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Dragon Medical One is now available in the Epic electronic medical records system for prescribers across Johns Hopkins Medicine. Early reviews have been positive for the voice recognition tool, introduced as part of the Joy at Johns Hopkins Medicine initiative.

The system, available since Nov. 14, adds text in Epic when the user speaks into a microphone on a mobile device. Clinicians are using it to take notes during their patient encounters, providing the double benefit of letting patients hear the notes, while reducing the time spent adding and editing them — time that might otherwise be required during evenings and weekends.

“Dragon Medical One in Epic permits real-time, quality transcription,” says internist Joseph Cofrancesco Jr. “I can close my note after seeing a patient and not have this hanging over me.”

Dragon Speech Recognition Medical Transcription

Providers will see the Dragon icon on the Epic tool bar, as well as a Learning link that takes users to the Learning Dashboard with more Dragon Medical One resources.

To use Dragon Medical One, clinicians can speak through the headset attached to the clinical workstation, or use their smartphone by installing the PowerMic Mobile app to their mobile device, using either Workplace ONE Intelligent Hub or the Microsoft Intune Company Portal. In areas with a lot of background noise, such as emergency departments or intensive care units, a microphone or headset attached to the clinical workstation may work better than the PowerMic Mobile app.

“I have been incredibly impressed by how accurate the dictation is,” says Nestoras Mathioudakis, clinical director for endocrinology, diabetes and metabolism. “It recognizes the medical terms and the names of the medications that I use.”

Below are some Dragon Medical One tips provided by Michelle Campbell, administrator for ambulatory operations for Johns Hopkins University School of Medicine, and Danny Lee, chief medical informatics officer at Johns Hopkins Community Physicians.

1. Use the microphone wisely. The microphone on your phone works best when it’s about 1 to 3 inches from your mouth and off to the side. Press and hold the microphone button for a half-second before talking. Speak directly into the microphone, not across it.
2. Speak naturally. Talk clearly, at a normal pace and using complete sentences. Dictate commands and punctuation, for example saying the words “colon,” “new paragraph” or “end sentence.” Pause briefly before and after a command. For a list of commands, ask, “What can I say?” ​
3. Use the auto-texts feature for frequently used language. To create an auto text, say, “Manage auto texts” or navigate there through the Dragon Medical One button. When the dialogue box opens, click + and enter what you want to say to access the material, such as, “Insert pain medication instructions.” In the “content” box, write the material that you want to appear when you say the word. Special characters are not allowed, and acronyms must be in all capital letters, with spaces between. Then click “apply all” and close. Tip: You don’t need to fill in the description field.
4. Try the speech focus feature. This lets users dictate in one application while opening and closing others. To access it, click the blue Dragon Medical One button and go to options, then general, then check the box that says “anchor the speech focus when recording is started.” Click “apply all” and close.
5. Add words you commonly use. It’s easy to add words to your vocabulary list — for example, teaching Dragon Medical One that when you say “jay hock” it should write JHOC. Either say, “Manage vocabulary” or navigate there through the Dragon Medical One button. Click + and enter the desired word in the dialogue box that pops up. Click the microphone button to record the word, then click “confirm” and close the box. You can also correct text by highlighting the word, which will open a corrections box.
6. Log out at the end of your session. You do not want another provider to use Dragon Medical One and mess up the voice recognition it has developed for you.
7. Don’t get intimidated. You don’t need to use every feature and shortcut right away. Just get started, and over time make the changes you want.

Speech recognition has its origins way before computers as we know them existed. Back in the 1880s Alexander Graham Bell invented a way to record speech onto wax cylinders. Others improved on the technique, moving through technologies like plastic and magnetic tape.

When computers became sophisticated enough to include memory and processing capabilities, speech recognition took some giant steps forwards. But early speech recognition was limited to very small vocabularies, and had to be trained with specific voices. They used pattern matching techniques.

A new way of working

When mathematicians Dr Jim Baker and Dr Janet Baker decided to work on speech recognition, they changed the paradigm, using predictive techniques to help with recognition. They launched Dragon Systems in 1982. Several products later, in 1997, came Dragon Naturally Speaking, the first continuous speech recognition software. Users could speak in their natural way without leaving pauses between spoken words.

Still, even at this time, users needed to familiarise the software with their voices, going through a short training regime involving reading texts aloud into the system.

In 2006 came another major breakthrough, with the release of Dragon Naturally Speaking 9. For the first time users did not have to go through an initial enrollment and speech recognition was up to 99 percent accurate right out of the box. Users could literally install the software and start dictating right away.

Expanding technological horizons

In 2007, Dragon celebrated its 10^th birthday, and could now boast the ability to recognize 160 words a minute with 99 percent accuracy. Dragon had also gone international, being available in English, Dutch, French, German, Italian and Spanish. And in the previous year special editions of Dragon Naturally Speaking had been introduced for the medical and legal professions, allowing those sectors to benefit from sector-specific language recognition.

These breakthroughs are all the more remarkable when we consider what else was happening in the world of technology in 2007 – it was a long way away from today’s technology landscape:

Dragon Speak Medical Edition

• Apple launched the first iPhone (the iPad didn’t come along until 2010, Android made its first appearance in a commercially available phone in 2008)
• Hitachi introduced the world’s first 1TB hard drive
• Amazon released its first Kindle in the US (The Kindle became available outside the US in 2009)

In the years between then and now, Dragon has gone on to embrace new technologies as they have been developed. For example, Dragon has utilised Deep Learning techniques to improve its ability to recognise individual’s speech patterns, improving its predictive ability and thus its speed and its accuracy.

Meanwhile the rise and rise of smartphones has opened the way for a new Dragon application – Dragon Anywhere – which was launched in 2015. Dragon Anywhere runs on Android and iOS. It can access personalised standard phrases and commands, using cloud to synchronize with Dragon back at the office. This means users can start a dictated document on the move, and finish it back at the office.

Dragon Medical Dictation Software

In those early days of the 1980s smartphones, cloud computing, artificial intelligence and other aspects of computing that we take for granted today did not exist. Dragon has embraced them all in pursuit of its mission to increase documentation productivity and improve work processes so that customers can save time and money, improve customer service and work towards their own goals for success.