Abstract:
Automatic text generation is marked in a text document to allow later re-invocation of automatic text generation to revise the expanded text and to ensure integrity in capture of machine interpretable data generated during automatic text generation.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This application claims the benefit of provisional patent application No. 60/598,686, filed Aug. 4, 2004, entitled “Medical Report Tool with Revisable Text Expansion” incorporated herein by reference. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT  
     BACKGROUND OF THE INVENTION  
       [0002]     The present invention relates generally to computer programs for text entry and in particular to a program allowing protection and revision of text expansions generated by software from simple user commands.  
         [0003]     Physicians, in maintaining patient records, ordinarily prepare summaries of patient visits or treatments. Although these summaries may be dictated by the physician for later transcription, often the physician types these summaries directly into a computer system in order to avoid transcription errors, delay and the additional cost of transcription services. In these circumstances, it is desirable to simplify the process of typing the summaries as much as possible.  
         [0004]     One method of rapidly creating patient visit summaries, often termed “checkbox charting,” allows the physician to simply check, on a computer screen, checkboxes associated with particular report information. A computer program maps checkboxes to text strings to create the report. This method speeds report generation and has the added benefit of allowing the information of the report to be captured in a machine-readable format (for example, searchable diagnosis codes) at the time the text is created.  
         [0005]     “Checkbox charting” has a number of disadvantages. The checkbox form is generated by a program and relatively inflexible if changes in the form are required. Checkboxes may not adequately record complex observations, unusual diagnoses or may not be compatible with a physician&#39;s particular style or preference.  
         [0006]     For these reasons, report generation systems that allow direct text entry and editing, as with a word processor, are often preferred. Generating reports using such direct text entry can be simplified by automatic text generation techniques such as text expansion. In one technique described in U.S. Pat. No. 5,781,891, short abbreviations preceded by a special character prefix automatically cause the abbreviation to be replaced by a longer, previously stored phrase corresponding to that abbreviation.  
         [0007]     More sophisticated text expansion may use embedded links within a text template that are replaced by data from a database, such as an electronic medical record, to automatically import not simply a static phrase but data about a patient or condition that may vary over time or in different contexts. For example, the assignee of the present inventions offers a commercial program in which a character string link “.id”, when entered into a text field, is automatically replaced with a sentence describing the name, age and sex of the particular patient for whom the report is being generated. Alternatively, a link may invoke a set of pick lists, individually or in nested format, so as to allow selection among a variety of text phrases that will be used to replace the link.  
         [0008]     The result of direct text entry and editing, with or without automatic text generation, is a flexible text document that can be readily reused and edited, for example, for later reports regarding the same patient. Because the links in the original template are replaced with expanded text, the resulting text document normally loses the simple text expansion capabilities and must be edited using only normal text-editing techniques.  
         [0009]     The versatility of a text document in capturing patient notes is offset by the difficulty of extracting machine-interpretable data from such text. While programs exist which attempt to “mine” text data for information, such programs are imperfect and prone to error.  
       BRIEF SUMMARY OF THE INVENTION  
       [0010]     The present invention provides a direct text entry and editing system allowing software text expansion, not only in an original template document but also in later versions of the resultant text document or portions thereof. This is accomplished by marking text expansions as not directly editable. Marking prevents unrecorded alteration of the substance of the expanded text, allowing the act of text expansion to be used to generate machine readable data about the text. Further, the marking allows revision of the expanded text by invoking the same text expansion procedure that originally generated the expanded text.  
         [0011]     Specifically then, the present invention provides a program for drafting clinical documentation, executable on a computer, to display to a user a text-editing box allowing entry and editing of the text within a text field of the text-editing box. The program, like a standard text editor, allows the user to replace text with different text in a standard edition operation. The program also accepts links into the text field that allow selection among different text to be imported from an outside source into the text field by user selection commands so as to provide “expanded text”. Upon receiving a first user selection command, the program imports selected text from the outside source into the text field and marks the expanded text to allow later selection of different text from the outside source by a second user selection command.  
         [0012]     Thus it is one object of at least one embodiment of the invention to allow software expanded text to be later “re-expanded” so that copies of a text report can be modified as easily as the original.  
