Abstract:
A computer program product for use with dictated medical patient information resides on a computer-readable medium and comprises computer-readable instructions for causing a computer to analyze the dictated information, identify likely confidential information in the dictated medical patient information, and treat the likely confidential information disparately from likely non-confidential information in the dictated medical patient information.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    Healthcare costs in the United States account for a significant share of the GNP. The affordability of healthcare is of great concern to many Americans. Technological innovations offer an important leverage to reduce healthcare costs. 
         [0002]    Many Healthcare institutions require doctors to keep accurate and detailed records concerning diagnosis and treatment of patients. Motivation for keeping such records include government regulations (such as Medicare and Medicaid regulations), desire for the best outcome for the patient, and mitigation of liability. The records include patient notes that reflect information that a doctor or other person adds to a patient record after a given diagnosis, patient interaction, lab test or the like. 
         [0003]    Record keeping can be a time-consuming task, and the physician&#39;s time is valuable. The time required for a physician to hand-write or type patient notes can represent a significant expense. Verbal dictation of patient notes offers significant time savings to physicians, and is becoming increasingly prevalent in modern healthcare organizations. 
         [0004]    Over time, a significant industry has evolved around the transcription of medical dictation. Several companies produce special-purpose voice mailbox systems for storing medical dictation. These centralized systems hold voice mailboxes for a large number of physicians, each of whom can access a voice mailbox by dialing a phone number and putting in his or her identification code. These dictation voice mailbox systems are typically purchased or shared by healthcare institutions. Prices can be over $100,000 per voice mailbox system. Even at these prices, these centralized systems save healthcare institutions vast sums of money over the cost of maintaining records in a more distributed fashion. 
         [0005]    Using today&#39;s voice mailbox medical dictation systems, when a doctor completes an interaction with a patient, the doctor calls a dictation voice mailbox, and dictates the records of the interaction with the patient. The voice mailbox is later accessed by a medical transcriptionist who listens to the audio and transcribes the audio into a text record. The playback of the audio data from the voice mailbox may be controlled by the transcriptionist through a set of foot pedals that mimic the action of the “forward”, “play”, and “rewind” buttons on a tape player. Should a transcriptionist hear an unfamiliar word, the standard practice is to stop the audio playback and look up the word in a printed dictionary. 
         [0006]    The medical transcriptionist&#39;s time is less costly for the hospital than the doctor&#39;s time, and the medical transcriptionist is typically much more familiar with the computerized record-keeping systems than the doctor is, so this system offers a significant overall cost saving to the hospital. 
         [0007]    The information dictated by the doctor often includes sensitive or confidential information, such as patient name, age, visit dates, medical record numbers, account numbers, referring physicians, consulting physicians, and other provider names and addresses, for example. Furthermore, recent federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) increase the importance of maintaining the confidentiality of patient information. For example, HIPAA describes data called “Protected Health Information (PHI)”. Protected Health Information includes medical records data in which the patient is identified. As a result of this Act, many security measures are being created to protect this data. 
       SUMMARY OF THE INVENTION 
       [0008]    Embodiments of the invention may provide security that is useful for medical records documents that include patient identification material. A mechanism may be provided that permits documents to be separated from the patient identification during transmission. Thus, an interceptor of a document during transmission will preferably not have enough information to identify the patient to which the document refers. Even if a document and its patient identification information are both intercepted, determining that the two portions of information belong with each other may be difficult. Security may be further enhanced by separating the patient identifying material from the text of the document. 
         [0009]    In general, in an aspect, the invention provides a computer program product for use with dictated medical patient information, the computer program product residing on a computer-readable medium and comprising computer-readable instructions for causing a computer to analyze the dictated information, identify likely confidential information in the dictated medical patient information, and treat the likely confidential information disparately from likely non-confidential information in the dictated medical patient information. 
         [0010]    Embodiments of the invention may include one or more of the following features. The computer program can be configured to cause the computer to restrict access to the likely confidential information. The instructions for causing the computer to treat the likely confidential information disparately from likely non-confidential information can cause the computer to store the likely confidential information and the likely non-confidential information such that which information is the likely confidential information is discernable. The instructions for causing the computer to treat the likely confidential information disparately from likely non-confidential information can also cause the computer to store a confidential indication in association with the likely-confidential information. The instructions for causing the computer to treat the likely confidential information disparately from likely non-confidential information can further cause the computer to transmit the likely confidential information separately from the likely non-confidential information to a communication network. The instructions for causing the computer to transmit the likely confidential information separately from the likely non-confidential information to a communication network can cause the computer to transmit likely confidential audio dictated information separately from likely non-confidential audio dictated information and to transmit likely confidential transcribed textual information corresponding to the likely confidential audio information separately from likely non-confidential transcribed textual information corresponding to the likely non-confidential audio dictated information. 
         [0011]    Embodiments of the invention may further include one or more of the following features. The instructions for causing the computer to identify likely confidential information in the dictated medical patient information can cause the computer to identify particular phrases, containing at least one word, as the likely confidential information. The instructions for causing the computer to identify likely confidential information in the dictated medical patient information can further cause the computer to identify a boundary between a body of a transcribed document associated with the dictated information and at least one of a header and a footer of the transcribed document. The instructions for causing the computer to identify the boundary can further cause the computer to apply a statistical trigger model to the dictated information. The instructions for causing the computer to identify the boundary can also cause the computer to search for trigger phrases, of at least one word, associated with the boundary and compare boundary likelihoods associated with found trigger phrases. The instructions for causing the computer to identify the boundary can cause the computer to determine boundary likelihoods associated with the found trigger phrases by analyzing positions of the found trigger phrases in the dictated information relative to a beginning or an end of the dictated information. 
