Pressures to decrease both turnaround time and operating costs simultaneously have placed conflicting demands on traditional forms of medical transcription. The new technology of voice recognition extends the promise of enabling the pathologist or other medical professional to dictate a correct report and have it printed and/or transmitted to a database immediately. The usefulness of voice recognition systems depends on several factors, including ease of use, reliability, speed, and accuracy. These in turn depend on the general underlying design of the systems and inclusion in the systems of a specific knowledge base appropriate for each application. Development of a good knowledge base requires close collaboration between a domain expert and a knowledge engineer with expertise in voice recognition. The authors have recently completed a knowledge base for surgical pathology using the Kurzweil VoiceReport 5,000-word system.