Abstract:
A computer program product for use with text transcribed from audio information, the computer program product residing on a computer-readable medium, includes computer-readable instructions for causing a computer to: enable defined keystroke combinations for use in editing the text transcribed from audio, the defined keystroke combinations corresponding to formatting functions identified as frequently-used functions during editing of a transcribed text; and respond to an activated keystroke combination by replacing a first format in the text document with a second format corresponding to the chosen keystroke combination.

Description:
This application is a divisional of U.S. Ser. No. 11/004,756, filed Dec. 3, 2004, now pending, which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The invention relates to shortcut keystroke combinations used during editing of a transcribed document and further to the monitoring of use of shortcut keystroke combinations used during editing. 
     BACKGROUND OF THE INVENTION 
     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. 
     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. 
     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 timesavings to physicians, and is becoming increasingly prevalent in modern healthcare organizations. 
     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. 
     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. 
     Some medical transcriptionists may specialize in one area of medicine, or may deal primarily with a specific group of doctors. The level of familiarity with the doctors&#39; voices and with the subject matter can increase the transcriptionist accuracy and efficiency over time. 
     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. 
     To reduce costs further, health care organizations are deploying speech recognition technology, such as the AutoScript™ product (made by eScription™ of Needham, Mass.), to automatically transcribe medical dictations. Automatically transcribed medical records documents usually require editing by the transcriptionist. This is especially true with respect to the formatting of medical records documents. Whereas speech recognition may accurately capture the literal word string spoken by the provider, the resulting document is generally not presented in an acceptable format. Examples of formatting which may need correction are punctuation, section headings and enumerated lists. While some speakers may dictate instructions which can assist in providing formatting, many will not, especially in the context of background speech recognition where most providers may not even know that the technology is being used to create the draft transcription. 
     Some healthcare institutions have specific formatting requirements that are difficult to accommodate automatically. Speakers may not be aware of the requirements, and therefore fail to provide verbal directives to assist in formatting, which is therefore prone to include errors. For example, some institutions require that physical examination sections of medical reports be divided into sub-sections, such as the following: 
     PHYSICAL EXAMINATION: 
     VITAL SIGNS: BP 120/80, pulse 75, temperature 99.1. 
     LUNGS: Clear to A&amp;P. 
     HEART: Regular rate and rhythm. S1, S2 normal. 
     EXTREMITIES: Without edema. 
     Further, formatting corrections often involve substantially complex manipulation of existing text, such as insertions of line-feeds and punctuation marks, capitalization and cursor movement to correct a “single” error. For example, to turn a particular sentence into an enumerated list item, a transcriptionist inserts a line-feed, inserts the number ‘1’, inserts a period ‘.’, and inserts a space. 
     Another class of verbalizations that is especially prone to automatic speech recognition errors are proper names, particularly those of medical providers that do not practice at the same institution as the speaker. Within-institution providers often dictate “contact names” as the referring providers, or to whom copies of the medical record should be sent. Since there is a large diversity of such proper names, and many are very rare, these words are especially susceptible to speech recognition errors. 
     SUMMARY OF THE INVENTION 
     In general, in an 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: enable defined keystroke combinations for use in editing the text transcribed from audio, the defined keystroke combinations corresponding to formatting functions identified as frequently-used functions during editing of a transcribed text; and respond to an activated keystroke combination by replacing a first format in the text document with a second format corresponding to the chosen keystroke combination. 
     Implementations of the invention may include one or more of the following features. Activation of one of the defined keystroke combinations causes the computer to form a new sentence by inserting a period at the end of a selected word, adding a space and capitalizing the first letter of a word immediately after the selected word. Activation of one of the defined keystroke combination causes the computer to remove a sentence structure by removing a selected period, removing extra space and adjusting capitalization of words after the removed period. Activation of one of the defined keystroke combinations causes the computer to insert a comma after a selected word and cause the cursor to jump to the end of a next word. Activation of one of the defined keystroke combinations causes the computer to remove a comma and move the cursor to the end of a word immediately after the comma. 
     Implementations of the invention may also include one or more of the following features. Activation of one of the defined keystroke combinations causes the computer to produce a new enumerated list item. Activation of one of the defined keystroke combinations causes the computer to remove an enumerated list item. Activation of one of the defined keystroke combinations causes the computer to modify a sequence of words to appear as a single multi-word heading. Activation of one of the defined keystroke combinations causes the computer to remove a multi-word heading and alter the text to appear as plain text. Activation of one of the defined keystroke combinations causes the computer to present a menu of available text entries, wherein selection of one of the text entries causes the computer to insert text associated with the selected entry and delete a former entry, if any. The menu of available entries includes at least one of section headings and contact names. 
