Introduction

 Thank you for using TranScriptionist, the most advanced and flexible text generation system for devices running the Newton¨ Operating System. We designed TranScriptionist with one goal in mind, to save time. While we initially set out to create a transcription program for medical professionals we have found that anyone who writes structured reports or letters can benefit by using TranScriptionist.

Using TranScriptionist you can now create custom reports by simply clicking on the screen of your PDA. Your report can be printed or exported to a desktop computer in its entirety or you can choose to only export the data that was collected.

By loading other Tactile Systems modules you will be able to use the patients in the Names file to track patient information, write prescriptions, track laboratory data and track variance from critical pathways. By providing our software in a modular format we hope to give the end user the choice of what functionality they would like to install in their Newton device. Also this design architecture conserves precious ÒheapÓ memory resulting in less Òout of memoryÓ restart messages on the Newton device.

From individual user to integration into your institutions enterprise system, Tactile can provide the Newton solution you need to increase your productivity and empower you at the point of care. Please contact us if you require any modification of our existing product line or design of a custom installation.

At Tactile, we're constantly looking for ways to improve our software. Your opinions and demands for future products are very important to us. If you can think of something we haven't done or a better way to implement one of our existing features please drop us a letter or email. We always want to provide you with highest quality software.

Tactile Systems, Inc.


Installation

 TranScriptionist must be downloaded from a desktop computer to your Newton. To do this you can use the Newton Backup Utility. It is included with all new Newtons, if you don't have a copy, you can call Apple at 800-SOS-APPL.

It is highly recommended that you install the TranScriptionist into your internal memory. This will ensure that you have access to your data even when you use different PC-Cards (for example many people use a fax/modem card to fax patient information).

To ensure that the TranScriptionist gets installed into the internal memory of your Newton, first open the Extras drawer by tapping on the "Extras" icon at the bottom of your Newton screen. If you have a PC-Card inserted you should see a "Card" icon listed. If the icon is not displayed make sure you are in the "Unfiled Icons" folder (you can switch folders by tapping on the "folder tab" at the top of the drawer). Tapping the "Card" icon will display an information screen for the card. There will be a check box labeled "Save all new info and packages on this card." If it is checked, tap on the box to uncheck it. Once you have done this close the screen by tapping the "Close Box" in the bottom left corner of the Card Info Screen.

Connect the Newton to your desktop computer using the serial cable that came with your Newton. If you have any problem please consult your Newton Backup Utility manual. After this has been accomplished launch the Newton Backup Utility on your desktop computer. It will prompt you to start the connection from your Newton. Tap the "Connection" icon in the Extras drawer to bring up the Connection screen. Choose your connection type (Serial, Modem, AppleTalk) by tapping on the "Connect via" picker. Most people will use the Serial option. Next tap the "Connect" button.

Once the connection has been completed choose the "Download Package" option of the Newton Backup Utility. Next select the TScript.pkg using the dialog box. This will start the download process. Once it has finished TranScriptionist sofware will have been installed.


Software Registration

 After you install TranScriptionist for the first time, and once per day thereafter, you will be greeted with the registration screen. If left unregistered, your software will expire in thirty days. To register your software, call the number listed on the registration screen or send email to sales@tactile.com. You will need to provide the registration code that shows on your registration screen and the two key words that are on your original disks. Tactile will provide you with the unlock code to enter on the registration screen. Once successfully unlocked, this screen will no longer appear. You may request a full refund from the establishment where you purchased TranScriptionist any time prior to obtaining your personal unlock code.



A Quick Tour

 Refer to your Newton users manual on how to make the "Extras Drawer" appear on your Newton screen. Find the icon labelled TranScriptionist and start the application by tapping on it. The first time TranScriptionist runs it will do some initialization of data. Don't worry, the program won't take this long to start up again.

You should now be in the TranScriptionist "home screen". Make sure the "Reports" radio button is hilighted in the main screen. Tap the "New" button to create a new report. Select "Admission note" when the list of templates appears.


Once you are in the Admission Note you should see some words in outline font. If you don't see words in outline font, tap on the "show" button and select "styled text". Also make sure that the "Auto Select Words" checkbox in the upper left portion of the screen is checked. Tap on the outline font words. With every one tapped you will be presented with a means of entering in the desired information.

