On Thursday, October 17, 2019, Nuance Communications Inc. and Microsoft Corp. announced they have joined forces to help transform healthcare delivery for a more sustainable future. Together, the companies will accelerate the delivery of ambient clinical intelligence (ACI) technologies that will power the exam room of the future where clinical documentation writes itself.

Links to the Nuance press release and the Microsoft blog are below.

• Microsoft-Nuance press release
• Microsoft blog post

These best practice guidelines include being aware of your environment, positioning your microphone, running the Audio Setup Wizard, if necessary, as well as other ways to learn and/or correct misrecognized words or phrases.

To achieve the best speech recognition results with PowerScribe One, Nuance recommends use these best practice guidelines:

Be aware of your environment

• Keep background noise to a reasonable minimum. For example, close the window to block out street noise, or turn down the volume of the radio on your desk.
• Close all other computer applications that have audio capabilities (such as Windows® Media Player or iTunes®).

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Position microphone properly for optimal speech recognition

• Hold the microphone the same way each time you use it.
• Do not dictate into the side of the microphone.

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Run the Audio Setup Wizard again

Run the Audio Setup Wizard daily if you:

• Share a workstation with others
• Work in a room with multiple workstations
• Use different workstations every day

In addition, run the Audio Setup Wizard if you have issues with speech recognition accuracy.

To run the Audio Setup Wizard:

1. Click Speech > Audio Setup.
2. Follow the instructions in the dialog boxes. The entire process should take only a minute or two.
3. Log out of the application, then log in again.

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Best practices for making corrections

PowerScribe One can "learn" new words and phrases which helps to increase your dictation accuracy, enabling you to dictate your reports more efficiently.

The following best practice topics can be applied when correcting misrecognized words or phrases.

Use the "Correct That" voice command

There are three possible scenarios provided below for using the "Correct That" voice command.

• Correction list contains the word or phrase you dictated
• Correction list does not contain the word or phrase you dictated
• Spell dialog box does not contain the word or phrase you dictated

Correction list contains the word or phrase you dictated

In this example, the word you dictated, cardiomediastinal, appears in the report as cardiomediastinum.

1. Say "Correct cardiomediastinum" to highlight the misrecognized word and open the correction list.

   If you want to select more than one word, use the "Select <x> through <y>" voice command, followed by the "Correct that" voice command.

2. Say "Choose 1" to select the first item in the correction list. The correction list closes and the word you selected, cardiomediastinal, replaces the misrecognized cardiomediastinum.

Correction list does not contain the word or phrase you dictated

In this example, the word you dictated, Tekturna (a drug) appears in the report as external.

1. Say "Correct external" to highlight the misrecognized word and open the correction list.

   The word Tekturna is not in the list.

2. From the correction list, say "Spell that" to open the Spell dialog box which displays the likely correction choices from the vocabulary. Notice that Tekturna is not in this list either.
3. Begin dictating or typing the first few letters of the word. In this example, Tekturna appears in the list after typing the first three letters.
4. Use your mouse or cursor keys to select Tekturna from the list.
5. Click OK. The Spell dialog box closes and the word you selected, Tekturna, replaces the misrecognized word, external.

Spell dialog box does not contain the word or phrase you dictated

If in step 3 above, the Spell dialog box does not display your word, use the Vocabulary Editor to add and train the word or phrase.

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Use the Vocabulary Editor to Add and/or Train Words or Phrases

If you find that you still have words or phrases that are consistently misrecognized after using the "Correct that" voice command methods explained above, use the Vocabulary Editor to Add and/or Train them.

There are three possible scenarios provided below for using the Vocabulary Editor to Add and/or Train Words or Phrases.

• Word or phrase is in the Vocabulary Editor
• Word is not in the Vocabulary Editor
• Phrase is not in the Vocabulary Editor

Word or Phrase Is in the Vocabulary Editor

In this example, the word you want to locate and train is hydropelvicalectasis and is already in the Vocabulary Editor.

1. Click Speech > Vocabulary Editor to open the editor.
2. In the Written Form field, begin typing the word or phrase you want to locate and train.
3. When you find the word or phrase in the list, select it to place it in the Written Form field.
4. After finding the word, click Train and follow the instructions for training a word.

Word Is Not in the Vocabulary Editor

In this example, the word you want to train is not in the Vocabulary Editor and you want to add a custom word.