     In general, in another aspect, the invention provides a computer program product residing on a computer-readable medium and comprising computer-readable, computer-executable instructions for causing a computer to: monitor the use of a keystroke combination shortcut in editing a text transcribed from an audio recording recorded by a first speaker and edited by a first listener; count a number of times the keystroke combination is used during editing of the transcribed text; and determine a first productivity indicator based on the number of times the keystroke combination was used during editing and a number of times the keystroke combination could have been used during editing. 
     Implementations of the invention may include one or more of the following features. The first productivity indicator is a ratio of the number of times the keystroke combination is used during editing of the transcribed text and the number of times the keystroke combination could have been used during editing. The computer program product further comprises instructions for causing the computer to monitor keystroke combinations used in editing a plurality of texts, each of the plurality of texts transcribed from one of a plurality of audio recordings, wherein the instructions to determine the first productivity indicator comprise instructions to determine a productivity report for the plurality of texts. The computer program product further comprises instructions to report the first productivity indicator. The computer program product further comprises instructions to compare the number of times the keystroke combination is used during editing of the transcribed text with a count of lines of edited text per hour of editing to determine a second productivity indicator. The computer program product further comprises instructions for causing the computer to store an indication of the keystroke combinations as part of a history such that the computer program product can learn from historical keystroke combinations and adapt future keystroke combinations based on the historical keystroke combinations. 
     In general, in another aspect, the invention provides a method of determining use of keystroke combinations in an editing function of a transcribed document, the method including analyzing keystroke usage for at least one predefined shortcut keystroke combination employed during editing of a first transcribed text document, the first text document being edited by a document editor, the shortcut keystroke combination representing an editing function that, without the shortcut keystroke combination, would involve more keystrokes than in the shortcut keystroke combination to achieve, determining from the keystroke usage in the first document a productivity indicator indicative of effective use of the shortcut keystroke combination by the document editor, and informing the document editor of the productivity indicator to improve editing efficiency of the document editor in the editing of a second text document. 
     Implementations of the invention may include one or more of the following features. The method further comprises storing a record of the keystroke usage in a database. The productivity indicator is a productivity ratio and determining the productivity ratio includes comparing a count of actual usage of the keystroke combination and a number of times the keystroke combination could have been used during editing. 
     Various aspects of the invention may provide one or more of the following capabilities. Transcriptionists can be encouraged and assisted in editing documents more quickly. Transcription review times, and corresponding cost, can be reduced. Keystroke combinations can be added to improve the editing time for each transcriptionist, and reduce the number of keys/steps required in editing. Transcriptionist fatigue can be reduced. Consistency in the appearance of medical records documents can be increased. Editing productivity can be increased. The accuracy of medical transcription documents can be improved. The expediency and turn-around time of medical transcriptions can be improved. Stress on medical transcriptionists can be reduced. 
     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 
         FIG. 1  is a simplified diagram of a system for transcribing dictations and editing corresponding transcriptions. 
         FIG. 2  is a simplified block diagram of an editing device of the system shown in  FIG. 1 . 
         FIGS. 3A-3J  are portions of a transcribed document showing editing functions. 
         FIG. 4  is a block flow diagram of a process of using editing functions to edit transcription documents. 
         FIG. 5  is a block flow diagram of a process of using a heading editing function to edit transcription documents. 
         FIG. 6  is a block flow diagram of a process of using a contacts editing function to edit transcription documents. 
         FIG. 7  is a block flow diagram of a process of monitoring, and applying knowledge of, use of editing functions. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Embodiments of the invention provide keystroke combination shortcuts (referred to herein as “e-shortcuts”) in a system for editing text documents, that have been transcribed from speech. Analysis of editing activity on a standard keyboard can reveal keystroke sequences that are repeated by a transcriptionist from document to document. Repetitive keystroke sequences can be incorporated into new e-shortcuts for the transcriptionist. E-shortcuts can be configured for implementation using an existing keyboard or can be accounted for in the manufacture of a keyboard specific to transcription editing. Other embodiments are within the scope of the invention. 
     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. 
     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 . 
     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 the 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 . 
     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. 
     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 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 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 . 
     The database server  24  is configured to store the incoming data from the voice mailbox system  16 , as well as from other sources. The database server  24  may include the SpeechBase™ 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. 
     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, 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. 
