Version 9 of Dragon Naturally Speaking is a huge improvement over previous versions. Coupled with 2GB of RAM, it spits out complex medical terms with remarkable speed and accuracy. Since Dragon is licensed by user, not by device, there is great flexibility in its deployment. At least one customer is experimenting with using roaming profiles so that the doc's can dictate in the exam room with in the presence of the patient. Using the built in templating features of Dragon can be a nice compliment to using text templates. This allows more granular personalization without adding clutter to the EHR. One customer, who was not intending to use Dragon a large scale, saw the demand for it spread like wildfire. After individual doc's started purchasing it on their own, the IS department realized that they needed to roll it out enterprise wide. Now the vast majority of doc's are using it as a full replacement for dictation and transcription costs have been nearly eliminated.
One area where Dragon does not perform well is in sections of the note that require the inclusion of people's names. In this rare circumstances, traditional dictation works best.
Of course not all note sections are well suited for Dragon. In areas where capturing discrete data is desired, the use of Medcin templates would be required.
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 doc's are provided with a Philips Speech Mike and Dragon. In one small practice, all 5 physicians were using Dragon for all of their dictations within a week.
Dragon and Citrix
We’re using Citrix to present TouchWorks to the users. Because of the resource requirements for Dragon (2GB+ RAM), we decided to install it locally on the client PC’s and access the EHR through Citrix.
Although using Dragon directly in the application works ok, the accuracy and consistency is better when using the dictation box. Unfortunately when using the EHR in Citrix and Dragon locally on the PC, the ‘Transfer’ button in the Dictation Box is not able to determine where in the application to put 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 application 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
So the entire workflow would be something like this. Press the ‘Insert Overwrites’ button on the microphone to bring up the dictation box Press the record button to dictate Press the fast forward button Click in the appropriate field in the EHR Using the microphone say "paste that"
Of course you can always dictate directly into TouchWorks, but the commands don’t seem to work as consistently as they do in the Dictation Box.
Special Thanks to Melissa Heath for the workflow and programming!