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"I have been using Dragon Naturally Speaking version 9.5, which was the last low-cost version to work with AC. After this version it was necessary to purchase the Medical version, which is vastly more expensive, to dictate directly into AC. I have been considering buying the DNS 12 Premium. If anyone on the forum has been using the later versions of DNS I would like to know if it is possible to dictate to the Dragonpad or Word and then copy and paste to AC?"

Ted,

Premium 12 is primarily designed for consumer use and lacks a number amenities that would be useful for professionals such as Roaming user profile (the ability to combine information from multiple user profiles without having to overwrite or maintain separate profiles on multiple computers), the ability to batch transcribe digital recordings, the ability to create Advanced-Scripting, step-by-step and macro recorder commands (as opposed to the limitation of boilerplate text commands), network support, multiple vocabularies and the use of medical language models (medical vocabularies on steroids). I?m not saying that you can?t use Premium 12 in an EMR but rather that it won?t be nearly as efficient as using the proper tools.

You do have several choices:

1. You can use Premium 12 and manually cut and paste your dictation from DragonPad but every time you paste your dictation into your EMR, the microphone will be turned off and you won?t be able to use the Dictation Box. You will have to manually switch back to DragonPad or Microsoft Word and manually turn the microphone back on. This gets old fast.

2. You can use Premium 12 with KnowBrainer 2012 which includes all medical language models and terminology that are contained in Dragon Medical as well as it's own command browser for creating advanced scripting commands and additionally utilizes a specialized utility (similar to DragonPad) that bounces back and forth between DragonPad and your EMR, transfers your dictation and turns the microphone back on. Although this approach isn?t as user-friendly as being able to dictate directly into EMR, it would at least automate the functionality and give you the advantage of the person 12 speech engine because Dragon Medical is still on Ver. 11.

3. You can use Dragon Professional 12 with KnowBrainer Medical 2012 which will give all of the previously mentioned capabilities plus network capability, the ability to use a professional digital recorder, the ability to have a roaming user profile and the ability to create advanced scripting commands inside of NaturallySpeaking.

4. You can use Dragon Medical 11 and take advantage of all capabilities mentioned above with no tricks and no work arounds.

Dragon Medical 11 costs $1600. Nuance has made the less expensive versions not work with EMR. I appreciate your response but I don't need all of the bells and whistles of Dragon Medial 11. I don't need to roam from one computer to another. I have never seen any voice recognition software be able to accurately interpret dictations from a voice recorder. I want to be able to dictate an office visit note with few errors. It would be interesting to know how many copies of Dragon Medical 11 that Nuance sells. Perhaps they should model their business like Angry Birds apps for the iPhone. They priced it at $1 and sold millions of copies. If they had charged, say, $20 for the app they would have sold a lot fewer downloads. If Nuance priced the medical version more reasonably they might make more money off of the product. I agree that copying and pasting is a tedious and time consuming process but I am not willing to pay $1600.

Ted,

As Tom Hamilton pointed out, IF you want to use Dragon to make your workflow in AC more efficient and less time consuming using ANY recent version of Dragon other than Medical does NOT really work well. When Dragon Prof 11 or 12 see's that you are in Amazing Charts or most EHR's is just shuts down and will not allow you to work directly in the EHR. There are work arounds but by the time you are done it is more time (and $$) efficient to just type the darn note into AC. Cut and past with Word, Notepad or whatever for each field is unbelievably cumbersome and time consuming. I have Dragon Medical Small Practice Edition and the speech modelling, accuracy, and medical vocab work extraordinarily well especially when compared to Dragon Medical 9 and 10 versions! I do not use Dragon for AC (much easier to type and use templates while in the room interacting with patients). I do use Dragon for dictating consult notes and letters to patients and if that is your only use than I suspect using Dragon 12 Pro with KnowBrainer 2012 with medical vocab will work fine and cost significantly less.

Best,

James P. Clayton, M.D.
www.redhookfamilypractice.com
USVI

Ted,

I couldn?t agree more about Nuances sales model. I have proposed to them multiple times to dump the Premium/Preferred and home versions, then make the Professional version around 400.00 vs. the current 600.00. I think Medical should be around 800.00 but it shouldn?t be forced upon physicians but rather sold based upon its performance and value. I?m sure you can imagine my advice probably produced lots of laughter around the Nuance roundtable.

