Guide to Using Dragon 10 Medical
Contents
1. the bottom of the window e Backing up your Commands See the section on Exporting Commands to learn how you can easily export all of our custom made commands to a folder on your hard drive e Backing up your entire user profile although this is less important as Dragon has become so accurate with even the minimum of training particularly after importing your vocabulary and commands into a newly created profile it s not a bad idea to save your profile to a location off of your pc such as a back up drive or disk This is done by going to Dragon Manage User Advanced Export 7 Runthe Audio Set up Wizard once in a while This is the basic volume setting step and audio quality check you rain the first time you ran NaturallySpeaking There are a few good reasons to consider running it again one in a while Some are mandatory and some are optional e When you switch microphone or sound input source native sound card versus external USB sound adapter it is critically important the you run the audio set up wizard or you will notice worse results or no recognition whatsoever e When you change environments either in terms of significantly altered room acoustics leading to more or less reflection of sound off of walls and other objects or in terms of different levels of contaminating external noise loud environment The audio set up wizard can be run one of two ways 1 simply say Check Audio when dragon is running 22. Apply formatting SAY Bold That Italicize That Underline That Restore That department Business Department Type the next word in all capitals Example All Caps please PLEASE Type the next word in all lowercase Example No Caps jack jack Turn initial caps on Turn initial caps off TO Apply bold to either the last thing you said or selected text Apply italics to either the last thing you said or selected text Apply underlining to either the last thing you said or selected text Remove formatting from selected text Copy Cut and Paste Text SAY TO Copy That Copy selected text Cut That Cut selected text Paste That Paste cut or copied text Quick Voice Editing and formatting New to version 10 SAY Delete text Delete from text to text Delete text through text Cut text Cut from text to text Cut text through text Copy text Copy from text to text Copy text through text Bold text Bold from text to text Bold text through text Italicize text Italicize from text to text Italicize text through text Underline text Underline from text to text Underline text through text Select text Select text through text Select text to text Select from text to text Enter Numbers TO Delete the specified text or range of text Cut the specified
3. Using Dragon Templates with default values ccccssscccccesssssnscecececesessesaeeeecesessesaeaeeeeeceseaaeeeeess 14 Removing Variable Field Delimiters cccccccccecessssssecescceceeseeseeecsceeseeaaecececssesaaeseeeeseessessnaeeesens 14 Using Dragon Commands to Extend your Productivity eese eene nnne nnn nnne 15 Types Of COMMANAS cccsccccccsssssssececececessessuaeeecessseseeaeeeeeeeceseesaeaeeseceseeseaaeaeeeeecesesaeaeeeseesseesesaeaeeessesees 15 Text Commands Why They re so Important cceceesssscececessesseaeceeeeseesseeseeeeeceseeseaaeaeeeeeseseseaeeeeess 16 Buildirig Text Comrtniatds eet eoe etm ERE ERE ERES Ehre tuere ive Rea a rre ba esee D eevee 17 Editing ererecienz ao E Oe 19 IMPOrtiNg COMMANAS ARM 19 Exporting COMMANAS REN 20 Pelei om S 22 Using the PowerMic II Microphone cccccseesssseceececeeseaeaeceeecesecseaeceeeesceseesaeaecesesseeseaaeaeeeesesssessaeeeeess 22 Setting Up the POWer MIC 22 Assigning functions to the PowerMic ll keys cccsessccececessseaeceeeescesseseaaeeescessesauaeaeecessesenteaeeeeeens 22 Method of Programming Buttons on the PowerMic ll eeeeeeseeeee eene nnns 23 Commands for Downloading 2 eene iieri eren epo eta orna e dE ERE oe ER UV Y REEL Ee Ya o naa RR Eee ee Ya Ra ERR d Rule 2
4. e General Dictation Box e Capitalization amp DragonPad e Numbers Units amp Dates e Abbreviations e Miscellaneous Formatting Options We strongly suggest that you review the formatting options and decide what makes sense for you Many of these pertain to your preference in terms of how things are shown i e do you want CHF automatically expanded to congestive heart failure Do you want g o d expanded to every other day Formatting General Capitalization Numbers Units and Dates Abbreviations Miscellaneous Tips on Using Dragon Here are a few tips to making your experience with Dragon a more successful one 1 Microphone management is key to taming the Dragon Be sure you ve assigned a keyboard hotkey to turn the microphone off and on Being able to turn your microphone off when you pause from your dictation will dramatically reduce the likelihood you will inadvertently create text when the phone rings a colleague pops in your room or you clear your throat 2 Setto memory the common Dragon commands An overview which can be printed and used as a reference guide is present in the appendix 3 Make sure Dragon gets better with time by learning from its mistakes This only happens when you correct errors or train words it s having trouble with 4 Create commands to make Dragon more efficient 5 Prevent errors on a preemptive basis by adding to Dragon s vocabulary a list of words t
5. Manually go to the wizard via Tools Accuracy Center Check your Audio Settings Keys to Achieving a High Level of Accuracy When used properly you can achieve extremely high levels of accuracy with Dragon easily in excess of 99 It is important to recognize though that extending the accuracy of Dragon is more a result of how you speak than any aspect of software configuration microphone or computer The most important way to obtain high levels of accuracy is speaking in a smooth manner in either short phrases or complete sentences and enunciating your words clearly Keys to obtaining high accuracy 1 Optimize Your Dictation Style Despite our tendency to seek technical ways to improve recognition accuracy far and away the most important key to optimizing accuracy with voice recognition software is the manner in which you dictate e Enunciate clearly e Speakin a smooth manner neither overly slowly or excessively rapidly Speak in either sentences or phrases Recognition is worst when speaking one word at a time e Maintain a relatively consistent pitch and tone when dictating 2 Optimize Your System e Don t run unnecessary programs will compete with available RAM e Run disk defragmenter periodically programs gt accessories gt system tools gt disk defragmenter This can be somewhat time consuming so don t start it in the middle of the day e Be sure your computer has adequate RAM although 512 MB is considered
6. Subjective 01 Objective 02 Assessment 03 Plan 04 In both of the above examples each successive next variable or next field command would bring you to the next occurrence of and highlight the brackets and all intervening text a place from which you could do one of two things 1 Accept the default text if there and remove the brackets 2 Dictate something new over the highlighted variable region if the default text needs to be changed As added functionality if you are using a Dictaphone PowerMic II microphone you can program buttons to initiate the next variable and previous variable commands and rapidly move forward and backwards through your note template by pressing the assigned buttons An added enhancement not contained within Dragon 10 is to use a separate navigation field command to supplement the native functionality by allowing you when desired to navigate to a specific field as specified by a 2 digit number These navigation field commands are available for download in the section below Using this method you can simple say field 3 and be brought immediately to the next instance of 03 Using Dragon Templates with default values This is another use of Dragon templates and supplements the navigation function of this command An example is this After reviewing the medical history and discussing the matter with the patients we decided to proceed with heart catheterization Usu
