Home Forums Discussions Problems Only DNS 10 Medical will work for new ver10 in AC

I just got this email from <an insider who has asked not to be quoted>. It seems that DNS version 10 has been intentionally crippled for use with AC unless we pony up many hundreds of dollars extra to upgrade to Medical version. I have been further advised that this act was almost certainly illegal (AC does not use their licensed TKD version which would allow them to legally do so). So....will Jonathan step up to the legal plate and swing or have we been shut out?

Inquiring minds want to know....


Quote from <an insider who has asked not to be quoted> on DNS 10:
--------
"I just wanted to let you know that I'm probably better qualified to answer your Amazing Charts question then Chuck.



As it stands right now, only Medical 10 will allow you to dictate into Amazing Charts. Nuance has crippled all the other versions of DNS to turn the microphone completely off when dictating into a window that says Amazing Charts, eClinicalWorks etc. I personally think they've left themselves open for major class-action lawsuit and may even rewrite their software before releasing it but as it stands right now, if you even attempt to respond to an e-mail that has Amazing Charts, S.O.A.P. Notes, eClinicalWorks etc. in the subject line, you won't even be able to turn on the microphone. If you save a document with Amazing Charts in the name and later chided dictate in that document, it won't be possible. I'm thoroughly certain that Nuance is left themselves open for a very major lawsuit from the title government but this is the case for now and if you don't want to take a chance, you may have to upgrade to DNS Medical 10 or stay with Ver. 9."

I would just stick with version 9 and boycott version 10 altogether. If physicians refuse to be bullied, this type of stuff will stop. Alternatively, you can buy Microsoft's voice dictation... so far, Microsoft doesn't seem to do such stuff, which is probably why they are such a beheamoth: they simply treat their customers well.

It probably is "legal", since they are only singling out the names of well-known EMRs. It's just a low road that they are taking.

Amazing!

Thanks for the heads-up guys. I will CERTAINLY look into this ASAP.

We've worked hard to incorporate DNS into Amazing Charts, and I would truly be shocked (and dismayed) if, in fact, this were true.

Jon

This is true. I just bought DNS version 10 (Preferred), and it will not dictate into any window of Amazing Charts. A dialog box opens, stating that dictation into any EMR is only possible with the Medical edition.

So what are you going to do? You should send it back, since it has a 1 month guarantee.

Unfortunately, on eBay this situation has made the version 9 more valuable, so it's currently selling for close to $1500 on the "buy it now" and I'm sure that the rare ones going for auction will all go for over $1000. One trick might be to buy one of the DNS8 upgrades ( these go for ~199.99 ), then purchase the DNS9 upgrade for $250.00 asking price. Ask Linus from Knowbrainer if just having the DNS8 disk is all that you need for the upgrade...

In the past, Nuance programmed into their upgrades code that would only upgrade a program that has been actually set up in a computer, so if you have DNS disks that you can't setup due to a lost password or you have broken or lost "full version" disks, even if 2 to 3 versions back, you're out of luck. I recently asked Linus (from the Knowbrainer DNS reseller company) about this, since that is why I haven't upgraded to the DNS9 medical, and he stated that nowadays you only need a disk to be in the CD caddy, which is what Microsoft asks for. In any matter, he would be willing to help out with the setup.

I have alredy called Nuance for an RMA #.

I am also planning to make posts on the Nuance forums, and also email David Pogue, the NY Times tech columnist who is a big DNS fan and just reviewed DNS 10 on his blog.

In the General Discussion Sub-Forum of this forum you'll find our DNS review. On page 5 you'll find we're putting in a universal EMR work-a-round command into KB 2008. The command utilizes Windows Notepad in place of the Dicatation Box. I fully agree there should'nt have to be a work-a-round and understand your dismay.

KnowBrainer, Inc. Support Staff – Tom Hamilton

Great Tom! Keep us abreast... I'm sure that this will be resolved eventually.

