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Admin is about to cut our transcriptionists and likely we'll be forced into transitioning to Dragon. Any experienced users out there with advice?
Who uses Dragon for dictations?
- Thread starter Napoleon1801
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I looked into DRAGON and the reviews and anecdotal comments concerning it and pathology were uniformly negative.Those who tried it abandoned it post haste.
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Using voice recognition software like Dragon significantly increases the risk of major errors, like missing the word "not".
I find it easier and faster to just type my reports as then I do not have to parse through them with a fine toothed comb looking for syntax errors.
I find it easier and faster to just type my reports as then I do not have to parse through them with a fine toothed comb looking for syntax errors.
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I use Dragon -- previously Dragon Medical Network Edition and now Dragon Medical One.
If you are using it as a pure dictation solution, you are going to burn time. However, as an automation solution (e.g. dragon commands/canned text/macros/whatever-you-wanna-call it) it works fairly well. With DMNE (which can send mouse clicks and such) I had it tuned it pretty well to get navigate the LIS, get a diagnosis in, and signed out. DMO is a little more limited in that it can't drive the computer as seamlessly (it is more integrated with EPIC than with the PC as a wholes), so you can't automate to the level you can with DMNE, but still works pretty well.
IMHO, the key to these pieces of software is to use them as a command center, not as a dictation tool. E.g; I have dragon commands that enter EPIC dot phrases. Once I drop into "dictation mode", things get squirrely quickly and requires careful reading.
I sign out (at times) in up to 4 or 5 LIS's in a day, so I actually have been migrating my canned texts to a more keyboard based macro product that can work on top of whatever LIS I happen to be in (and doesn't require admin privileges to install/use) -- it's an older program (Breevy at Text expander for Windows - Breevy) which costs a whopping $35 (although I got for $5 in a humble bundle). That one is nice because it is pretty agnostic with respect to LIS -- although for some reason it doesn't like SOFT AP (then again...who does?) over Citrix.
If you are using it as a pure dictation solution, you are going to burn time. However, as an automation solution (e.g. dragon commands/canned text/macros/whatever-you-wanna-call it) it works fairly well. With DMNE (which can send mouse clicks and such) I had it tuned it pretty well to get navigate the LIS, get a diagnosis in, and signed out. DMO is a little more limited in that it can't drive the computer as seamlessly (it is more integrated with EPIC than with the PC as a wholes), so you can't automate to the level you can with DMNE, but still works pretty well.
IMHO, the key to these pieces of software is to use them as a command center, not as a dictation tool. E.g; I have dragon commands that enter EPIC dot phrases. Once I drop into "dictation mode", things get squirrely quickly and requires careful reading.
I sign out (at times) in up to 4 or 5 LIS's in a day, so I actually have been migrating my canned texts to a more keyboard based macro product that can work on top of whatever LIS I happen to be in (and doesn't require admin privileges to install/use) -- it's an older program (Breevy at Text expander for Windows - Breevy) which costs a whopping $35 (although I got for $5 in a humble bundle). That one is nice because it is pretty agnostic with respect to LIS -- although for some reason it doesn't like SOFT AP (then again...who does?) over Citrix.
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I used recently at a locums job. Horrific. Made grossing and sign out 10x longer. Honestly in the age of ours I'd rather type.
Screw Dragon. Run for the hills. Do they make the surgeons mop the OR floor? Why make pathologists use Dragon.?
I would honestly put a disclaimer at the end of every report saying:'
THIS REPORT DICTATED WITH VOICE RECOGNITION TECHNOLOGY AND ERRORS ARE EXPECTED.
QUOTE ME HERE, SUBPOENA ME FOR COURT. I WILL SHOW UP AND CRAP ON ALL OF THIS.
WOE THE LOSS OF OUR BEAUTIFUL TRANSCRIPTION SERVICES. LIKE MICHELANGELO LOSING HIS BRUSHES.
Screw Dragon. Run for the hills. Do they make the surgeons mop the OR floor? Why make pathologists use Dragon.?
I would honestly put a disclaimer at the end of every report saying:'
THIS REPORT DICTATED WITH VOICE RECOGNITION TECHNOLOGY AND ERRORS ARE EXPECTED.
QUOTE ME HERE, SUBPOENA ME FOR COURT. I WILL SHOW UP AND CRAP ON ALL OF THIS.
