Dragon Overview
Overview
Versions 9 and 10 of Dragon Naturally Speaking are a huge improvement over previous versions. Version 10.1 Medical has been test thoroughly and works very well with medical terms. The more RAM the better (2GB recommended) when it comes to accuracy and keeping up with the users speech. Since Dragon is licensed by user, not by device, there is great flexibility in its deployment. Multiple customers are experimenting with using roaming profiles so that the doc's can dictate in exam rooms with the patient along with other Dragon workstations in the office. Some of the microphones used with Dragon can store user profiles in them, which enable flexiblity when switching devices. In addition to the many fundamental Dragon commands, using the built in templating features of Dragon can be a nice compliment to using text templates and illustrates a powerful application of custom Dragon voice commands. This allows more granular personalization without adding clutter to the EHR. One customer, who was not intending to use Dragon on 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 or proper nouns in general. In these rare circumstances traditional dictation may work best. Dragon does however 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 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 or Enterprise EHR, but the commands don’t seem to work as consistently as they do in the Dictation Box. Also, some of the commands may cause functions, such as a strike-through in your text. You can re-conifgure these commands in the Dragon Menu.
Special Thanks to Melissa Heath for the workflow and programming!