     The automatic transcription device  30  may access the database 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 identifying information to access speaker-dependent ASR models with which to perform the transcription. 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 . 
     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 request a dictation job by, e.g., clicking an on-screen icon. The request is serviced by the database server  24 , which finds the dictation for the transcriptionist, and transmits the corresponding audio file and the draft transcription text file, as stored in the database. 
     The transcriptionist edits the draft using the editing device  20 , which includes the editing shortcuts discussed below, and sends the edited transcript back to the database server  24 . For example, to end the editing session the transcriptionist can click 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. 
     The editing device  20  also sends the database server  24  a count of the e-shortcut keys used by the transcriptionist during the editing session. The database server  24  can stores the begin-time and the end-time of the editing session for each dictation, and indicia of the inherent length of the dictation (e.g. total audio duration, number of lines of transcribed text in the edited document, etc.). One or more measures of productivity may be calculated based on the e-shortcut use count and document data, and possibilities for which this information is useful are described in detail below. 
     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, a shortcut key count, and the length of the dictation. 
     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. 
     Referring to  FIG. 2 , components of the editing device  20 , e.g., a computer, include a database interaction module  41 , a user interface  42 , a word processor module  44 , an audio playback module  46 , an audio file pointer  48 , an e-shortcut key module  49 , a multi-cursor control  50 , a monitor  52 , and an audio device  54 . 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 database interaction, audio playback, and editing of the draft transcription is accomplished by means of the appropriate software such as the EditScript™ software product made by eScription. 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. 
     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 , the e-shortcut key module  49  and the cursor control  50 . 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. 
     The transcriptionist can request a job from the database by selecting an 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. The database server  24  ( FIG. 1 ) responds by transmitting the audio data file, the draft transcription file and the enabled e-shortcuts to the database interaction module  41 . With this information, the editing software can initialize a word-processing session by loading the draft text into the word processing module  44 . 
     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 . Most standard key presses, shortcut 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 , e.g., 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 and an e-shortcut count based on the shortcut keys used by the transcriptionist are sent through the database interaction module  41  to the database server  24 . 
     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 . Movement to a different part of the audio is implemented by the audio file pointer module  48  by incrementing or decrementing a pointer into the digital audio file. Hot keys and mouse clicks may also be used to adjust the audio file pointer. 
     As the audio plays, the transcriptionist uses the cursor to move to different locations within the text document that correspond to the audio. Throughout editing, the transcriptionist presses designated keys on the computer keyboard  62  to perform the editing function shortcuts. The e-shortcuts are formatted keys or combinations of keys that actuate designated functions. The designated functions can be formatting changes that are performed throughout the edit of the document. 
     Actuation of the e-shortcut keys is regulated by the e-shortcut module  49 . The e-shortcut module  49  includes a list of e-shortcuts and corresponding actions. Actions may be formatting lines, adding or removing punctuation, sentence structure alterations, inserting headings or removing headings, inserting contact names, correcting spacing, etc. The module  49  is configured to perform editing functions in the text document according to the e-shortcut key sequence that is actuated. The list of e-shortcuts in the module  49  preferably include key sequences to alter formatting in the document that frequently requires attention from the transcriptionist, so that a transcriptionist can quickly, yet accurately edit a transcription. The e-shortcuts preferably correspond to format changes that transcriptionists frequently make while editing transcriptions. The format changes thus correspond to format styles that are often or repeatedly desired but for which instructions are typically not dictated and/or typically not recognized by a transcription system/program. The e-shortcuts preferably allow the transcriptionist to make frequently-occurring edits in fewer keystrokes than without the shortcuts. For example, an e-shortcut may be performed by pressing one or two keys instead of, e.g., inserting a period, possibly deleting a comma, adding at least one space, and capitalizing an ensuing word by deleting its lead lower-case letter and inserting an upper-case letter. The e-shortcuts preferably balance the transcriptionist&#39;s need to edit quickly, and the need for accurate, cost-efficient editing. The initial list of e-shortcuts may be developed based on any of numerous factors, but preferably depends on at least the frequency with which a transcriptionist makes a particular formatting edit. In further preferred embodiments, the development and implementation of e-shortcut keys also depends on the speaker and/or the worktype of the document. 
     It has been discovered that several formatting (initial formatting, reformatting, removing formatting) procedures are frequently performed in medical transcription editing. In particular, Table 1 is a list of exemplary e-shortcut keystroke combinations discovered to be frequently used during such editing of a text document. E-shortcut key sequences are preferably available to the transcriptionist in tandem for each edited document. The e-shortcuts can work in tandem to perform simple or complex reformatting operations. 
     
