US20070299665A1 - Automatic Decision Support - Google Patents

Abstract

Speech is transcribed to produce a transcript. At least some of the text in the transcript is encoded as data. These codings may be verified for accuracy and corrected if inaccurate. The resulting transcript is provided to a decision support system to perform functions such as checking for drug-drug, drug-allergy, and drug-procedure interactions, and checking against clinical performance measures (such as recommended treatments). Alerts and other information output by the decision support system are associated with the transcript. The transcript and associated decision support output are provided to a physician to assist the physician in reviewing the transcript and in taking any appropriate action in response to the transcript.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application claims the benefit of U.S. Prov. Pat. App. Ser. No. 60/815,689, filed on Jun. 22, 2006, entitled, “Verification of Extracted Facts”; U.S. Prov. Pat. App. Ser. No. 60/815,688, filed on Jun. 22, 2006, entitled, “Automatic Clinical Decision Support”; and U.S. Prov. Pat. App. Ser. No. 60/815/687, filed on Jun. 22, 2006, entitled, “Data Extraction Using Service Levels,” all of which are hereby incorporated by reference herein.
• This application is related to copending and commonly-owned U.S. patent application Ser. No. 10/923,517, filed on Aug. 20, 2004, entitled “Automated Extraction of Semantic Content and Generation of a Structured Document from Speech,” which is hereby incorporated by reference herein.
BACKGROUND
• It is desirable in many contexts to generate a structured textual document based on human speech. In the legal profession, for example, transcriptionists transcribe testimony given in court proceedings and in depositions to produce a written transcript of the testimony. Similarly, in the medical profession, transcripts are produced of diagnoses, prognoses, prescriptions, and other information dictated by doctors and other medical professionals.
• Producing such transcripts can be time-consuming. For example, the speed with which a human transcriptionist can produce a transcript is limited by the transcriptionist's typing speed and ability to understand the speech being transcribed. Although software-based automatic speech recognizers are often used to supplement or replace the role of the human transcriptionist in producing an initial transcript, even a transcript produced by a combination of human transcriptionist and automatic speech recognizer will contain errors. Any transcript that is produced, therefore, must be considered to be a draft, to which some form of error correction is to be applied.
• Producing a transcript is time-consuming for these and other reasons. For example, it may be desirable or necessary for certain kinds of transcripts (such as medical reports) to be stored and/or displayed in a particular format. Providing a transcript in an appropriate format typically requires some combination of human editing and automatic processing, which introduces an additional delay into the production of the final transcript.
• Consumers of reports, such as doctors and radiologists in the medical context, often stand to benefit from receiving reports quickly. If a diagnosis depends on the availability of a certain report, for example, then the diagnosis cannot be provided until the required report is ready. For these and other reasons it is desirable to increase the speed with which transcripts and other kinds of reports derived from speech may be produced, without sacrificing accuracy.
• Furthermore, even when a report is provided quickly to its consumer, the consumer typically must read and interpret the report in order to decide on which action, if any, to take in response to the report. Performing such interpretation and making such decisions may be time-consuming and require significant training and skill. In the medical context, for example, it would be desirable to facilitate the process of acting on reports, particularly in time-critical situations.
SUMMARY
• Speech is transcribed to produce a transcript. At least some of the text in the transcript is encoded as data. These codings may be verified for accuracy and corrected if inaccurate. The resulting transcript is provided to a decision support system to perform functions such as checking for drug-drug, drug-allergy, and drug-procedure interactions, and checking against clinical performance measures (such as recommended treatments). Alerts and other information output by the decision support system are associated with the transcript. The transcript and associated decision support output are provided to a physician to assist the physician in reviewing the transcript and in taking any appropriate action in response to the transcript.
• For example, one embodiment of the present invention is a computer-implemented method comprising: (A) applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document; (B) providing the first document to an automatic decision support system; (C) receiving, from the automatic decision support system, decision support output derived from the first document; and (D) transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.
• Another embodiment of the present invention is an apparatus comprising: speech recognition means for applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document; document provision means for providing the first document to an automatic decision support system; output receiving means for receiving, from the automatic decision support system, decision support output derived from the first document; and document transmission means for transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.