I wanted to update everyone on my latest communications with David Pogue (Tech columnist for the NY Times) who recently posted a favorable review of DNS version 10, and a reply he was able to receive from a Nuance spokesperson.

As usual with emails & replies, the earliest is at the bottom:

-----------------

FROM: ERICA HILL
Senior Manager, Corporate Communications

Hi Dr. Ryan. (And thank you David for copying me in so that I could
respond to Dr. Ryan).

You are correct that we decided to remove EMR support from the
non-Medical versions of Dragon. We thoroughly test dictation into EMRs
with our medical products and have specific features that make Dragon
Medical much more suitable for medical applications. We found that some
large hospitals were using the consumer editions of Dragon and not
getting the accuracy, quality and manageability that would be achieved
when using Dragon Medical. It is also a common practice in the software
industry to create feature packages for several markets and sell them at
different price points (e.g. Microsoft Office). That practice allows us
to maintain a low consumer price point for Dragon while offering higher
value solutions for our Medical customers that come with a higher price
point, but also deliver much more significant benefits.

Finally, while the price difference is significant for a single copy of
Dragon Medical, most of our large customers who use Dragon in
conjunction with an EMR leverage our volume licensing programs that make
that price differential smaller. Having said that, please note that
along with the launch of Dragon Medical 10 in September 2008, we will
announce attractive upgrade offers for customers who have been using
non-medical Dragon versions in medical settings.

Dr. Ryan you should feel free to contact me via phone or email if you
have additional questions. I understand from your previous message that
you've already purchased a copy of Dragon 10 (Preferred?) and I'll be
happy to work with you to either issue a refund or discuss options for
upgrading to Dragon Medical 10 when it is available.

Best,
Erica Hill

____________________________________________
ERICA HILL
Senior Manager, Corporate Communications
NUANCE COMMUNICATIONS, INC.


-----Original Message-----
From: David Pogue [mailto:david@pogueman.com]
Sent: Thursday, August 14, 2008 10:45 PM
To: John Ryan
Cc: Hill, Erica
Subject: Re: Nuance takes the low road with Dragon Naturally Speaking,
ver. 10

That's peculiar... It should dictate into ANY app.

Erica?

Dp


On 8/14/08 10:30 PM, "John Ryan" <ryanjo@flaintmed.com> wrote:

David,

I know that you are a big fan of Dragon Naturally Speaking (DNS), and
I also am a regular user of version 9.5. You see, I am a doctor, but
not a good typist, and I have found that DNS is indispensable in
making entries into the text boxes of my Electronic Medical Record
(EMR) program.

For years, Nuance made a version of DNS that has a medical dictionary,
but this costs 10 times the price of DNS Preferred, which "learns"
medical jargon quite promptly, without the pricey medical dictionary.
DNS has saved me literally thousands of hours in the last few years in
efficiently updating my patients' records. In fact, the EMR that I use
recommends DNS, and has made special commands available to allow tight
integration with the EMR.

So you see, I was very interested in DNS 10, and I purchased a copy as
soon as it was available. After installing version 10, I fired up the
new slick interface, loaded my user files, and tried to begin
dictating into my EMR. DNS stopped dead. A dialog box appeared stating
that the only version of Naturally Speaking 10 that would dictate into
an EMR was the (pricey) Medical version. (Adding insult to injury, DNS
Medical version 10 isn't even available for sale yet.)

Although Nuance has allowed earlier versions of DNS to work with EMR
software, apparently the company has removed this feature in version
10! Very unfortunate for me, and sad that Nuance has chosen to take
the "low road" in dealing with its new and established customers.

John Ryan

So will DNS 10 Medical still cost TEN TIMES as much? I bet it will. What a rip off!!!

The ONLY big advantage I see to medical is that the license applies to the entire practice, meaning if you have it on 5 computers you still only need one license. The other versions are only licensed for 1 computer.

This is the info I received from the vendor at the AC conference.

I have been using 8 preferred and it worked well, until the computer died. I didn't use it that much, since I can type and template faster except for complex patients, I have not reinstalled it on another computer yet.