Tap the word "Diagnosis". Select "chest pain [chest pain]". Note how this causes the chest pain template to be inserted. So far we have only encountered single choice questions. The chest pain template contains some multiple answer questions such as description of pain. The chest pain template also shows example of "nested questions" such as Radiation. Indicating that the pain radiates causes another question regarding the locations of pain radiation to be inserted in the report.


Note that you may re-answer any question by tapping on the answer (shown in bold text) and opening the original data collection screen again. Tap on "chest pain" in the first paragraph. Select another diagnosis. Note that all the irrelevant data is now thrown out and the other template (with very little text defined) is substituted.

Basic Concepts

Templates
Templates form the foundation upon which TranScriptionist reports are based. Essentially, templates are the "skeleton" of the report to be created and contain the non-data specific portions of the text that make the report easy to read.

Templates contain the text which is displayed to the user and usually contain references to TranScriptionist macros or components as well.

An example of a simple template might be something like "The quick fox jumped over the lazy brown ." This template refers to two "macros", color and animal, contained within the "<" and ">" signs. In the report editor these unanswered macros may be shown in outline font to improve readability; i.e., "The color fox jumped over the lazy brown animal." These macros represent popup choices for "color" and "animal" which must be seperately defined. Filling out this template could give us the sentence "The quick red fox jumped over the lazy brown dog". Note that the answered macros are shown in bold font within the report editor. Tapping on these words would pop up the original macro associated with the entry.

If a template is contained within a macro (explained in the next section) or another template it will be identified by having its name surrounded by the "[" and "]" characters.



Macros

 Macros are the primary data collection tools that reside within templates. Each macro consists of a name, a series of choices and an identifier signifying if the user is limited to a single choice when answering this macro or if multiple answers are allowed. The macro name is shown in the template when no data have been entered. In the template editor the name will appear between the "<" and ">" characters.

Macro answers can be text or can contain references to other macros or templates which will be evaluated and converted by the report editor. An example of this can be seen in the example hospital admission template that comes with TranScriptionist. The last macro in the Admission Note deals with diagnosis. Selecting the "chest pain" diagnosis then inserts a template (paragraph) whose function is to collect data about chest pain. Similarly, within the chest pain template is a macro relating to relieving factors. This macro can either be answered "Nothing relieves the pain." or "The pain is relieved by ". The first choice simply inserts the text. The second choice inserts some text as well as another macro dealing with what factors relieve the chest pain.




Components

 Components are special objects that can be referenced in the report editor. Components can be used to insert numbers via a numeric keypad, date and time or current date and time, ICD-9 codes or CPT codes. Components are identified in the template editor by being surrounded by the pipe "|" characters.



Demographics

 One of the most powerful features of TranScriptionist is that an individual person can be identified as being the subject of a report. Provided this person exists within the Newton's built in "Names" application, demographic data can then be automatically entered into the report. These demographic data consist of most of the built in fields within the Newtons "Names" file as well as user defined custom name fields and fields provided if the user has Tactile Systems "Medical Extensions" loaded. ÒCustomÓ fields created by the user in the ÒNamesÓ application are supported as well.

Tapping on any demographic item, answered or unanswered, will pop up a list of persons which can be assigned to this report. Selecting a person assigns that person's demographic data to all Demographic items within the current report.

If the requested demographic data for the person cannot be found the user will be given the choice of skipping over it or being taken directly into the entry for this person within the names application where the missing data can be entered.




Overview of Controls

Home screen The majority of the main TranScriptionist screen consists of an alphabetic list of items. The contents of this list are controlled by three radio buttons at the top of the screen. Filing is also supported via the folder tab in the upper right portion of the screen.

Changing the hilighted radio button changes the contents of the alphabetic picker and the function of the "New" button at the bottom of the screen. When the "Macros" button is hilighted the picker shows the list of macros which can be used within templates. Tapping on one of these macros opens up the macro editor. Similarly the list of templates and reports are shown when their respective buttons are hilighted. Tapping the "New" button when the "Macros" or "Templates" buttons are hilighted creates a new object of that type. Tapping the "New" button when "Reports" is hilighted pops up a list of templates upon which the new report is based.

Multiple items can be selected via the checkboxes and can then have functions performed upon them by tapping the routing button (shaped like a small envelope) in the bottom right corner of the screen. Checked items can also be filed into different categories using the folder tab to organize a usersÕ lists.




Template Editor

 When you first begin to use TranScriptionist, you will spend most of your time in the template editor. This process involves a slight learning curve and can be time consuming but will allow you to save much time in the future when all you will have to do is point and click to generate a report.

