Voice Recognition and EMRs from EMRConsultant.com

Using "Show Dictation Box" with Dragon

Mon, 07 Mar 2005 21:03:02 +0000

Dragon NaturallySpeaking Version 8 is designed 'out of the box' to interact with many types of productivity applications, interact with Internet Explorer, but what happens when the application in question doesn't work right? By that I mean when the text box, or text area doesn't work as far as being able to verbally select incorrect words to correct. Or if the cursor won't move around a text box, and won't bring any correction lists into view...

Part of the problem might be that the application in question is using a type of text box or text area that Dragon may consider to be 'non-standard'.

One way around this issue is to use Dragon NaturallySpeaking's "Show Dictation Box". This built-in feature allows users to say the command -"show dictation box" - then dictate into a small window that has all of Dragon NaturallySpeakings powerful correction features. When the user is done dictating into the Dictation Box he or she simply clicks or says OK, and the processed text is pasted into the non-standard text area...

By the way, this tool is an excellent starting programming example to learn how to use Dragon NaturallySpeaking's Advanced Scripting language as well... As long as you have any version of Dragon NaturallySpeaking Professional Series (Professional, Medical, Legal).

Open the command browser (dragon bar >> tools >> command browser) and look for it in Global Commands...

If you open it (script >> show dictation box) you have full access to it's code, and of course, a basic idea of how Dragon NaturallySpeaking's Advanced Scripting Language works!

Talking Powerpoint presentation

Tue, 05 Apr 2005 20:25:46 +0000

The macro set won't work unless you have Dragon NaturallySpeaking Version 8 Professional, Medical, or Legal!

unzip the file, and import the macro into your user.
Start the powerpoint, and say ""
the text to speech engine speaks and moves the screens for you...

Hope you like it.

Attached File(s)

PPT.zip (11.79K)
Number of downloads: 107

Integration

Mon, 16 Jan 2006 21:24:16 +0000

Hi,

Do you know if anyone has integrate Dragon Naturally Speaking with Flash (using action script)?

Any hints on the viability of such integration?

Medical Computers Are Full Of Germs

Sun, 12 Feb 2006 17:36:17 +0000

I hate to be the one to mention this, but IMHO, all the computers used by doctors in the exam room should be completely voice-controlled for sanitary reasons. I don't think you can boil a computer, and alcohol does bad things to plastic. To me, the only sensible future computer interface for an exam-room EMR computer is total voice recognition--complete voice actuation.

Besides germs, many doctors find it difficult to work on a computer while talking with a patient. They often feel they are ignoring the patient.

Star Trek and most other science fiction depicts the computer interface of the future as voice recognition. Captain Kirk doesn't type. He talks.

We have long been aware of the potential power of the human voice as a means of communication. And some doctors just don't love computers. They would rather not have to be constantly touching one.

Right now, EMR can only use voice recognition in entering blocks of text. But I'll bet you my laptop that you will see entire EMR programs being voice-controlled in the near future.

Dragon, I hope you are listening, and recognizing!

Neurology, VR, and EMR: Interview With Dr. Block

Tue, 11 Apr 2006 19:56:03 +0000

Recognition vs. Transcription:
W. Palm Beach, FL neurologist saves $12,000 per year on medical transcription using state-of-the-art voice recognition software

Dr. H. Steven Block uses Dragon NaturallySpeaking Medical Edition, voice recognition software for medical professionals, to eliminate a very real business problem--medical transcription costs-- which six years ago, began topping the $1,000-a-month mark. Today, a doctor can easily spend three times that amount.

Very open about his high regard for the Dragon Medical VR product, Dr. Block had much to say about its place in his solo practice: �I purchased Dragon Medical from Eric Fishman�s company, Nuance, which is actually located in the same building as my practice, on the floor above me. Neurology is all about �nuance�, no pun intended. But �nuance� is really the best word to describe the health effects of a neurological problem. It has been a major focus of my practice.�

�Very subtle neurological changes can have devastating health consequences. You have to be able to communicate those subtleties in order for a medical record to have any meaning.�

�I see some really sick patients. Using an on-the-spot note generation product like Dragon, instead of a transcriptionist, lets me get back to the referring physician with a fast note, usually within 10 minutes of seeing the patient. That kind of speed in delivering a medical exam note with �nuance� can mean a great deal to everyone involved. You see, I can�t type. I never learned how to type. My kids who grew up instant-messaging can type faster than I can speak. They don�t need Dragon. But for me, Dragon is a wonderful tool.�

Dr. Block, 49, is no stranger to high technology tools:
�There are only so many hours in the day,� he laughed, driving down the road, talking via wireless cell phone headset, �and I�m very detail-oriented. I couldn�t be without Dragon, quite frankly.� One word I did not hear from Dr. Block is the word �downtime�. It doesn�t seem to exist in his vocabulary.