• Another embodiment of the present invention is a computer-implemented method comprising: (A) applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document; (B) applying a decision support method to the first document to produce decision support output; (C) storing a record associating the decision support output with the first document; and (D) transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.
• Another embodiment of the present invention is an apparatus comprising: speech recognition means for applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document; decision support means for applying a decision support method to the first document to produce decision support output; record storage means for storing a record associating the decision support output with the first document; and document transmission means for transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.
• Another embodiment of the present invention is a computer-implemented method comprising: (A) receiving, from a remote location, a spoken audio stream; (B) applying an automatic speech recognizer to the spoken audio stream to produce a first document including first codings associated with text in the first document; (C) providing the first document to an automatic decision support system; (D) receiving, from the automatic decision support system, decision support output derived from the first document; and (E) transmitting, to a recipient, at the remote location, a second document, derived from the first document and the decision support output.
• Another embodiment of the present invention is an apparatus comprising: means for receiving, from a remote location, a spoken audio stream; means for applying an automatic speech recognizer to the spoken audio stream to produce a first document including first codings associated with text in the first document; means for providing the first document to an automatic decision support system; means for receiving, from the automatic decision support system, decision support output derived from the first document; and means for transmitting, to a recipient, at the remote location, a second document, derived from the first document and the decision support output.
• Another embodiment of the present invention is a computer-implemented method comprising: (A) receiving a first portion of a streamed spoken audio stream from an audio stream transmitter; (B) applying an automatic speech recognizer to the stream spoken audio stream to produce a first partial document including first codings associated with text in the first partial document; (C) providing the first partial document to an automatic decision support system; (D) receiving, from the automatic decision support system, decision support output derived from the first partial document; (E) determining whether the decision support output satisfies a predetermined criterion triggering human review; (F) if the decision support output is determined to satisfy the predetermined criterion, then transmitting to the audio stream transmitter, while receiving a second portion of the streamed spoken audio stream, an indication that the decision support output satisfies the predetermined criterion.
• Another embodiment of the present invention is an apparatus comprising: means for receiving a first portion of a streamed spoken audio stream from an audio stream transmitter; means for applying an automatic speech recognizer to the stream spoken audio stream to produce a first partial document including first codings associated with text in the first partial document; means for providing the first partial document to an automatic decision support system; means for receiving, from the automatic decision support system, decision support output derived from the first partial document; means for determining whether the decision support output satisfies a predetermined criterion triggering human review; and means for transmitting to the audio stream transmitter, while receiving a second portion of the streamed spoken audio stream, an indication that the decision support output satisfies the predetermined criterion if the decision support output is determined to satisfy the predetermined criterion.
• Other features and advantages of various aspects and embodiments of the present invention will become apparent from the following description and from the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a dataflow diagram of a system for applying automatic clinical decision support to a transcript of speech; and
• FIG. 2 is a flowchart of a method performed by the system ofFIG. 1 according to one embodiment of the present invention.
DETAILED DESCRIPTION
• Embodiments of the invention are directed to techniques for providing a transcript to a clinical decision support system for the purpose of attaching critical alerts and other information to the transcript for review by a physician. In general, speech is transcribed to produce a report. At least some of the text in the transcript is encoded as data. The codings may be verified for accuracy and corrected if inaccurate. The resulting transcript is provided to a decision support system to perform functions such as checking for drug-drug, drug-allergy, and drug-procedure interactions, and checking against clinical performance measures (such as recommended treatments). Alerts and other information provided by the decision support system are associated with the transcript. The transcript and associated decision support output are provided to a physician for review and any other appropriate action in response to the decision support output.
• More specifically, referring toFIG. 1, a dataflow diagram is shown of asystem100 for applying automatic clinical decision support to a transcript of speech. Referring toFIG. 2, a flowchart is shown of amethod200 performed by thesystem100 ofFIG. 1 according to one embodiment of the present invention.