         [0012]    In general, in another aspect, the invention provides a computer program product for use with text transcribed from audio information, the computer program product residing on a computer-readable medium and comprising computer-readable instructions for causing a computer to differentiate between a first portion and a second portion of the text, display the first portion of the text transcribed from audio information, inhibit the second portion of the text from being displayed, and display an indication that the second portion of the text exists. 
         [0013]    Embodiments of the invention may include one or more of the following features. The indication that the second portion of the text exists can be a box. The box can be of a fixed size regardless of an amount of text contained in the second portion of the text. The indication that the second portion of the text exists can be an audible indicator. The instructions can be configured to cause the computer to display the indication in a location within the text using a token-alignment file that associates portions of the audio information with portions of the text. 
         [0014]    Embodiments of the invention may further include one or more of the following features. The computer product may further include instructions for displaying the second portion of the text in response to a second-portion request for display of the second portion, distinct from a text request for display of the transcribed text. The computer product can include instructions for causing the computer to display the second portion of the text in response to provision of authorization information. Further, the computer product can include instructions for causing the computer to securely store the second portion of the text. 
         [0015]    In general, in another aspect, the invention provides a method of processing text transcribed from an audio file regarding a patient, the method comprising displaying a portion of the transcribed text containing non-confidential patient information on a monitor, playing portions of an audio file associated with the transcribed text, and inhibiting a portion of the transcribed text containing confidential patient information from being displayed on the monitor. 
         [0016]    Embodiments of the invention can include one or more of the following features. The inhibiting can comprise displaying an indication on the monitor that confidential information is being concealed. The indication can be disposed at a location within the transcribed text corresponding to where the confidential information belongs in the text. The indication can comprise a shaded box. The box can be of a fixed size regardless of an amount of confidential information being concealed. The indication can be an alias for the confidential information. The method can further comprise displaying the confidential information in response to a request to display the confidential information that is distinct from an initial request to display the transcribed text. 
         [0017]    In general, in another aspect, the invention provides a method of processing a medical patient dictation, the method comprising analyzing the dictated information, identifying likely confidential information in the dictated medical patient information, and treating the likely confidential information disparately from likely non-confidential information in the dictated medical patient information. 
         [0018]    Embodiments of the invention can include one or more of the following features. The method may further comprise labeling a portion of the dictated information to distinguish the likely confidential information from the likely non-confidential information. The method may further comprise inhibiting access to the likely confidential information. The method may also comprise transmitting the likely confidential information and the likely non-confidential information separately over a communication network. The method still further may comprise identifying a boundary between a body of a transcribed document associated with the medical patient dictation and at least one of a header and a footer of the transcribed document. Identifying the boundary can comprise applying a statistical trigger model to the medical patient dictation. Applying the statistical trigger model may comprise searching for trigger phrases, of at least one word, associated with the boundary and comparing boundary likelihoods associated with found trigger phrases. 
         [0019]    Aspects of the invention may include one or more of the following capabilities. Confidential information is removed or concealed from the body of a medical record document. The confidential information is accessible to authorized users by listening to audio associated with a medical record document, or by accessing a secure database. Separate audio files having various levels of confidential information can be transmitted and/or stored separately from non-confidential information. Separate text files having various levels of confidential information can be transmitted and/or stored separately from non-confidential transcribed information. The confidential information is secured by associating it with a medical record document via a unique identifier. Medical records information contained in clinician audio dictations are de-identified from the resulting transcriptions. Transcribed information can be added or changed at a transcription device without revealing the confidential information. The cost of medical transcription is reduced. Information associated with a patient&#39;s identity can be inhibited from being paired with information of a patient&#39;s medical exam by an interceptor of information transmitted over a public network. 
         [0020]    These and other capabilities of the invention, along with the invention itself, will be more fully understood after a review of the following figures, detailed description, and claims. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0021]      FIG. 1  is a simplified diagram of a system for transcribing dictations and editing corresponding transcriptions. 
           [0022]      FIG. 2  is a simplified block diagram of an editing device of the system shown in  FIG. 1 . 
           [0023]      FIG. 3-5  are portions of a transcribed dictation showing concealment of a portion of the text. 
           [0024]      FIG. 6  is a block flow diagram of a process of extracting information from an automatic transcription device. 
           [0025]      FIG. 7  is a block flow diagram of a process of producing and editing a transcription. 
           [0026]      FIG. 8  is a block flow diagram of a process of editing information extracted from an automatic transcription device. 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0027]    Embodiments of the invention can provide a secure database for the storage of confidential information related to documents associated with a digital audio signal of speech to be transcribed. Confidential information can be removed from the body of a medical records document. Authorized users access the confidential information by listening to the audio associated with the document. Confidential information is stored separately in textual form in a medical records database, and associated with a medical record document. Confidential information is concealed from view in a text document being edited. The private information is accessible to authorized persons via a login or a password. Other embodiments are within the scope of the disclosure. 