Having traveled the long and winding upgrade path for both Dragon and laptop hardware, Dr. Block has watched and participated in the evolution of the product for six years. �Like a surfer looking for the perfect wave,� he joked. The improvement he�s seen in the most recent version of Dragon Medical�combined with a high-RAM laptop with at least 512MB�has boosted performance to an almost unbelievable 99.5% real time voice recognition accuracy level, according to his observations.

His advice to new users: �If you haven�t tried Dragon Medical in the last four years,� he said, �try it again, the way it is now, with the new speech engine. It uses mathematical models to analyze word groups. There is a learning curve, but the training is not that bad, consisting of you reading a 15 minute script into a microphone, then a little touch-up here and there.�

�Try a few charts each day, and sit down where it�s quiet, where you can relax and concentrate on your speaking habits. Tech support is great; they�ll help you, and be sure to read the help file �How to Speak to a Computer��and the manual. Especially for often repeated phrases, the voice-actuated �macros� are great, a real time-saver. It�s well-worth the time you invest in learning how to use this tool.�

What are the pitfalls? �Mumbling,� says Dr. Block, �that�s the main problem. Doctors are used to dictating in a low, monotone mumble, as fast as they can. A person might be able to handle it by going back and listening to the recording again and again. But for voice recognition, doctors need to speak in a normal, conversational tone of voice, just like we are doing right now. Speak normally, and Dragon has no problem, it works very well. It�s really quite simple.�

He stated that using a handheld Sony digital voice recorder with removable memory stick allows him to dictate anywhere, anytime, then later, �feed� the sound file to Dragon, achieving about 98% voice recognition accuracy.

Although he is considering it, Dr. Block has not yet adopted a commercial EMR(Electronic Medical Records) software system for his medical records, mainly because of concerns about interoperability standards. (Coming soon to an EMR near you.)

However, by using Dragon Medical as his �front-end� for the creation of detailed paper medical records, email reports, and digital-FAX messages, Dr. Block not only uses computers, but has also created a highly personal and expressive way to �chart� a patient, unmatched in detail, depth, and the �human touch� by out-of-the-box EMR software.

Would EMR software developers do well to discuss with this doctor any design plans for a voice-controlled, voice-recognition-based EMR program? I think so. Will a �hands-free� EMR workstation which responds to voice commands--as does the entire Dragon program--ever be used to help maintain a �sterile field� in the medical environment of the future? It certainly worked well on the Starship Enterprise, didn�t it?

I'm interested in your thoughts and comments regarding this story. If you are a medical professional who would like to be interviewed via telephone for this series, "The Dragon Doctors", please email me at rgleeman@comcast.net

Is your EMR VR Compatible?

Tue, 09 May 2006 23:16:28 +0000

If you use Dragon NaturallySpeaking with your EMR, is it fully integrated, or are there areas that could use improvement?

Medical Transcription vs. Voice Recognition

Thu, 10 Aug 2006 12:54:40 +0000

Medical Transcription in the Era of Electronic Medical Records

NewswireToday - 08/09/2006 - EMR has revolutionized the healthcare industry in recent times. Many experts felt that EMR & Voice Recognition would totally replace Medical Transcription - however; the industry soon realized that transcription has certain advantage.

The most critical part of any Electronic Medical Record (EMR) is the method of data entry. EMR is about aggregation of patient encounter data at the point of care in order to provide a complete, accurate, and timely view of patient information. An electronic medical record is not just a typed record of the patient encounter, but an extremely useful decision support tool. The data can be entered into the EMR via any of the two general mechanisms: direct entry by the physician using point and click templates or transcription of dictated notes. Point and click template indicates that each data element, which is to be inserted, requires selection, navigation, point and click process for capturing patient information.

Transcriptions have been around for years for documenting patient encounters. A medical provider dictates the medical note into a phone or a recording device. The transcriptionist receives the dictation and transcribes it. It may be reviewed by the supervisor for checking errors. The final computerized file is then either emailed directly to the healthcare provider or the file is transferred to a website and is later downloaded by the provider. Each method has its pros and cons. Point and Click Templates .

Most EMR systems allow providers to generate clinical documentation, by selecting variable terms from pre-structured point-and-click templates. Users simply point and click to select appropriate choices from lists of choices to record a patient encounter. The end result would be a document that closely resembles a transcribed procedure note.