WOE THE LOSS OF OUR BEAUTIFUL TRANSCRIPTION SERVICES. LIKE MICHELANGELO LOSING HIS BRUSHES.
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We use Dragon Medical Practice Edition. We use it for voice commands/to drive automation as described by chooks above and also to dictate all reports. We certainly have a lot of templates/canned comments, but not for every single thing. I appear to be in the minority here, but I think it does a decent job dictating my speech and I personally find it faster to be able to simultaneously dictate into a headset while looking at slides vs looking at the slides first, then moving my chair over in front of the keyboard and typing afterward. I also typically dictate the responses for synoptic reports and some longer text comments as well.
FYI - I am an adequate typist (I don't really need to look at my hands at all while typing), not someone who types with single-fingers and/or has to hunt for letters.
I would also note that it was NOT faster to dictate vs type AT FIRST. It took a lot of up front effort to get Dragon into a state where it actually became useful. I had to add many words to the vocabulary editor, adjust a few settings for numerals/digits to my liking, and also use the "correct ___" and "spell ___" trainers frequently at first. It did eventually learn the terminology and phrases I use commonly and NOW it is faster than typing. I probably had less difficulty than some other folks would, as English is my first language and I have what most would consider very minimal to no regional accent.
FYI - I am an adequate typist (I don't really need to look at my hands at all while typing), not someone who types with single-fingers and/or has to hunt for letters.
I would also note that it was NOT faster to dictate vs type AT FIRST. It took a lot of up front effort to get Dragon into a state where it actually became useful. I had to add many words to the vocabulary editor, adjust a few settings for numerals/digits to my liking, and also use the "correct ___" and "spell ___" trainers frequently at first. It did eventually learn the terminology and phrases I use commonly and NOW it is faster than typing. I probably had less difficulty than some other folks would, as English is my first language and I have what most would consider very minimal to no regional accent.
My group as a whole switched to Dragon. I prefer to type. Can't say I really gave Dragon too much of a chance, but my quicktexts are so fast to type in and sign out that I can't see how it would be faster to say them.
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Euchromatin: How is dragon at grossing when you have poop and blood all over your gloves?
D
deleted314957
Hey, you’re making me all nostalgic here!
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I'm in fairly large group so none of us gross routinely. Our PAs seem to manage with it just fine and the number of voice recognition errors I find seems to be about the same as the number of clerical errors/typos I'd find when I was at other places that had transcriptionists (YMMV). I'm pretty sure you're just joking, but, if not, I don't see how dictating into a speaker attached to a dictaphone (covered in plastic) at your grossing station vs typing (on a keyboard covered in plastic) or dictating into a headset (which you put on before grossing while your hands are still clean) with Dragon would be significantly different while one has "poop and blood all over your gloves."
In case anyone legit wanted more details - Our PAs put in the gross description template for whatever kind of specimen it is into the case (we have templates for the vast majority of specimens we receive) and then the only things they actually have to dictate are weights/measurements, a few words of description here and there, and the section code/cassette summary. The keyboards and mice at our grossing station computers are only used while wearing gloves and there are thick plastic covers over the keyboards - just like the dictaphones and/or various computer inputs in literally every other gross room I've ever used or seen.
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Not joking.
None of us gross routinely? Whew don't say that in court.
I gross. No PA's in the ass crack of the planet where death dwells. After years of doing this, they can't compete. I find so much secondary pathology and tumors I really question the utility of PA's compared to an expert. Sounds conceited but I mean it. I find pathology I question if my partners would have discovered, I suspect not.
I've used Dragon at some gigs and for grossing I find it horrific. There were no plastic coverings for anything and as I mentioned, blood and turds get on everything, and some are not as clean as I am. I probably used 10x the amount of gloves because the dictation was absolute crap during grossing and have to go back and type key measurements etc. I am blessed currently with a transcriptionist at my current gig. Dragon for sign out is better as there is a more of comfort area (chug a coke, smirk at a mirror of yourself, etc.).
I honestly contend there should be a disclaimer on such path reports that voice recognition technology was used and there are likely errors, much like the radiologists have on their reports if one has ever examined those.
I feel Dragon has turned everyone into secretaries. Templates or no.
None of us gross routinely? Whew don't say that in court.