         [0028]    Referring to  FIG. 1 , a system  10  for transcribing audio and editing transcribed audio includes a speaker/person  12 , a communications network  14 , a voice mailbox system  16 , an administrative console  18 , an editing device  20 , a communications network  22 , a database server  24 , a communications network  26 , and an automatic transcription device  30 . Here, the network  14  is preferably a public switched telephone network (PSTN) although other networks, including packet-switched networks could be used, e.g., if the speaker  12  uses an Internet phone for dictation. The network  22  is preferably a packet-switched network such as the global packet-switched network known as the Internet. The network  26  is preferably a packet-switched, local area network (LAN). Other types of networks may be used, however, for the networks  14 ,  22 ,  26 , or any or all of the networks  14 ,  22 ,  26  may be eliminated, e.g., if items shown in  FIG. 1  are combined or eliminated. 
         [0029]    Preferably, the voice mailbox system  16 , the administrative console  18 , and the editing device  20  are situated “off site” from the database server  24  and the automatic transcription device  30 . These systems/devices  16 ,  18 ,  20 , however, could be located “on site,” and communications between them may take place, e.g., over a local area network. Similarly, it is possible to locate the automatic transcription device  30  off-site, and have the device  30  communicate with the database server  24  over the network  22 . 
         [0030]    The network  14  is configured to convey dictation from the speaker  12  to the voice mailbox system  16 . Preferably, the speaker  12  dictates into an audio transducer such as a telephone, and the transduced audio is transmitted over the telephone network  14  into the voice mailbox system  16 , such as the Intelliscript™ product made by eScription™ of Needham, Mass. The speaker  12  may, however, use means other than a standard telephone for creating a digital audio file for each dictation. For example, the speaker  12  may dictate into a handheld PDA device that includes its own digitization mechanism for storing the audio file. Or, the speaker  12  may use a standard “dictation station,” such as those provided by many vendors. Still other devices may be used by the speaker  12  for dictating, and possibly digitizing the dictation, and sending it to the voice mailbox system  16 . 
         [0031]    The voice mailbox system  16  is configured to digitize audio from the speaker  12  to produce a digital audio file of the dictation. For example, the system  16  may use the Intelliscript™ product made by eScription. 
         [0032]    The voice mailbox system  16  is further configured to prompt the speaker  12  to enter an identification code and a worktype code. The speaker  12  can enter the codes, e.g., by pressing buttons on a telephone to send DTMF tones, or by speaking the codes into the telephone. The system  16  may provide speech recognition to convert the spoken codes into a digital identification code and a digital worktype code. The mailbox system  16  is further configured to store the identifying code and the worktype code in association with the dictation. The system  16  preferably prompts the speaker  12  to provide the worktype code at least for each dictation related to the medical field. The worktype code designates a category of work to which the dictation pertains, e.g., for medical applications this could include Office Note, Consultation, Operative Note, Discharge Summary, Radiology report, etc. The worktype code may be used to refine speed settings, such that settings may be specific not only to speaker-transcriptionist pairings, but further to worktype of dictations provided by the speaker, and/or to other parameters or indicia. The following discussion, however, focuses on using only speaker-transcriptionist pairings. 
         [0033]    The voice mailbox system  16  is further configured to transmit the digital audio file and speaker identification code over the network  22  to the database server  24  for storage. This transmission is accomplished by the system  16  product using standard network transmission protocols communicating with the database server  24 . 
         [0034]    The database server  24  is configured to store the incoming data from the voice mailbox system  16 , as well as from other sources. For example, information such as patient Medical Record Number (MRN), date of dictation, date of encounter, account number, and other information can originate from the voice mailbox system  16 , from a hospital billing system, or from another source. The database server  24  may include the EditScript Server™ database product from eScription. Software of the database server is configured to produce a database record for the dictation, including a file pointer to the digital audio data, and a field containing the identification code for the speaker  12 . If the audio and identifying data are stored on a PDA, the PDA may be connected to a computer running the HandiScript™ software product made by eScription that will perform the data transfer and communication with the database server  24  to enable a database record to be produced for the dictation. 
         [0035]    Preferably, all communication with the database server  24  is intermediated by a “servlet” application  32  that includes an in-memory cached representation of recent database entries. The servlet  32  is configured to service requests from the voice mailbox system  16 , the automatic transcription device  30 , the editing device  20 , and the administrative console  18 , reading from the database when the servlet&#39;s cache does not contain the required information. The servlet  32  includes a separate software module that helps ensure that the servlet&#39;s cache is synchronized with the contents of the database. This helps allow the database to be off-loaded of much of the real-time data-communication and to grow to be much larger than otherwise possible. For simplicity, however, the below discussion does not refer to the servlet, but all database access activities may be realized using the servlet application  32  as an intermediary. 
         [0036]    The automatic transcription device  30  may access the database  40  in the database server  24  over the data network  26  for transcribing the stored dictation. The automatic transcription device  30  uses an automatic speech recognition (ASR) device (e.g., software) to produce a draft transcription for the dictation. An example of ASR technology is the AutoScript™ product made by eScription that also uses the speaker and, optionally, worktype identifying information to access speaker and speaker-worktype dependent ASR models with which to perform the transcription. 
         [0037]    The device  30  transmits the draft transcription over the data network  26  to the database server  24  for storage in the database and to be accessed, along with the digital audio file, by the editing device  20 . 
         [0038]    The device  30  is further configured to affect the presentation of the draft transcription. The device  30 , as part of speech recognition or as part of post-processing after speech recognition, can add or change items affecting document presentation such as formats, abbreviations, and other text features. The device  28  includes a speech recognizer and may also include a post-processor for performing operations in addition to the speech recognition, although the speech recognizer itself may perform some or all of these additional functions. 