7. starter microphone Better results especially in environments with external noise contamination will be obtained with a higher quality microphone Depending up your needs you should consider upgrading to one of the following microphones e Sennheiser ME3 This is the best quality wired microphone for use with NaturallySpeaking and provides the highest accuracy and noise cancellation It is head worn and does not include speakers It is best used with an external sound adapter such as the Andrea USB adapter or Buddy 6G USB adapter In comes with an 8 ft cord Price with included USB adapter 178 e Dictaphone PowerMic Il This is a hand held microphone with a series of programmable button and included USB interface with your PC For the busy physician or other professional this microphone offers a number of advantages including the convenience of being hand held and ability to program buttons to initiate a number of dragon functions including moving through navigation fields turning microphone off and on and lots more See addendum with additional information about the PowerMic II Price 489 e Sennheiser BW900 This is a high quality wireless Bluetooth microphone In addition to providing excellent results with NaturallySpeaking it is designed to interface with a wired telephone Q and can also pair directly with a Bluetooth cell phone In order to use this with your computer you will need to purchase this micropho
8. text or range of text Copy the specified text or range of text Bold the specified text or range of text Italicize text or specified range of text Underline text or specified range of text Select the specified text or range of text FOR SAY 1 9 numeral number Numbers one through nine should be dictated with the word numeral to obtain figure format 57 fifty seven 235 two hundred thirty five 4385 four thousand three hundred eighty five correct to 4 385 13 837 thirteen thousand eight hundred thirty seven 142 015 one hundred forty two thousand fifteen April 22 2004 April twenty two comma two thousand four 04 22 04 zero four slash twenty two slash zero four 9 30 a m nine colon thirty a m 65 sixty five dollars 99 50 ninety nine dollars and fifty cents Ve one half 818 710 4244 eight one eight seven one zero four two four four Switching Between Open Applications SAY TO Switch to next window Switch to next application Switch to previous window Switch to previous application Switch to application Switch to application you say Changing font STYLE as you dictate SAY THEN Set font to Arial Courier Courier New Garamond Helvetica Palatino Times Times New Roman Changing font SIZE as you dictate SAY THEN Set size Any number between 4 and 100 Enter punctuation and special characters For Say For Say period semicolon comma hyphen question mark exclamation mark colo
9. within a category Method of Exporting only selective commands from your collection see figure below 1 Openthe Command Browser Tools Command Browser or say Open Command Browser 2 If you don t see the view show below click on Manage on the left most menu At the group function on the top left of the window select either all or the specific command category you want to select from the commands from this category will show up in the main portion of the command browser If you want to pick selective commands from more than a single group of commands you should pick all 4 Clickto put a check mark in the box to the left of any command you want to export 5 Click Export 6 Usethe navigation function of the Export Commands window to choose a location to which the commands should be saved 7 Provide a file name for your saved file 8 Click on Save Appendix Using the PowerMic II Microphone The Dictaphone PowerMic II is uniquely integrated with Dragon 10 Medical and offers levels of functionality not available in any other microphone Drivers for the PowerMic are automatically installed when Dragon 10 is installed Basic use of this microphone requires nothing more than plugging it into an available USB port and then instructing Dragon to use it as the preferred input device Setting up the PowerMic II 1 The first time you plug in the PowerMic II your PC will install needed driver files It might request a rest
10. zl Import amp Export E To Script ER Preview MyCommand Name Ap Differential Acute Pericarditis Ap Differential Cardiomyopathy Ap Differential Chest Pain Ap Differential Contrictive Pericarditis 4p Differential Dyspnea Ap Pifferential edema ap DKferential Hyponatremia ential Narrow QRS Tachycardia dential Post Op Fever Second Double click on the command name to open MyCommands Editor being opened in the form of the original MyCommands Editor from which you can modify the name description category content etc of the command When you re done be sure to click Save Importing Commands Whether you decide to import commands from this site or from a colleague the ability to accept commands from outside sources is an important means of accepting the good work of others After all why should each one of us develop a series of medical commands from scratch Likewise if you decide to create a new user profile unfortunately the commands you build in your old profile are not Import Commands Look in 1 22 08 i My Recent Documents E CIS Navigation Commands e Related Commands list commands file to import File name differential dx commands My Network Files of type MyCommands files dat automatically incorporated into your new profile Importing your own commands into your new user profle essential way of giving your new profile a jump star
11. 4 Overview of Common Dragon Commands esses eene nn nnns sane ni ansa nasse enne nan 26 Additional ResoUrces irte eerte teo t axe nat Fou la eate eau Vui tex EEE 30 Introduction Although previously seen only in the realm of science fiction during the last few years the dream of computerized speech recognition has truly come to life In no field has the success of this technology more revolutionized work flow than in the medical field Leading to dramatic time and cost savings when compared with secretarial transcription and dramatic efficiencies when compared with hand typing this exciting new software has truly been thrust to forefront with the recent release of Dragon 10 Medical Like no prior edition Dragon 10 Medical brings the speed and accuracy of this software to new heights and adds a variety of features particularly useful to the medical practitioner What does this software accomplish In the simplest terms speech recognition software is a means to control your personal computer with your voice Dragon NaturallySpeaking effectively does the following 1 Turns your spoken word into text in word processing documents Allows use of voice to navigate and affect other command and control processes on a personal computer PC 3 Through the use of macros or commands allows multi step repetitive tasks to be performed with a single voice command Perhaps the most remarkable feature of this software is that out of the
12. Dragon correction method for every recognition error is that Dragon saves the associated pronunciation with any error and if you pronunciation was slurred or otherwise faulty this will be associated with the words and will actually lead to a degradation of your acoustic model Another option which you should be aware of is the other one shown in the graphic Automatically add words to the vocabulary This is usually selected by default and results in any word you correct and which is not already in the Dragon vocabulary being automatically added to the list of your custom words The reason this is important to realize is that in the correction process it is very easy to misspell words or otherwise accept something unintended By doing so you end up corrupting the vocabulary with words you don t really want there If you have this selected which is fine you might want to look at your list of custom words once in a while go to Words View Edit and under display select custom words only and see what s there In all likelihood you ll find some if not a lot of words you don t want there You can easily delete any words that don t belong Formatting Options New to Dragon 10 is a hugely expanded ability to format words and detail the nature of the formatting The formatting options are accessed dad gm Words Sound Help under the tools menu Q Accuracy Center The formatting categories include 1P command Browser 7 1 Add New Command
