Frequently Asked Questions
Dragon Medical 10

What Healthcare Challenges Does Dragon Medical Solve?

Electronic Medical Record (EMR) systems offer the potential to dramatically improve the cost and quality of health- care. Despite their potential, however, EMR software is used by only 20% of clinicians in the U.s. today1—and less than 5% in small practices. Adoption is slower than expected in part due to:

A new, assistive technology is needed to facilitate EMR adoption, which would address clinician productivity, clinician and patient satisfaction and quality of medical record concerns.

Dragon Medical 10 is a mission-critical, enterprise speech recognition solution for all physicians, used in physician practices, hospitals, or other healthcare provider organizations. It accelerates EMR adoption, helping clinicians to navigate industrial-strength EMR packages quickly to review lab tests or past medical history while documenting care anywhere in the record.

Dragon Medical 10's seamless integration with all com- mercial EMR packages, medical specialty vocabularies and regional accent tools, and numerous other features make physicians more productive, delivering the highest quality of care while improving outcomes and economics across an entire health care enterprise.

Why Use Dragon Medical?
Here are just a few reasons why Dragon Medical 10 is for you:
• Improves the quality, efficiency, and profitability of the care you provide.

• Raises clinician satisfaction. Physicians who use Dragon Medical report that it makes the practice of med- icine more enjoyable, and that they can get home in time for dinner: no more late nights and weekends catching up on dictating/typing and signing patient charts.

• Accelerates EMR Adoption. Clinicians can dictate the “medical decision-making”—History of Present Illness, Review of systems, Assessment and Plan—while within the electronic medical record. (Dragon Medical and Medical Enterprise only)

How Does Dragon Medical Compare to Other Dragon non-Medical Products?

Nuance provides other Dragon products, such as Dragon Naturallyspeaking Professional 10 and Dragon Naturallyspeaking Preferred 10, which are excellent speech recognition products used for “general-purpose” home, business or educational use.

However, the size and scope of Dragon Medical 10’s medical vocabularies will provide a far superior dictation experience for physicians compared to Dragon Professional or Preferred.

Tests comparing products in a clinical setting show that Dragon Medical is over 38% more accurate than Dragon Professional for dictating patient records. Dragon Medical’s support of nearly 80 medical specialties and subspecialties means that you won’t encounter missing terms or phrases—they’re all there “out-of-the-box.” The lost productivity that a physician using Dragon Professional would experience would cost thousands of dollars in lost practice revenue or more than a year in time spent correcting errors or adding medical terms that are already in Dragon Medical. As a result, Dragon Medical is the most cost effective Dragon speech recognition for clinicians—by far.

How Many Physicians Are Using Speech Recognition such as Dragon Medical Today?

Today, over 80,000 physicians are using Dragon Medical —over 10% of all clinicians in the Us. That may not seem like a lot, but we only started counting a few years ago. Physicians are adopting Dragon Medical as rapidly—or more rapidly—as they are adopting EMR systems.

By the end of 2008, there will be over 100,000 clinicians using Dragon Medical. This number will continue to grow considerably with this announcement of Dragon Medical 10, and as clinical leadership in practices and hospitals recognize its benefits and more actively promote its use as a “best in class” solution.

Physicians are also using “front end” (dictate, edit and sign without transcription) speech recognition in other specialties. In radiology, for example, nearly 40% of all radiologists are using Dictaphone’s Powerscribe for Radiology solution.

How Does Dragon Medical Stack up against the Competition?

Dragon Medical 10’s predecessor, Dragon Natural- lyspeaking Medical 9, was named Best in KLAs in the 2007 Year End KLAs* report for the front-end speech rec- ognition market for small practices. Dragon Medical is be- lieved to have 95+% of the market for speech recognition systems which are used to dictate into and control EMR products. Dragon Medical 10’s superior speed, accuracy and other productivity and quality features are expected to widen the performance gap with other speech vendors.

Are There Different Versions of Dragon Medical 10? Which Product is right for my Organization?

Dragon Medical 10 is available in three distinct pricing and packaging versions designed to meet the needs of these distinct customer groups.
• Small Physician Practices (1-5 physicians) should consider using Dragon Medical Small Practice 10. This speech recognition software version is the fast- est, most complete way for practices with five or less physicians to create transcription-free medical records and correspondence. Dragon Medical small Practice 10 is priced and packaged for physicians who principally wish to dictate notes or email in Microsoft® Word or other word processing systems; who may be looking to reduce or eliminate transcription as a first step; and who have no plans to deploy an EMR over the next year or two. Dragon Medical small Practice 10 is not for use by either practices currently using an EMR, mid-sized prac- tices (six or more physicians), hospitals, or an integrated health system (a medical enterprise with one or more hospitals and/or practices).