         [0039]    Automatic speech recognition (ASR) models in the device  30  used to produce draft transcriptions include different types of grammars for recognizing the speaker&#39;s dictation. The grammars can be, for example, generic, specific, or intermediate. Generic grammars are designed to recognize speech from a random speaker. Specific grammars are designed/adapted for a particular speaker, either being designed from scratch for the speaker  12  or having been adapted from a more general grammar in response to previous dictations and edited transcriptions. An example of an intermediate grammar is a grammar designed not for a particular speaker, but for speakers that are likely to follow a particular pattern. For example, doctors from a particular institution may be instructed to dictate patient records with a particular format, and the grammar can be designed to improve recognition based on knowledge of expected phrases and/or organization of the patient record. 
         [0040]    The automatic transcription device  30  is further configured to identify confidential portions of dictations, including particular data, header regions, and footer regions. Confidential/private patient information includes, e.g., patient name, medical record number, and/or other information from which a patient&#39;s identity may be discerned, at least to reasonable (or unacceptable) degree of certainty. The ASR models can be used to identify particular data, such as portions of the dictation that includes the provider name, patient name, patient names spelled out, date of encounter, worktype and/or Medical Record Number (MRN). The device  30  also preferably is able to identify header and footer portions of a dictation as these introductory and closing portions often contain confidential information. The device  30  can analyze the text for the manner in which the speaker begins the dictation. For example, the device  30  may include a grammar such as, “This is Dr. &lt;PROVIDER NAME&gt; dictating an office note on &lt;PATIENT NAME&gt;, medical record number &lt;MRN&gt;. Date of visit is &lt;DATE OF ENCOUNTER&gt;”. The device  30  can additionally analyze the text for the manner in which a speaker  12  begins the body of a dictation, which indicates the completion of the header. For example, the device  30  may include a grammar such as, “CHIEF COMPLAINT: Mr. &lt;PATIENT_LAST_NAME&gt; comes in today complaining of chest pain.” The device  30  may also include a grammar related to the manner in which a speaker  12  dictates the end of a note, or footer. For example, the device  30  may include a grammar such as, “This is &lt;PROVIDER NAME&gt;. Please send a copy to &lt;CONTACT1&gt; and &lt;CONTACT2&gt;, as well as to my office.” 
         [0041]    Preferably, the device  30  uses the grammars to identify the location of the header and footer in a dictation. These grammars provide trigger words or phrases that indicate the boundary from the header to the body of the dictation or from the body of the dictation to the footer. Examples of additional end-of-header (i.e. beginning-of-body) trigger phrases include: “The patient is a”, followed by an age; “The patient comes in today complaining of . . . ”; “history”. Examples of footer (i.e. end-of-body) trigger phrases include: “That&#39;s all”; “Please send a copy of this to . . . ”. In many cases, these triggers by themselves will be sufficient to reliably identify the end of the header and beginning of the footer. These phrases may, however, be supplemented by a statistical trigger model to help identify the boundaries. The model is statistical in that it determines the likelihood of one or more locations being a header/body or body/footer transition, and uses the most likely location as the actual location of the transition. A statistical trigger model can be used alone, or can be combined with a duration model, such as a specified number of words, for the header, body, and footer in order to resolve ambiguities in determining whether particular grammar is a part of the header or the footer. For example, a statistical analysis may include that the phrase “Please send a copy to . . . ” has a 90% probability of being a boundary phrase when it occurs within the final thirty words of a dictation. The statistical trigger model may be constrained by the structure of the document, for example, requiring that the footer follows the body, which follows the header. 
         [0042]    The header and footer region of the dictation can alternatively be identified by the transcription device  30  in one of the following ways. The header and footer may be identified by using an instance of a listened-to/transcribed header/footer to form the grammar which is used to remove the header/footer from subsequent dictations. A catalog of grammars from a database of providers may be employed to identify headers/footers. The grammars can be scored to determine likely instances of headers/footers in different grammars. A generalized search for words associated with tags in the token-alignment file, discussed below, can be conducted, and may be narrowed using the current date or medical record numbers. 
         [0043]    In the event that speech recognition errors occur, a) known or common errors from speech recognition can be explicitly included; b) “wild-cards” that model words which are known to cause recognition errors can be utilized. For example, instead of “the patient comes in today complaining of”, the grammar might be “* patient comes * complaining *”, since the non-wildcarded words are known to be reliably recognized. The identified confidential information, including header and footer information, are stored separately and treated differently than non-confidential information for the editing process discussed below. Portions of the dictation that include confidential information can be stored separately from non-confidential information in the database  40 . For example, the database  40  may include multiple databases, and the confidential information may be stored in a database separate from a database in which non-confidential information is stored. Confidential information can be stored in the same database, but in a separate portion (e.g., a separate file), as non-confidential information. The confidential information is stored separately in that access to the confidential information is inhibited/restricted such that a user that has access to non-confidential information in the database  40  does not necessarily have access to the confidential information. For example, access to the confidential information may require a password or other security measure. Further, the confidential information that appears in the body of the dictation document is tagged, e.g., to help inhibit access to the confidential information even if it is not contained in the header or footer. Additional security can include encrypting the data before sending the data to the user terminal for the editing process, or encrypting the data while the data is en route to the user terminal. 