13. Dragon 8 or 9 Medical is currently running about 250 this will nearly double after November 30 2008 and the full version will likely range between 1200 and 1500 depending on where you purchase Should you consider something less than the medical version Preferred or Professional versions No and for 3 good reasons e The medical version has extensive medical vocabularies and this will dramatically increase the likelihood of the program getting it right the first time e Only the medical version will work in the environment of most electronic health records Nuance unfortunately has specifically disabled functionality of other versions in common EHRs we hope they will reconsider this e Only the Medical version provides tight integration with the PowerMic Il microphone We provide links to commercial entities and do so only to direct you in a good direction We have no financial arrangement with Softnet System Inc Nuance or any other entities PC Requirements The minimum processor need is an Intel Pentium 4 or AMD equivalent at 1GHz or greater with minimum 512 MB of RAM and recommended 1GB of RAM If you plan to run other high demand programs at the same time we recommend upgrading to 2GB or even 4GB of RAM If you need extra RAM a simple method of assessing your current RAM and purchasing additional RAM is to visit http www crucial com Microphone The microphone that is bundled with NaturallySpeaking should be considered a
14. Guide to Using Dragon 10 Medical Jon W Wahrenberger MD Table of Contents rigeefolyfeirTolupee e 2 PFE FEQUISILES 5 cece 3 xut c 3 PC Requirements terrae acs Sede aha teria prestare ert Pertuad rese ea eroe ba coed ei rr Hara a s rua ARR TRES e IAE 3 Microphone etr titii etre renin ere ett eres reer er treet tty s errs tee ere creer rere UAE EIE 3 Setting Up MIT eT 5 Basic CEDERE 5 Creating your first User Profile esses enne enne nennnnnn nnns en neni iai eaae aE sna aie 5 Basic Use Of D agOn os a iat ud sa e tespE C VEUE 7 Configuring Dragon for Medical USe c ccccccccsssssecececeesesseeeeeescesseseaeeeeecescseaaeeeeeescessesaaaeeeesessesesaeaeeeesens 7 Assigning EO D V LUL LLL LU LLLI LEER 8 Correction OPON tic aN 8 HEB hrdbicriem e 9 Keys to Achieving a High Level of Accuracy sssssssesseee esee ener nnns nnne nnn 11 Using Dragon Templates as Navigation Fields cccscccccssssssssssecececeseesseceeeesseeseseeaeeeseesseseaaeaeeeeseesees 12 Using Dragon Templates as navigation fields esses eese nene 13 Navigating via Dragon Templates sess nn nnne nnne nn nnns Eaei i nasse 13
15. al pre catheterization counseling was provided and the patient was apprised of the 1 in 1000 risk of death heart attack stroke bleeding complications infection and vascular complication After answering appropriate questions the consent was signed continue medical treatment We reviewed the patient s current medications discussed indications for seeking emergency medical attention and reviewed follow up plans As you use verbal commands or a command programmed into the PowerMic to move through the above sentence each of the alternative statement s would become highlighted At each point you would have the option of 1 Accepting the text and removing the brackets by saying Clear variable delimiters 2 Deleting the highlighted default text by saying delete that 3 Replacing the default content simply by dictating alternative text In the above example two lengthy alternative courses of action were placed in the note template and only the appropriate one or none would be chosen Removing Variable Field Delimiters The dragon command for removing variable delimiters is a bit of a mouthful clear variable delimiters and has the disadvantage of clearing variable field markers throughout the document Although this scheme can be useful if you work your way through a document and issue the command at the end if you forget and do this before reaching the end of the document you have lost the identifiers to variable fields through
16. art before you can use the microphone 2 If you are starting a new user profile on the initial screen you will pick the sound input source and you should pick PowerMic II 3 If you plan to use the PowerMic II with an existing profile these are the basic steps a Be sure the PowerMic Il is plugged into a USB port all drivers have been installed and if requested to do so you have done a system restart b Under the Dragon menu select Open User and select Source and then New This will bring you to a screen with a drop down menu in which you can choose PowerMic Il We recommend that you choose the default short under the training method but you can also choose None Assigning functions to the PowerMic II keys 1 Application buttons can be programmed to launch Options eit h er Text to speech Miscellaneous Dictation Box Data Correction Commands View Hot keys PowerMicll e dictation box Application EE a v e launch the DragonBar menu Button Action Dictaphone Transcribe page up 2 Dictation functions a button can be programmed to do any of the following functions Tab Backward Show correction window Tab Forward Tab forward Dictate Microphone on off e Microphone on off e Show correction window e Microphone sleep on e Press to talk e Train new word e Transcribe recording e Transfer text part of dictation box function Rewind previous variable Fast Forward next variable v v Sto
17. at you choose Talking to your computer as this provides a lot of basic information about using Dragon Once you have completed reading the training Select Text text Dragon will adjust your user file incorporating information about the pitch Please select the text that you would like to read volume and quality of your voice and you will Talking to your Computer Easier Reading Instructional m Kennedy s Inaugural Address Medium Reading Historical Speech then be faced with a few more decisions in a Dave Barry in Cyberspace Medium Reading Humor c oupl e of final screens Medical Reports Harder Reading Medicine Radiology Reports Harder Reading Medicine Pathology Reports Harder Reading Medicine One of the final screens offers you the choice of scanning documents in your MyDocuments and Email folders to assess your vocabulary If these folders are filled with a lot of documents NOT of your making we strongly suggest you skip this phase as otherwise you may alter the Dragon vocabulary to include vocabulary and word usage patterns which are not reflective of your own Basic Use of Dragon This section is extremely short because once you have the program installed and preliminary training done there s not much to using it Basic use of Dragon involves nothing more than this 1 Open NaturallySpeaking Have the cursor in the window of a word processing program your EMR Word email program
18. box and with the basic 6 minutes of training Dragon offers accuracy rates in the 9596 or higher range With a little more practice and use typical users are seeing accuracy rates in the 9996 range Compared with version 9 Dragon 10 Medical has a number of new features that will make this a worthwhile investment for current version 8 or 9 users Enhancements include 1 Notable increases in speed and accuracy 2 Improved formatting options for medical terminology Greatly enhanced integration with the hand held PowerMic II microphone Improved general formatting options Voice shortcuts for email and calendar functions Voice shortcuts for web searches and desktop searches Enhanced functionality of the dictation box which can now be used in a hidden mode Dragon Templates or variable regions which can be used as a means of navigating through a document 00 ME Qvour se ws Prerequisites Software For use in the medical arena the vocabulary and functionality of the Dragon Medical is highly recommended This can be purchased directly from Nuance www nuance com but can be obtained more cost effectively from a value added reseller Where to buy Particularly good prices are obtained from Softnet System Inc at http www pcspeak com Larry Allen who runs Softnet wrote the bible on building commands for NaturallySpeaking and offers both excellent prices and useful information on all aspects of speech recognition The upgrade from