For everyone following this thread, my letter and Nuance's reply are included in David Pogue's blog from the online version of the NY Times (http://pogue.blogs.nytimes.com/2008/08/21/todays-mailbag-reader-complaints/)

Not really a rousing cheer of support for us victims of Nuance's "downgrade" of DNS Preferred 10, but maybe turning the spotlight on their business practices will shame them into lowering the upgrade cost. Yeah, in my dreams!

Or else Jon can claim that Amazing Charts now costs only half as much as DNS....

I started using my DNS 8.1 Medical version again since the June meeting and realized how much typing DNS saved me, even my old version. I was shocked, like you all, to read about the non-Medical versions of DNS 10 "not working" in AC (like everyone, I was thinking of upgrading to DNS 10 but did not want to paid the outrages 1500$ for the Medical version and thought of dropping to the professional version). A couple of days ago, I got an email form Nuance about the 250$ upgrade from my version to DNS 10 Medical. Although higher than I wanted to pay, it seems upgrading is worth it. Have others received the similar email?

Because we are Nuance partners, we have decided against adding a workaround update to KnowBrainer to enable dictation in EMR applications with nonmedical 10 versions of DNS but we will assist our customers with a simple EMR enabling workaround that won't violate the NaturallySpeaking EULA.

I'm sticking with version 9. They want an outrageous amount of money to upgrade, and unless I'm missing something, it doesn't work all THAT much better than version 9 did.

A simple way to fix this is for Jon to simply change the default name on the top of the window - if they're searching for hard coded strings, so be it, we'll change the hard coded strings! I'd be interested in getting my hands on a live copy of version 10 to see where the code with the window titles is, and substitute a nice patch that returns OK for any window name, or replace the search strings with all nulls.

One of the many reasons why for close to 30 years I've called the computer industry the second sleeziest industry on the planet.

Regards,

V.

I haven't received any email about a discount, although I have a registered copy of DNS 9.

>>> Or else Jon can claim that Amazing Charts now costs only half as much as DNS....

What if Jon decided to turn off AC when a user wanted to use DNS10?

That would be a kicker! What would work even better, though, if EMR vendors en masse lock out DNS 10 for retaliation's sake. THAT would make an impression! Physicians would remain happy with their DNS9 and Nuance's medical intrusion would quickly fade away...

It is time to end Nuance's monopoly on speech recognition --

The alternatives are:

• Microsoft's newest speech recognition venture (Vista - ugh).
• One of the open-source speech recognition ventures.

I say "one of them" because none of them are complete yet. However, a motivated group of ex-Nuance users might be able to provide the impetus to bring one to fruition.

Read here to get up to date on the state of the Linux endeavors:

http://en.wikipedia.org/wiki/Linux_speech_recognition_software

Maybe Vinny or some other Linux maven can tell us which one of the open-source speech recognition projects is the most viable -- so we can get behind it.

One of the things that all these projects need is for people to provide speech samples to create an open-source acoustic model. I know some of us could help with that.

While attempting to dictate a response to this posting, my DNS Pro 10 microphone suddenly turned off. When I looked at the name in my Firefox browser Window I noted that it was {{{Only DNS 10 Medical will work for new Ver. 10 in Amazing Charts}}} etc. The only way I could respond to this posting, without typing, was via Internet Explorer but it's interesting that non-Medical 10 versions of DNS will not even allow the microphone to turn on in Firefox when browsing the entire Amazing Charts website. Ouch!

What Nuance has done will likely have all sorts of unintended consequences. Hopefully, non-medical users will harass Nuance's call centers with complaints about DNS 10, until the "suits" in the corner offices see the drain on their bottom line.

Some frustrated users of DNS 10 have postulated (in the voice recognition forums) that changing the name of the "exe" file for the EMR program might be a work-around for the DNS 10 restrictions. I have tried doing this on a back up copy of AC -- but AC starts up with an error box. Is this likely to work, and will it cause database problems?