         [0013]     The expanded text may be marked with characters embedded in the text field.  
         [0014]     Thus it is another object of at least one embodiment of the invention to provide a method of marking expanded text that can be carried within the text document.  
         [0015]     The characters may cause a highlighting of the expanded text.  
         [0016]     It is thus another object of at least one embodiment of the invention to provide an indication to the user that the text is not directly editable without re-expansion.  
         [0017]     The expanded text may come from a database such as an electronic medical record.  
         [0018]     Thus it is another object of at least one embodiment of the invention to provide a method of quickly creating or editing a medical report to contain previously acquired medical data about a patient.  
         [0019]     The selection command may include the step of selecting a text string associated with a link.  
         [0020]     Thus it is yet another object of at least one embodiment of the invention to provide for user control over the importation text.  
         [0021]     Upon receiving the selection command, the program may present a menu from which text may be selected.  
         [0022]     It is thus another object of at least one embodiment of the invention to provide a rapid menu or tree-type selection process for text that can be invoked multiple times in the editing history of a document.  
         [0023]     The menu may allow simultaneous selection of multiple text items to be imported in sequence.  
         [0024]     It is thus another object of at least one embodiment of the invention to allow re-editing of text that is only part of an expanded text string.  
         [0025]     A database may be updated upon each importation to provide a machine-interpretable record of the expanded text.  
         [0026]     Thus, it is one object of at least one embodiment of the invention to provide integrity in automatically entered text so that its generation may be relied on to prepare a machine-readable version of the text content using standard terms and discrete values for reporting and the like.  
         [0027]     The database may be a patient electronic medical record or other data repository.  
         [0028]     It is thus another object of at least one embodiment of the invention to provide automatic updating of an electronic medical record accessible by many health care professionals to disseminate information that would normally be locked in the patient visit summary.  
         [0029]     The program may provide for a transfer of expanded text from a first user to a second user. The second user may select the expanded text to cause a re-expansion of the text from a local source.  
         [0030]     Thus it is another object of at least one embodiment of the invention to allow sharing of templates providing text expansion among users.  
         [0031]     These particular objects and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0032]      FIG. 1  is a block diagram of the program of the present invention showing the steps of automatic text generation and the marking of the expanded text;  
         [0033]      FIG. 2  is a simplified block diagram of the two programs similar to those of  FIG. 1  showing the importing of a text document between applications and the establishment of context for subsequent revision of expanded text;  
         [0034]      FIG. 3  is a flow chart executed by the program of the present invention when automatically generating text per the diagram of  FIG. 1 ; and  
         [0035]      FIG. 4  is a flow chart showing steps taken by a subsequent program enabled to accept the marked text showing the results of a user attempt to edit marked text. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0036]     Referring now to  FIG. 1 , a clinical documentation program  10 , such as may run on a standard computer or the like, may provide a smart text object  11  instantiated with context information  33  as part of the documentation program  10 . The context information  33  may, for example, provide an identification of a patient for whom the medical report is being generated as well as institutional data.  
         [0037]     Upon instantiation, the smart text object generates a text-edit box  12  associated with a text file  14 . The text file  14  contains stored text  16  (either entered by a user through the text-edit box  12  or loaded from a file or the like) displayed in the text-edit box  12  as displayed text  18 . The stored text  16  may be, for example, a template for preparing patient visit notes or the like, a “copy forward” copy of previously prepared patient visit notes.  
         [0038]     As will be understood to those of ordinary skill in the art, the text-edit box  12  includes capabilities for standard editing of the stored text  16  by manipulation of the displayed text  18  to insert text, delete text and reformat text, for example.  
         [0039]     In the present invention, the stored text  16  includes alphanumeric ASCII characters of standard text  17 , specially designated linking characters  20  (represented as the “@” symbol), and specially designated marking characters  50  (represented as the “*” symbol), the latter to be described further below. More generally, the linking characters  20  and the marking characters  50  need not be printing characters and may be character strings so long as they are uniquely distinguishable from normal text. The linking characters  20  and marking characters  50  inform the smart text object  11  that associated link text  22  and expanded text  46  are “protected” to be treated differently from standard text  17  and, in particular, that the link text  22  and expanded text are not edited with normal editing commands.  