19. can say Scratch That more than once to keep erasing previous words or phrases Delete selected text Undo That Backspace Undo the last action useful for undoing commands Press the Backspace key To press it more than once say Backspace 2 Backspace 3 and so forth up to 20 Correct and Edit Text SAY Correct That Correct text Select text Select Again Capitalize text SAY Cap That All Caps That No Caps That Cap word All Caps On All Caps Off No Caps On No Caps Off No Space word TO Correct either the last thing you said or selected text Correct a specific word or words must be visible on screen Select a specific word or words must be visible on screen Used to dictate substitute words or phrases Select the same text again but in a different place must be visible on screen TO Capitalize either the last thing you said or selected text Make either the last thing you said or selected text all capitals Make either the last thing you said or selected text all lowercase Capitalizes the next word you say Turns all capitals on like pressing the CAPS LOCK key Turn all capitals off Turn all lowercase on Turn all lowercase off Type the next word without a space before it Example cap john no space cap paul JohnPaul Start the next word with a capital Example Cap the Cap end The End Example Cap business Cap All Caps word No Caps word Caps On Caps Off
20. disease pericardial disease etc pulmonary causes intrinsic lung disease pneumonia reactive airway disease pulmonary embolism etc obesity deconditioning and others being inserted One caveat When a text gt Command Browser MyCommands command is inserted Dragon Mode MyCommands Help has a tendency to ignore some a e g Task Pane C3 alb MyCommand Name formatting options like the need MCI ted Ap Differential Acute Pericarditis dcs f to put two spaces after a period A Browse f differential palais bue nud Z3 Dragon 4 SN a Gel IB Differential Contrictive Pericarditis If your command is a complete eir pe HN Ap Differential Dyspnea i s Manage BS Ap Differential edema sentence that is to be inserted eism Gh Differential Hyponatremia Fy A E f i after a sentence with a period it E outline Polka niei inii im MyConmancdt E Samples ja Differential Post Op Fever IB Differential Post Op Hypotension will likely be inserted with no 1 amp New fic Dferenlial pilmonary hepertension T Ap Differential sinus tachycardia spaces following the previous ee Harea z T I Differential Syncope Edi a er 7 sentence For this reason when amp it doesn t show the Import Ap Wide QRS Tachcardia Differential i Edit Properties option click on you build the command you ME New Copy should manually put a couple of ER Import BR Export Click on Import to initiate the spaces int
21. etc 3 Make the microphone active by clicking on in Dragon toolbar or activating with your assigned hotkey 4 Talk enunciating carefully 5 Be sure to dictate all punctuation comma period new line new paragraph etc That s it Dragon Words Sound Help Microphone is off Q Accuracy Center Configuring Dragon for Medical Use Ip Command Browser r Add Mew Command Dictation Box Although most of the configuration of Dragon DragonPad done from the Options and formatting menus under the Tools menu see image on the right will depend upon the specifics of how you plan to use the product we can make a few suggestions which might be helpful to most users of the medical version In truth none of these suggestions are specific to the medical version but rather will be helpful to any Dragon user Assigning Hot Keys Hot keys are keyboard keys that can initiate Dragon functions Setting up a few of these can be very helpful recommend the following 1 Assign a key to turn your microphone off and on this is extremely helpful as it allows you to toggle the microphone off and on without issuing a go to sleep command or navigating with your mouse to the microphone icon on your tool bar We suggest that you assign this function to an easily reachable key on the edge of your keyboard so you can reach it quickly If you are using the PowerMic Il by default the large central button is as
22. hat you use regularly and which are not likely to be in the medical vocabulary This might reasonably include Names of physicians and other practitioners within your own group or with whom you communicate regularly or you may refer to in your dictation Names of local hospitals Names of any specialized programs within your office or hospital that you may refer to regularly i e Post Anesthesia Recovery Area Welby General Cardiac Rehab etc 6 Protect yourself by backing up your vocabulary commands and your entire profile Backing up your vocabulary specially trained words is done by clicking on the Words menu followed by Export Your words will be saved as a list of words in a text file txt at whatever 23 Import 3 Export location you choose Before exporting your words we suggest that you 88 y lt gt Vocabulary Editor look through your Em Written form Spoken form if different custom trained rare words and delete Written form Spoken form any that might be 4 East s EZ Alice Peck Day Memorial Hospital there in error You aie Alison Hutson can view your oo Allison Wilcox alwhorse custom words by 3 Andrew Torkelson us g oin g to Wor d s gt pS selects E Valley Hospital View Edit and then 3j Barbara Gerling Train i Bruce Hettleman selecting custom a Caloras words only in the Central Vermont Hospital 3 CHADS score v Help Display menu at
23. he very bottom or not viewable your input microphone input signal may be a bit strong and we suggest moving the microphone a little farther away from your mouth or speaking a bit more softly New User Wizard A typical volume result is shown to the right Adjust Your Microphone Volume Check Next you will be presented with the quality check screen ee gas Click Next to continue as shown below This step assesses the relative ratio of your audio signal to background noise and assesses the overall suitability of your system for speech recognition The absolute number obtained during this step will vary based on the microphone you are using the nature of Stat Volume Check Finished your voice and background condition and in general a signal noise ratio between 15 and 26 will be fine Don t lt Back Jp Nen gt Cmm He J worry if your number is on the low side New User Wizard Adjust Your Microphone Quality Check The computer will now test the quality of your sound system and microphone After the basic volume and quality check you will proceed Click Start Quality Check and then begin reading the following text aloud to the training process Select GO to begin the process You will need to speak several screens as the process begins and will then be presented with the screen shown below which offers you a number of choices for training text Cue s We suggest th
24. itiated The beauty of the text command is that once you ve created it you can use it repeatedly simply by stating the command name while Dragon is running and you re in a word processing document Here are the steps also shown in the figure below 1 Openthe new command editor MyCommands Editor MyCommand Name Differential Dyspnea Description Inserts a quick differential diagnosis for dyspnea Group User defined Availability Global OP Application specific indow specific Command Type Ap Text and Graphics v Q Name Editor The differential diagnosis for dyspnea in this patient includes cardiac causes ischemia manifestations of LV dysfunction valvular disease pericardial disease etc pulmonary causes instrinsic lung disease pneumonia reactive airway disease pulmonary embolism etc obesity deconditioning and others Content E amu Plain Text The command name this is the verbiage that will initiate the command Description optional Cateogry By default it will be User Defined Create your own category by tying anything you want your command goes This is the text or graphic that will be inserted when you ecKing cause the text inserted by the command to assume the font characteristics style size etc of the receiving document Recommended for most Technically called the MyCommands Editor by any of two me