Within a template can be incorporated Macros, Components, Demographics or other templates. These objects need to be surrounded by the special characters "<" and ">" for macros, "{" and "}" for demographics, "|"'s for components and "[" and "]" for other templates. While you may either type these characters as well as the specific module name directly into the template editor it is easier to position the caret where you want the object inserted and tap the "Insert" button. By following the popup menus, you can either select demographic, component or macro from the alphabetic list. In the case of inserting macros you can create a new macro to be inserted into your template from the alphabetic macro list.


Macro Editor

 The macro editor is accessed by tapping the "New" button from the alphabetic list of macros. Each macro needs to be given a name which will show up in templates when the macro is unanswered. In addition to this macros need to be defined as single answer or multiple answer. If a macro is multiple answer the "Format" option identifies if multiple selections should be shown in sentence form (i.e., "one, two and three") or in paragraph form.

Choices to macros are entered by tapping the "Edit Choices" button. As each new choice is entered on the input line, the "Add" button becomes visible. Tapping this button adds the choice to the list of multiple choices for this macro. Tapping one of the items in the choice list gives the user the option to duplicate, change or delete a choice in the macro editor. Choices can be stored in the order they are created or the order can be changed from within the macro editor.


Once choices for a macro exist, the user can sort these choices in ascending or descending alphabetic order using the "Sort" button in the lower left corner of the macro screen. Additionally, individual entries can be moved up or down the popup order by selecting that entry in the Macro editor and tapping the "Up" or "Down" buttons which will appear only when an entry has been selected in the Macro Editor.

Note also that the list of choices in the Macro Editor need not be comprehensive. New choices can be added while you are using Transcriptionist and can be retained for future use.


Advanced users may wish to "nest" other templates or macros to be shown only when the user selects certain responses to macros. This is done by referencing the desired macro, demographic, component or template within its respective special characters; <" and ">" for macros, "{" and "}" for demographics, "|"'s for components and "[" and "]" for other templates. More on this topic in the next section.


Advanced Techniques

Nested macros and templates

 "Nesting" refers to the ability to have an item such as a macro, component or template reside within another item. The ability to nest items is the strongest feature within TranScriptionist. By using nested items the user can have the report be completely customized to the data that has been entered. In this manner the end user need never be presented with irrelevant questions that do not fit the present circumstances.

For example a template about medical history may contain a macro that asks the person whether they smoke or not. Answering this macro with "non-smoking" would simply insert that text in the appropriate point in the report. If the person answered that they did smoke, however, the macro could be designed to insert other macros or even other templates into the report.

Examples of nested templates and macros can be found in the samples that are created when TranScriptionist is loaded for the first time. In the "Hospital admission note" the first paragraph ends with the sentence "The patient is admitted with diagnosis of diagnosis" and the user is given the choices of chest pain. [chest pain], abdominal pain. [abdominal pain] or back pain. [back pain]." Note that each of these choices is followed by the name of another template contained within brackets.

When the answer is inserted into the current report the program will automatically replace the item in brackets with the appropriate template. In some situations, such as this one, the template to be inserted may need to begin with a carriage return so it is inserted as a new paragraph.


An example of a nested macro can be seen in the chest pain template. In this situation we are answering a question about whether the chest pain radiates to other locations. The report reads "The pain radiation". Looking at the choices for the radiation macro we see that this sentence can be completed as "The pain does not radiate" or "The pain radiates to the radiation locations". Radiation Locations is another macro which is then called to show the user a list of locations to check off and complete the sentence so that the final sentence may look like "The pain radiates to the neck and left arm". To improve readability, we have chosen only to show the first word in a transcriptionist object as bold or outline font. However, the user may change the answer by tapping on any of the inserted text.



Report Editor

 The report editor has a minimal set of controls. This is where the user will actually "use" TranScriptionist to save time and generate reports. Generally, reports will be entered in "Styled Text" mode where unanswered macros are shown in outline font and answered macros are shown in bold font. To make sure the editor is in WYSIWYG mode tap the "Show" button in the lower left corner of the Report Editor and make sure that "Styled Text" is selected.
The "Ask me" button is used to select alternative ways of data input. The "Ask me" button allows the users to use "Manually by list" mode where the user is simply presented with a list of items that need to be filled in. "Automatically in Order" mode walks the user through all of the unanswered items in order on the report editor.