         [0044]    The transcription device  30  is further configured to produce a token-alignment file that synchronizes the audio with the corresponding text. This file comprises a set of token records, with each record preferably containing a token, a begin index, and an end index. The token comprises a character or a sequence of characters that are to appear on the screen during a word-processing session, or one or more sounds that may or may not appear as text on a screen. A begin index comprises an array reference into the audio file corresponding to the place in the audio file where the corresponding token begins. The end index comprises an array reference into the digital audio file corresponding to the point in the audio file where the corresponding token ends. As an alternative, the end index may not exist separately, with it being assumed that the starting point of the next token (the next begin index) is also the ending point of the previous token. The transcription device  30  can store the token-alignment file in the database  40 . 
         [0045]    The token-alignment file may contain further information, such as a display indicator and/or a playback indicator. The display indicator&#39;s value indicates whether the corresponding token is to be displayed, e.g., on a computer monitor, while the transcription is being edited. Using non-displayed tokens can help facilitate editing of the transcription while maintaining synchronization between on-screen tokens and the digital audio file. For example, a speaker may use an alias, e.g., for a heading, and standard heading (e.g., Physical Examination) may be displayed while the words actually spoken by the speaker (e.g., “On exam today”) are audibly played but not displayed as text (hidden). The playback indicator&#39;s value indicates whether the corresponding token has audio associated with the token. Using the playback indicator can also help facilitate editing the transcription while maintaining synchronization between on-screen tokens and the digital audio file. The playback indicator&#39;s value may be adjusted dynamically during audio playback, e.g., by input from the transcriptionist. The adjustment may, e.g., cause audio associated with corresponding tokens (e.g., hesitation words) to be skipped partially or entirely, that may help increase the transcriptionist&#39;s productivity. 
         [0046]    The tokens stored in the token-alignment file may or may not correspond to words. Instead, a token may represent one or more characters that appear on a display during editing of the transcription, or sounds that occur in the audio file. Thus, the written transcription may have a different form and/or format than the exact words that were spoken by the person  12 . For example, a token may represent conventional words such as “the,” “patient,” or “esophagogastroduodenoscopy,” multiple words, partial words, abbreviations or acronyms, numbers, dates, sounds (e.g., a cough, a yawn, a bell), absence of sound (silence), etc. For example, the speaker  12  may say “USA” and the automatic transcription device  30  may interpret and expand this into “United States of America.” In this example, the token is “United States of America” and the begin index would point to the beginning of the audio signal for “USA” and, if the token-alignment file uses end indexes, the end index would point to the end of the audio signal “USA.” As another example, the speaker  12  might say “April 2 of last year,” and the text might appear on the display as “04/02/2003.” The tokens, however, can synchronize the text “04/02/2003” with the audio of “April 2 of last year.” As another example, the speaker  12  might say “miles per hour” while the text is displayed as “MPH.” Using the tokens, the speech recognizer  30 , or a post-processor in or separate from the device  30 , may alter, expand, contract, and/or format the spoken words when converting to text without losing the audio synchronization. Tokens preferably have variable lengths, with different tokens having different lengths. 
         [0047]    The token-alignment file provides an environment with many features. Items may appear on a screen but not have any audio signal associated with them (e.g., implicit titles and headings). Items may have audio associated with them and may appear on the screen but may not appear as words (e.g., numeric tokens such as “120/88”). Items may have audio associated with them, appear on the screen, and appear as words contained in the audio (e.g., “the patient showed delayed recovery”). Multiple words may appear on the screen corresponding to audio that is an abbreviated form of what appears on the screen (e.g., “United States of America” may be displayed corresponding to audio of “USA”). Items may have audio associated with them but not have corresponding symbols appear on the screen (e.g., a cough, an ending salutation such as “that&#39;s all,” commands or instructions to the transcriptionist such as “start a new paragraph,” etc.). 
         [0048]    In addition, in the token-alignment file, XML tags, such as &lt;Header&gt;, &lt;/Header&gt; and &lt;Footer&gt;, &lt;/Footer&gt; are included as zero-duration, non-playable, non-displayable records. Tags are also added around other data contained in the headers and footers. For example, tags can be added to identify &lt;MRN&gt;, &lt;DATE OF ENCOUNTER&gt;, and &lt;CONTACTS&gt;. In the body of the dictation, tags are added around recognized information, including but not limited to &lt;PATIENT NAME&gt;, &lt;PROVIDER NAME&gt;, and &lt;CONTACTS&gt;. The tags allow identification of words in the dictation that contain specific information. The specified words can be manipulated due to the tag assigned to the words. For example, the words having specified tags associated with private/confidential information can be blocked from view in a transcribed document. At the time of editing, tagged words can be obfuscated. For example, &lt;PATIENT NAME&gt; can be changed to “the patient” or to “Mr. ???” for instances of its occurrence throughout the transcribed document to protect the identity of the patient. 