Advantages
� Completely customizable templates. The doctor can specify the layout of the template, which helps him to adjust the template as per his practice & procedure
� Provide consistent, complete and accurate data. The chances of medical erros are reduced since the data is documented in customised forms
� Notes for similar type of exams will appear to be standard and similar
� Store / organize data for subsequent retrieval
� Each click adds data elements to the database. Point-and-click systems create data that can be used to generate clinically useful reports, such as health maintenance reminders, disease management etc
� One of the major advantages of template based charting is the time needed to make the document available as a medical record. Since notes are created within the EMR, they are available immediately upon completion.

Disadvantages
� It takes more time, and definitely more concentration for a physician to navigate through large data set and create progress notes using point and click templates
� Templates must be customized as per the physician�s requirement. Customization can be inflexible and costly
� Well accepted by only tech-savvy doctors
� The approach of direct data entry by the physician has generally failed because busy providers reject it altogether
� Output from these templates is too canned and identical. It loses individuality for each patient
� It is difficult for a provider to capture complete patient encounter on computer in front of a patient.

Medical Transcription
Transcription has long been the standard for documenting patient encounters. It is more convenient for a provider as compared to handwritten notes or electronic data entry. There are many advantages of transcription in comparison to point and click charting. There are a few disadvantages as well.

Advantages
� Corresponds intuitively to the physician's usual method of working. Dictation remains the most intuitive and least time-consuming means of data entry
� Physicians can dictate anytime, anywhere using PDA, Dictaphone or telephone at their convenience.
� Providers need not change the way they practice just to accommodate an EMR. EMR can interact with transcription service so that transcriptions can be attached directly into the patient�s electronic medical record, if such a facility is provided by the EMR vendor
� It requires minimal training for physicians
� Provides expressive power to describe patient�s condition and other health related events.

Disadvantages
� Details of the exam can easily be forgotten and omitted while dictating, if dictation is not captured immediately at the point of care
� It cannot be queried for generating reports unless transcribed in pre-formatted templates
� Transcribed reports are not immediately accessible. Physicians would normally have to wait for 12 to 24 hours for charts to be delivered, unless few vendors supporting 2-4 hours short turn around time
� Transcription provides for more efficient use of doctor's time
� Although average transcribed report costs $2 to $4, it can reduce the doctor's time spent on data entry. Considering the value of doctor�s time, transcription is not a costly proposition.

EMR should give the freedom to the physician to decide to use either Point & Click or Medical Transcription. For a physician, the EMR that fits into his practice workflow would be invaluable. A competent EMR must have a template driven charting feature and the ability to interact with a transcription service at the same time. Both are indispensable features of Electronic Medical Record Software, as doctors are not unanimous on point and click charting or transcription. Such an EMR will be both efficient and cost effective.
The trends in transcription itself are changing with Medical Transcription service providers aiming to adopt new technologies. These technologies will evolve to increase efficiency & accuracy, decrease turnaround time and support data capture. While many of these technologies like such as digital dictation and electronic signature exist today, several technologies are still on the horizon.

The author, Mr. Divan Da�ve, is the CEO and Founder of OmniMD, a developer of HIPAA compliant EMR, EHR, and Practice Management System plus other healthcare IT products and services. OmniMD also provides medical transcription, medical billing, scanning and indexing, patient portal design and patient insurance eligibility services.

OmniMD
Ph: 914-332-5590
Fax: 914-332-5766

Dragon or

Sat, 09 Dec 2006 15:55:40 +0000

I have heard that most EMRs that use voice recognition use Dragon. But IBM developed Via Voice. Is Via Voice used with any EMRs? Are there any other voice recognition programs that are commonly used, or is it just Dragon.

Thanks in advance for any advice you can give me.

Make a Word Document Header

Mon, 01 Jan 2007 23:41:17 +0000

custom_header.zip (1.47K)
Number of downloads: 110

Here's a simple way to add a header to a microsoft word document... Download, un-zip, and import into a copy of Dragon NaturallySpeaking Professional (Professional/Medical/Legal) to try it out

1. From the DragonBar, click Tools >> Add New Command.

2. Give your command a name - this is what you say as the command.

3. Then... Change the "Command Type" to Advanced Scripting.

4. right click in the area where you see

Sub Main

End Sub

and select 'references' and...

5. scroll through the list of various references and find something that looks like
"Microsoft Word XX.x Object Library(XX)" where the x's are the version on your computer...

6. delete the current sub main /end sub, copy the following code, and paste into the same location...

Close the macro, start microsoft word, and say the name of your command.
3 boxes will ask you for information, and when you've completed you'll have a complete header at the top of your document.

'##### copy this code from here ####
'remember to set your object references...
'press "{alt+enter}" here or right-click and select 'references'
'un-check this particular Word Object library - if you're not running Office 2003
'scroll through the list to find the correct Microsoft Word x Object library, and check it!
'click OK and your references should work for this macro...

