcomes of patients with rheumatic diseases through audit and research. OPAL is the custodian of one of the largest datasets of patients with rheumatic diseases in the world, containing data captured from more than 192,000 unique patients during more than 1 million clinical consultations. Deidentified data is regularly extracted and aggregated from the electronic medical records (EMR) of consenting patients treated by approximately 104 rheumatologists around Australia. The EMR (Audit4) shared by OPAL clinicians was specifically customised for rheumatology and collects comprehensive information on demographics, comorbidities, pathology, disease history and severity, and medication use. In addition, OPAL captures multifaceted outcomes data from both the physician and the patient perspective through a novel patient reported outcome (PRO) mechanism which allows for quality of life to be matched with clinical outcomes and medication utilisation. Since inception in 2009, OPAL has produced over 50 publications and abstracts. In addition, OPAL provides real world evidence to guide medical affairs and commercial strategy, and to support regulatory and reimbursement submissions.