       
         
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 E-shortcut key 
                   
               
               
                 sequence 
                 Function Performed 
               
               
                   
               
             
             
               
                 Alt -.- 
                 Inserts/removes sentence boundary formatting in the  
               
               
                   
                 transcribed text, that is, inserts/removes a period at the end  
               
               
                   
                 of the present word (at the next white space); inserts/ 
               
               
                   
                 removes an extra space (i.e., a “hard space”) at the end of  
               
               
                   
                 the present word; capitalizes/decapitalizes the word after  
               
               
                   
                 the next white space in the transcribed text 
               
               
                 Alt -,- 
                 Inserts/removes a comma after the present word,  
               
               
                   
                 then cursor jumps to the end of the next word 
               
               
                 Alt -#- 
                 Creates/removes an enumerated list out of a sentence 
               
               
                 Alt -:- 
                 Turns sequence of words into a Heading or into plain text 
               
               
                 Alt -H- 
                 Lists allowable section Headings for choice by  
               
               
                   
                 transcriptionist 
               
               
                 Alt -C- 
                 Lists allowable contact names for choice by transcriptionist 
               
               
                   
               
             
          
         
       
     
     The ‘Alt-.-’ (i.e., press “Alt” and “.” concurrently) or new/remove sentence e-shortcut is used to format a new sentence. Referring to  FIG. 3A , a new sentence is inserted into a document  80  using the new/remove sentence e-shortcut, resulting in the document as shown in  FIG. 3B . The new/remove sentence e-shortcut is activated to insert a period  83  at the end of the word at which the cursor  82  is positioned in  FIG. 3A  (at the next white-space to the right of the cursor&#39;s current position). An extra space is added after the period and the first letter  84  of the word following (to the right of) the period  83  is capitalized. Alternatively, the ‘Alt-.-’ e-shortcut can be used to remove the given sentence formatting (i.e., beginning with the document as in  FIG. 3B  and resulting with the document in  FIG. 3A ), based on an analysis of the current formatting. Where the word to the left of, or at, the cursor position ends in a period  83 , actuating the new/remove sentence e-shortcut causes the period  83  to be removed, and any extra spaces (&gt;1) after (to the right of) the period to be removed. The first letter  84  of the word to the right of the period  83  is made lowercase (i.e., initial capitalization is removed). 
     The ‘Alt-,-’ (i.e., press “Alt” and “,” concurrently) or add/remove comma shortcut is used by the transcriptionist to insert a comma after the present word (i.e., the word in or next to which the cursor is positioned), and jump the cursor to the end of the next word. In  FIG. 3C , the cursor  82  is positioned at a word  85 . The add/remove comma e-shortcut is actuated and a comma  87  is inserted after the word  85 , as shown in  FIG. 3D . The cursor  82  jumps to a next word  86  in the series, and a comma  87  is inserted after the word  86  if the add/remove shortcut is invoked again. The add/remove comma e-shortcut can be actuated as many times as there are words in a sequence or list. A modifier key can perform the same operation for the next N white spaces, e.g. ‘Alt-N-Alt’, would be the same as hitting “Alt-,-” N times (e.g. five times) in a row, e.g., where there is a list of three (3) or more items to be separated by commas. The ‘Alt-,-’ shortcut key can be used to remove the given formatting, i.e., edit the document  80  from an initial text as in  FIG. 3D  to an edited text as in  FIG. 3C . Where a word  85  at or to the left of the cursor  82  position ends in a comma  87 , the comma  87  is removed, and the cursor  82  moves to the end of the next word  86  following the initial position of the removed comma. 
