Home Forums Using Speech Recognition and Pretty Happ

I've gained so much from having this user board I wanted to post something new that I'm trying that's working pretty well for me.

I'm pretty wordy when it comes to patient charts and felt like I was developing carpal tunnel syndrome from all the typing. I decided I wanted to try out dragon naturally speaking but after hearing about needing to use medical version 10 I decided to go the cheap route and try out Microsoft's speech recognition. I bought a cheapo microphone for $19.99 and decided to give it a whirl. So far been using it now for about two weeks and I'm pleasantly surprised. I'm in the process of training and teaching it a lot of medical terms but it hasn't been that bad. I'd love to hear if anyone else out there's trying it and what they think.

I'm very interested in this. I would think that I could teach a system most of the medical terminology I would need, as I would mostly dictate the chief complaint where the terminology would be limited and predictable.

What system from Microsoft are you talking about, and is that with XP, Vista or Windows 7?

I'm using Windows Vista. It comes standard, nothing extra to download or install. It's not perfect and I don't think I'm saving any real time but I am saving my wrists. I am liking it more as it learns my terminology and pronunciations.

I did play around with xp and the speech recog from office a while ago and it was OK but Dragon 8 (back then) was better.

Another thought is to get a cheap copy of dragon 9 from ebay and use that. It will still work directly with AC, where Version 10 will not.

I will have to try microsoft voice recog again. Thanks for the tip

Interesting. I didn't know anything except Dragon Medical 10 worked with AC. I might look into that. I'm pretty sure that Dragon will still work better than Microsoft's Speech Recognition.

Dragon 10 (without medical) has been disabled by Nuance to work with any EMR - any other will work - people suggest Preferred 9.5 on ebay (under $100 I believe). I have not tried it, but am interested,just too many other toys/hardware/software to buy.

I've been a long time dragon user, for approx 14-15 years. I have upgraded through out the years. I now have Dragon Medical 10.1 and it is definitely better than any prior version. I have save a bundle over the years on transcription. It works well with AC 4.7+.

I have just been looking into this and found Dragon 9 medical on Amazon for 299 bucks. It arrived the other day, was brand-new, and I am using it now to dictate this note. As I said on one of the other threads, I really like the ability to create a template that can be called up by a simple command; I've created ones for URI, pharyngitis, bronchitis, et cetera. I've got one for both the exam and plan for each of these and plan to create many more. With the templates, I can still go in and edit where necessary, but I think it will make the overall flow much faster.

Melanie

Melanie - can you show us some examples - just use your Dragon commands to "dictate" a response.

Without corrections, please :-)

Just started using Dragon 10.1 Medical. Initially, I didn't have the Dictaphone II Mic and was using the headset that came with Dragon. I was a little disappointed that I just dropped $1200 on Dragon as the error rate was frustrating. But Thursday the Dictaphone II Mic came in. Markedly better performance with a lot less errors. So with a combination of some excellent templates and my "sometimes wordy" dictation, I think Dragon is going to work finally.

Dragon 10.1 is noticeably better than 9. I just have to remember that its not like dictating an operative note at the hospital where a living person is at the other end cutting out my "uhs" and "ums". But if I talk like a guy from the news, it works nicely.

The dictating doesn't really speed up my charting because when I dictate, I am much more detailed. Of course if I tried to type the same things, it would take me ages.

So, so far, so good. I think it might stick this time.

Travis - your experience matches mine. I'm not a typist and Dragon is a major time-saver.

I have continued to see improvements in accuracy with DNS 10.1 over the past 6 months, as I've been using it daily. I think part of it is the program "learning" how you dictate. Even though at the start it interrupts your flow, you have to take a moment every time there is an error to select the word and say "spell that". You will really notice improvement over a few (dozen) sessions.

I also think that part of the improved accuracy I'm seeing is Dragon "training me". I have learned to speak clearer and not skip endings. I was pleased to discover that the recognition software can keep up with fairly fast rate of speaking, as long as each word is discrete.

I'm still impressed by the voice macros as well. Saying a brief macro phrase and having the program type 3 paragraphs of text -- wow!