25. k com Google Microsoft live search Additional Resources Dragon 10 User s Guide Dragon is packaged with only a very small guide for usage To read the full User s Guide visit the following link it s big 2 39 MB and 132 pages long http www nuance com naturallyspeaking pdf usergd pdf Scripting for NaturallySpeaking this is the bible on building commands and macros for Dragon and can be obtained directly from Speech Recognition Solutions view now or from site of the author Larry Allen at www pcspeak com On line Forums Dedicated to Speech Recognition e Knowbrainer Forum http www knowbrainer com pubforum e VoiceRecognition com Forum http www voicerecognition com board e Speech Computing Forum http www speechcomputing com e Nuance User Forum http support Ihsl com databases dragon webdisc nsf SAll OpenView amp Count 100 Nuance Online Knowledge Base http knowledgebase nuance com
26. l for death heart attack stroke kidney failure hemorrhage allergic reaction vascular complications and infection were reviewed in detail The possibility of stenting and other percutaneous intervention with associated risk was reviewed The possible need for emergent coronary artery bypass surgery was reviewed After a discussion about the above and having answered all questions posed the patient was provided with a consent which was reviewed and signed Differential chest pain Although a cardiac ischemic etiology to the chest pain in this patient seems most likely other potential causes include 1 Musculoskeletal 2 Pulmonary pulmonary embolism pneumothorax 3 Gastrointestinal esophageal acid peptic disease biliary 4 Stress and anxiety 5 Other cardiac valvular disease pericardial etc If the results of testing further evaluation do not confirm a cardiac ischemia further exploration of the above possibilities may be appropriate Counseling Smoking In addition to usual counseling we discussed the issue of on going smoking its medical consequences stressed the relationship between cigarette smoking and heart disease lung disease and cancer The statistics regarding the impact of ongoing smoking were reviewed General measures used to assist in smoking cessation were reviewed including nicotine replacement anti depressant medications social support and an approach consisting of multiple
27. modalities Hopefully you get the picture Things that you do repeatedly don t need to be repeatedly dictated from scratch They can be built into simple text commands so they are easily reusable whenever you need them The key point is that these are not programmed into Dragon and need to be constructed But once constructed these can be shared with colleagues In fact the author is happy to share almost all of his commands with you they can be imported directly into your copy of Dragon medical and used or modified as you desire How has the author incorporated text commands into his practice have created a series of text commands that can be called whenever necessary My general categories of commands are these e Examination commands these cover everything from full boilerplate exams gender based exams to small snippets of exams useable whenever appropriate e Counseling commands these document common discussions with patients which come up repeatedly in the course of the day i e counseling re non pharmacologic measures for the hypertensive patient heart failure precautions dietary counseling and lots lots more e Procedure Consent commands e Differential diagnosis commands Building Text Commands Building a text command is about as simple a writing an email you need to pick a recipient for the email name of the command and write the text of email the content to be pasted when the command is in
28. n apostrophe slash backslash open quote i close quote open parenthesis close parenthesis openbracket close bracket atsign minus sign numbersign plus sign dollar sign equal sign 96 percentsign _ ellipsis caret B tilde amp ampersand asterisk smiley face frowny face Desktop Search Commands New to Dragon 10 These commands require use of either Google Desktop or Microsoft Vista Search Google desktop is available from http desktop google com Need to wait for search engine to fully index your hard drive before desktop search with Google Desktop will work SAY TO Search computer for keyword Search engine displays all indexed items with the chosen keyword Search Mail for keyword Search engine displays all indexed email with the keyword Search Documents for keyword Search engine displays all indexed documents with the keyword Search web history for keyword Search engine displays search results containing all pages from your web history with the keyword Web Search Commands in each case the text can be any word or phrase SAY Search site below for text TO web Open default web browser and display search for specific text eBay Opens eBay and searches for specified text Amazon com Opens Amazon com and About com Answers com Creative Commons Wikipedia Altavista Opens specified search engine and initiates search for text term AOL Search As
29. n the figure on the right B ro som cun eo The following sound systems are available on your computer Choose one of these for use with speech recognition If you are using the PowerMic Il AK5370 Realtek HD Audio Input microphone you will proceed Realtek HD Digital input directly to the volume check portion of the set up Otherwise To have the Audio Setup Wizard automatically you will go to a screen in which you choose the most likely sound system click Default select your specific audio input device as follows If your computer does not actually have one of these sound systems click Help e f using an Andrea USB adapter with the Sennheiser ME3 you should select the AK5370 on Windows XP and USB Audio Device on Windows Vista e If using the Buddy 6G USB adapter you should choose Buddy6G e If using the PowerMic Il microphone this screen will be bypassed don t worry Following selection of the audio source you will move to the volume adjustment portion of the audio setup wizard This appears as showed below and is simple to follow Ideally the blue bar which varies position as you read the practice dictation should end up somewhere between a quarter and 1 3 of the way up from the bottom when you are complete e f more than half way up this indicates that your audio input signal may be a bit attenuated soft and we suggest moving the microphone a bit closer to your mouth e If at t
30. ne bundled with a separate pc interface device the Sennheiser modular to PC adapter the ZoomSwitch or the GN Netcom SeleCT switch The only downside of this microphone is the paraphernalia which is required with it base station interface device and the need for AC power for the base unit Price about 307 Where to buy a high quality microphone There are many excellent suppliers of high quality microphones for speech recognition including Speech Recognition Solutions eMicrophones and Knowbrainer Before you purchase elsewhere we kindly ask that you look over our product line and prices and consider purchasing from us at http www SpeechRecSolutions com A note about Nuances Dragon microphone rating scale They have always provided high rating for the inexpensive microphone included with the product While this is certainly a serviceable microphone and provides reasonable results there are clearly better microphones out there We suggest you take the Nuance rating scale with a grain of salt Setting Up Dragon skip this if you re familiar with Dragon Basic Installation Basic Installation is fairly straight forward If you have a previous version of NaturallySpeaking installed on your PC you can transfer your vocabulary and personalized commands to the new version recommend that you manually export these from your old version storing them somewhere on your hard drive before doing the installation of Dragon 10 See method