     Referring to  FIGS. 3E-3F , to alter a sentence so that it appears as an enumerated list item, a transcriptionist uses the ‘Alt-#-’ (i.e., press “Alt” and “#” concurrently) or add/remove list e-shortcut. Upon invoking the add/remove list e-shortcut in a document  80  shown in  FIG. 3E , a period  90  is added to the end of a word  91  at which the cursor  82  is positioned, if a period is missing. If a comma is present at the end of the word at the cursor&#39;s location, the comma is replaced with a period  90 . A line-feed (carriage return) is next inserted after the period  90 . An arabic number  92  is inserted followed by a period  93  and two spaces. The next word  94  (to the right) is capitalized, if it is not already. The value of the arabic number  92  inserted depends on the first word in the preceding line. If that word (white-space delineated) is a number followed by a period, then the arabic number inserted is the next higher ordinal arabic number, otherwise it is ‘1’. The add/remove list e-shortcut can be actuated as many times as there are list items to enumerate. In this example, the add/remove list e-shortcut was used three times in the document  80  shown in  FIG. 3E  to achieve the appearance of the document  80  shown in  FIG. 3F . A modifier may also be used with this e-shortcut to repeat the operation N times, similar to the modification discussed above with respect to the add/remove comma shortcut. 
     Enumerated list items are also removed using the e-shortcut ‘Alt-#-’. If the line on which the cursor  82  is located begins with an enumerated list item, this function removes the number  92  and subsequent period  93 , and removes the line feed prior to that item, so that the formerly enumerated line has been moved to the previous line (e.g., beginning with the document in  FIG. 3F  and resulting in the document as in  FIG. 3E  if this operation is invoked three times on each of the enumerated lines shown in  FIG. 3F ). The cursor  82  is moved to the beginning of the word  94  that was at the beginning of the formerly enumerated list item, so that other manipulations (e.g. Alt-.- or Alt-,-) can proceed. The values of subsequent enumerated list items are preferably modified/reduced by one (1). 
     The transcriptionist uses the ‘Alt-:-’ (i.e., press “Alt” and “:” concurrently) or heading e-shortcut to turn a sequence of words into a heading. With reference to  FIGS. 3G and 3H , if a word  95  at the present location of the cursor  82  is not at the beginning of the line, this function inserts a line-feed. Preferably, all the letters of the current word or words (if multiple words are highlighted or indicated, as discussed below)  95  are capitalized and a colon  96  is placed at the end of the capitalized word or words. If the word to the left of the cursor had a colon at the end, that colon is removed. The cursor moves to the beginning of an immediately subsequent word  97 , two spaces are inserted before it (i.e., after the colon), and the first letter of the next word  97  is capitalized. 
     Alternatively, a modifier key can be pressed to turn the next N words into a single section heading. For example, ‘Alt-3 Alt-:-’ (or ‘Alt-:-3-’, etc.) causes the next three words to appear as a section heading, with the colon at the end of the third word. Thus, using the heading e-shortcut, a sequence of words can be turned in a single multi-word heading. 
     The keystroke combination ‘Alt-:-’ may also be employed to remove headings (e.g., editing the document  80  as shown in  FIG. 3H  to appear as the document  80  as shown in  FIG. 3G ). If the word at the current cursor  82  position is all uppercased, but has no colon at the end, the word is changed to lowercase, unless it is at the beginning of the line or sentence, in which case the first character remains uppercased, and the cursor moves forward to the next word, so that ‘Alt-:-’ can be expeditiously invoked again. If the current word has a colon at the end of it, the colon is removed and, if the next word begins with an uppercased letter, this letter is changed to lower case, also removing any extra (&gt;1) spaces before the next word. A numerical modifier may be used to affect multiple words similar to the discussions above. 
     Referring to  FIGS. 3I and 3J , e-shortcuts can be tailored for the insertion of speaker-specific and/or worktype-specific formatting elements in a medical transcription document  80 . Examples of such formatting elements are section-headings and contact-names, which may be invoked using the ‘Alt-H’ (i.e., press “Alt” and “H” concurrently) and ‘Alt-C’ (i.e., press “Alt” and “C” concurrently) e-shortcuts, respectively, as listed in Table 1. For section headings and contact names, the database server  24  ( FIG. 2 ) is used to associate with each document  80  a set of allowable entries  98  for the particular document type and speaker, with information associating entries  98 , document type and speaker being stored in the database server  24 . The document  80  is downloaded to the editing device  20 , and the allowable entries  98  are also downloaded and become accessible to the editing program, via the predefined e-shortcut keys. When the relevant e-shortcut key is pressed, a menu  99  of the allowable items  98  appears, and the transcriptionist can select the particular item  98  desired, e.g., using a mouse-click or arrow keys and the enter key. The chosen item is inserted into the document  80  at the position of the cursor  82 . A word or space currently at the position of the cursor  82  is replaced by the chosen item  98 , and the menu  99  is hidden from view. The menu  99  reappears if the respective e-shortcut key is activated again in the document  80 . The allowable items  98  can be, for example, contact-names or section headings. 