• Atranscription system104 transcribes a spokenaudio stream102 to produce a draft transcript106 (step202). The spokenaudio stream102 may, for example, be dictation by a doctor describing a patient visit. The spokenaudio stream102 may take any form. For example, it may be a live audio stream received directly or indirectly (such as over a telephone or IP connection), or an audio stream recorded on any medium and in any format.
• Thetranscription system104 may produce thedraft transcript106 using, for example, an automated speech recognizer or a combination of an automated speech recognizer and human transcriptionist. Thetranscription system104 may, for example, produce thedraft transcript106 using any of the techniques disclosed in the above-referenced patent application entitled “Automated Extraction of Semantic Content and Generation of a Structured Document from Speech.” As described therein, thedraft transcript106 may includetext116 that is either a literal (verbatim) transcript or a non-literal transcript of the spokenaudio stream102. As further described therein, although thedraft transcript106 may be a plain text document, thedraft transcript106 may also, for example, in whole or in part be a structured document, such as an XML document which delineates document sections and other kinds of document structure. Various standards exist for encoding structured documents, and for annotating parts of the structured text with discrete facts (data) that are in some way related to the structured text. Examples of existing techniques for encoding medical documents include the HL7 CDA v2 XML standard (ANSI-approved since May 2005), SNOMED CT, LOINC, CPT, ICD-9 and ICD-10, and UMLS.
• As shown inFIG. 1, thedraft transcript106 includes one or more codings108, each of which encodes a “concept” extracted from the spokenaudio stream102. The term “concept” is used herein as defined in the above-referenced patent application entitled “Automated Extraction of Semantic content and Generation of a Structured Document from Speech.” Reference numeral108 is used herein to refer generally to all of the codings within thedraft transcript106. Although inFIG. 1 only two codings, designated108aand108b, are shown, thedraft transcript106 may include any number of codings.
• In the context of a medical report, each of the codings108 may, for example, encode an allergy, prescription, diagnosis, or prognosis. In general, each of the codings108 includes a code and corresponding data, which are not shown inFIG. 1 for ease of illustration. Each of the codings108 may be linked to text in thetranscript106. For example, coding108amay be linked to text118aandcoding108bmay be linked totext118b. Further details of embodiments of the codings108 may be found in the above-referenced patent application entitled, “Verification of Data Extracted from Speech.”
• Acoding verifier120 may verify the codings108 (step204). Any of a variety of techniques may be used to verify the codings, examples of which may be found in the above-referenced patent application entitled, “Verification of Data Extracted from Speech.” The verification process performed by thecoding verifier120 may include correcting any codings that are found to be incorrect. Thecoding verifier120 therefore produces a modifieddraft transcript122, which includes any corrections to the codings108 or other modifications made by the coding verifier120 (step206). Note, however, that it is optional to verify the codings108.
• The modifieddraft transcript122 is provided to adecision support engine124, which appliesdecision support methods126 to the modifieddraft transcript122 to produce decision support output128 (step208). If the codings108 were not verified (e.g., ifstep204 was not performed), then theoriginal draft transcript106, instead of the modifieddraft transcript122, may be provided to thedecision support engine124 instep208 to produce thedecision support output128. In other words, thedraft transcript106 may be unverified when decision support is applied to it.
• An example of a decision support method is a method which checks for drug-drug, drug-allergy, and/or drug-procedure interactions. Thedecision support engine124 may easily perform such a method because concepts such as drugs, allergies, and procedures have already been encoded in the modifieddraft transcript122 in a form that is computer-readable. Therefore, thedecision support engine124 may use a database of drug-drug interactions, for example, to determine whether the modifieddraft transcript122 describes any such interactions requiring attention of a physician.
• Another example of a decision support method is a method which checks concepts encoded in the modifieddraft transcript122 against clinical performance measures (such as recommended treatments). For example, the American Heart Association (AHA) recommends that patients who have had a heart attack, unstable angina, or ischemic stroke take aspirin regularly. Therefore, one of thedecision support methods126 may determine whether the draft transcript106 (or modified draft transcript122) indicates that the dictating physician stated that the patient has experienced a heart attack, unstable angina, or ischemic stroke. If so, the decision support method may further determine whether the draft transcript106 (or modified draft transcript122) recommends (e.g., in the “recommended treatments” section) that the patient take aspirin. If the decision support method determines that the patient has had one of the three indicated conditions and that the doctor did not recommend aspirin for the patient, then the decision support method may alert the physician (through the decision support output128) to this fact and suggest that the physician recommend aspirin to the patient. Again, thedecision support engine124 may easily perform such a method because concepts such as the patient's medical history and recommended treatments have already been encoded in thetranscripts106 and122 in a form that is computer-readable.