1. Click Speech > Vocabulary Editor to open the editor.
2. In the Written Form field, begin typing the word or phrase you want to locate and train.
3. If the word you are looking for does not appear in the list, type the complete word in the Written Form field. Make sure to double-check your spelling.
4. Click Add. The word appears in the vocabulary list with a red asterisk to its left that indicates a custom word.
5. Click Train and follow the instructions for training a word.

Phrase Is Not in the Vocabulary Editor

In this example, the phrase you want to train is not in the Vocabulary Editor and you want to add a custom phrase.

1. Click Speech > Vocabulary Editor to open the editor.
2. In the Written Form field, begin typing the phrase you want to locate and train.
3. If the phrase you are looking for does not appear in the list, close the Vocabulary Editor.
4. Select the misrecognized phrase from your report and say, "Spell that." The Spell dialog box opens.
5. Follow the instructions for adding and training a phrase.

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Use AutoCorrect

1. Click Tools > Preferences > AutoCorrect.
2. Type the word or letters that you want to use when dictating into the Replace field. For example, HRMC.
3. Type the words you would like to see in your report in the With field. For example, Holmes Regional Medical Center.
4. Click Add.
5. Click OK.

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Adjust the Speed vs. Accuracy Control

1. Click Speech > Options and select the Miscellaneous tab.
2. Drag the Speed vs. Accuracy slider using the following guidelines:
   • Minimum position should be set to approximately the 50% mark on the slider bar.
   • Maximum position should not go beyond 70% on the slider bar.

      

1. Check permissions on the required folders:
• C:\ProgramData\Nuance

Users should have full rights to this folder and all subfolder.

2. Check the Antivirus exclusions are set correctly.
   
   For more information about Antivirus Exclusions, see Knowledge Article 12788 Files and Folders Acted Upon by the PS360 Client and Servers available on the Nuance Healthcare Community.
3. Reboot the workstation.

Some common PowerScribe 360 Client error messages you may receive and are able to fix by yourself are shown below:

“Application cannot be started. Contact the application vendor.”

To fix this issue:

1. Click OK to close the error window and exit the PowerScribe 360 Reporting Client.
2. Start the Task Manager.
3. On the Process tab, find and right-click DFSVC.exe and select End Task to stop the process.
4. In C:\Users\Username\AppData\Local\Apps, find the folder named 2.0.
5. Rename the 2.0 folder to 2.0old.
6. Relaunch the PowerScribe 360 Reporting Client.

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“An error occurred trying to load speech files. Speech functionality will be disabled:

Unable to create speaker 'xxxxx' with a dictation source of 'dgndictsrcPowerMic II' and an acoustic model of 'US English | PS360 BestMatch IV'.”

To fix this issue:

1. Click OK to close the error window and exit the PowerScribe 360 Reporting Client.
2. Attempt to log in to the PowerScribe 360 Reporting Client again, but this time hold down the left SHIFT key when clicking on the Login button. This will force the PowerScribe 360 Reporting Client to download a new copy of the user’s Dragon profile and replace the local copy.
3. If the above step above does not work, then restore the user’s speech profile from checkpoint.

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“An error occurred trying to load speech files. Speech functionality will be disabled:

The speech engine returned the following error:
Unexpected”

This error can be caused when files are missing in the speech profile on your PowerScribe 360 Reporting application server, such as the Current\US_Engli\token_d.enh file.

To fix this issue:

1. Restore the entire user’s speech profile from checkpoint.

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“An error occurred trying to load speech files. Speech functionality will be disabled:

The speech engine returned the following error: 148”

This issue is related to a mismatch between the installed version of Dragon in PowerScribe 360 Reporting Client (Radiology, Transcription or Medical) and the Language Model (LM) selected for the user/account trying to log in to the Client in RadPortal: Setup > Accounts. The LMs need to match.

To fix this issue:

• Uninstall Dragon and reinstall the correct version of Dragon for the PowerScribe 360 Reporting Client installed version.

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“An error occurred trying to load speech files. Speech functionality will be disabled:

COM returned an unexpected error code: Details are Access is denied. (ERROR_ACCESS_DENIED, 5)”

This issue is typically caused by permissions on the C:\ProgramData\Nuance folder not being set properly.

To fix this issue:

1. Ensure that everyone has FULL permissions against the folder and subfolders.
   
   Less commonly, this can be caused by a process (such as anti-virus) accesses that directory.

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“An Unexpected error occurred:

Only one usage of each socket address (protocol/network address/port) is normally permitted.

