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Support Tips
CPRS Focus
Recommended iSupport KBs

VA Support Trends
Contact Us

Support Tips

Benefits of Knowing Your VA Dragon Medical Network Edition (DMNE) Administrator

The VA DMNE administrator at your facility can help improve your overall experience for DMNE. Benefits of knowing your DMNE Admin:

• Reduced support time by providing immediate answers or solutions
• Resolution of many issues without OIT direct support
• Experience to assist with product features and advanced operations
• Insight on when to solicit direct involvement from OIT or Nuance
• Knowledge of available training and documentation resources

A list of DMNE Admins is posted on the Enterprise Wide Speech Recognition (EWSR SharePoint) site.

Training DMNE for Accented Users

Dragon Medical Network Edition (DMNE) aggressively promotes an environment to achieve the best possible speech recognition accuracy for each user using multiple architectural components. One such component offers accent models for new users when creating user profiles for DMNE.

Customers running DMNE vocabularies for United States English (ENU) can choose from the following entries in the Accent list of the New User Wizard:

• Standard/General (default value) — Use this if your accent is not covered by the other choices or you are not sure which accent to select.
• Australia Accented English
• British Accented English
• Indian Accented English
• Inland Northern US (Great Lakes area) — This accent model covers Upstate New York through the Chicago area.
• Pakistani accented English
• Southeast Asian Accented English
• Southern US — This accent model covers most of the southern United States, including Texas.
• Spanish Accented English

Determining a user's accent can potentially be difficult. For example, if a user grew up in one part of the United States, but has lived long enough in another part, their original regional accent may be less pronounced.

IMPORTANT: If there is any uncertainty about selecting the proper accent, try the Standard/General accent model first.

The following guidelines should be considered when deciding which accent model to select:

• Start with the Standard/General accent first.
• If the user grew up in India or Southeast Asia and was educated in their language prior to college, the user should likely choose the Indian Accented English or Southeast Asian Accented English.
• If the user grew up and was educated in Australian or Great Britain, the user needs to make a judgment as to how pronounced their accent is.
• If the Standard accent is selected, after using the product for several hours, Acoustic Optimization can be run manually in order to take immediate advantage of any improvements made. Acoustic Optimization updates the User Profile with accumulated acoustic data from any corrections and additional training you may have done. Running Acoustic Optimization will increase the user's overall accuracy.
• With a Standard accent model selected and in the process of increasing your accuracy, Acoustic Optimization (Regional Accent Tuning feature) may select a different accent for the user. However, if a non-standard accent is selected, Acoustic Optimization will still increase the overall accuracy, but will not change the accent.

Once an accent model is selected for the User Profile, the accent cannot be changed. Instead, a new user profile will need to be created.

Also, users can improve their accuracy by additional training. Navigate on the Dragon Bar to Help > Improve My Accuracy. Then select Read text with/without prompt to further train DMNE.

To train a specific word or phrase, navigate on the Dragon Bar to Vocabulary > Vocabulary Editor. Find and select the word/phrase and then click Train….

How DMNE Saves Time

Nuance is redefining how physicians interact with clinical documentation on every level. Dragon Medical Network Edition (DMNE) is empowering physicians in a more natural way to capture and communicate the patient story more accurately, without disrupting workflows, so providers can spend more time with patients.

Below are some interesting statistics [Link]:

• 43% of a provider's workday is spent on data entry
• 4,000 clicks for an average day of documentation
• 7.2 million words documented by a single provider in just one year

Providers can dictate 150 words per minute—three times faster than using a keyboard. Physicians using DMNE to dictate progress notes, HPI, and assessment and plan directly into their CPRS software, can save themselves at least 20 minutes of documentation time each day [Link].