         [0040]     The linking characters  20  and marking characters of the text file  14  may be mapped to arbitrary characters of the displayed text  18  and in the preferred embodiment, the linking characters  20  are displayed as “{ } ” symbols in displayed text  18  embracing the link text  22 , and the marking characters  50  are displayed as a highlighting expanded text  46 . Usefully, the linking characters  20  and marking characters  50  are displayed in a form that is readily distinguishable from standard text so as to inform the user that the link text  22  and expanded text  46  is treated as protected text by the smart text object  11 . Clearly any method of distinguishing this protected text may be used. The linking characters  20  may be the same in both the text-edit box  12  and the text file  14  so long as they can be distinguished from regular text. Thus link text  22  may be preceded by a “.” linking character  20 ′ and followed by a space linking character  20 ′ in both the text file  14  and the text-edit box  12 , as this unusual use of these characters identifies them as linking characters  20  and not standard text  17 .  
         [0041]     As will be explained in more detail below, the smart text object  11  allows for the insertion of linking characters  20  in the text file  14  associated with expanded text  46  held in an external source. On an automatic basis, or by command from the user, the linking characters  20  and the link text  22  is replaced with the expanded text  46  from the external source to create expanded text file  14 ′. In this expanded text file  14 ′, the expanded text  46  is marked by marking characters  50 .  
         [0042]     Generally, the invention contemplates three categories of linking characters  20  and link text  22 , (1) “SmartText” that when invoked causes the smart text object  11  to replace the link characters  20  and link text  22  with expanded text obtained from the external source, (2) SmartList that when invoked causes the smart text object  11  to provide a pick list of options each providing for replacing the link characters  20  and link text  22  with different expanded text obtained from the external source, and (3) “SmartSections” that provide a list of pre-defined section headers and footers that serve to delineate sections of the text, the link text  22 , for later machine searching or cataloging.  
         [0043]     The smart text object  11  may allow for the saving or loading of both the text file  14  and expanded text file  14 ′. In the former case, the ability to save and load a text file  14  with link text  22  and linking characters  20  allows the creation of templates having pre-prepared standard text  17  and linking characters  20 , but possibly requiring selection among different options for the insertion of expanded text  46 . In the latter case, the saving and loading of expanded text files  14 ′ allows reuse (“copy forward”) of previously prepared patient notes in which the expanded text  46  has been selected and inserted, but which may now be changed to be suitable for a current patient visit with minor editing.  
         [0044]     The smart text object  11 , under control of a user communicating through a keyboard and/or cursor control device, may not only edit the standard text  17  but may insert and modify link text  22  and linking character  20  using special auxiliary editing routines. This latter process of inserting and/or modifying link text  22  and linking character  20  requires not only the insertion of link text  22  and linking character  20  into the text file  14 , but also the establishment of a connection between the link text  22  and expanded text  46  from an external source.  
         [0045]     In the preferred embodiment, the external source will typically be a specially prepared link database  32  and/or the electronic medical record  36 , but it can be any electronic data repository including searchable text files, web pages and the like. The electronic medical record  36  is a database holding patient medical data and accessible by a variety of healthcare professionals who collect or use such medical data. As such, the electronic medical record  36  is constantly changing outside of the context of the documentation program  10 . In this sense, the expanded text  46  will be dynamic.  
         [0046]     The link database  32 , on the other hand, is typically only changed within the context of the documentation program  10  and will hold static phrases of expanded text  46 . The link database  32  will also hold pick list information  47 , created by the user through the smart text object  11 , to facilitate the selection of expanded text  46 . Skeleton phrases of expanded text  46  in the link database  32  allow the expanded text  46  to be obtained, both from the link database  32  and the electronic medical record  36 , by placing link text  22  in skeleton static phrases in the link database  32  where the embedded link text  22  points to dynamic text from the electronic medical record  36  as indicated by arrow  49 .  
