Jim, I'm a surgeon and I used to do something similar with the whole cassette tape/pick up/drop off thing. I found that my local transcriptionist was more than eager to stop the driving all over the city. I dictate into one of the Olympus digital recorders that is able to plug directly into my USB port. The Olympus recorder makes WMA files. These files are actually reasonably sized. All I do is download the files and email them off. When they're completed, the Word docs are sent back to me. I print them on letterhead as appropriate and off they go. Could this be better sure. I realize it doesn't address your difficulty with offsite access but possibly one way to accomplish this would be to save these letters as PDF and make yourself a password protected web site to access from the hospital. I'm sure there are no end of database backend solutions to search, store, etc. -- Andy Fragen