Saturday, March 6, 2010

Training my Dragon

We were offered a $2000 bonus to switch from dictating our office visit notes onto a cassette tape which another human then transcribes, to dictating to voice-recognition software. The software is called Dragon Naturally Speaking 10. The advantage to the office is probably cost (and yes, I am worried about the ladies who've been doing our transcription, but also a little mad at them for deciding to eliminate all apostrophes a few months back; I dont like things that make ME look poorly schooled). The advantage to all of us is an instant record; no waiting days to weeks--usually weeks--for the chart note to come back, be checked (apostrophes added) and signed off by us, and then to be pasted into the paper chart. It's all part of our move to electronic medical records, hereafter referred to as EMR. I think EMR will eventually be good for all of us, but the switchover is a bit like a 50-week pregnancy followed by a difficult labor.

So, for those of you who don't use voice-recognition software, I will describe some of the adventures of "training" the Dragon to hear what I am really saying. For some reason, the version the office bought is not the medical version, and, this will not surprise you, I use a lot of medical terms in my dictation. Setting aside the fact that the world might be better off if we used normal English to describe the patients' symptoms and the findings in their exams (I once said I would never use the term "erythematous" when the term "red" was available, but I have reneged for purely cultural reasons), sometimes you just need to say "paralumbar" to denote those back muscles alongside the lower spine, which often hurt. Dragon insisted it heard "parallel bars". My job is to convince it that when I say "paralumbar" I mean "paralumbar". This was a hard sell. What you do is say "select paralumbar", then it highlights the words "parallel bars" and you say "spell that" and you spell the term out for it. Then you hope it recognizes it the next time. I think it didn't. Maybe you have to do it a couple of times for it to take you seriously. I picture it thinking, "No, honey, you didn't mean that; that makes no sense. Go with me, I know what I'm doing, and you clearly don't."

A sentence I dictated something like, "The patient couldn't get his Geodon" (Geodon is a common antipsychotic drug) comes out "The patient couldn't get his jihad on." Poor guy. Dragon just lost it on "otorhinolaryngology", which I admit I spoke just to mess with it. It did recognize "ENT", so I'm going with that in the future. It has drugs it knows and drugs it doesn't. I wonder if there are prescribers who've just decided to limit their personal formularies to drugs that Dragon recognizes to save themselves misery. There is actually some medical rationale for that approach if you subscribe to the theory that old drugs are often better and safer than newer "me-too" drugs.

After I got it installed and a little bit trained, I logged off the computer, and when I logged back on, I found it wouldn't even let me in as I'd installed it with an administrator's password. My Dragon refused to recognize me as someone it had to obey, or even deal with. So I got it put on again, by a real administrator, and now I have to start training it all over again. I just keep saying to myself, "$2000...$2000....$2000...."

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