• As stated above, thedecision support engine124 producesdecision support output128. An example of such output is a critical alert indicating that thetranscript122 states that the patient has been prescribed two drugs which are contraindicated with each other. Thedecision support engine124 may be configured to label different components of theoutput128 with different priority levels. For example, thedecision support engine124 may label certain components of theoutput128 as requiring immediate physician review, while labeling other components of theoutput128 as requiring physician review, but not immediately. Alternatively, for example, thedecision support engine124 may filter the results it produces and include in theoutput128 only those pieces of information which exceed a certain priority level (e.g., only those pieces of information requiring immediate physician review).
• A decisionsupport output processor130 may attach thedecision support output128 to the modifieddraft transcript122 or otherwise associate thedecision support output128 with the modified draft transcript122 (step210). For example, in the embodiment shown inFIG. 1, the decisionsupport output processor130 stores thedecision support output128 within the modifieddraft transcript122, thereby producing a processed draft transcript132 containing the contents of both the modifieddraft transcript122 and thedecision support output128.
• As another example, decisionsupport output processor130 may use thedecision support output128 to modify the modifieddraft transcript122. For example, if thedecision support output128 indicates a drug-drug allergy, the decisionsupport output processor130 may modify the code(s) for the contraindicated drug(s) in thetranscript122 so that the text corresponding to the drug(s) appears in boldface, in a conspicuous color (e.g., red), or in some other manner that calls attention to the text. As another example, the decisionsupport output processor130 may include in the transcript122 a textual comment describing the drug-drug allergy such that the comment appears in the vicinity of the text when it is rendered.
• The processed draft transcript132 (and thedecision support output128, if it is not contained within the processed draft transcript132) may be provided to a physician orother reviewer138 for review. Alternatively, for example, information derived from the processed draft transcript132 and/ordecision support output128 may be provided to thereviewer138 for review. Thereviewer138 may be the same person as the dictator of the spokenaudio stream102.
• For example, arenderer134 may render the processed transcript132 based on thedecision support output128 to produce a rendering136 (step212). Therendering136 may display both the text of the transcript132 and theoutput128. As described above, therendering136 may reflect theoutput128 in a variety of ways, such as by using theoutput128 to modify the manner in which the text of the transcript132 is rendered.
• For example, therendering136 may be a flat text document or other document which does not include the codings108a-band other data which typically require an EMR and/or decision support system to process. For example, therendering136 may be a Rich Text Format (RTF) or HTML document suitable for display by a conventional word processor or web browser. Therenderer134 may, for example, strip out the codings108a-bfrom the processed draft transcript132 or otherwise process the draft transcript132 to produce therendering136 in a format suitable for processing (e.g., displaying) without an on-site EMR and/or decision support system. Therendering136, therefore, need not be directly or immediately displayed to thereviewer138. For example, therenderer134 may transmit therendering136 to thereviewer138 electronically (e.g., by email, FTP, or HTTP), for subsequent viewing in any manner by thereviewer138.
• The reviewer138 (e.g., physician) reviews therendering136. Thesystem100 may include an approval mechanism (not shown) which enables thereviewer138 to provide input indicating whether thereviewer138 approves of the transcript132. In the medical context, for example, if thereviewer138 is a physician, the physician may be required to sign off on the transcript132, as represented by therendering136. The use of thedecision support output128 in the process of producing therendering136 facilitates the process of reviewing the transcript132. For example, if theoutput128 indicates that thetranscript122 describes a particular drug-drug allergy, then therendering136 may display a conspicuous indication of such allergy, thereby increasing the likelihood that the physician-reviewer138 will notice such an allergy and decreasing the time required for the physician-reviewer138 to do so.
• Embodiments of the present invention have a variety of advantages. For example, in conventional systems, a physician typically dictates a report. The report is transcribed and the transcript is presented to the physician for review and signature. The physician must conclude that the report is accurate before signing it. If the physician's facility does not have an onsite EMR system and/or decision support system, then it may not be possible or feasible for decision support to be applied to the report before presenting it to the physician for signature. As a result, the physician must review and sign the report, thereby attesting to its accuracy, without the additional assurance of accuracy that a decision support system may provide.
• In contrast, the techniques disclosed herein facilitate the process of applying decision support and other quality assurance measures to a draft report before providing the report to the physician for signature, i.e., while the report is still in its unsigned state. As a result, the techniques disclosed herein may be used both to increase the quality of signed reports and to reduce the amount of time required by physicians to review reports before signing.
