Custom Commands

A microphone button or keyboard shortcut normally triggers one fixed action — merge findings, toggle the findings panel, and so on. Custom Commands let you bundle several steps into a single named sequence and bind it to one trigger. Think of it as AutoHotkey for radiology: tap one button, run a short script.

A few things one command can do from a single press:

• Set up your reading workspace — launch PACS and Epic, then tile each across your monitors.
• Jump to the next dictation field — focus PowerScribe and send a Tab keystroke.
• Open a reference lookup — open Radiopaedia (or any URL) in your browser.
• Capture and merge — grab a region of the screen, then run a merge.

Sign in to app.presto.run and select Custom Commands from the sidebar.

Click Add Command and give it a name. The name is how the command appears later in the Microphone Buttons and Keyboard Shortcuts dropdowns, so make it descriptive (e.g. “Open reading workspace”).

Each command is an ordered list of steps that run top to bottom. Click to add a step and choose its type:

• Run a Presto action — merge findings, refresh AI findings, or run a capture (region, window, or repeat last capture)
• Focus a window — bring a window to the front by its title (full support on Windows; best-effort on macOS)
• Wait for a window — pause until a window with a matching title appears, then continue
• Send a keypress — send synthetic keystrokes to the focused or a title-matched window (Windows only)
• Arrange a window — move and resize a window to a monitor and position (maximize, left half, quarters, and so on) for one-press monitor layouts
• Open a URL — open a web page in your default browser
• Launch an application — start a program by name or path, with optional arguments
• Wait — pause for a fixed delay before the next step

Use the move up / move down controls to reorder steps. By default a command stops at the first step that fails; you can set a step to continue on error instead.

Click Save Commands. Your commands are stored against your account and follow you to any workstation where you sign in.

A saved command does nothing until you bind it. Open Microphone Buttons or Keyboard Shortcuts and pick your command by name from the action dropdown — your commands appear alongside the built-in actions, prefixed with ▸ (for example, ▸ Open reading workspace).

A common use is arranging your reading apps with a single press. A workspace command might:

1. Launch an application — PACS
2. Launch an application — Epic
3. Wait for a window — title contains PACS (so the next step doesn’t run before it opens)
4. Arrange a window — PACS → Monitor 1, Maximize
5. Arrange a window — PowerScribe → Monitor 2, Top half
6. Arrange a window — Epic → Monitor 2, Bottom-left quarter

Bind it to a button and your monitors lay themselves out the same way every morning.

Use Export JSON to copy a command bundle, and Import JSON to paste one in. This is how you share a command with a colleague or move it between accounts — the exported JSON is the portable format.

I don’t see Custom Commands in the sidebar The feature is off by default. Contact your Presto rep to enable it for your account.

My command doesn’t run when I press the button

• Confirm the command is Enabled and Saved
• Confirm the button or shortcut is bound to the command (the action shows ▸ followed by the command name)
• If the command has a Windows-only step, it won’t run on macOS — see the Windows-only steps note above

Only one command runs at a time Presto runs a single command to completion before starting another. If you trigger a second command while one is still running, the second is ignored.

A keypress lands in the wrong window Add a Focus a window or Wait for a window step before the keypress so the right window is in front first.