I gross. No PA's in the ass crack of the planet where death dwells. After years of doing this, they can't compete. I find so much secondary pathology and tumors I really question the utility of PA's compared to an expert. Sounds conceited but I mean it. I find pathology I question if my partners would have discovered, I suspect not.
I've used Dragon at some gigs and for grossing I find it horrific. There were no plastic coverings for anything and as I mentioned, blood and turds get on everything, and some are not as clean as I am. I probably used 10x the amount of gloves because the dictation was absolute crap during grossing and have to go back and type key measurements etc. I am blessed currently with a transcriptionist at my current gig. Dragon for sign out is better as there is a more of comfort area (chug a coke, smirk at a mirror of yourself, etc.).
I honestly contend there should be a disclaimer on such path reports that voice recognition technology was used and there are likely errors, much like the radiologists have on their reports if one has ever examined those.
I feel Dragon has turned everyone into secretaries. Templates or no.
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The reports at my training institution included a disclaimer much like the one you have suggested.
I use Dragon at my workplace for cut-up / grossing, and it was very, VERY innacurate at the start. On my very first day at work this year, I quite literally only did 10 blocks of biopsy transfers in one hour because Dragon made so many mistakes; I would've been better off typing, even with the gloves on.
It took at least 3 months of voice calibration, and EXTREMELY heavy use of macroscopic templates to reduce the number of dictation parameters (and subsequent Dragon errors), to make it tolerable for grossing 5 days / week. Some of my templates (especially for skin) are so specific that I only have to dictate the measurements, and I think by now Dragon recognizes the numbers with my accent.
I also create lots of templates in which I say one or two words, and it prints out a sentence. This is because Dragon refuses to, or is extremely slow to recognize my pronunciation for a specific word within that sentence, even with copious voice calibration.
Eg I say "blue blue" to say "The resection margin was inked blue."
If I manually say "The resection margin was inked blue.", half the time the inked shows up as "into" which really annoys me.
Having a North American accent would also help, but I doubt that's an issue for you.
It also depends on whether you have the "Professional" (ie normal / non-medical) version, or "Medical Dragon".
I'm lucky that any Dragon errors I make in cut-up / grossing get corrected by the consultant, but I worry that the consultants themselves might make Dragon errors on histology that show up in the report when it gets signed off...
Here are some errors from Dragon that I've noticed this year so far:
abuts - "a butt"
an unoriented skin - "and oriented skin" (my pet peeve!!!)
antrum - "and trim"
four / 4 - "for" (have to say "numeral four")
GORD ("gee oh are dee", or GERD in US) - "G IRD" (Dragon puts a space between the G and the IRD for some reason)
next field - "click field" (my 2nd pet peeve!!!)
pale tan - "pale 10"
parasaggitally - "Paris and Italy" (pretty cute
)
polyp Bx - "polyp sex"
sebaceous cyst - "masturbation" ( imagine if this showed up in the validated report!!! )
serosa - "Sarah Rosa", "zeros ah"
the - "duh"
vaginal sinus - "virginal sinus"
wart - "what"
It took at least 3 months of voice calibration, and EXTREMELY heavy use of macroscopic templates to reduce the number of dictation parameters (and subsequent Dragon errors), to make it tolerable for grossing 5 days / week. Some of my templates (especially for skin) are so specific that I only have to dictate the measurements, and I think by now Dragon recognizes the numbers with my accent.
I also create lots of templates in which I say one or two words, and it prints out a sentence. This is because Dragon refuses to, or is extremely slow to recognize my pronunciation for a specific word within that sentence, even with copious voice calibration.
Eg I say "blue blue" to say "The resection margin was inked blue."
If I manually say "The resection margin was inked blue.", half the time the inked shows up as "into" which really annoys me.
Having a North American accent would also help, but I doubt that's an issue for you.
It also depends on whether you have the "Professional" (ie normal / non-medical) version, or "Medical Dragon".
I'm lucky that any Dragon errors I make in cut-up / grossing get corrected by the consultant, but I worry that the consultants themselves might make Dragon errors on histology that show up in the report when it gets signed off...