Creating reports

Styled Text

 The default method of data entry in "Styled Text" mode with the "Auto Select Words" option checked is to answer a macro by tapping on it in the report editor. While these two options are active, users will be able to fill in data in the report editor by simply tapping on words shown in outline or bold font. Words in outline font represent unanswered bits of data. Boldface words show that data has already been input but can be changed by pointing and clicking.

List Mode

 If the "Manually by list" selection in the "Ask me" button is selected in the report editor the user will be presented with a list of all the data points to be collected for the current report. Each data point is represented by a checkbox. If the box is checked then the question has already been answered but may be reanswered by tapping on the checkbox. If a box is unchecked the question can be answered by checking it's box. Note that the question list may dynamically change in length as questions are added or taken out based on answers to "nested" macros.

Interview mode

 If "Automatically in order" is selected in the "Ask me" button in the report editor then the program will simply "walk through" the current template stopping to prompt the user to answer any unanswered items. To stop this process simply tap outside of the popup menu in a single choice answer.



Using Transcriptionist

To create a report using TranScriptionist first make sure that the "Reports" button at the top of the home screen is hilighted. At this point previous reports are shown in the alphabetic picker and you may tap on a previous report to edit it. To create a new report just tap the "New" button at the bottom of the page.
If you elected to create a new report you will then be presented with a list of the available templates. Select the one that you wish to base this report on. This template will now be shown in the report editor.

In this example, we will be assuming that you wish to use the "styled text" method of data entry. The "Auto select words" checkbox in the upper left portion of the screen should be checked. If you do not see any words in outline or bold font check to see that you are in styled text mode by tapping the "Show" button at the bottom left portion of the page and making sure that "Styled text" is checked.

Tapping on words in outline font should open up the appropriate macro, component or demographic editor. In the case of demographics you will be prompted to select a person from the "Names" file. The last eight unique names are retained for use by the program. If you choose a person for which some demographic data are missing you will be given the opportunity to enter it now or skip it altogether. This person will be used to fill in all demographic data for this report.

If you select a macro that does not exist you will be given the opportunity to create it at run time, skip it or find it in the list of existing macros. Tapping the "Create" button will open the Macro editor with the name filled in. You will need to define it as a single or multiple choice question and add any default choices.

If the choice you wish to select does not appear as one of the answers in a macro, you may select "other" and write it in. If you then tap the "Add" button the choice will become a permanent part of this macro. In this manner you may add multiple new choices to this macro. If you tap the close box without tapping the "Add" button the text you write is substituted for the macro but is not added to the list of answers for that macro.

The default name that a report is filed under is the template name appended with the date. If the template contains references to demographic data the persons name will appear in the title as well. The title of a report can be editted by tapping on it within the report editor. If you change the person upon whom this report is based by tapping on a demographic item the report title will be rebuilt.

Desktop Connectivity

If you choose an item for Export, Transcriptionist intelligently bundles in all the referenced macros and templates and any references those may contain. For example, if you chose to export "Admission Note" you would export out basically all the templates and macros that are used in the demo.

To connect to a Macintosh you first need to put the Apple Modem Tool, Appletalk ADSP tool and Serial Tool files in the extensions folder within your system folder.

Launch the TSExchange application and set the preferences for the type of connection to your Newton. Then tell the desktop to either send or receive and the Newton to import or export. You will be prompted for filenames.

Note: If you export out data to your Macintosh, edit it on the desktop and want to import it back into your Newton you will be prompted to delete those items which you want replaced with the desktop version. Check off the items that you wish to beoverwritten with the new data. Any items you do not check off will be left unchanged.


Frequently Asked Questions

Can TranScriptionist run on my original MessagePad or MessagePad 110?
No, TranScriptionist requires a device running version 2.0 of Apple Computer's Newton Operating System.

How can I speed up TranScriptionist?
Try accessing the preferences screen by tapping the "i" button in the lower left corner of the home screen and checking the "Don't Hilite Words" option

Can TranScriptionist use templates created by other programs?
We are working on convertors so that registered users of similar programs can use their existing templates. Call Tactile for specific availability.

Can TranScriptionist be used within other applications?
At Tactile, we're open to the idea of creating a custom application for you and integrating TranScriptionist's functionality.

Tactile's Transcriptionist is available from directly from Tactile Systems (800-5-NEWTON/info@tactile.com) for $249.95.