         [0047]     Referring now to  FIGS. 1 and 3 , a typical use of the smart text object  11  involves the loading of a template consisting of a previously prepared text file  14  having standard text  17  as well as link text  22 . As indicated by arrow  24 , the smart text object  11  translates the text file  14  to text displayed in the text-edit box  12  marking the link text  22  by curly braces being the manifestation of the linking characters  20  of the text file  14  in the text-edit box  12 .  
         [0048]     The smart text object  11  communicates with a keyboard, mouse or other user input device of a computer (not shown) to allow unrestrained editing of the standard text  17  and to detect any “enabled” smart text  25  as indicated by process block  26 . Enabled smart text  25  is smart text  25  that is ready to be expanded because no further argument information is required for the expansion. Generally link text  22  that is a simple abbreviation to be expanded (“SmartText”) is immediately enabled for expansion. In other cases, as will be described below, where the user must provide additional argument information before the text expansion (“SmartLists”), enabling is obtained by selection of the link text  22  and the pressing of a special key (for example, the F2 key on the keyboard) and the supply of additional information (usually through pick lists) by the user. “SmartSections” are generally not expanded but exist as protected text in a manner similar to expanded text from “SmartText” and “SmartLists”.  
         [0049]     As indicated by arrow  28  in  FIG. 1  and process block  30  of  FIG. 3 , detection of enabled smart text  25  causes the smart text object  11  to obtain expanded text  46  from the link database  32  or electronic medical record  36 . In this process, the link database  32  is typically presented with data from the context information  33  of the smart text object  11  together with the link text  22  and user-supplied additional arguments so that it may identify the appropriate expanded text  46 , the latter which may be indexed in database fashion by these arguments and inserted directly into the text file  14 , replacing the link text  22  as indicated by arrow  38  in  FIG. 1  and process block  44  of  FIG. 3 .  
         [0050]     Thus, for example, if the application documentation program  10  is working on patient notes for a particular patient, the context information  33  will include a patient identification number and the link text  22  will provide the remaining argument, for example “id”. In this case, the link database  32  selects expanded text  46  of a skeleton sentence (e.g. “@patient name@ is a @age@ year old @gender@”) containing further link text  22  that cause the sentence to be populated with the patient&#39;s name, age, and gender from the electronic medical record  36 .  
         [0051]     In a simpler case, the link text  22  may be an abbreviation that maps directly to static text held in the link database  32  without further reference to the electronic medical record  36 , as referred to in U.S. Pat. No. 5,781,891 cited above and hereby incorporated by reference, or that maps to a single element of data of the electronic medical record  36 .  
         [0052]     The above examples provide smart text  25  that may be instantly expanded upon opening of the text file  14 . The present invention also contemplates expanded text that accommodates additional user input, typically the selection from among different expanded text  46 . This approach not only speeds text entry but also provides cues of possible text entries, for example, a list of diagnoses.  
         [0053]     For link text  22  that require further user input before expansion, the link database  32 , as indicated by arrow  34 , provides a pick list  37  to the smart text object  11  in lieu of replacement text to be inserted directly into the text file  14 . No special linking characters  20  are required, rather the link database  32  may identify the need for additional user input when it receives the link text  22  by the result of a database query that reveals the presence, for example, of pick list information  47 . In this case, a pick list  37  is generated from the pick list information  47  and sent to the smart text object  11  to be displayed to the user in the text-edit box  12  as indicated by arrow  34 .  
         [0054]     Pick lists  37  may be nested so that selection of one pick list item  39  invokes a second pick list  37  (per arrow  42  of  FIG. 3 ) as will be understood to those of ordinary skill in the art, to provide a hierarchical menu. Pick lists may carry conditions of only one element of the list being selected or may allow for multiple selections from each list per rules contained in the link database  32 . The particular pick list may be modified by the context information  33 , for example, to provide choices relevant solely to male or female patients as required.  
         [0055]     Ultimately, the user selections provide sufficient arguments to the link database  32  so that particular expanded text  46  may be input into the text file  14  as indicated by process block  44 . Thus, as shown, the phrase “The patient has @pain@” (where “@” are the linking characters  20  and “pain” is the link text  22 ) in text file  14  may be completed through this process with automatically expanded text  46  “severe pain” in expanded text file  14 ″.  