If you ever decide to take the plunge I can reduce your cost a bit, give you a free copy of our KnowBrainer 2012 Command Software and give you the support one would expect when spending that kind of money on hardware or software as I do for all AC clients. Dragon Medical 11 also has a 30 day customer satisfaction guarantee as does everything we sell so if you decide your workflow has not improved you can reclaim your investment. http://amazingcharts.com/ub/ubbthreads.php/topics/43348/Dragon_Medical_DMPE_Appreciati#Post43348


In regards to the digital recorder in older versions the results weren?t stellar and accuracy was not that good. With the release of NaturallySpeaking version 11 Professional, Legal and Medical mixed with a Olympus DS 7000/3500 or a Philips 9600 the results and accuracy are stunning. In fact Version 10 and the older Olympus DS 5000 produced very high accuracy. Technology will continue to march forward and get better and better.

Tom,
Where is DNS 12 Medical?
Dave

Hopefully, Tom will have some insider knowledge.

When Dragon 11 non-professional versions appeared a few years ago, Dragon Medical 11 was delayed over a year, as I recall, at the time update 11.5 was released.

Sorry, I know that's not an answer.

Dragon 12 is very accurate if one is careful about microphone, mic placement, clear enunciation,etc., and it doesn't take it very long to learn one's own medical vocabulary -- if you put in the time required to enter the medical words. There are those environments where the docs won't be bothered to "teach" DNS -- they should obviously buy the medical version.

What I have seen of "voice recognition" notes from big hospitals and groups in Portland that are using DNS Medical suggest to me that no matter how much money your Exec. committee is willing to spend, the results will suck if the doctors won't become their own transcriptionists. Someone has to proof read that garbage it puts out.

In my solo office situation, I do the simple notes by typing and template, but there are some notes and letters that actually require reflection and thought and can't be whumped up in the exam room or between patients.

I also don't like spending time at the office when I can be home -- that is one of the benefits of EMR.

From home I use RDP to access office computer, DNS 12 on home machine. It will automatically bring up the "dictation box" when you start talking into the "remote" window -- DNS only knows it is remote, doesn't know it is AC. At the end of the transcription, say "click transfer" and it automatically is pasted to the AC window. There is a second or two delay in opening the dicatation box, but it is hardly laborious -- and most of the time, your dictation is in the buffer and is being processed even before dictation box opens, so there is no delay at all.

Used like that, there would be no advantage to me to the Medical version, in fact, I suspect the speech engine might just be a little better in DNS 12 than in Medical 11. If I actually spent my time at the office, I would probably spring for Med11 -- but of course, you can do the same workaround in the office. Use DNS12 on one machine and remote to another over the office network that is actually running AC.

Dave,

Typically Nuance will notify us about a week before the release of Medical and invite us to a webinar. This usually follows the release of Professional and Legal by about two months with the exception of version 9 which I believe was well over a year. I have heard rumors of a June release as well as a September release. We never spam our customers unless requested but we have had so many requests that we've started an E-mail folder for all who wish to be notified about Medical 12. It's a good idea to buy early if one is interested because for about two months after the release they allow us to offer it at a much lower price. If anyone is interested just send an E-mail to sales@knowbrainer.com or support@knowbrainer.com and request to be added to the Dragon Medical 12 alert folder.

Tom,

You are quite correct in your assumption about the Version 12 speech engine being a bit more accurate than Version 11. The lag time (the time it takes for spoken words to appear as written words) has been improved and BestMatch IV has been introduced.

BestMatch III was utilized in NaturallySpeaking 10 and consists of trigrams. Essentially, if you dictate a minimum of 5 words, NaturallySpeaking can check 2 words to the left and 2 words to the right of the 3rd word of the phrase. NaturallySpeaking 11 introduced BestMatch IV which is based on quad grams. BestMatch IV comes into play when you dictate a minimum of 7 words. BestMatch V is exclusive to DNS 12 and comes into play when you dictate a minimum of 9 words.

Your advice about the microphone is also spot on. The enduser should have a USB microphone whether the souncard is fused onto the mic or the mic is connected to an external USB soundcard as the integrated soundcards on even high end computers produce less than optimal results. One doesn?t have to buy the most expensive mic on the market but should purchase a mic tested and approved by a reseller that specializes in them.

The computer is also very important. Nuance lowballs the specs one should have to run DNS effectively, we like to see our clients have 8 GB of RAM and really like 16 GB. When a client comes to us wanting to buy a full copy of Pro or Medical with less than 4 GB of RAM we actually turn them away and advise them to upgrade their RAM or computer before rushing into a purchase from us. The best place to go for detailed PC talk in relation to DNS is The KnowBrainer Speech Recognition Forums computer sub forum http://www.knowbrainer.com/forums/forum/index.cfm where you can find up to date active conversation. There?s actually quite a few docs that participate on there as well with personal posts numbering in the hundreds.