• In particular, the techniques disclosed herein may be used to bring the benefits of automatic clinical decision support and other automated quality assurance measures to care providers who do not have an on-site Electronic Medical Record (EMR) system which is capable of consuming coded document formats. Such EMR systems are costly and therefore are not used by small clinics. Embodiments of the present invention do not require an on-site EMR system because all processing of encoded documents may be integrated into the transcription workflow and therefore performed by, for example, an outsourced transcription service at a remote location in relation to the clinic or other source organization. The dictator ofspeech102 may, for example, transmit the spokenaudio stream102 to such a service at a remote location in any manner, such as by electronic transmission.
• The service may then perform method200 (FIG. 2) at an off-site location in relation to the dictator ofspeech102. The service may then transmit the processed draft transcript132,decision support output128, and/or therendering136 to thereviewer138 in any manner, such as by any form of electronic transmission. If thereviewer138 does not have an on-site EMR and/or decision support system, however, the service may provide the transcript132,decision support output128, and/orrendering136 to thereviewer138 in a flat text format or other format that does not require thereviewer138 to have an on-site EMR or decision support system to process. For example, the service may provide only therendering136, and not the processed draft transcript132 ordecision support output128, to thereviewer138. Therefore, embodiments of the present invention may be used to provide the benefits of automatic clinical decision support systems to providers through medical transcription services without requiring deployment of EMR systems on the provider side.
• More generally, embodiments of the present invention use a human transcription workflow to enable automatic clinical decision support, disease management, and performance tracking. As described above, conventional transcription systems typically produce transcripts which are “flat” text documents, and which therefore are not suitable for acting as input to decision support processes. In contrast, embodiments of the present invention produce transcripts including structured data which encode concepts such as allergies and medications, and which therefore may be processed easily by automatic decision support systems. Such embodiments may therefore be integrated with clinical decision support systems and provide the benefits of such systems quickly and easily.
• It is difficult or impossible to use flat text transcripts in this way because a decision support system would need first to interpret such text to apply decision support methods to it. Any attempt to use human intervention and/or natural language processing to perform such interpretation will suffer from the slow turnaround times and relatively high error rates associated with such techniques. In contrast, and as described in more detail in the above-referenced patent applications, transcripts may be produced using embodiments of the present invention quickly and with a high degree of accuracy, thereby making such transcripts particularly suitable for use as input to automatic clinical decision support systems.
• Even in cases in which thesystem100 ofFIG. 1 is implemented in conjunction with an outsourced transcription service, the techniques disclosed herein do not require the entire spokenaudio stream102 to be spoken before clinical decision support may be applied to it. For example, consider a case in which a physician dictates the spokenaudio stream102 into a handheld recording device, which streams the spokenaudio stream102 to thetranscription system104 while the physician is speaking the spokenaudio stream102. Thetranscription system104 may begin transcribing the beginning of the spokenaudio stream104 while the physician dictates subsequent portions of the spokenaudio stream102, which continue to be streamed to thetranscription system104. As thedraft transcript104 is being produced, it may be processed by the remainder of thesystem100 as described above with respect toFIGS. 1 and 2.
• As a result, if thedecision support system124 identifies a problem (such as a drug-drug allergy) requiring physician review, the decision support output128 (e.g., in the form of the processed draft transcript132 and/or the rendering136) may be provided to the physician-reviewer138 while the physician is still dictating the remainder of the spoken audio stream, i.e., before the entire spokenaudio stream102 has been transmitted to thetranscription system104 and before theentire draft transcript106 has been produced. One benefit of such real-time application of decision support to the spokenaudio stream102 is that thedecision support output128 may be provided to the dictating physician before the physician has finished dictating, thereby presenting the physician with an opportunity to correct any errors during a single dictation session and while the correct content of the session is still fresh in the physician's mind.
• It is to be understood that although the invention has been described above in terms of particular embodiments, the foregoing embodiments are provided as illustrative only, and do not limit or define the scope of the invention. Various other embodiments, including but not limited to the following, are also within the scope of the claims. For example, elements and components described herein may be further divided into additional components or joined together to form fewer components for performing the same functions.
• Although certain examples provided herein involve documents generated by a speech recognizer, this is not a requirement of the present invention. Rather, the techniques disclosed herein may be applied to any kind of document, regardless of how it was generated. Such techniques may, for example, be used in conjunction with documents typed using conventional text editors.