     Referring to  FIG. 4 , and with further reference to  FIG. 1  and  FIG. 2 , a process  100  of editing a document using standard editing keystrokes and/or the e-shortcut keys includes the stages shown. The process  100 , however, is exemplary only and not limiting. The process  100  can be altered, e.g., by having stages added, removed, or rearranged. At stage  102 , a set of enabled e-shortcuts is obtained. The enabled e-shortcuts can be obtained automatically by analysis of existing edited documents and repeated keystroke combinations. Analysis of existing edited documents can include analysis of the frequency (e.g., ratio relative to lines reviewed) at which keystroke combinations are used, and how the use of the keystroke combinations improves productivity. 
     At stage  104 , the transcriptionist downloads a dictation for editing. Upon download, the transcriptionist can begin editing. At stage  106 , the transcriptionist positions the cursor at a position for editing. At stage  107 , standard (non-shortcut) keystrokes are used to edit the document as desired (e.g., using delete, carriage return, space bar, etc. keystrokes). From stage  107 , the process  100  proceeds to stage  110  discussed below. Alternatively, at stage  108 , an e-shortcut key sequence is employed for editing. During editing, the transcriptionist can select an e-shortcut when the cursor is positioned at a desired location in the text. The transcriptionist can choose the Alt-.-, Alt-,-, Alt-#-, or Alt-:- e-shortcuts depending on the correction to be made, e.g., to add/remove a paragraph, insert/remove a heading, create/remove a sentence, add/remove a list item, etc. Additional edits can be made without the use of the e-shortcuts. E-shortcuts can be used multiple times throughout the editing process. 
     At stage  110 , the transcriptionist completes the edit using standard editing and/or e-shortcuts as appropriate, and the transcriptionist moves the cursor to the next editing position in the document. Upon completion of the editing process, at stage  112 , the edited document is uploaded to the database, and the transcriptionist can choose another document for editing. 
     Referring to  FIG. 5 , and with further reference to  FIG. 1  and  FIG. 2 , a process  200  of using the ‘Alt-H’ e-shortcut includes the stages shown. The process  200 , however, is exemplary only and not limiting. The process  200  can be altered, e.g., by having stages added, removed, or rearranged. At stage  202 , a set of allowable headings for a given worktype is obtained. The list of allowable section headings may be entered manually for example, and be based on the formatting requirements for an institution, or the list can be determined by analysis of existing medical records documents of the given worktype. The headings may be obtained in other manners as well. 
     At stage  204 , the allowable section-headings lists are stored in the database server  24 , keyed on the relevant worktype-identifier. Thus, worktype-identifiers and section headings lists are associated with each other so that, knowing the worktype, the corresponding list can be recalled for display. Preferably, a subset of approved section headings is stored for each speaker. 
     At stage  206 , a transcriptionist downloads a dictation for editing. The editing device  20  also downloads the list of approved section-headings for the worktype (or speaker-worktype), which is stored in the database server  24  corresponding to the dictation. The transcriptionist begins editing at stage  208 . While editing the document, actuation of the Alt-H e-shortcut-key at stage  210  causes a menu of the approved headings to pop up on the screen  52 . At stage  212 , the transcriptionist selects the desired heading, e.g., using the mouse  64  or arrow keys and the enter key (or other acceptable techniques). 
     At stage  214 , if the heading is selected at stage  212  while the cursor is on a portion of the text that does not currently contain a section heading, or that contains an improper section heading, the selected heading is produced. If the transcription did not contain any heading at the location of the cursor, the selected heading is inserted at this location, followed by a colon and two spaces, and the next word is capitalized. If the transcription contained an erroneous heading at the location of the cursor, this heading is deleted (i.e., all of the capitalized letters surrounding the cursor), and the selected heading replaces this text. The colon is retained, as is the spacing between the heading and the word immediately after the heading and capitalization of this word. 
     At stage  216 , the transcriptionist continues the editing process  200 . The process  200  may return to stage  210  where an e-shortcut is employed again. Or, the process  200  may proceed to stage  218 , where editing is completed, and the edited document is uploaded to the database server  24 . 
     Referring to  FIG. 6  and with further reference to  FIG. 1  and  FIG. 2 , a process  300  of using the ‘Alt-C’ e-shortcut includes the stages shown. The process  300 , however, is exemplary only and not limiting. The process  300  can be altered, e.g., by having stages added, removed, or rearranged. 