         [0049]    Referring further to  FIG. 1 , the editing device  20  is configured to be used by a transcriptionist to access and edit the draft transcription stored in the database of the database server  24 . The editing device  20  includes a computer (e.g., display, keyboard, mouse, monitor, memory, and a processor, etc.), an attached foot-pedal, and appropriate software such as the EditScript™ software product made by eScription. The transcriptionist can log onto the database server  24  with a password. The transcriptionist can request a dictation job by, e.g., clicking on an on-screen icon. The request is serviced by the database server  24 , which finds the dictation for the transcriptionist, and transmits the corresponding header, footer, and body audio files and the draft transcription text files. The transcriptionist edits the draft using the editing device  20  and sends the edited transcript back to the database server  24 . For example, to end the editing the transcriptionist can click on an on-screen icon button to instruct the editing device  20  to send the final edited document to the database server  24  via the network  22 , along with a unique identifier for the transcriptionist. With the data sent from the editing device  20 , the database in the server  24  contains, for each dictation: a speaker identifier, a transcriptionist identifier, a file pointer to the digital audio signal, and a file pointer to the edited text document. 
         [0050]    The edited text document can be transmitted directly to a customer&#39;s medical record system or accessed over the data network  22  from the database by the administrative console  18 . The console  18  may include an administrative console software product such as Emon™ made by eScription. 
         [0051]    Referring to  FIG. 2 , components of the editing device  20 , e.g., a computer, include a database interaction module  41 , a user interface  42 , non-confidential information storage  43 , confidential information storage  45 , a word processor module  44 , an audio playback module  46 , an audio file pointer  48 , a cursor module  50 , a monitor  52 , and an audio device  54 . A computer implementing portions of the editing device  20  includes a processor and memory that stores appropriate computer-readable, computer-executable software code instructions that can cause the processor to execute appropriate instructions for performing functions described. The monitor  52  and audio device  54 , e.g., speakers, are physical components while the other components shown in  FIG. 2  are functional components that may be implemented with software, hardware, etc., or combinations thereof. The audio playback device  46 , such as a SoundBlaster® card, is attached to the audio output transducer  54  such as speakers or headphones. The transcriptionist can use the audio device  54  (e.g., headphones or a speaker) to listen to audio and can view the monitor  52  to see the corresponding text. The transcriptionist can use the foot pedal  66 , the keyboard  62 , and/or the mouse  64  to control the audio playback. The database interaction, audio playback, and editing of the draft transcription is accomplished by means of the appropriate software such as the EditScript Client™ software product made by eScription. The body of dictation files  43  and the header/footer data files are sent to the user interface from the database. The editing software is loaded on the editing device computer  20  and configured appropriately for interaction with other components of the editing device  20 . The editing software can use a standard word processing software library, such as that provided with Microsoft Word®, in order to load, edit and save documents corresponding to each dictation. 
         [0052]    The editing software includes the database interaction module  41 , the user interface module  42 , the word processing module  44 , the audio playback module  46 , the audio file pointer adjustment module  48  and the multi-cursor control module  50 . The interaction module  41  regulates communications between database server  24  and the editing device  20  via the network  22 . The control module  50  regulates the interaction between the interface module  42  and the word processors  44 , the audio playback modules  46 , and the audio file pointer  48 . The control module  50  regulates the flow of actions relating to processing of a transcription, including playing audio and providing cursors in the transcribed text. The user interface module  42  controls the activity of the other modules and includes keyboard detection  56 , mouse detection  58 , and foot pedal detection  60  sub-modules for processing input from a keyboard  62 , a mouse  64 , and a foot-pedal  66 . The foot pedal  66  is a standard transcription foot pedal and is connected to the editing device computer through the computer&#39;s serial port. The foot pedal  66  preferably includes a “fast forward” portion and a “rewind” portion. 
         [0053]    The transcriptionist is permitted to access dictations downloaded to the user interface module  42  based on provider (or groups of providers) and patient identification. The transcriptionist logs onto the user interface module  42  with a logon name and a password so that dictations assigned to a particular transcriptionist are visible in a work queue. The transcriptionist can request a job from the database by selecting on-screen icon with the mouse  64 . The user interface module  42  interprets this mouse click and invokes the database interaction module  41  to request the next job from the database  40 . The database server  24  ( FIG. 1 ) responds by transmitting the audio data files, the draft transcription files, and the token-alignment files to the user interaction module  42 . The audio for confidential information is preferably transmitted to the device  20  separately from the audio for the non-confidential information. Likewise, the text for confidential information is preferably transmitted to the device  20  separately from the text for the non-confidential information. The confidential information is stored in the confidential information storage  43  separate from the non-confidential information storage  45 . The confidential information storage  43  can be access-restricted, e.g., by a password and/or other security feature(s). Also, portions of the confidential information can be restricted from access by a particular user, rather than all of the confidential information. With this downloaded information, the editing software can initialize a word-processing session by loading the draft text into the word processing module  44 . Audio information is accessed through function calls of the editing program while the dictation is being edited. 
         [0054]    The audio playback module  46  is configured to play the audio file associated with the body of the dictation  43  and the audio associated with the header/footer  45 . The transcriptionist accesses the audio files  43  and  45  when prepared for editing. For initial playback, the module  46  plays the audio file sequentially. The playback module  46  can, however, jump to audio corresponding to an indicated portion of the transcription and begin playback from the indicated location. For example, the playback module  46  can request the header audio and begin playback of the header. The location may be indicated by a transcriptionist using appropriate portions of the editing device  20  such as the keyboard  62 , or the mouse  64 . For playback that starts at an indicated location, the playback module  46  uses the token-alignment file to determine the location in the audio file corresponding to the indicated transcription text. Since many audio playback programs play audio in fixed-sized sections (called “frames”), the audio playback module  46  may convert the indicated begin index to the nearest preceding frame for playback. For example, an audio device  54  may play only frames of 128 bytes in length. In this example, the audio playback module uses the token-alignment file to find the nearest prior starting frame that is a multiple of 128 bytes from the beginning of the audio file. Thus, the starting point for audio playback may not correspond precisely to the selected text in the transcription. 