31. nsively from Speech Recognition Solutions www SpeechRecSolutions com o NaturallySpeaking QuickMacros This is a short and helpful 52 page book on creating custom commands You can learn more about it or purchase it at http www speak it com quickmacros htm If listing all these command types has overwhelmed you and remind you that you are not reading this to learn computer programming take heart you only really need to learn the first very simple command type the text and graphics command In fact forget the graphic part It s unlikely you ll really need to do this So it all boils down to this you need to learn the very simple process of teaching dragon how to insert an entire phrase sentence or paragraph when you ask it to Text Commands Why They re so Important Why is it important to learn how to build text commands It will save you time It will make your clinical documentation look better It will allow you to document the complex discussion you had with your patient without having to type it out or describe the details In a nutshell learning how to build commands will allow you t or a double if not triple the usefulness of this software you paid 1500 for Some Examples of what a simple Dragon text command can accomplish You Say Dragon Inserts the following text Cath Risk The indications expected benefits and potential risks of heart catheterization were reviewed in detail with the patient The potentia
32. o download http www speechrecsolutions com Commands2 Differential dat Medical Counseling Commands these are templates the author uses to document some common counseling done during clinical visits Again these are to get you started and are very limited in scope Click on link below to download http www speechrecsolutions com Commands2 Counseling dat Management templates this is a limited number of templates documenting management for a few selected cardiac conditions Click on link below to download http www speechrecsolutions com Commands2 Management dat Outline commands this is a small set up commands that assists in the construction of an outline Click on link below to download http www speechrecsolutions com Commands2 Outline dat Structured Note Templates if you haven t already created note templates in your EMR this is a small collection of structured note templates including navigation field Click on link below to download http www speechrecsolutions com Commands2 Note Template dat Utility Commands This is a collection of helpful commands that accomplish a variety of useful functions You ll have to try these to see what they do Click on link below to download http www speechrecsolutions com Commands2 Utility dat For assistance in downloading these command sets view the tutorial on importing commands above Overview of Common Dragon Commands Note Some of these commands are specific to Drag
33. o the beginning of the 2 command import process content of the command These E Preview spaces will become part of the command and be inserted and insure formatting looks good on your final document Editing Commands Once you ve created a command or imported commands from someone else you might find yourself wanting to alter the content of the command This is a simple process and requires only that you summon the command in the form of the MyCommands Editor in which it was originally created Here s the basic method 1 Open the Command Browser by going to Tools Command Browser If the command browser doesn t look like the figure below under the Mode panel click MyCommands 3 Click on the category of the command if you can t remember you can click on All This will lead to a list of all commands within the category being listed on the right 4 Double click on the name of the command This will lead to the command Command Browser MyCommands Mode MyCommands Help ty View By Availability Task Pane all Cardiology E differential mn Dragon E Exam E JWPersonal E MiscMed E NoteTemplate E Outline E Samples E sounds User defined C utility First Select category or click all If the command browser doesn t look like this click on MyCommands here Mode Q Browse amp Script Manage Li MyCommand Edit Properties E New Copy
34. ofile you create in the future 2 Forsharing commands with a colleague 3 Although a case can be made for backing up or exporting your entire user profile highly recommend keeping an exported copy of your commands and vocabulary This allows selective importation of each of Command Browser Manage these into a new Mae Renee S Method of Exporting Individual or Selected Commands profile a process Group differential which is often Task Pane preferred over the Mono A Differential rdom 2 Select the category of 2 amp Browse differential Chest Pain command you want to export complete importation 4 Soi Mosa me Peri from the drop down menu nifFerential Dyspnea x O Differential edem of a full and old C m Differential Hyponatremia 3 Select the individual profile S MpCommands a i Differential Narrow QRS Tachycardia commands within the aglia Post Op Fever category you want to export Manage il ial Pa potension RA Import D1 Differential pulmonary gt L1 Differential sinus tachycardia Export Differential Syncope commands you have the M Eno Ee ORS Tachcardia Differential 1 Click on Manage to bring this A X Delete format to you command browser option of exporting either a all tr 4 Click on Export of your personalized To Script commands or b an entire When you export your category of commands categories which you have set up or c a specific subset of commands
35. on 10 Medical Control the microphone SAY Go to Sleep Stop Listening Wake Up Listen to me Microphone Off TO Make the microphone stop listening temporarily Reactivate the microphone when it is asleep Turn the microphone off Create new paragraphs lines and spaces SAY New Paragraph New Line Tab Space TO Press the Enter key twice Press the Enter key once Press the Tab key Press the space bar Move around in a document SAY Go to Bottom Go to Top Press Home Press End Insert After text TO Move the cursor to the end of your document Move the cursor to the beginning of your document Move the cursor to the start of the current line Move the cursor to the end of the current line Place the cursor after a specific word or words must be visible on screen Insert Before text Place the cursor before a specific word or words must be visible on screen Navigation Fields Dragon Templates Dragon 10 Medical Version Only Variable regions are defined by field delimiters which be default are right and left brackets and Next Variable Next Field Previous variable Previous field Move to and highlight next variable region Move to and highlight next variable region Move to and select previous variable region Move to and select previous variable region Delete text and undo actions SAY Scratch That Delete That TO Erase the last thing you said You
36. out the documents We suggest as an alternative a simple command that removes the variable field marker only from the text you have highlighted Our version of this command isn t elegant but works fine It is included with the command set labeled Navigation Field Commands and the set is available for download below The specific command is termed delete brackets The only disadvantage of this command is that it is designed only to remove left and right brackets and nothing else Using Dragon Commands to Extend your Productivity Once you ve got Dragon working and have made necessary corrections and bolstered your vocabulary with the names of your local hospitals referring physicians etc it s time to truly unleash the power of Dragon How is this done Learn to build some commands Types of Commands What are commands Basically commands are means of using a verbal utterance to accomplish anything other than the simple speech to language and desktop control functions that you ve already learned They come in a variety of categories and all are fairly easy to accomplish Here are the basic types of commands e Text amp Graphics Commands These commands have the affect of inserting specified text or graphics within a word processing document These are extremely easy to construct and are the ones you absolutely need to learn to build The rest you can live without e Macro Recorder These types of commands used for the last