Customer Testimonial Video

Case Studies on Customers Using DMNE:

Advocate Illinois Masonic Medical Center reduces transcription costs 70%, drives EHR adoption

MD Anderson Cancer Center reduces transcription costs by $3 million

Sharp Rees-Stealy Medical Group reduces transcription costs by 90%, increases EHR adoption

White Papers:

Top 5 reasons to speech-enable clinical documentation

Optimizing Clinical Productivity: Using speech recognition with medical features vs. a general-purpose solution

CPRS Focus
CPRS V30C – Jumping Cursor  

The jumping cursor problem was initially identified after CPRS V30B was installed. This is a compatibility issue with the DMNE software. The issue was solved by running the advertised program below:

Start > Control Panel > Programs > Run Advertised Programs (32-bit) > "Dragon INI Fix for CPRS30b - "

However, when CPRS 30C was installed, the jumping cursor occurred again. Here is the fix:

1. Run the CPRS V30C (1.30.75) Update only.
2. Restart the PC.

If needed, have local OIT reinstall the DMNE .ini modification (below) that resolves the jumping cursor issue in CPRS. By default, the executable is named CPRSChart.exe.

[CPRSChart]

App Support GUID={dd100104-6205-11cf-ae61-0000e8a28647}

[CPRSChart\Enable Class Names]

TRichEdit=4

However, if the executable has been renamed to say CPRS.exe, then this modification would need to be updated to:

[CPRS]

App Support GUID={dd100104-6205-11cf-ae61-0000e8a28647}

[CPRS\Enable Class Names]

TRichEdit=4

 NOTE: Verify that the executable name matches what is set in the .ini file. If not, the .ini value must be changed to match the executable name.

Recommended iSupport KBs

Link up with Information Fast!

The following iSupport solutions (knowledge base articles) are recommended for the VA.

iSupport users can add specific solutions to the Quick Links section on their iSupport Dashboard.

 NOTE: Viewing linked iSupport solutions below requires logging into iSupport.

Contact Us

We're Listening!

As a speech recognition company serving our customers, Nuance places a premium on listening.

Please use the resources below to contact us.

VA Support Trends

Closing DMNE Gracefully to Avoid Profile Corruption

The DMNE User Profile is a large collection of dynamic speech files maintained across multiple levels of folders and consisting of several main components, including:

• Language Model
• Acoustic Models
• Speech Vocabularies
• Configuration files
• Archiving components
• Temporary folder/file structures
• Backup/Restore components
• Logging

The complex nature of maintaining and optimizing profiles for speech recognition in diverse environments involves modifying the profile on a constant basis. While Nuance continues to implement features that protect profile integrity and guard against external threats, corruption of the Dragon Medical profile can still occur.

• (Most common) Workstation is ungracefully shut down before Dragon Medical could complete the save/synchronization action on the profile
• Inadequate system resources (CPU, memory, disk space, paging file, etc.)
• Profile currently opened on another workstation
• username.lck lock file exists
• _DGNRenamed suffix in folder name or file name
• Profile folder structure locked by another application (Windows Explorer, etc.)
• Insufficient Windows folder, file, and network share permissions
• Aggressive anti-virus settings or conflicts (Dragon Medical exclusions needed)
• Electrical power disruptions
• Network drop-out / latency issues
• Opening a DMNE profile on a lower-versioned Dragon Medical client

The following recommendations can ensure that DMNE profiles have completed the saving/synchronizing process before users close their Windows operating system.

1. Verify DMNE has completely exited as evidenced when both the Dragon Bar and the Dragon Medical system tray icon have closed.
2. The Windows Task Manager can also confirm that the Natspeak.exe process is no longer listed.

The DMNE Offline Mode can be used to limit the login/logout time by not synchronizing their profile across the network as part of the login/logout process. If the Offline Mode feature is enabled, users can check the checkbox for If your connectivity is slow… on the DMNE user login dialogue to run in Offline Mode.

Note, a good working copy of the local profile must be present on the workstation. Any changes made to the profile during Offline Mode are not synchronized with the roaming profile until the next Online login.

Run SCCM Package to Install Correct Authentication Method

In the event that Dragon Medical Network Edition (DMNE) is being installed for the first time or reinstalled for some reason, the SCCM package adjusting the authentication method should be run to ensure the proper authentication changes are applied.