         [0055]    The transcriptionist can review and edit a document by appropriately controlling portions of the editing device  20 . The transcriptionist can regulate the playback using the foot pedal  66 , and listen to the audio corresponding to the text as played by the playback module  46  and converted to sound by the audio device  54 . Further, the transcriptionist can move a cursor to a desired portion of the display of the monitor  52  using the keyboard  62  and/or mouse  64 , and can make edits at the location of the cursor using the keyboard  62  and/or mouse  64 . 
         [0056]    The user interface  42  downloads the text of the document to the word processor  44  according to the editing program, which provides restricted access and display of header/footer data and other confidential information. If the transcriptionist positions the cursor for playback of confidential information, then the transcriptionist can be prompted to enter a password, or otherwise fulfill a security measure (e.g., provide bioinformatic information such as a fingerprint) in order to be provided with the text and/or audio corresponding to the confidential information. 
         [0057]    Referring to  FIGS. 3-5 , confidential information can be obscured/hidden from view absent authorization. As shown in  FIG. 3 , a header  70  and a footer data  72  appear as gray boxes on the monitor  52 . Thus, the confidential data in the header  70  and the footer  72  is not apparent to the user, but is hidden from view. The gray box is preferably of a standard size. As shown in  FIG. 4 , confidential information contained in a body  74  of a document  76  is hidden with gray boxes  78 ,  79 . The boxes  78 ,  79  indicate data that have been tagged as confidential, and have been removed from appearing in the body of the text while the document is edited. The boxes  78 ,  79  are preferably of a standard size to help prevent providing insight into confidential information (e.g., a length of a physician&#39;s name). In  FIG. 4 , the blocked access box  78  indicating a physician&#39;s name has been blocked from view, although the name may be presented to the transcriptionist through the audio playback of the dictation. The blocked access boxes  78 ,  79  allow presentation of the body of a document while concealing confidential information from a viewer. The blocked access boxes  78 ,  79  may be interactive, allowing an authorized transcriptionist to edit data in or check data that appears in the blocked access block  78  during editing functions. Data entered or reviewed in the boxes  78 ,  79  may include patient name, provider name, MRN, contacts, etc. Further, as shown in  FIG. 4  and  FIG. 5 , techniques other than gray boxes may be used for concealing confidential information, such as using a generic name  80  (“Patient X”) in lieu of actual confidential information. Other generic names include “the patient,” “Mr. ??,” etc. 
         [0058]    A second hot key sequence is used by the transcriptionist to reveal recognized words in the body of the document which have been obfuscated by internal tags. The transcriptionist may use the hot key sequence to call forth and edit the protected language. 
         [0059]    While the transcriptionist is editing the document, the user interface module  42  can service hardware interrupts from all three of its sub-modules  56 ,  58 ,  60 . The transcriptionist can use the foot pedal  66  to indicate that the audio should be “rewound,” or “fast-forwarded” to a different time point in the dictation. These foot-pedal presses are serviced as hardware interrupts by the user interaction module  42 . Most standard key presses and on-document mouse-clicks are sent to the word processing module  44  to perform the document editing functions indicated and to update the monitor display. Some user interaction, however, may be directed to the audio-playback oriented modules  46 ,  48 ,  50 , e.g., cursor control, audio position control, and/or volume control. The transcriptionist may indicate that editing is complete by clicking another icon. In response to such an indication, the final text file is sent through the database interaction module  42  to the database server  24 . 
         [0060]    In operation, referring to  FIG. 6 , with further reference to  FIGS. 1-2 , a process  100  for extracting information from a transcription of speech using the system  10  includes the stages shown. The process  100 , however, is exemplary only and not limiting. The process  100  may be altered, e.g., by having stages added, removed, or rearranged. 
         [0061]    At stage  102 , the automatic transcription device  30  seeks to transcribe the audio file, and to extract the header and footer from a dictation audio file stored in the database  40 . The automatic transcription device  30  accesses and retrieves the audio file from the database through the LAN  26 . The dictation is accompanied by the speaker name (and variants), the patient name (and variants), date information, MRN, as well as other available information. 
         [0062]    At stage  104 , a speech recognizer of the device  30  analyzes the audio file in accordance with ASR models to produce a draft text document from the audio file. The ASR model includes information on the manner in which physicians dictate to decode word sequence. 
         [0063]    At stage  106 , the device  30  identifies the header of the dictation using model grammars associated with header language. The identified header is removed from the dictation for separate storage in the database  40 . Confidential terms in the header are separately tagged. 
         [0064]    At stage  108 , the device  30  identifies the footer of the dictation using model grammars associated with footer language. The identified footer is removed from the dictation for separate storage in the database  40 . Confidential terms in the header are separately tagged. 
         [0065]    At stage  110 , the device  30  also produces a corresponding token-alignment file that includes the draft documents and associated portions of the audio file with the transcribed text of the documents. The token-alignment files include XML tags, such as &lt;HEADER&gt; &lt;/HEADER&gt; and &lt;FOOTER&gt; &lt;/FOOTER&gt; as meta information for the editing software, described below. The device  30  stores the token-alignment file in the database  40  via the LAN  26 . 
