Salem Health is a 454-bed hospital with a level II trauma center in Salem, Oregon. It runs the busiest emergency department (ED) between Los Angeles and Seattle and bills over 1.3 million lab tests annually. Salem Health has 2 labs, one at the hospital and another off campus. Each lab has its own Clinical Laboratory Improvement Amendments (CLIA) license and College of American Pathologists (CAP) accreditation. Brenda R. Crawford, MT (ASCP), SC, is the Senior Laboratory Specialist who oversees the chemistry departments in both labs. It was Ms. Crawford who led the launch of the CAP Proficiency Driver with Roche Middleware. Salem Health started running Roche Middleware Solutions in 2007. It implemented the CAP Proficiency Driver in 2014. By every measure, it has been a success.