Click Retry to continue or Cancel to terminate the application”

Or

TCP port 9090 is in use by another application on this computer. Remoting to this instance will be disabled.

Error: Only One Usage of each socket address (protocol/network address/port) is normally permitted”

These errors mean that another application is using the same port of 9090 on the workstation.

This is commonly caused by another instance of PowerScribe 360 Reporting running under a different Windows user.

To fix this issue:

1. Start the Task Manager.
2. On the Process tab, find and right-click each instance of Nuance.PowerScribe360.exe and select End Task to stop them from running.
3. Alternatively, you can reboot the workstation.

If the above resolutions do not resolve your issue, log in to the Nuance Healthcare Community, log a support case, or telephone Nuance Support for assistance.

 

To help a user who did not receive a password reset email:

1. Verify if the password reset email is in one of following email folders:
   • Email Spam Filter (Local and Domain)
   • Email Junk Folder (Local and Domain)
2. If the password reset email is in either the user's spam or junk folder, ask the user to follow the instructions provided in the email to setup their password, or request a password reset if the allowed 72 hours to setup a password has expired.
3. If the password reset email is not in the user's spam or junk folders, ensure that the user's account is provisioned.
4. Click www.NuanceActionableFindings.com to log in to the PowerConnect Actionable Findings.
5. From Accounts, select Manage Account Provisioning.
6. Search by User Type, and First/Last Name.
7. From Actions, click the Start Provisioning link.
8. On the Start Provisioning dialog, enter the correct email address in the Email field, and click Start Provisioning.

   

   If the user has already been provisioned, but did not complete the provisioning, a Resend Notification link displays.

   

9. Click the Resend Notification link. A password reset email is sent to the user with instructions.
10. Ask the user to open the email and to follow the instructions in the email to setup their password.

 

You need to make sure to select the correct RVU Types or you may see unexpected results.

For example, run a report and select the RVUs Types:

1. Log in to mPower and click mPower Analytics.

   

   The Radiology Analytics window displays.

   

2. From the Volume drop-down list, select Relative Value Units.

   

   A list of the available RVU Types appear.

   

3. In this example, select the RVU Type Work (Professional) from the list. As you can see in this example, there are 3 different Work RVU types.

   The Value column shown below provides different values for each  “Work” RVU Type.

   

   If you see a value that you did not expect, check to be sure you selected the correct RVU Type from the list.

 

To register for your free Spoke account today, contact outreach@nuancepowershare.com. Our Outreach Team makes the registration process easy. They are already familiar with the facilities in your area and can get your account connected and sharing images/reports with surrounding hubs in no time.

Spokes are non-Nuance clients with PowerShare facility accounts that can share images with hubs.

Hubs is a Nuance client, where a facility on PowerShare can share images with other Hubs and Spokes.

The difference between the two is that Hubs have contracts that allow them to host an unlimited number of studies uploaded to PowerShare; whereas, Spokes have a limited number of studies they can host (200 lifetime studies).

 

Completing these courses will give you the necessary knowledge and skills for your role as a clerk or administrator on the PowerShare Network.

To get started, download our Nuance University Training Guide that provides all the information about these free learning resources.

 

To change your email notification preferences:

1. Log in to your PowerShare account and click Account Settings. This option can be found in the drop-down context window beside your name at the top right-hand side of your screen as shown below:

   

   The following page displays:

   

2. Click the Notification Preferences email icon.
   

3. On the Change Email Notification Settings page, you can check the boxes for the email notifications that you would like to receive and uncheck the boxes for the email notifications you no longer want to receive.

   

4. Click Save to apply your updated email preferences.

   NOTE: With the exception of Batch Upload notifications, the options you uncheck will only affect the email notifications. All other messages will still appear in the Messages tab of your account.

Default-enabled Notifications Preferences

Facility Users:

• Messages are sent to me
• Contact requests are sent to me
• Image sets are requested from me

Physicians:

• Messages are sent to me
• Contact requests are sent to me
• Image sets are shared to me

Patients:

• Messages are sent to me
• Contact requests are sent to me

 

The most common matching criteria is Study Description.  However, more and more cases now show that different manufacturers are using different values. 

Each port within ModLink can only define one Matching Criteria. Therefore when setting up a new modality, if the matching criteria matches what is defined for an existing port, you can have it sent to that port. 

However, if it matches based on a different value, you need to set up a new port and select the correct option in the Matching criterion drop-down selection.

If you choose incorrectly, you can expect to see a new item coming in on that port without a value listed in the Matching Data Field.