         [0056]     At process block  48 , this expanded text  46  is identified with marking characters  50  (“*”) inserted by the smart text object  11 . At the same time, as indicated by arrow  38 , machine interpretable data representing the substance of the expanded text  46  may be inserted into a database such as the electronic medical record  36  as indicated by arrow  54  of  FIG. 1  and process block  56  of  FIG. 3 . Alternatively or in addition, the changes to the expanded text may be logged to create a history of such changes.  
         [0057]     The data entered into the electronic medical record  36  may be standardized, for example, by diagnosis code or other standard machine-interpretable code and does not require direct machine interpretation of the expanded text  46  or other text of the patient note inserted into the text file  14 .  
         [0058]     The smart text object  11  provides a “copy forward” command which, using the context information  33 , loads a previously expanded text file  14 ′ together with the marking characters  50  into the documentation program  10 .  
         [0059]     Referring now to  FIGS. 1 and 4 , should the user attempt to edit standard text  17  as identified by decision block  60 , such standard text  17  may be freely edited per process block  58 .  
         [0060]     On the other hand, if the user should try to edit expanded text  46  (“protected text” as identified by marking characters  50 , then at decision block  60 , the smart text object  11  identifies this as marked text and blocks that editing.  
         [0061]     In a first embodiment, for simple expanded text  46  that require no user supplied arguments (for example, the expansion of simple abbreviations) no editing is allowed except for deletion of the expanded text  46  as indicated by process block  59 . Generally no changes of this simple expanded text  46  will be required in the situation where a previous patient record for the same patient is being used as a model because no changes to this information will have occurred. Thus, if the user is attempting to replace or type over portions of the expanded text  46 , this is blocked.  
         [0062]     In a second embodiment, the marking characters  50  and the link text  22  are preserved (rather than overwritten) so that the expanded text  46  may be instantly recreated. The marking characters  50  signal the smart text object  11  to not display the link text  22  in the expanded text file  14 ′. This preservation of the link text  22  is useful, for example, when the expanded text refers to a dynamic quantity, (e.g., patient&#39;s weight) obtained from the electronic medical record  36 . In this case, again, no editing of the expanded text  46  (except for its automatic updating) is allowed.  
         [0063]     As determined by decision block  60 , the smart text object  11  may establish that the expanded text  46  requires additional user input (e.g., from pick lists  37 ) by review of the retained link text  22  forwarded to the link database  32  and as indicated by decision block  60 . In this case, as indicated by process block  62 , the smart text object  11  proceeds to process block  30 , and using the embedded link text  22 , executes the steps given in detail by process blocks  26  through  56  described above. In this case, the previous expanded text  46  is replaced by new expanded text  46  based on new user input through the newly invoked pick lists  37 .  
         [0064]     By recreating the expansion process, rather than allowing direct editing of the expanded text  46 , it can be ensured that the machine-interpretable data sent to the electronic medical record  36  is properly synchronized with changes in the text file  14 .  
         [0065]     Referring now to  FIG. 2 , a text file  14  may be used as a template that may be transferred to different copies of the documentation program  10 ,  10 ′ running, for example, at different institutions. The transferred template has all the properties of the original document including protection of marked text and re-expansion capabilities. This allows templates formed of the text files  14  to be exchanged and potentially for a market to develop of templates prepared for particular situations. For this purpose, the smart text object  11  may allow an exporting of the text file  14  as indicated by arrow  55 . In this case, the link database  32  is appended to the text file so that they may be transmitted together. At the destination documentation program  10 ′, the text file  14  is loaded and the contents of the link database  32  are installed as required under the control of the smart text object  11 ′. In use, the text file  14  takes it context information  33  (not shown) from the smart text object  11 ′ of the destination documentation program  10 ′, and may use the electronic medical record  36 ′ of the destination documentation program  10 ′ but the original link database  32  whose hierarchies and phrases will typically have been customized to the text file  14  by the user.  
         [0066]     It is specifically intended that the present invention not be limited to the embodiments and illustrations contained herein, but include modified forms of those embodiments including portions of the embodiments and combinations of elements of different embodiments as come within the scope of the following claims.