Toby, et al

Here you go:

This is what comes up when I say "exam bronchitis"
WNWD in NAD
HEENT: TMs normal
oropharynx without erythema or exudate
neck supple
LYMPH: anterior cervical nodes not enlarged
CHEST: normal excursion
LUNGS: rhonchi present, no rales or wheezes
HEART: RRR without m/r/g

And, this is what comes up when I say "plan bronchitis" :


Symptomatic relief with OTC medications.
Plenty of fluids.
Recheck if there are worsening symptoms, such as a higher fever, shortness of breath, or chest pain.

I leave a blank line at the top of the plan, so I can insert an antibiotic rx if I want to - I simply dictate it in. Here's what it looks like with an rx of Zithromax:


Zithromax Z-pak as directed
Symptomatic relief with OTC medications.
Plenty of fluids.
Recheck if there are worsening symptoms, such as a higher fever, shortness of breath, or chest pain.

Here's another, a bit more "complex" - this is for a laceration of the extremity. The exam and the repair are included. I simply would dictate the size of the lac, area, as well as the percent xylocaine and whether it is with or without Epi.
Here is the starter macro that comes up with saying "exam laceration extremity":


General: WNWD in NAD
Skin: cm. laceration of the aspect of the
Neuro: Circulation and sensation intact distally. Motor function 5/5.

The area was anesthetized locally with % xylocaine epinephrine., and prepped with Betadine solution, allowing time for it to dry on the skin. The area was prepped and draped in the usual sterile manner. After careful exploration of the wound to ensure that there was no foreign body or tendon involvement, the laceration was closed with sutures of Ethilon in simple interrupted fashion, with apposition and hemostasis. A non-stick dressing was applied.

Here is an example of a filled-in macro - it only required me to insert dictation at seven spots in the narrative:

General: WNWD in NAD
Skin: 1.5 cm. laceration of the volar aspect of the proximal phalanx of the right ring finger.
Neuro: Circulation and sensation intact distally. Motor function 5/5.

The area was anesthetized locally with 1% xylocaine without epinephrine., and prepped with Betadine solution, allowing time for it to dry on the skin. The area was prepped and draped in the usual sterile manner. After careful exploration of the wound to ensure that there was no foreign body or tendon involvement, the laceration was closed with 4 sutures of 4-0 Ethilon in simple interrupted fashion, with apposition and hemostasis. A non-stick dressing was applied.

And here is what I get with "plan laceration extremity" (there is one spot I add dictation, that is for the time to suture removal):

Instructions printed and provided to patient:

You should limit use of the injured area, and may elevate it to relieve pain. You may use OTC medications such as Tylenol for pain, as the manufacturer directs.
Cleanse the area daily with soap and water or hydrogen peroxide, dry thoroughly, and follow this with triple antibiotic ointment and a non-stick dressing. Except for bathing, you should keep the wound dry, unless otherwise stated.
Call if any tenderness, pus, or erythema of surrounding tissue appears.
Return for a wound recheck in 2 days, and for suture removal in days.

I know I may be putting the cart before the horse, because our group has not yet gotten formal approval for purchasing amazing charts - it has to be "blessed" by the compliance officer of our organization. The certification that Jon got last year will certainly help us make a case for going with this EMR!

Great demo on the voice macros. I notice that you missed a spot in your last line, right before "days":


This used to happen to me with the longer voice macros needing text in several places, so I added an obvious "placeholder" where I needed to dictate, ie:

Return for a wound recheck in @@@ days, and for suture removal in @@@ days.

The places you need to enter text stand out, even if you briefly glance at the template entered by the voice macro. Double click on it, dictate the text, you're done.