Here are some errors from Dragon that I've noticed this year so far:
abuts - "a butt"
an unoriented skin - "and oriented skin" (my pet peeve!!!)
antrum - "and trim"
four / 4 - "for" (have to say "numeral four")
GORD ("gee oh are dee", or GERD in US) - "G IRD" (Dragon puts a space between the G and the IRD for some reason)
next field - "click field" (my 2nd pet peeve!!!)
pale tan - "pale 10"
parasaggitally - "Paris and Italy" (pretty cute
)polyp Bx - "polyp sex"
sebaceous cyst - "masturbation" (
imagine if this showed up in the validated report!!! )serosa - "Sarah Rosa", "zeros ah"
the - "duh"
vaginal sinus - "virginal sinus"
wart - "what"
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As a rad who lives in PS360, the only thing I have to add is to mercilessly prune your vocabulary lists. Delete the words that you never want it to say (masturbation etc) and once it has fewer options to decide between when deciphering our mutterings, it usually gets better.
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I jerk dictated this using Dracula.
More Dragon errors this month:
Ganglion of the left wrist - "Dangling of the left breast".
Ureteritis - "You are to write to us".
A fresh sample was sent for flow cytometry prior to formalin being added - "A fresh sample was sent for flow cytometry prior to fondling being added".
Right lipectomy - "Write an Ipaq to me".
Hepatic flexure polyp - "Hepatic sexual polyp".
Ganglion of the left wrist - "Dangling of the left breast".
Ureteritis - "You are to write to us".
A fresh sample was sent for flow cytometry prior to formalin being added - "A fresh sample was sent for flow cytometry prior to fondling being added".
Right lipectomy - "Write an Ipaq to me".
Hepatic flexure polyp - "Hepatic sexual polyp".
emilyfromcolumbus
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Hi! I just downloaded Breevy as it was also recommended to me. I figured out how to input all of my phrases and abbreviations but can't seem to figure out how to turn the feature "on" so to speak. I'm assuming it's a relatively simple solution, but I've been waiting back to hear from their help desk and haven't heard a peep. Do you think you might be able to give me a quick rundown on how to do this? Thanks!
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I use the most current version of Dragon medical and it has its pros and cons, as with anything else. Digital dictation, in any iteration, presently is horrifically inadequate for grossing. What should be a seamless stream of dictation with simultaneous manipulation and dissection of the specimen turns into an awkward and tremendously inefficient experience. A 10 minute gross can easily get to be 30 min after all the errors are corrected during the grossing process. That was my experience with VoiceBrook that uses Dragon as its base dictation software.
Where I currently use Dragon with great efficiency is in my subspeciality. Rather than have the case tied up with transcription because my long cases are often the last things they do in the day, I quickly breeze through them with templates and macros and get them turned around efficiently, sometimes same day.
Where I currently use Dragon with great efficiency is in my subspeciality. Rather than have the case tied up with transcription because my long cases are often the last things they do in the day, I quickly breeze through them with templates and macros and get them turned around efficiently, sometimes same day.
D
deleted314957
the one that put me thru the roof ( only happened once) was an omission of the word “no”.
Report said “ There is (no) evidence of malignancy.” missing a typo like that is a nightmare.
The phrase “ there is evidence of malignancy” sounds fine to just about anybody except a pathologist.
Report said “ There is (no) evidence of malignancy.” missing a typo like that is a nightmare.
The phrase “ there is evidence of malignancy” sounds fine to just about anybody except a pathologist.
2mikesheree: Why not to use instead phrase "Negative for dysplasia and negative for malignancy" to avoid missing NO?
For grossing one may try eZ Grossing (https://www.interactivediagnosis.com) but it is a sort of abandoware and sometimes crashing.
Breevy has not been updated for last several years and I feel the programis not any more under active development.
I personally use Phraseexpress (www.phraseexpress.com) because it is more powerfull when compared with Breevy and runs from USB stick (see photo).
Another competitor is PhraseExpander (www.phraseexpander.com) but it does not allow to run from USB.
For grossing one may try eZ Grossing (https://www.interactivediagnosis.com) but it is a sort of abandoware and sometimes crashing.
Breevy has not been updated for last several years and I feel the programis not any more under active development.
I personally use Phraseexpress (www.phraseexpress.com) because it is more powerfull when compared with Breevy and runs from USB stick (see photo).
Another competitor is PhraseExpander (www.phraseexpander.com) but it does not allow to run from USB.
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deleted314957
Well, i’m from the era when people did the transcribing. And after 30+ years of saying “ no evidence of malignancy“ it just became too ingrained.
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