Home Forums Discussions Problems Updating new medictions in the prescribing formulary.

I continue to see where there is an excessive delay in new medications being added to the prescribing formulary, especially medications that are becoming more common in use such as Combivent Respimat, Tudorza, and Linzess. Is there somewhere that we are supposed to go to make sure that these are updated in the formulary or is this a continued delay on the part of Sure Scripts? Pardon me if there is already a thread on this, but I did not find one. Amazing Charts technical support has told me, in the past, that I needed to contact Sure Scripts, but that seems to be similar to going into a black hole, as I cannot find anywhere in their website to address this problem.

Are you are still using 6.3.3? I had to upgrade to version 6.5 in order to get the updates, but all 3 of the medicines mentioned in your note are being updated on 6.5.

I am using V6.3.3. I find it very interesting that these medications have made it into the Dragon Naturally Speaking vocabulary already. I do not understand why something as important as medications and e-scribing is taking a back seat to other issues with AC.

I may eventually be forced to upgrade from v6.3.3 for this reason or another, but am holding out because the AC iPhone App is no longer supported.

I am a fast typist, but have considered going with Dragon. It looks like $600 is the price. I am wondering how the technology has progressed. Can I really dictate 'naturally', or do I have to speak very s*u*c*c*i*n*c*t*l*y? Is there a free trial available?

Chris

You better check I thought Dragon Medical was $1600 other versions of Dragon shut themselves down if they recognize you are within an EMR, I personally use Windows Speech Recognition free within windows Vista,7,8 not all the bells and whistles but does an acceptable job for me

Do you use a special microphone? I've thought of using that, but sometimes it doesn't hear me well. I wonder if you could just have Word open, and dictate the HPI, then the plan, and just cut and paste.

I use a Sennheiser e 835-S connected through a usb port, the cut and paste option is a way to get around the fleecing Dragon tries to do of docs

Mel,

I am on 6.5.5, and I find more of an issue is older medications; I can never find Flexeril, but it shows up OK as cyclobenzaprine. It is there ok, just requires I remember the generic and for some reason I find that one difficult to remember.

Chris,

Price aside, Dragon does a reasonable job. You actually have to speak at a normal speed to keep it from getting confused. It still makes mistakes, but is probably 99% accurate.

I have evolved the philosophy that it is good enough for my progress notes without much proofreading. I can figure out what I meant even with errors, and I'm not trying to impress anyone. Referral letters are a bit trickier since I don't want to look like a worse boob than I already am. I get annoyed by Dragon's inability to correctly recognize a few words the way I pronounce them, no matter how much I train it. "Period" is often replaced by things not even close.

I have copied a phrase used by one of the Anchorage nephrology groups to put at the bottom of my letters in 9 point type: "These documents were created using speech recognition software and may contain errors in content and syntax."

Chris,

I have been using Dragon Naturally Speaking since 2004, starting with version 7. I am now using Dragon Medical Practice Edition 2. Prior to using Amazing Charts, I was dictating patient notes using templates with Microsoft Word to create Word documents that would be saved in individual patients charts in a patient chart file. I now use Dragon to dictate into the Amazing Charts EMR. Although there are some problems with typographical errors, they are usually fixed easily but, as pointed out by others, some words just do not seem to be recognized routinely, such as "period", "he", etc. depending on the person who is dictating. Like issues with Amazing Charts, there does not seem to be rhyme or reason to some of these problems. However, I think that, overall, you will find that it is much quicker to dictate than to try to type your notes. You can train words with Dragon and this helps with the accuracy. I have no idea how complex your notes are. I have created some templates to help with physical exams, etc. One example is below:

GENERAL APPEARANCE: This is [default value], in no acute distress.
HEENT: Head is normocephalic and atraumatic. Ear canals [default value]. TMs are normal in appearance. No scleral icterus or conjunctival injection noted. Nasal passages [default value]. Oral mucous membranes are moist. No pharyngeal erythema or exudate noted. Postnasal drip [default value].
NECK: supple without lymphadenopathy or thyromegaly.
LUNGS: Clear to auscultation. Normal respiratory effort. O2 saturation = [default value].
CVR: Heart is [default value]. No murmur, rub, or gallop.
ABDOMEN: Non-distended with active bowel sounds. No tenderness, masses or organomegaly noted. No rebound or guarding noted. Rectal exam [default value].
GU: [default value].
SKIN: Warm and dry.
MUSCULOSKELETAL: No clubbing, cyanosis or edema.