• The spokenaudio stream102 may be any audio stream, such as a live audio stream received directly or indirectly (such as over a telephone or IP connection), or an audio stream recorded on any medium and in any format. In distributed speech recognition (DSR), a client performs preprocessing on an audio stream to produce a processed audio stream that is transmitted to a server, which performs speech recognition on the processed audio stream. The audio stream may, for example, be a processed audio stream produced by a DSR client.
• The invention is not limited to any of the described domains (such as the medical and legal fields), but generally applies to any kind of documents in any domain. For example, although thereviewer138 may be described herein as a physician, this is not a limitation of the present invention. Rather, thereviewer138 may be any person. Furthermore, documents used in conjunction with embodiments of the present invention may be represented in any machine-readable form. Such forms include plain text documents and structured documents represented in markup languages such as XML. Such documents may be stored in any computer-readable medium and transmitted using any kind of communications channel and protocol.
• Furthermore, although particular examples are described herein in conjunction with clinical decision support, this is not a limitation of the present invention. Rather, the techniques disclosed herein may be applied to other forms of automated decision support based on transcripts containing structured text with encoded data. For example, the techniques disclosed herein may be used to verify document completeness, such as whether the dictator of thetranscript106 mistakenly omitted a required section of thetranscript106.
• Thedecision support engine124 may include any mechanism, such as a software- or hardware-based mechanism, for applying automatic decision support to the modifieddraft transcript122. Although thedecision support engine124 may be described herein as applying automated methods, this does not preclude some degree of human interaction with thedecision support engine124 to perform its functions.
• Furthermore, thedecision support engine124 may receive inputs in addition to the modifieddraft transcript122 to assist in providing decision support. For example, a transcription service may produce multiple transcripts over time describing a single patient. In the course of producing such transcripts, the transcription service may build an archive of data about the patient, derived from data in the transcripts. Then, when the transcription service receives a new spoken audio stream for transcription, the transcription service may identify that the new spoken audio stream refers to a patient for whom a data archive already exists. The transcription service may then provide not only the current draft transcript, but also some or all of the patient's data archive, to thedecision support engine124. Thedecision support engine124 may benefit from such additional data about the patient, such as medications previously prescribed to the patient, to detect drug-drug allergies or other problems which could not be detected from the current transcript in isolation.
• The techniques described above may be implemented, for example, in hardware, software, firmware, or any combination thereof. The techniques described above may be implemented in one or more computer programs executing on a programmable computer including a processor, a storage medium readable by the processor (including, for example, volatile and non-volatile memory and/or storage elements), at least one input device, and at least one output device. Program code may be applied to input entered using the input device to perform the functions described and to generate output. The output may be provided to one or more output devices.
• Each computer program within the scope of the claims below may be implemented in any programming language, such as assembly language, machine language, a high-level procedural programming language, or an object-oriented programming language. The programming language may, for example, be a compiled or interpreted programming language.
• Each such computer program may be implemented in a computer program product tangibly embodied in a machine-readable storage device for execution by a computer processor. Method steps of the invention may be performed by a computer processor executing a program tangibly embodied on a computer-readable medium to perform functions of the invention by operating on input and generating output. Suitable processors include, by way of example, both general and special purpose microprocessors. Generally, the processor receives instructions and data from a read-only memory and/or a random access memory. Storage devices suitable for tangibly embodying computer program instructions include, for example, all forms of non-volatile memory, such as semiconductor memory devices, including EPROM, EEPROM, and flash memory devices; magnetic disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROMs. Any of the foregoing may be supplemented by, or incorporated in, specially-designed ASICs (application-specific integrated circuits) or FPGAs (Field-Programmable Gate Arrays). A computer can generally also receive programs and data from a storage medium such as an internal disk (not shown) or a removable disk. These elements will also be found in a conventional desktop or workstation computer as well as other computers suitable for executing computer programs implementing the methods described herein, which may be used in conjunction with any digital print engine or marking engine, display monitor, or other raster output device capable of producing color or gray scale pixels on paper, film, display screen, or other output medium.