'Macro gathers data from you, then creates a header with that information - Microsoft Word Only.
'
'john ingram � 2005 EMRConsultant.com

'
'General declarations
Option Explicit
Dim strName, strMRN, strDOB As String 'string variables that get filled with patient name, MRN#, and DOB

Sub Main
'
'1. Get our variables filled with name and MRN numbers -
'when the macro runs each of these input boxes will appear for the dragon user...
'
strName = InputBox("What is the patient's name?", "Example Header - Patient Name") 'gets patient name
strDOB = InputBox("What is the patient's Birthday?", "Example Header - Patient DOB")'gets patients birthday
strMRN = InputBox("What is the patient's MRN?", "Example Header - Patient MRN") 'gets patients MRN number
'
'
'initialize Word's header
If ActiveWindow.View.SplitSpecial <> wdPaneNone Then
ActiveWindow.Panes(2).Close
End If
If ActiveWindow.ActivePane.View.type = wdNormalView Or ActiveWindow. _
ActivePane.View.type = wdOutlineView Then
ActiveWindow.ActivePane.View.type = wdPrintView
End If
'
'create a 4 column, 1 row table in the header so we can fill it with our data
ActiveWindow.ActivePane.View.SeekView = wdSeekCurrentPageHeader
ActiveDocument.Tables.Add Range:=Selection.Range, NumRows:=1, NumColumns:= _
4, DefaultTableBehavior:=wdWord9TableBehavior, AutoFitBehavior:= _
wdAutoFitFixed
With Selection.Tables(1)
If .Style <> "Table Grid" Then
.Style = "Table Grid"
End If
.ApplyStyleHeadingRows = True
.ApplyStyleLastRow = True
.ApplyStyleFirstColumn = True
.ApplyStyleLastColumn = True
End With
'
'we work our way across the table from left to right...
'and add our data to the columns in the table
Selection.SplitTable
Selection.Delete Unit:=wdCharacter, Count:=1
Selection.TypeText Text:="Name: " & strName 'print "Name:
Selection.MoveRight Unit:=wdCharacter, Count:=1
'
Selection.Delete Unit:=wdCharacter, Count:=1
Selection.TypeText Text:="DOB: " & strDOB 'print "DOB:
Selection.MoveRight Unit:=wdCharacter, Count:=1
'
Selection.ParagraphFormat.Alignment = wdAlignParagraphCenter
Selection.Fields.Add Range:=Selection.Range, Type:=wdFieldPage 'this is the automatic pagenumber in column 3
'
Selection.MoveRight Unit:=wdCharacter, Count:=1
Selection.TypeText Text:="MRN: " & strMRN 'print "MRN:
ActiveWindow.ActivePane.View.SeekView = wdSeekMainDocument
'
'close the header - we're done
End Sub

'######## end code #########

Tell us what you think! I've included the command as a file for you to import if you don't want to make the code... Remember to change the references.

This code is provided as an example only! use at your own risk!

Thanks!

New - Dragon NaturallySpeaking Medical Small Practice

Mon, 19 Feb 2007 18:42:56 +0000

Good Day:

Nuance has just announced to its Value Added Resellers the release of Dragon NaturallySpeaking Medical Small Practice Edition. This offering is almost identical to the much higher priced Dragon NaturallySpeaking 'Full Boxed Product' but it is lacking only a few features which are not of great relevance to small practices. Specifically, Radiology and Pathology language models are missing, as are Citrix compatibility and Push installation. This new version is not appropriate for hospitals.

However, if you are in a small practice, this is the perfect solution. It has all the accuracy and other features of the full product which has an MSRP of $1199.99. However, even before the current promotion, the Small Practice Edition has the following pricing structure:

1 License: $999.99
5 License pack: $899.99 per license
10 License pack: $799.99 per license.

There is currently a $100.00 discount, per license, between now and March 21st, 2007.

Having been in the speech recognition business for 12 years, and selling 'Dragon' for over 10 of them, I can honestly state that this is an incredible value.

If you already have a relationship with a Dragon NaturallySpeaking Certified Solutions Provider (VAR) I strongly encourage you to contact them immediately. If not, or for more information, please see: http://www.emrconsultant.com/spe/ or call 1.888.898.1450. We'll be happy to recommend a local Value Added Reseller to you. Or visit http://speechrecognition.com/resellers/ for a map of our resellers.

And, of course, if you need assistance integrating Dragon NaturallySpeaking with your EMR, we can assist you with that as well.

Yours,

Eric

-=-=-=-=-=-=-=-=-=-=-=-=-

Eric Fishman, MD
Pres., EMRConsultant.com
http://www.emrconsultant.com
Pres., 1450, Inc.
http://www.1450.com