eTIPS

Did you know Dragon Medical has Voice Commands to Navigate within a document?

Instead of reaching for the mouse, you can save time navigating to different areas of your document by using voice commands.

Click the play button on the following eTIPS video icon to learn how easy it is to use voice commands to navigate within your document.

The following table shows some of the basic voice commands available for navigating within your document.

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Did you know there is a solution for Text and Graphic Commands that are not functioning properly in published Citrix applications when using Dragon Medical Network Edition?

This issue has been reported across different EHRs for the Dragon Medical Network Edition (DMNE) product. The symptom is that Dragon successfully recognizes custom Text and Graphics commands, but these commands fail to insert their text and graphics content within Citrix published applications, including DragonPad.

This issue may be intermittent in some cases. The published target application is presented as having Full Text Control (Select and Say) capability, and the Dragon Text and Graphics command name is recognized in the Dragon Results Box, bordered in blue, as a command. As well, these Text and Graphics commands seem to function successfully in locally installed target applications. Also note that Dragon Step-by-Step custom commands seem to function successfully in the Citrix published application.

To resolve, try changing the following setting in NMC (Nuance Management Console):

1. Under the NMC, navigate to Site Details > Dragon Settings > Insert Text & Graphics command using…
2. Ensure this setting's value is set to the default value Type keys (Shift+Insert).
3. Have the Dragon client users log out and back in.

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Did you know general recognition delays in Dragon Medical Practice Edition can be resolved by changing CPU Affinity and Processor Priority?

The Dragon Medical Practice Edition, version 11, is designed to support multiple CPU cores on a client workstation. However, there may be scenarios where multiple CPU cores can cause recognition performance issues. Symptoms can be manifested as latency or delays (up to 60 seconds) for recognized text, presented correctly in the Dragon Results Box, to be populated to the target application. This delay may occur in the Dragon Dictation Box as well.

In this case, the Dragon natspeak.exe process may run more efficiently if it is assigned to use a decreased number of CPU cores. For example, if this issue is reported on a dual-core processor, then configuring the natspeak.exe process for CPU Affinity to run on a single CPU core may improve or resolve performance issues.

Running the natspeak.exe process at a higher Priority is also suggested. In the recommendation below, the Priority is raised from “Normal” to “High”.  Changes to the CPU Affinity and Priority for the natspeak.exe process can be tried separately or together.

The following are step-by-step instructions about how to set the natspeak.exe file to use a specific CPU with a priority level of high:

1. Browse to C:\Program Files\Nuance\NaturallySpeaking11\Program.
2. Right-click on natspeak.exe and select Send To>Desktop (create shortcut).
3. Browse to the newly created shortcut on the desktop Shortcut to natspeak.exe.
4. Right-click on the icon and select Properties.
5. Under the Shortcut tab, modify the Target field with:
   
   C:\Windows\system32\cmd.exe /c start /high /affinity 1 natspeak.exe
   
   Note: As "affinity 1" corresponds to CPU 0, this may conflict with the operating system usage of CPU 0, and therefore require that another CPU be used like "affinity 2" which corresponds to CPU 1.
   
   
6. Click Apply and OK to exit.
7. Exit Dragon and re-launch using the new shortcut.
8. Confirm the above changes have occurred by right-clicking the natspeak.exe process in the Windows Task Manager

CPU Core Affinity choices are shown below (/affinity #):

Processor Priority choices are shown below:

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Did you know there is a solution for the Dragon Medical User Profile error: “The user/local cache files…be accessed”?

The following errors presented when attempting to open a Dragon Medical User Profile. These errors can occur for multiple reasons.

• The user files you have selected cannot be accessed.
• The local cache files for the user you have selected cannot be accessed.

These can occur when a user doesn't have sufficient privileges to use the files or because the files are currently being accessed by another program.

Pursue the recommendations below to resolve this issue:

1. Close the same Dragon user currently logged in at any other workstation(s).
2. Confirm that the Profile folder structure is not being accessed by another application, including Windows Explorer or any text editor. Windows Explorer from any workstation accessing the folder structure can lock the Profile and therefore should be closed.
3. Check the profile folder structure for any username.lck files, or folder/file names with _DgnRenamed appended.
• username.lck is commonly found under the Profile's \Current sub-folder and can simply be deleted. Search for this string over the entire profile folder structure.
• _DgnRenamed can be appended to any profile sub-folder or file. It is commonly seen as \[input device]_container\aoptions.ini_DgnRenamed or \current\options.ini.DgnRenamed. Search for this string over the entire profile folder structure.
• If the unappended file is also present, compare the modified dates for both files and retain the most recent file which will require renaming both files.
• Otherwise, if the unappended file is not also present, simply rename that file by removing the "_DgnRenamed" string.
• If a folder name is appended, simply rename that folder by removing the "_DgnRenamed" string.
• Dragon places a lock on the folder structure and certain files while synchronizing, saving, and updating the Profile. The presence of the above appended files/folders means that process was somehow interrupted. The causes include:
• The user shutting the workstation down ungracefully, resulting in Dragon not being able to complete its own proper closure of the user's profile (most common).
• Network drop-out / latency issues.
4. Verify that each Windows user account has the appropriate Read/Write/Modify NTFS permissions to the entire Dragon local/locally-cached, and master roaming folder structure (including the Delete Subfolders and Files permission).
5. Add the proper file exclusions for Dragon Medical to all antivirus/malware/security software. This should include the complete profile folder structure for all subfolder and files:

For Windows XP…

• All Files/Folders in C:\Program Files\Nuance
• All Files/Folders in C:\Documents and Settings\All Users\Application Data\Nuance
• All Files/Folders in C:\Documents and Settings\[windows login account]\Application Data\Nuance

Windows Vista / 7…

• All Files/Folders in C:\Program Files\Nuance
• All Files/Folders in C:\ProgramData\Nuance
• All Files/Folders in C:\Users\Dragon\AppData\Roaming\Nuance\

Local cache location (if configured for a custom value and different from the above defaults).