Melanie and John,
I have some experience with Dragon as well, but I found it to be rather frustrating to use long-term. Successful users seem to report recurring themes, like the need for a good mike, a decent training period, and the need to enunciate clearly without a lot of extra vocalizations. Even so, I found the time spent making corrections (both to the final document and to my voice file) to be significant. Add to that the frustration of words that just couldn't be "learned" by the program, as well as technical glitches (e.g. with the program and mike turning on and off-among others) and I finally gave up on it.
Having the program dictate a few paragraphs on a cue as you demonstrate above is one of the most satisfying things with Dragon. On the other hand, you can accomplish the same thing with Shortkeys, or other text shortcut programs. With that program, I can type "lac extrem exam" and get the exact same text printed as when you say your cue; and I would suggest I can do so just as quickly, and a bit more reliably.
What is much more challenging for voice dictation is a few paragraphs of "free text". That is also where the program can provide a lot more benefit; it takes a lot of time to type a long hpi that can't easily be "templated". It is also where the program tends to make a lot of errors.
So...that is why I asked for some examples of dictation "without corrections". I think it would be valuable to see an unvarnished version of what Dragon produces when you dictate a few paragraphs of medical text. I don't want to rain on anyone's parade; if it works for you, that is great. Can you show it to us in action, please?

Jon,

You bring up some excellent points. I was unaware of the shortkeys program until Leslie mentioned it. I think that I was drawn to Dragon because I really am a lousy typist. It seems I'm constantly having to go back and make corrections when I type. You are correct, there are glitches with Dragon that I do have to correct on occasion. I tried to make the voice macros as simple as possible, for that very reason. As you may or may not know, Dragon allows you to train each voice command, so hopefully they'll be pretty consistent. Since I am not yet an AC user, I don't know how I'm going to like this in the long run, but so far I'm actually pretty encouraged. Although I've lived in New Jersey, the Midwest, the upper South and California, I don't really have a hard accent for any one place-and that probably makes the speech recognition a little bit easier. I've just dictated this entire reply, and had only two small corrections to make. And, I've only been playing around with Dragon for about two weeks. Time will tell!

John,

Ohhhh, I really like that suggestion! I actually did not leave out a word before "day", I planned on entering the number there. The placeholder idea is an EXCELLENT idea, because you are exactly correct-I have to carefully hunt for the areas where I need to insert dictation. An awesome suggestion!

Melanie

Melanie,
When making new commands in Dragon you can insert a "variable" placeholder by clicking the button at the bottom of the New Command window. When the new voice macro prints, you navigate to the next variable by saying "next variable" and the placeholder is replaced by your stated word. Check out the Command Browser window and you'll see what I'm talking about.
Dave

Here are a few paragraphs I dictated this am, using DNS Medical 10.1 and the Dictaphone PowerMike II:


You will notice that the errors are the physician name ("can't join" instead of "Cangiano") and it inserted "1:30" instead of 130 for the blood sugar reading. I do notice that error correction never seems to work with certain names. For instance "Katz" almost always gets dictated as "cats".

Speaking of microphones...Has anyone had any luck with the Buddy StylusMic G7?

It may sound crazy to get a stylus mic when I don't have a tablet, but here's the thing - I wanted to use a netbook (if possible) to take from room to room, and I liked the fact that this clipped on to the side, and was not bulky (otherwise, I'd have gotten a Dictaphone PowerMic - John, how large is the PowerMic and how portable do you think it would be to carry around with a netbook?)

I just got off the phone with the owner of e-microphones and I ordered a Buddy StylusMic G7 to try out. He states that the StylusMic was recently redesigned, and it's tiny - like and inch and a half long, because it's made to fit onto the end of whatever stylus one is using. The other thought with this was- if we could ever use AC on a touchscreen tablet, I'd have a mic that doubled as a stylus to use.

I really didn't want to have to put a boom microphone/headset on and off everytime I wanted to dictate. I'll probably be dictating each chart on the fly (in the room), and it would be a pain.

Melanie

The PowerMic II is too large to carry around, not to mention that it has a 10 foot cord that plugs into the USB port. Excellent for a fixed dictation station, however, since it has a directional mike and pushbutton control, so can be used in an open environment.

I agree with your impression of a headset mike. Too dorky to use in front of patients, and after taking it on/off multiple times a day, eventually the earpiece or boom breaks or bends.

If you would like to read I have some responses for all in the vendor forum.
http://www.amazingcharts.com/ub/ubbthreads.php/topics/19871/Using_Speech_Recognition_and_P#Post19871

Dave,

Sorry - stoopid here...I am not sure how to do what you are explaining. Are you talking about when I make a new command? I don't see anything at the bottom of the window except icons to cut, paste, copy...

Can you elaborate a bit more? It sounds very useful, so I'd like to try it!

Melanie