LAB:

DIAGNOSTIC STUDIES:


When you look at this template, you notice the words [default value] in several fields. By using the Dragon command "next variable", I am able to go to each of these and insert a physical exam finding such as ear canals occluded with cerumen bilaterally. This gives me a lot of flexibility when dealing with the large variety of patients that we see in family medicine. One could also create templates for family history, social history, laboratory, etc. very easily. The program is extremely powerful and is made more possible by the addition of KnowBrainer software. My personal view is that one should not skimp on certain parts of the practice such as your computer software, hardware or other things that help you make money and be efficient. Most of us would not think of trying to examine people with a cheap stethoscope, for example. An excellent source of information regarding Dragon Naturally Speaking and its medical application can be found at the KnowBrainer website and the KnowBrainer forums for Dragon Naturally Speaking. As you can see, other people have different ideas about word processing applications that can be used with Amazing Charts, instead of Dragon. As the saying goes, there is more than one way to skin a cat. I encourage you to ask more questions and visit with others who are using word processing programs in order to help you make a decision. Regardless of the word processing program you use, you can always type into Amazing Charts as needed and I do that all the time.

Mel,

Don't forget the placeholders in AC that can automatically fill in those default values.. like %He, %His, %Lname, etc. Saves a lot of time in things that Dragon does not do well, like people's names.

Thank you Dr. MEL for the detailed response of information given. It is in fact true the Dragon Naturally Speaking has a $1600 price tag.
I find this excessive, but price is not an object if it saved me time. It sounds like people still spend a lot of time messing around with it. Services like Siri will soon take over the market, and I predict make some big impacts in the price they can charge or even their very existence.

This dictated with Siri without any corrections or editing, and without using a microphone other than that built in:

We the people of United States, in order to form a more perfect union, establish justice, ensure domestic tranquility, provide for the common defense, Promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

It does well with medical words too:
Laryngeal stenosis, Kestenbaum sign, infratrochlear nerve, human papilloma virus, human T cell lymphoma.
Flexeril bacitracin amoxicillin Percocet Osteoporosis osteoarthritis tendinosis neurology ischemic cerebral vascular accident Cardiology infectious disease, Haemophilus influenza, Pedvax, meningitis, meningococcal, chlamydia, gonorrhea, Kernig and Brudzinski signs (WOW)

Dragon seems to have problems with words like he she period this that etc.

David, where may I and other users get more information about using placeholders?

Chris, that is very impressive. The question is how would you get that into your Amazing Charts field?

Here is the post on AC's "conditional text" (% macro), or as David calls them, "placeholders":

%MR
%FNAME
%LNAME
%sex
%AGE
%him
%he
%his
%Him

For example:
%MR %FNAME %LNAME, %AGE years of age, notes a runny nose, head congestion, and some post-nasal drip. %He denies fever, chills, chest pain or dyspnea.

Is displayed as (for a patient "Mary Smith"):
Mrs. Mary Smith, 46 years of age, notes a runny nose, head congestion, and some post-nasal drip. She denies fever, chills, chest pain or dyspnea.

I just click on the text field, press Fct key twice, and start talking. I hit return when done with a paragraph.

Chris,

Do you use a Bluetooth device to dictate into the computer?

John,

I am still confused as to how the placeholders work. Does one type the symbols? Is there a video about this in the help section? Can one use a place holder if dictating with Dragon?

John,

I am still confused as to how the placeholders work. Does one type the symbols? Is there a video about this in the help section? Can one use a place holder if dictating with Dragon?

The placeholder text is placed in a template created in Amazing Charts. You can access templates when a patient encounter note is open by right-clicking on any text area. For example, if you saved my example (%MR %FNAME %LNAME, %AGE years of age, etc.) as a template in the history section, when applied as a template it would create text specific for that patient.

What John is describing is very useful in AC templates. It does not help with Dragon. On the other hand, you can create fields in your templates and tab to them with Dragon, accomplishing much the same thing.

Not sure how often the updates come, but in looking at other emrs, the industry standard seems to be every 3 months