Claims (26)

1. A computer-implemented method comprising:

(A) applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document;

(B) providing the first document to an automatic decision support system;

(C) receiving, from the automatic decision support system, decision support output derived from the first document; and

(D) transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.

2. The method ofclaim 1, wherein transcribing the spoken audio stream and providing the first document to the automatic decision support system are performed contemporaneously.

3. The method ofclaim 1, wherein the first codings encode concepts represented by the text.

4. The method ofclaim 1, wherein (A) comprises:

(A)(1) identifying a second document including second codings associated with the text;

(A)(2) determining whether any of the second codings is inaccurate; and

(A)(2) correcting any of the second codings determined to be inaccurate to produce the first document.

5. The method ofclaim 1, further comprising:

(A) storing a record associating the output with the first document.

6-8. (canceled)

9. The method ofclaim 1, further comprising:

(D) rendering the first document based on the output to produce a rendering of the first document.

10. An apparatus comprising:

speech recognition means for applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document;

document provision means for providing the first document to an automatic decision support system;

output receiving means for receiving, from the automatic decision support system, decision support output derived from the first document; and

document transmission means for transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.

11. The apparatus ofclaim 10, wherein the document provision means comprises means for providing the first document to the automatic decision support system contemporaneously with operation of the speech recognition means.

12. The apparatus ofclaim 10, wherein the speech recognition means comprises:

means for identifying a second document including second codings associated with the text;

means for determining whether any of the second codings is inaccurate; and

means for correcting any of the second codings determined to be inaccurate to produce the first document.

13. The apparatus ofclaim 10, further comprising:

means for storing a record associating the output with the first document.

14. The apparatus ofclaim 10, further comprising:

means for rendering the first document based on the output to produce a rendering of the first document.

15. A computer-implemented method comprising:

(A) applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document;

(B) applying a decision support method to the first document to produce decision support output;

(C) storing a record associating the decision support output with the first document; and

(D) transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.

16. The method ofclaim 15, wherein (B) comprises determining whether the first document indicates at least one of a drug-drug, drug-allergy, and drug-procedure interaction.

17. The method ofclaim 15, wherein (B) comprises determining whether the first document indicates satisfaction of a clinical performance measure.

18. The method ofclaim 15, wherein the first codings encode concepts represented by the text.

19. The method ofclaim 15, wherein (A) comprises:

(A)(1) identifying a third document including third codings associated with the text;

(A)(2) determining whether any of the third codings is inaccurate; and

(A)(2) correcting any of the third codings determined to be inaccurate to produce the first document.

20-22. (canceled)

23. The method ofclaim 15, further comprising:

(A) rendering the first document based on the output to produce a rendering of the first document.

24. An apparatus comprising:

speech recognition means for applying an automatic speech recognizer to a spoken audio stream to produce a first document including first codings associated with text in the first document;

decision support means for applying a decision support method to the first document to produce decision support output;

record storage means for storing a record associating the decision support output with the first document; and

document transmission means for transmitting to a recipient a second document, derived from the first document and the decision support output, wherein the second document does not include the first codings.

25. The apparatus ofclaim 24, wherein the decision support means comprises means for determining whether the first document indicates at least one of a drug-drug, drug-allergy, and drug-procedure interaction.

26. The apparatus ofclaim 24, wherein the decision support means comprises determining whether the first document indicates satisfaction of a clinical performance measure.

27. The apparatus ofclaim 24, wherein the speech recognition means comprises:

means for identifying a third document including third codings associated with the text;

means for determining whether any of the third codings is inaccurate; and

means for correcting any of the third codings determined to be inaccurate to produce the first document.

28. The apparatus ofclaim 24, wherein the record storage means comprises means for modifying the first document based on the output.

29. The apparatus ofclaim 24, further comprising:

means for rendering the first document based on the output to produce a rendering of the first document.

30-33. (canceled)

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