     At stage  302 , a set of allowable contact names for a given speaker is obtained. This list of allowable contact names may be entered manually, for example, and be based on the requirements for a speaker or for an entire institution. The list can be determined by analysis of existing medical records documents of the given worktype. The contact names may be obtained in other manners as well. This is done for each speaker on the system and the list of allowable contact names for each speaker is stored in the database server  24  keyed on the relevant speaker-identifier. Thus, worktype-identifiers and contact names lists are associated with each other so that, knowing the worktype, the corresponding list can be recalled for display. Preferably, a subset of approved contact names is stored for each speaker. 
     At stage  304 , a transcriptionist downloads a dictation for editing, and at stage  306 , the transcriptionist begins editing. The editing device  20  downloads the list of contact names for the speaker stored in the database server  24 . At stage  308 , the ‘Alt-C’ e-shortcut causes a menu of allowed contact names to pop up on the screen  52 . At stage  310 , the transcriptionist selects the desired contact name, e.g. using the mouse  64  or arrow keys and return key. At stage  312 , the selected contact name is inserted into the document at the current location of the text cursor. 
     At stage  314 , the transcriptionist continues the editing process  300 . The process  300  may return to stage  310  where an e-shortcut is employed again. Or, the process  300  may proceed to stage  316 , where editing is completed, and the edited document is uploaded to the database server  24 . 
     Referring again to  FIGS. 4-6 , each of the processes  100 ,  200 ,  300  can be used in combination, such that after the download of a document for editing, and during editing of a single document, preferably any of the e-shortcut keys are available preferably throughout the editing of the document. 
     During an editing session, i.e., during any of the processes  100 ,  200 ,  300  of  FIGS. 4-6 , the use of the e-shortcut keys is monitored automatically by the editing device  20 . This can be accomplished using generally available keystroke logging software, and filtering the software&#39;s output to include only the e-shortcut keystroke combinations, or by developing software that does so or that tracks only the usage of the e-shortcut keystroke combinations. A count of the number of times an e-shortcut is used is accumulated. By analyzing how the text was actually modified between the draft and the edited transcription, the number of times each keystroke combinations could have been used to modify the text is determined. An indicator, e.g., a ratio, is computed that expresses how often the transcriptionist uses e-shortcuts versus how often the transcriptionist could have used e-shortcuts. A ratio can be computed that expresses the comparison of e-shortcut usage to the lines of text edited. The monitoring process allows analysis of the frequency with which e-shortcut keys are used, individually or in collaboration. Data obtained from the monitoring process can be used to add, remove, or alter e-shortcuts to suit the transcriptionist during the editing process. For example, e-shortcut keys can be enabled and disabled. Further, performance can be monitored and reported to increase e-shortcut use, and improve productivity. 
     Referring to  FIG. 7  and with further reference to  FIGS. 1-6 , a process  400  of monitoring use of the e-shortcut keystroke combinations includes the stages shown. The process  400 , however, is exemplary only and not limiting. The process  400  can be altered, e.g., by having stages added, removed, or rearranged. 
     At stage  402 , an automatic speech recognition draft is created from the audio recording of a speaker. At stage  404 , the transcriptionist downloads the draft and the audio. At stage  406 , the transcriptionist begins editing the draft. 
     At stage  408 , while editing, software monitors the usage of each of the e-shortcut keys by counting when each one is pressed. These counts are saved in memory at stage  410 , one count for each e-shortcut key used. At stage  412  the edited transcription is uploaded into the database server  24 , and the counts for each e-shortcut are also uploaded into the database server  24 , using an identification key to associate the draft, the edited transcription and the key count. The database server  24  can also store the begin-time and end-time of the editing session for each dictation, along with an indicator of the inherent length of the dictation, e.g. total audio duration, number of “lines” of transcribed text in the edited document, number of words in the edited document, etc. Standard metrics for measuring productivity are computed, such as lines of edited text per hour of editing. 
     At stage  414 , an offline process compares the draft with the edited transcription in order to identify modifications associated with e-shortcuts that could have been made using the e-shortcut keys. The process identifies: the number of textual locations where a period was added followed by upper-casing the first letter of the next word (or visa versa); the number of locations where more than one comma was added to a word sequence, or where more than one comma was deleted from a word sequence; the number of locations where an enumerated list item was added or removed; and the number of locations where plain text was turned into a section-heading or a section-heading was turned into plain text. Other editing functions can be identified. 