The VA originally used multi-domain LDAP authentication for logging into DMNE which required a certain nssystem.ini file configuration value be set at "2". However, the VA switched to the native authentication method in November of 2016. In order for native authentication to work, that same .ini value needed to be updated to "0", otherwise the error below is presented.

This SCCM package was developed to be applied to all DMNE installations, both existing and new, to modify that value in the nssystem.ini from 2 to 0. The package also deletes the locally-cached profiles and the nsuser.ini file on the workstation. This clears any remnants of the old authentication mechanism that may be stored locally.

Error Resolution For End Users

       Domain login not allowed. Please try again

VA users encountering the above specific error will need to have the following SCCM package run:

1VA – Nuance Dragon Naturally Speaking 12 Configuration 1.0

Local IT should be able to assist if the package needs to be pushed to/installed on the PC. Once this package has been successfully installed, users should be able to login to DMNE successfully.

 NOTE: Nuance cannot install this package.

Verification Of Correct Authentication Method by DMNE Admin

VA DMNE Admins and local OIT staff can verify if the SCCM package has been successfully applied to individual user workstations using the following steps:

1. Browse to: C:\ProgramData\Nuance\NaturallySpeaking12.
2. Open the nssystem.ini file using Windows Notepad.
3. Search for the Allow NAS LDAP line.
   

   

   If the value equals 2, then the SCCM package was not run and needs to installed. The value should equal 0 (zero).

Troubleshoot USB Microphones That Stop Responding

The following troubleshooting topic for DMNE customers can be applied to scenarios where the USB microphone and/or the Dragon Medical client application stops responding.

Affected operating systems and hardware are Microsoft Windows 7 with the Intel USB 3.0 eXtensible Host Controller installed, and either USB 2.0 or USB 3.0 ports used.

See the possible symptoms reported below:

• Internal audio error is presented and the application unexpectedly stops responding.
• The USB microphone stops working.
• The USB microphone will not start recording.
• The application stops responding while the USB microphone is recording.
• The Microsoft Windows Sound property page stops responding.
• The Citrix Receiver stops responding.

An example of this issue would be when the application is in the recording mode and the user stops recording, but no change or response is evident from the USB microphone. When the user attempts to start recording again, an error is displayed and recording is no longer possible.

Nuance internal tests have shown that this problem can occur with any USB composite device; for example, the Philips SpeechMike, Nuance PowerMic, and Grundig devices.

Cause

When the application sends a STOP API call which is forwarded through the USB Host Controller to the USB microphone, this call is not returned by the USB Host Controller and a time-out condition occurs. This results in the application and/or USB microphone stopping from responding. Further, there is no way to recover from this condition except to physically disconnect and reconnect the USB microphone from the USB port.

Nuance has discovered that a faulty driver for the Intel USB Host Controller, in combination with a specific chipset, is the cause, on Windows 7 workstations.

Solutions

The following solutions and resources are available, the details of which are presented in iSupport solution 20567: Troubleshooting USB Microphones That Stop Responding.

• A temporary workaround can be invoked by disconnecting and reconnecting the input audio device from/to the USB port.
• However, Nuance has found that the USB Host Controller is at fault in these cases and recommends updating the driver for the Intel USB 3.0 eXtensible Host Controller Driver to version 4.0.6.60 (required minimum version).
• Otherwise, if the USB Host Controller driver cannot be upgraded, a recommendation can be made to upgrade the operating system to Microsoft Windows 8.1, or higher, as this issue had not been reported on Windows 8.1 or Windows 10.
• If Windows cannot be upgraded and the affected workstation is currently at Windows 7, note this issue only occurs when the CPU is idle and the frequency drops below 1 GHz. Making sure that the CPU does not drop below 1 GHz can help alleviate this issue (although this is not a guaranteed solution).
• How to determine the USB Host Controller version.
• Release Notes for Intel(R) USB 3 0 eXtensible Host Controller Driver.
• Other related iSupport resources such as; resolving USB device detection issues, USB device cleanup, Nuance PowerMic™ microphone downloads and resources, instructions on submitting PowerMic microphones for repair, and a Nuance hardware compatibility website.

Thank you for partnering with Nuance!