Voice recognition (VR) technology in computer systems converts speech directly into electronic text. In pathology, VR holds promise to improve efficiency and to reduce transcription delays and costs. We investigated the utility and cost effectiveness of targeted VR deployment in surgical pathology. A VR system was deployed for entry of gross descriptions of biopsies and of low to moderate complexity specimens and for entry of final reports for specimens not requiring microscopic analysis. Templates for VR were developed for all reports. Free-text speech entry was used to enter information not covered by templates. Voice converted to text by VR crossed over an interface into the anatomic pathology laboratory information system. Tallies were kept of whether individual specimens were entered by VR or by conventional dictation. Pathology reports consist of observations and interpretations recorded as words and numbers in electronic and paper form. A transcription step is typically necessary for dictated observations and diagnoses to be typed as text into an anatomic pathology laboratory information system (APLIS), from which reports are produced. Voice recognition (VR) technology in computer systems offers the capability to convert human speech directly into electronic text.In VR systems, a microphone converts human speech into an analog electrical signal that an electronic circuit board within a computer then converts to a digital signal (1-3). Speech recognition engine software then uses acoustic, language, and vocabulary models as well as complex statistical algorithms to transform the digital signal into words and punctuation marks. Language and vocabulary models specific to pathology have been developed and are available in commercially available VR systems. Such pathology-specific language models and vocabulary models improve the accuracy of word recognition and word prediction in the context of the language used pathology reports. Earlier generations of VR systems were termed "discrete" because the speaker had to separate each word by a short pause. VR systems now available allow "continuous" voice recognition in which a speaker may speak more naturally without pausing between each word.In surgical pathology, voice recognition (VR) technology holds promise to improve efficiency of workflow and to reduce transcription delays and costs. Dictation in pathology that a VR system converts directly into electronic text does not require transcription into the APLIS if the VR system is either interfaced to or integrated as part of the

A b s t r a c t Integrating data that reside in different systems remains an often laboriousprocess, requiring either manual steps or complicated programming. This paper describes a method for state-mandated reporting of childhood blood lead testing results that makes use of object linking and embedding technology and readily available software products to pull together information from different legacy systems. A terminal session emulator employs object linking and embedding automation to extract host data, and Visual Basic routines specify the user interface and database manipulation. This system has significantly increased the efficiency and accuracy with which blood lead testing reports are provided to the local state health department. The system provides a model for a relatively easy solution for laboratories and other groups that need a way to integrate standard data sets that are distributed across legacy systems. Integrating data from legacy systems remains one of the greatest challenges in health care informatics. Laborious and expensive methods are often necessary to combine information from two or more different systems. Information requirements for reporting childhood blood lead testing are a specific example of such a situation.Lead poisoning in children remains a major preventable environmental health problem in the United States. Approximately 1 million children in the United States have blood lead levels of at least 10 g/dL, a level that has been linked with cognition deficits, learning disabilities, and other neurodevelopment defects. 3 The CDC has recently issued revisions to its original 1991 guidelines for childhood lead screening. 4 The guidelines recommend that state health departments require clinical laboratories performing lead tests to report all lead test results and other important demographic information for persons on whom they perform testing. In Ohio, the Department of Health collects all laboratory blood lead, mercury, cadmium, and arsenic results from clinical laboratories performing such tests. The information that the clinical laboratory must report to the department typically resides in different systems, including the laboratory information system and the hospital information system. Performance of such tasks requires significant personnel time and is subject to human error.In this paper, we present a system that uses object linking and embedding (OLE) technologies and offthe-shelf tools to automate the search for and collection of legacy system data and transform these data into a format necessary for manipulation and placement into a PC-based database, in this case for heavy metal poisoning result reporting to governmental agencies.

This system is a practical application of intelligent reasoning about the planning and sequencing of inspection tasks peiformed by a coordinate measuring machine (CMM). This research is part of an Air Force supported effort to develop a feature-based concurrent engineering system using an object-oriented development platform. Manipulation of design, manufacturing, and inspection features (in this system) is unique in thatftatures are transformed into domain specific objects rather than degraded into elementary geometry. The object-oriented platform provides a meansfor transformation through built-in qualities such as inheritance, tree-search, and a cohesivepart/sub-part organization. Inspectionfeatures represent not only geometry, but references to a world coordinate .system, proper probe approach, and preferred evaluation method. Reasoning through inspection rulesforms a single data object which can then be transformed into CMM executable code.

Transforming health care remains a challenge as many continuous improvement (CI) initiatives fail or are not sustained. Although the literature suggests the importance of culture, few studies provide evidence of cultural change creating sustained CI. This improvement initiative focused on creating cultural change through goal alignment, visual management, and empowering frontline employees. Data included 113 133 encounters. Cochran-Armitage tests and X-bar charting compared wait times during the CI initiative. Odds of waiting <15 minutes increased in both phase 2 (odds ratio = 3.57, 95% confidence interval = [3.43-3.71]) and phase 3 (odds ratio = 5.39, 95% confidence interval = [5.07, 5.74]). At 3 years follow-up, 95% of wait times were <15 minutes. Productivity increased from 519 to 644 patients/full-time equivalent/month; 33/42 Press Ganey employee engagement components significantly improved. This study demonstrates the efficacy of a culture of CI approach to sustain wait time improvement in outpatient laboratory services, and should be considered for application in other areas of health care quality.