         [0066]    At stage  112 , the header and the footer are stored in the database separate from other portions of the dictation. The header and footer are stored in a secure portion of memory in the server  24 . The remainder of the dictation is stored separately from the confidential information, e.g., in a separate file. 
         [0067]    In operation, referring to  FIG. 7 , with further reference to  FIG. 1-6 , a process  200  for producing and editing a transcription of speech using the system  10  includes the stages shown. The process  200 , however, is exemplary only and not limiting. The process  200  may be altered, e.g., by having stages added, removed, or rearranged. 
         [0068]    At stage  202 , the speaker  12  dictates desired speech to be converted to text. The speaker can use, e.g., a hand-held device such as a personal digital assistant, to dictate audio that is transmitted over the network  14  to the voice mailbox  16 . The audio is stored in the voice mailbox  16  as at least one audio file. The audio file is transmitted over the network  22  to the database server  24  and is stored in the database  40 . 
         [0069]    At stage  204 , the automatic transcription device  30  seeks to transcribe the audio file according to the process  100  in  FIG. 6 . The automatic transcription device  30  accesses and retrieves the audio file from the database through the LAN  26 . The dictation is accompanied by the speaker name (and variants), the patient name (and variants), date information, MRN, as well as other available information. 
         [0070]    At stage  206 , the transcriptionist reviews and edits the transcribed draft document as appropriate. The transcriptionist uses the editing device  20  to access the database  40  and retrieve the audio file and the token-alignment file that includes the draft text document. The editing of header and footer data is further described below with respect to  FIG. 8 . The transcriptionist plays the audio file and reviews the corresponding text as highlighted or otherwise indicated by an audio cursor and makes desired edits using, e.g., a text cursor  72 . The word processor  44  produces and stores track-changes information in response to edits made by the transcriptionist. 
         [0071]    At stage  208 , the track-changes information is provided to the automatic transcription device  30  for use in improving the speech models used by the speech recognizer of the device  30  by analyzing the transcribed draft text and what revisions were made by the transcriptionist. The models can be adjusted so that the next time the speech recognizer analyzes speech that was edited by the transcriptionist, the recognizer will transcribe the same or similar audio to the edited text instead of the draft text previously provided. At stage  210 , the word processor provides a final, revised text document as edited by the transcriptionist. This final document can be stored in the database  40  and provided via the network  22  to interested parties, e.g., the speaker that dictated the audio file. 
         [0072]    Referring to  FIG. 8 , with further reference to  FIGS. 1-7 , a process  300  for editing the header/footer data of the draft transcribed document, continued from stage  206  of  FIG. 7 , using the editing device  20  includes the stages shown. The process  300 , however, is exemplary only and not limiting. The process  300  may be altered, e.g., by having stages added, removed, or rearranged. 
         [0073]    At stage  302 , the transcriptionist logs in with a user name and password, and dictations assigned to them are shown in the queue. When a dictation is chosen, the audio and document are downloaded, preferably separately, to the transcriptionist&#39;s computer. The audio is preferably stored in a secure location. The audio may be separated into more than one file, such as a file for the header, a file for the footer, and a file for the body. Information from the token alignment file is used to find the correct location in the audio file in order to accomplish the audio separation. 
         [0074]    In exemplary embodiments, audio separation is employed to additionally alter the audio file to remove patient identification information. For example, the audio might sound a tone in lieu of a spoken patient name is spoken. The audio exchanged for the confidential information may alternatively be an alias for the confidential term, such as a generic name, or other desired sound masking/concealing the actual spoken audio. 
         [0075]    When the document is being edited, particular audio files can be accessed. The file-read permissions on the audio files and the document can restrict access to anyone but the transcriptionist who has logged on. 
         [0076]    At stage  306 , the transcriptionist chooses an audio file associated with either the header, the footer, or the body. If the header or the footer are desired to be edited, the transcriptionist activates a hot key, at stage  312 , to call forth the grey boxes  78 ,  79  so that the boxes appear on the monitor  52 . At stage  314 , the blocked access boxes  78 ,  79  are displayed, and at stage  316 , the transcriptionist listens to audio associated with the header. A similar procedure would be used for editing other portions of a document containing confidential information. The transcriptionist may be required to enter a password or provide other security information before the grey boxes  78 ,  79  appear on the monitor. 
         [0077]    At stage  318 , the header fields are reviewed and/or edited. Data appearing in the grey boxes includes patient name and other confidential data that is reviewed for accuracy. Upon completion of editing, at stage  320 , the grey boxes  78 ,  79  are hidden from view once again. Data entered into the boxes is no longer visible on the monitor  52 . 
         [0078]    Other embodiments are within the scope and spirit of the appended claims. For example, due to the nature of software, functions described above can be implemented using software, hardware, firmware, hardwiring, or combinations of any of these. Features implementing functions may also be physically located at various positions, including being distributed such that portions of functions are implemented at different physical locations. In exemplary embodiments of the invention, the header and footer data are identified and separately stored in a database. It is possible that only one of the header and the footer may be identified and separately stored, or both the header and the footer data can be stored, e.g., in a common file separate from the remainder of the document. Storage of the header and the footer may not be separate from the remainder of the document, but transmittal of the header and the footer may be separated from transmittal of the remainder of the document. In an alternative embodiment, the editing program can include a timeout portion which observes whether there has been a break in editing or audio playback for a given amount of time.