37. p Play page down Custom Left Force command recognition v Enter Select Show dictation box v Custom Right Force dictation recognition i Ce 3 Navigation functions e Skip backward e Skip forward e Press OK button e Press Cancel button e Tab forward e Select previous variable field e Select next variable field e Clear delimiting character 4 Recognition Modes e Force normal recognition e Force dictation recognition e Force command recognition e Force numbers recognition e Force spell recognition e Hidden mode on off 5 Playback e Plackback e Fast playback 5 User Command Ability to program button to initiate any dragon or personally created command Options Text to speech Miscellaneous z Dictation Box Data Conection Commands View Hotkeys PowerMic I Method of Programming Buttons on Application Global the PowerMic II Button Action Dictaphone Transcribe E 7 This is a simple process and goes as follows lt None gt p e p 8 Tab Backward Applications Tab Forward Dictation e Open the PowerMic II tab on the Navigati n 4 Dictate Recognition modes Options panel Tools gt Options gt Playback PowerMic ll tab Rewind User Commands v page up page down e Onthe picture of the PowerMic Il Fast Forward nest variable next variable previous variable next slide previous slide Click on the button you want to Stop Play page down program thi
38. r word sentence or longer segment of text placed between the defined delimiters becomes such a variable region The beauty of these variable fields is two fold 1 They can be used as navigation markers as Dragon 10 has the ability to navigate upon your command sequentially from one to another through a document say next variable or previous variable to move forward or backward through these variable regions The terms Next Field and Previous Field will accomplish the same thing 2 They can contain text which you can choose to accept or reject as you go through a document The term template comes from the fact that use of this function requires that these variable regions are constructed into a note template in advance of the time that it is actually used These can be added to a note template in your electronic health record or added to the text within a text command you intend to initiate Navigating via Dragon Templates If you do nothing else you can use these variable regions as a means of navigating through a document As an example if you use the default left and right brackets and place them within a note template such as the one shown below you can navigate from variable region to variable region simply by saying Next Variable or Previous Variable Sample Simple Navigation Field Sample Navigation Fields allowing jump to specific location Subjective Objective Assessment Plan
39. resort tasks that you can t think of any other way to make Building this type of command involves having Dragon record a series of steps you take on the computer and saving them for recreation upon initiation of the command Most users never use this type of command e Step by step these are commands in which a series of processes or steps you might take on your computer are sequenced one step at a time and saved as a command The allowed steps include o Specific keystrokes Short segments of text Opening an application Turning the Dragon microphone on or off Initiating a pause or wait O O O O Practically speaking the step by step commands are helpful for creating a command to open an application if you are otherwise having a hard time doing it and don t want to create an advanced scripting command to do so Step by step commands are fairly intuitive e Advanced Scripting These are extremely powerful commands that use a relatively simple programming language called Visual Basic and can accomplish a variety of functions ranging from the simple to complex Teaching you how to build this type of command is clearly beyond the scope of this document For further information you might consider the following o Scripting for NaturallySpeaking this is truly the bible of constructing commands It s written by Larry Allen of Softnet Systems Inc and can be purchased either directly from Larry see www pcspeak com or less expe
40. s of Exporting Commands and Vocabulary below for more information on this topic Before doing the actual install we recommend the following e Export your personalized words and commands from your current version 8 or 9 user profile see methods below e Close all open applications e Turn off or disable antivirus New User Wizard software Create User Select any name for your profile Spaces not allowed e Insert the installation disk Your name and follow all instructions e Unless you have reason to do Language Us Engish Select the appropriate sound source otherwise unlikely you Accent General IMI depending on S h ou d C h oose Dictation source PowerMic II Microphone m microphone pe i n P PASCERE Tm T ica Co m ete w h en Vocabulary General Medical BI Advanced yP p Select the medical asked during the installation Initial training None Short O Special see Help vocabulary most To continue click Next appropriate for your eee specialty Creating your first User Profile Once the Software is fully installed you will be asked to activate it on line and to register you product Activation can be done automatically if so chosen when given the option We recommend you register your software Thereafter you will begin the process of starting your first user profile On the first screen you will be faced New User Wizard with choosing a number of options as show i
41. s will highlight the corresponding section on the Action area on the right of screen e Select the function you wish to assign the selected button on the drop down menu the only selection which might not be intuitive is the User Command Custom Left Force command recognilic Enter Select Show dictation box Custom Right Force dictation recognition option This will show you the last 6 commands you ve used in Dragon and allow you to choose one of these commands to be associated with the button Alternatively you can choose the specify category and type in the name of the command you want the button to initiate Commands for Downloading For those wanting a jump start in the process of using commands the following command sets are offered for your importation and use within Dragon 10 Medical or the professional or medical 9 Please consider these a start and feel free to modify or change any of the commands within the set These were created primarily for the author s cardiology practice and may or may not be applicable to your patients and work flow Look them over and be sure you agree with their content before using them with your own documentation The point to using them is to save time but not to misrepresent anything you observed or discussed during your patient encounter These commands will not work in version 8 of Dragon These can be viewed for downloading at http www speechrecsolutions com Command