• Mid-Sized Practices (6-24 physicians) should use Dragon Medical 10. Dragon Medical 10 speech rec- ognition software is the fastest, most complete way for physicians in mid-sized practices (6-24 physicians) to create transcription-free clinical documentation. Dragon Medical 10 supports physicians’ dictating directly into any Windows-based EMR. Use voice commands to quickly navigate within the EMR to review lab tests or dictate a prescription. Dragon Medical 10 is not for use by hos- pitals, large (25+ physician) practices, or an integrated health system.

• Large (25+ physician) Practices, Hospitals, and Health Systems should deploy Dragon Medical Enter- prise 10. Dragon Medical Enterprise 10 software is the most effective solution for healthcare organizations to de- ploy mission-critical, industrial-strength speech recogni- tion across the enterprise. Dragon Medical Enterprise 10 is designed for large practices or hospitals, which have deployed enterprise-wide EMR solutions and now can add speech recognition as an enabling technology for all physicians in the organization. This version supports Citrix®-based EMRs, and also includes DragonConnect, which gives physicians the option to send voice and text files to transcription for final editing. Additional system management tools reduce the total cost of ownership of speech recognition, including remote support (“push”) in- stallation to any networked PC, and the ability to manage word lists and commands from a central server.



With Which Electronic Medical Records Solutions Does Dragon Medical Work?

Dragon Medical 10 and Dragon Medical Enterprise 10 let physicians navigate and dictate in any Windows-based EMR system using voice commands. Physicians use Dragon Medical with EMR systems such as Allscripts (an authorized Dragon Medical reseller), Epic, GE, NextGen, Cerner, Meditech, eClinicalWorks, Eclipsys and dozens more Windows-based EMR software products.

What's New In Dragon Medical 10?
Major new Features and enhancements
• Improved Accuracy. (Enhanced) You won’t find a more accurate speech recognition product for your PC any- where. Dragon Medical 10 is up to 20% more accurate before enrollment than Medical Version 9, and it is over 38% more accurate than Dragon Professional 10 when used in a medical setting.

• Faster than Ever. (Enhanced) Compared to Version 9, Dragon Medical 10 delivers significant improvement in response time. Fast speakers will observe more than a 50% reduction in the time it takes for words to appear on the screen. since some speakers pause in their dictation to watch the results, having words appear on the screen sooner facilitates a more seamless dictation experience.

• Electronic Medical Records Support. (New)—Medical professionals can navigate and dictate inside third-party EMR application software.

• Hidden Mode. (New) Users can dictate while review- ing lab or radiology test results and save when finished anywhere in the EMR. (Not available in Dragon Medical Small Practice Edition)

• HIPAA Supportive. (New) Protects patient confidential- ity and helps provider organizations supports HIPAA standards.

• Medical Vocabularies. (Enhanced) Dragon Medical and Dragon Medical Enterprise contain vocabularies covering nearly 80 medical specialties and subspecialties, which ensure high dictation accuracy. Dragon Medical small Practice 10 contains vocabularies covering 75 medical specialties and subspecialties.

• DragonConnect Compatible. (New) Send voice and text files to back-end transcription for final editing (optional).

Physicians can have their voice-dictated files routed to a transcriptionist who can review the physician’s voice file and the Dragon-transcribed file and make corrections prior to returning it to the physician for review and signa- ture. (Only available in Dragon Medical Enterprise).

• PowerMic Ready. (Enhanced) Program your PowerMic buttons to run any Dragon function or user voice command.

• Medical Formatting Rules. (New)—smart software expands medical abbreviations and follows capitaliza- tion rules of medical terms.

• MyCommands. (New)—show user commands only in Command browser (Not available in Dragon Medical Small Practice)

• DragonTemplates. (New)—Text & Graphics com- mands with voice fields. Quickly automate form filling applications. Users can now create text and graphics commands in the MyCommands Editor that contains fields with a list of values that can be specified at the time of dictation. (Not available in Dragon Medical Small Practice)

• Improved Auto-Transcription. (Enhanced) The Auto- Transcribe Folder Agent now creates a synchronized audio file along with the automatic transcript for deferred correction. Dragon Medical 10 gives the Auto-Tran- scribe Agent the option of creating a synchronized audio (.DRA) file along with the transcript file, making it possible to later get the benefit of Playback and Cor- rection—just like users dictating in word processors can save the .DRA file along with their dictated document, which enables a third party to correct errors, refining the speaker’s profile.