Master roaming profile location.

6. Temporarily disable Antivirus Real-time or Endpoint protection modes to isolate this as a cause.
7. Eliminate any other application or process from locking that profile folder structure (including Windows Explorer, Dragon Acoustic and Language Model Optimization, Antivirus/Security/Malware software, IT backup software, etc.)
8. Try renaming the locally-cached Dragon profile on the workstation. DMEE (Enterprise Edition) Roaming configurations and DMNE (Network Edition) maintain a copy of the master roaming profile on the client workstation.
9. Review the Windows Event Viewer logs on the client workstation, and, if applicable, on any servers where Dragon profiles are stored. Look for evidence of errors or interference with Dragon Medical by another process.

If the problem's source cannot be identified, then the next time this occurs, Dragon Medical Technical Support will need to review the dragon.log file and remotely look at the profile folder structure.

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Nuance Healthcare Conversations 2012

Nuance is excited to announce that registration is now open for Nuance Healthcare's 2012 User Conference, Conversations Healthcare 2012. This year’s conference will be held at the luxurious ARIA Resort in Las Vegas, Nevada from April 22 - 25, 2012.

Conversations Healthcare 2012 is the most effective way to expand your knowledge, network with your peers, and gain valuable continuing education credits. As with prior years, the agenda is filled with customer presentations sharing best practices and strategies to reduce turnaround time, lower costs and improve efficiencies. New this year, you'll hear about Computer Assisted Physician Documentation and Quality Analytics; two new innovations Nuance Healthcare is delivering to address the upcoming transition to ICD-10. As always, ample time is made available for you to network with your peers and gain insights into how they are using Nuance Healthcare's solutions to their advantage.

So mark your calendars now and start planning for what will be an exciting event.

Click here for additional information and to register!

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What's New

For a complete listing of all updates for all released versions, login to iSupport and search for solution: 14274 "What's New in Dragon Medical Software and can I Download the Current Version?" If you are not an iSupport subscriber, click iSupport Timesaver for information on how to get started with iSupport.

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iSupport is a Proven Timesaver

iSupport is an Internet based support site where you can search our dynamic knowledge base for answers to your questions, access our library of operational manuals and quick reference guides, view the latest product enhancements, and submit online requests for service.

iSupport Knowledge Base Content Update:
A number of important knowledge base articles have been added or reissued with updated information to iSupport, as follows:

• 14612 DMEE Optimizer Scheduler errors and Windows Scheduled Tasks log (reissued 2/2/12)
• 14111 Dragon Medical Enterprise Network Edition User's Guides (reissued 2/1/12)
• 14235 Security of NuanceLink License & Update Servers (reissued 1/26/12)
• 14274 What's New in Dragon Medical Software and Can I download the current version? (reissued 1/23/12)
• 14645 DMNE Text and Graphics Commands not recognized in published Citrix applications (reissued 1/18/12)
• 14281 Dragon Medical NuanceLink Medical Updates (reissued 1/18/12)
• 14301 Did you know, after installing Adobe Reader X you may get errors "Sendkeys_Cancelled" or "HOOKERR_NONOTIFY" when using select and say commands within Dragon or while correcting words? (reissued 1/13/12)
• 14612 DMEE Optimizer Scheduler errors and Windows Scheduled Tasks log (reissued 1/12/12)
• 14205 Problem caused by Windows Presentation Foundation Host (reissued 1/9/12)
• 14646 User Profile Errors: Dragon User/Local Cache files"…selected cannot be accessed" External

To see the details of any item on the above listing, simply log in to iSupport and search for the article number that precedes each item.

Getting Started with iSupport:
In order to use the full features of iSupport and/or to submit an online service request you need to be a registered iSupport member. Click Getting Started with iSupport - Dragon-Medical to see step-by-step instructions on how to register to become an iSupport member. You will also learn how to access and log into iSupport, configure your iSupport profile, search our knowledge base for solution, manuals and quick reference materials, and how to use iSupport to submit a request for service.

Optimize Your iSupport Profile
If you're already an iSupport subscriber, you may want to consider accessing the Getting Started with iSupport - Dragon Medical link above and view the instructions. There is valuable information which will help you optimize your iSupport User Profile, thereby enabling you to submit a service request in minimal time. You will also learn how to enable additional time-saving features, requested by our customers, on the iSupport home page.

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Contacting Support

Dragon Medical customers who have an active maintenance contract with Nuance are serviced by a dedicated Healthcare Support team available 24x7x365.

Nuance Healthcare Technical Support
This organization can offer assistance via remote on-line connectivity to your systems. It's available toll-free at 800 833-7776 via our "Say Anything" menu. So Say, "Dragon Medical Support" at the prompt.

Or save the call and access Nuance Healthcare's Support Center through our iSupport, Internet-based website at https://isupport.nuance.com. If you are not an iSupport subscriber click here to learn more about iSupport and how you may get started.

Click here to navigate to the Nuance Technical Support website for additional details on contacting Dragon Medical customer support.

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Click here to reply to this email with your comments or suggestions.

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