42. s2 or by clicking on the individual links below Individual Command Sets for Immediate Downloading and importation into your version of Dragon e CIS related commands these are commands intended specifically for use within CIS at Dartmouth Hitchcock These are not likely to be helpful to you if you are not using Dartmouth Hitchcock s CIS Click on link below to download http www speechrecsolutions com Commands2 CIS dat http www speechrecsolutions com Commands2 CIS Navigation dat e Navigation Commands These are commands that allow you to navigate to specific locations on a document as defined by a digit number surrounded by brackets i e 01 02 19 20 This command set allows you to move directly to a field by saying field one field two etc Click on link below to download http www speechrecsolutions com Commands2 General Navigation dat not for use in DHMC s CIS e Physical Examination Commands These commands include a series of boilerplate normal examinations gender specific exams and a series of examination snippets for constructing honest and thorough examinations on the fly Click on link below to download http www speechrecsolutions com Commands2 Examination dat e Differential Diagnosis Commands This is a limited set of commands which insert a limited differential diagnosis for several common signs or symptoms They should be considered a starting point and not a thorough set Click on link below t
43. signed a push to talk functionality You might want to change this to a Microphone on off function so you don t have to hold it constantly while dictating 2 Assign a key to Correction By doing this activating this key will automatically bring up the Dragon correction function for any word in which your cursor is placed If you never navigate around with your mouse don t bother with this Correction Options We suggest one important selection in the correction tab Correction of the Option window select Automatic playback on correction By doing so any time you initiate the formal C Select commands bring up Correction menu Commands View Hot correction of a word or phrase dragon will play it back for Wi Saket commands search backwards you as it is launching the correction window This is os Correct ds bring up Spell dialog b essential in that it allows you to hear what you said and e Let at aati decide whether you spoke poorly the error was your fault C Spell commands bring up Spell dialog box in which case you should not correct but rather re di y dictate Automatically add words to vocabulary the word or phrase or whether it was Dragon s error in which case you should continue with the correction process v Automatic playback on correction The important point is that by choosing this option you are given the ability to decide why the error occurred The reason you should not use the formal
44. t Fortunately the process is very simple Basic Steps to Import a Command 1 Open the command browser and click on the Import function see above This will open the Import Commands navigation window 2 Navigate to the Import Commands location Import file name C Documents and SettingsJon W ahrenberge differential dx commands dat of the Please check the commands you want to import All MpCommands MyCommand Name Type Availabilty Descrip Content By availability R Ap Acute Peric Text and Graphics Global 13 linef Mv Ap Cardiomyop Text and Graphics Global 1 lines CX differential M Ap Chest Pain Text and Graphics Global 9 line s Mv Ap Contrictive Text and Graphics Global 16 linef View M Ap Dyspnea Dif Text and Graphics Global Differenti 1 linefs 9 lines 18 linef 9 line s 1 lines 1 line s 25 linef command file to import these files all end with dat 3 Select the file to import and click Open 4 Onthe next Import Commands screen click on Import if there are any individuals commands you don t want to import you have the option of de selecting any individual command Exporting Commands The flip side of importing commands is exporting your personalized commands There are two very important reasons for doing this 1 To save a copy of your personalized commands for archiving or importation into a new user pr
45. the correction menu e f your enunciation was clear you can reasonably correct the dictation e f your enunciation was not clear you should simply re dictate the wrong word or phrase otherwise the poor enunciation will be stored with your correction and acoustic model degraded e After establishing a good working user profile typically after a week or so or regular dictation and corrections stop saving your user files regularly Rather save user file only after making major corrections or additions to your vocabulary Using Dragon Templates as Navigation Fields Given the frequency with which physicians and other medical practitioners are using Dragon in the context of an electronic health record and during which areas of narrative history exam assessment plan are co mingled with other data which has been pre populated into a note in progress it is very helpful to have a means of quickly navigating to desired locations throughout a note Dragon 10 has incorporated a new function which makes this an extremely easy process the use of Variable Regions or Dragon Templates Using Dragon Templates as navigation fields This is a new function placed in Dragon 10 and involves definition of a variable region defined by text surrounded with variable delimiter and building such variable regions or Dragon Templates into a note template in your EHR By default these variable delimiters are a left and right bracket and Any characte
46. the minimum a full 1 Gb or more may be optimal If you are using Windows Vista double these figures e f you notice recognition accuracy deteriorate during the day consider restarting your computer to clear your RAM e Use the best microphone you can afford e f you are using a laptop computer and are not getting great accuracy consider bypassing your integrated sound card by using a USB sound adapter This is a device into which you plug your microphone and which in turn is plugged into a USB port on your computer The USB pod digitalizes the analog signal from your microphone and bypasses the internal sound card on your computer Two commonly sold USB pods are made by Andrea and VXI 3 Optimize Your Software e Run the audio set up wizard tools gt accuracy center gt check your audio settings when making a major change in dictating environment or when you notice a deterioration in recognition accuracy The audio set up wizard can also be opened simply by saying Check Audio e Let Dragon learn from its mistakes read the appropriate chapter in the User s Manual that came with your version of dragon but do not utilize training methods if the mistake occurred because you enunciated poorly e Before training an apparent error you should listen to the dictation either by setting dragon to automatically automatic playback on correction under the tools gt options gt correction menu or by choosing Play that Back from
47. thods a Say Add new command b Goto Tools Add New Command Select a name for the command 3 Type a description of what the command does optional Select a category for the command optional by default all new commands are in the User Defined category you can create a new category name simply by typing it Thereafter it will be selectable as a command category when you create another command 5 Enter the content text or graphic that the command is expected to insert when the command is initiated This can be entered by any of three methods a hand typing b pasting from elsewhere or c using Dragon and speaking the content 6 Click in the box next to Plain text on the bottom right of the command editor if you want the text inserted by the command to assume the font size style etc of the document into which it is inserted In most cases this is recommended The only exception is if you intentionally want to push a particular font size style or formatting with the command 7 Click Save Once you ve saved the command it is now incorporated into your user profile and any time you initiate the command by saying the command name with a short pause before and after the utterance it will instantly paste the contents of the command In the example above saying Differential Dyspnea will lead to The differential diagnosis for dyspnea in this patient includes cardiac causes ischemia manifestations of LV dysfunction valvular
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