RYANJO I also received the DNS medical upgrade notice. I have two licensed copies of DNS medical and am currently using 9.5. I jumped to the andrea usb sound card and array mic recently and either placebos work with me, or I've noticed fewer errors on prepositions and contractions. Unsure if I'll shell out the 250.00 for the discounted medical upgrade. I'vebeen pleased with Dragon since version 1.0. It has saved me the price of a transcriptionist and front office worker the last 10 or more years. I've spent less than 2500.00 dollars on DNS medical over that time and have saved atleast $175,000 over the time I've had Dragon medical. I'm still ahead.

CompUSA.com has Dragon ver 9 Preferred selling for $99 through the end of August.

Nuance is taking advantage of the medical industry. They seem to have no argument to charge more unless somebody absolutely needs the medical library they include with the medical versions. Even then, the Preferred Version of DNS allows us to add and train our own vocabulary. In my experience as a Pain Management Physician I have had no difficulty adding the very few additional words needed in my specialty. In fact, more then ever, physicians are getting away from "med-speak" to allow our documentation to be easier to understand by our colleagues in a different specialty field of expertise. A greater than $1000 premium for the Medical Version is a hefty price tag since most physicians will not dictate the majority of words included in the Medical DNS dictionary. Amazing Charts should end its formal endorsement of Nuance, and create a work-around to continue using any third party app that allows us to be more efficient.

This interview comes from EMR Update and was performed by Robert Gleeman. I thought I'd post it as this has been a pretty hot topic for the last month or so.

http://www.emrupdate.com/blogs/emri...vp-for-nuance-s-healthcare-division.aspx

Tom Hamilton - KnowBrainer Support Staff

Tom, Robert is getting beat up for the lousy interview. I say that it's worse than the Obama-McCain debate. He failed to bring up the relevant questions and it seemed more of an infomercial.

Well I guess we can call it forum entertainment.

Tom Hamilton - KnowBrainer Support Staff

Some discussion! Well, as you all know, it is true about Nuance's crappy move - joining the many EHR vendors out there that mistakenly believe that "docs can afford it."

Great to vote with your feet and avoid Nuance's products. While I have been quite pleased with a number of Nuance's resellers to whom we regularly refer clients, and feel conflicted about speaking out against Nuance as it may affect these reasonable folks who had nothing to do with Nuance's sleezy move but will suffer as a result thereof, I agree with the above. Just as many of us aggressively and vocally shun those companies that care more about their profit and less about improving our healthcare system (and world, for that matter), we need to do the same with Nuance. Why support a company that doesn't support its users?

Not that Microsoft isn't probably more dangerous than Nuance - but their speech processing has improved dramatically, as has others that are enterring the market. So try them out, and let me know what you like. Just as we added navigation tools to facilitate Dragon (only to have them screw our users with this locking mechanism), we will do the same for other speech recognition software that our users find usable.

Dear AC users,

I really think that Nuance's actions should be reported to the Federal Trade Commission--it can be done easily thru their website.

In the email I received I was encouraged to "upgrade" to the Dragon Dictate 10 preferred version, but NOWHERE in the ad did they mention that they had (intentionally) disabled EMR support--which I read on a blog.

I have read some of Nuance's justifications such as Microsoft charge more for different versions of their Office Suites. But Microsoft does not disable functions in their cheaper packages. For instance Microsoft Word does not stop working if it notices you are typing a business document.

Microsoft actually has reasonable speech recognition built in for free in their Vista OS. The only downside is that it cannot scan documents to increase vocabulary.

I'm a little confused. I use dragon 10 with AC without a problem. What kind of problems are you having?

Tom

I downloaded a, uh, trial for testing. Dragon 10 blocks the mic out whenever AC has focus in windows. At least it does in XP. You can speak happily into notepad but when you speak into AC the program stops and throws an error informing you it doesn't work with EMR. (IIRC)

Oh, and Robert, I understand from the emrupdate forums that you can train Microsoft's voice recognition by reading word documents and such.