Versions 9 and 10 of Dragon Naturally Speaking are a huge improvement over previous versions. Version 10.1 Medical has been tested thoroughly and works very well with medical terms. As far as PC hardware requirements go, the more memory (RAM) the better (2GB recommended) when it comes to accuracy and keeping up with the user's speech. Since Dragon is licensed by user and not by device, there is great flexibility in its deployment. Multiple customers are experimenting with using roaming profiles so that physicians can dictate in exam rooms with the patient, along with other Dragon-capable workstations in their offices. Some of the microphones used with Dragon can store user profiles in them, which allows flexibility when switching devices. In addition to the many fundamental Dragon commands, using the built in template features of Dragon can be a nice compliment to using text templates or note forms and illustrates a powerful application of custom Dragon voice commands. This allows more granular personalization without adding clutter to the EHR. One organization which was not intending to use Dragon on a large scale saw the demand for it spread like wildfire. After individual physicians started purchasing it on their own, the IS department realized that they needed to roll it out enterprise wide. Now the vast majority of physicians are using it as a full replacement for dictation, and transcription costs have been almost completely eliminated.
One area where Dragon does not perform well is in sections of the note that require the inclusion of people's names or proper nouns in general. In these rare circumstances, traditional dictation or free typing may work best. However, Dragon does offer some functions to make the process of incorporating proper nouns in Dragon's vocabulary a bit easier.
Of course, not all note sections are well suited for Dragon. In areas where capturing discrete data is required, the use of note forms containing medcin terms or adding the data via the Add Clinical Item workspace is essential.
Dragon as a prelude to EHR adoption
Dragon can be used as an effective way to begin an EHR deployment by allowing the physicians to get an early taste of success.
6-8 weeks prior to going live with the EHR, the physicians should be provided with a Philips SpeechMike and Dragon. One of the numerous examples of Dragon success include a small organization consisting of 5 physicians whom were using Dragon for all of their notes within a week of go-live.
Dragon and Citrix
Citrix is a viable option to provide access to Touchworks EHR to end users. Because of the resource requirements for Dragon (2GB+ RAM), Citrix can be installed locally on each workstation and access to the Touchworks EHR can be gained through the Citrix client.
Although using Dragon directly in the application works well, the accuracy and consistency is markedly better when using the Dragon dictation box. An unfortunate drawback to using the EHR in Citrix and Dragon locally on each workstation, the ‘Transfer’ button in the Dictation Box is not able to determine where in the application to transfer the dictated text. The Phillips SpeechMike can be configured to solve this problem of getting the dictated text from the Dictation Box into the Touchworks EHR with minimal effort.
First, configure the SpeechMike’s Fast Forward button so that the following commands are issued: - Ctrl-A, Ctrl-C, Tab, Tab, Enter
This selects the text from the dictation box, copies it to the clipboard, and then closes the dictation box.
The entire workflow for this configuration would look something like this:
- Press the ‘Insert Overwrites’ button on the SpeechMike to bring up the dictation box
- Press the record button to dictate
- Press the fast forward button when complete
- Click in the appropriate field in the EHR
- Using the microphone say "paste that"
Of course you always have the option to dictate directly into Touchworks EHR, but the commands don’t seem to work as consistently as they do in the Dictation Box within Dragon. Also, some of the commands may cause functions such as a strike-through in your text. You can re-configure these commands in the Dragon Menu.