     At stage  416 , for each of the textual modifications, a ratio between the number of times the relevant e-shortcut was used and the number of times it could have been used to make the modification is constructed. This ratio expresses how often a transcriptionist is using an e-shortcut when an e-shortcut is available to perform a formatting edit. Feedback is based on the ratios, and can include a count of the number of times a transcriptionist uses one particular e-shortcut, in comparison with the number of times the transcriptionist could have used the e-shortcut. Also, a determination of which e-shortcuts are being used by one or a number of transcriptionists and the increase in productivity for each of the respective transcriptionists can be expressed. Still further, a ratio of the line of text per hour of editing for a transcriptionist using e-shortcuts can indicate productivity increases. 
     Based on the ratio, at stage  418 , a report is created summarizing the statistics over a number of documents per transcriptionist, including documents from dictations by a large number of speakers, worktypes, etc. The report can also include correlation statistics between the e-shortcut key usage and the productivity measure (e.g. lines of edited text per hour of editing). A report can be created for a transcriptionist organization to summarize how frequently a transcriptionist or an aggregate of some or all transcriptionists is using the e-shortcut keys. 
     At stage  420 , the reports are updated at intervals, and changes in the usage of the e-shortcut keys are observed. Individual and/or aggregate reports can be provided to the transcriptionists or to the transcription supervisor to promote increased use of the e-shortcut keys to save transcription time. 
     At stage  422 , the benefit in terms of improving editing productivity of each e-shortcut key is evaluated via a factor analysis. The dependent variable is the productivity measure and the independent variables are the usage rates for each of the e-shortcut keys. Thus, the effect of usage of particular shortcuts on productivity can be seen and used for feedback to influence transcriptionist action (e.g., increased shortcut usage) to improve productivity. The reports can be used to prioritize research topics for ASR technology. By observing which e-shortcut keys are used more often and which keys increase productivity, informed decisions are made about which formatting features are most desirable in the draft transcriptions. The ASR software can be improved to better incorporate the desired formatting to obviate editing to provide the formatting. 
     Additional functions can be monitored in the process  400 . For example, navigational keys used to quickly move through a document to a place in the text that needs to be corrected can be monitored in addition to monitoring editing processes. This class of functions is especially relevant to editing drafts where all of the purported text is on the screen. In such a case, transcriptionists can often improve productivity by jumping to entirely different sections of the document than that which corresponds to the audio to which they are currently listening, Examples of these functions are the “ctrl-arrow” keys, which move the text cursor forward and backward by entire words instead of by characters, and the page-up and page-down keys, which move the text cursor up and down by a page of text. The usage of these functions can be monitored by the same mechanism as the editing e-shortcuts, as in  FIG. 7 . The effectiveness of the navigation around the document can be measured by constructing a ratio in which the number of e-shortcut navigation keystroke combinations used is compared to the number of total navigation keys used (i.e. just using the standard arrow keys). Transcriptionist productivity can be improved by increasing the ratio of e-shortcut navigation keys to standard navigation keys. 
     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 alternative embodiments, reports on e-shortcut use are based on the counts of the usage of each e-shortcut key rather than ratios. Reporting statistics can be accumulated over varied amounts of data (i.e., few or many edited documents). Enablement of e-shortcuts can vary depending on the reporting statistics on use and productivity. 
     Still further embodiments are within the scope and spirit of the invention. For example, the use of the particular keystroke combinations to implement the e-shortcuts can be any of a number of keystroke combinations. For example, in another embodiment, instead of Alt-.-, other characters could be used, including but not limited to ctrl-period, a specified function key, or a different key sequence. Keyboards can be manufactured with specific keys that perform these functions, or alternatively, the use of assigned function keys or other assigned keys on programmable keyboards can be utilized for e-shortcuts. Monitoring can occur over portions of the text document rather than a complete text document. Monitoring reports can be completed upon the evaluation of a number of completed editing sessions or a single editing session for a particular transcriptionist.