• Correction Only Mode. (New) Dragon Medical 10 lets “correctionists” open the dictation files to make correc- tions by keyboard, which contributes to the optimiza- tion of the speaker’s profile over time. (Not available in Dragon Medical Small Practice)

• New Look and Feel. (New) Updated icons are intui- tive and easy to see. Dragon Medical 10 introduces new graphical icons to enhance the DragonBar user interface, making the product easier to use.



• Improved Help System and Tutorials. (Enhanced) Dragon Medical 10 offers an enhanced interactive tutorial with a completely new look and feel. Customizable to provide your favorite commands.

In addition to the major new features and enhancements, Dragon Medical 10 includes dozens of additional new features and enhancements, some of which are described below, which are categorized for ease of review. new Accuracy Features

• Regional Accent Support. (New) Dragon provides support to many regional accents of both non-native speakers (Asian-Pacific, Asian-Indian English, Australian, British, Hispanic) and U.s. accents (Deep south, Northern Inland).

• Automatic Accuracy Tuning. (New) Dragon can auto- matically run tuning programs to improve accuracy while you sleep.

• Embedded Data Collection Tool. (New) A data collection engine (switched off by default) embedded in the product encourages more users to collect speech data and share with Nuance (optional) to help improve overall product accuracy in future releases.

• More Flexible Enrollment. (New) special simplified voice enrollment is available for speakers who have dif- ficulty reading interactive text passages. Dragon Medical 10 set-up now offers dysarthric support to tune acoustic models during initial configuration. By making it easier to read the text used to train the product to an individual user’s voice, Dragon Medical 10 improves the experi- ence for younger users and users with certain speech impairments.

• Medical Bluetooth® Acoustical Model Support. (Enhanced) special new acoustic software makes recognition with your Bluetooth headset higher than ever. new navigation and control Features

• Voice Shortcuts for Email and Calendar. (New) Dragon Voice shortcuts collapse common tasks into simple voice commands. Now you can send emails and schedule meetings—faster than ever before.

• Voice Shortcuts for Web Search. (New) Dragon Voice shortcuts collapse common tasks into simple voice commands. Now you can search the Web—faster than ever before.

• Voice Shortcuts for Desktop Search. (New) Dragon Voice shortcuts collapse common tasks into simple voice commands. Now you can search your desktop— faster than ever before.

• Quick Voice Formatting (Delete and Format commands) (Enhanced) In addition to the many existing editing commands such as “Delete line”, Dragon 10 introduces direct commands for formatting, deleting, and copying named words and passages. Rather than selecting the relevant word(s) or passage and commanding what to do with that text (e.g., “select very, [pause] Bold that”), you can now directly name the desired text with the desired action in a single voice command, such as “"Bold very."

• Improved Natural Commands for Firefox. (Enhanced) The same great Web browser experience with Internet Explorer is now available for FireFox.

• Improved Natural Commands for Microsoft Office 2007. (Enhanced)—Use your voice to control advanced features of Microsoft Office 2007.

• Option to Disable Microsoft Text Services. (CTFMon) (Enhanced)—Option to turn off Alternative User Input Text Input Processor (CTFMon) to eliminate potential conflicts with Dragon Medical.

• Disable Web Commands. (New) Disable HTML commands separately from dictation support, so Dragon Medical 10 won’t confuse commands with dictated words.

New system Management Features
• Improved Enterprise Security Features: Disable Scripting Commands to Prevent VBA Viruses. (New) More configuration options provide administrators with better control of Dragon in the enterprise.

• Improved Security Features: Encrypt Macros for Distribution. (New) Encrypt macros for distribution, providing resellers and administrators alike with better control of Dragon Medical 10. (Not available in Dragon Medical Small Practice).

• Upgradeable. (Enhanced) Uses your voice profiles and language models from Versions 8 & 9, so all words and phrases you’ve added are available.



• Auto Configuration Based on System Profile. (New) Dragon’s smart configuration software gets the highest accuracy and fastest response from older PCs and lap- tops by optimizing memory and processor performance.

• User-Configurable Word Formatting Rules. (New) A new inverse text normalization (ITN) dialog gives users a faster and easier way to define the formatting options for units of measure. Users can quickly indicate when numbers should be written as numerals vs. words.

• PowerMic Support for Citri. (New) The PowerMic is now certified for use in a Citrix environment.

• PowerMic Barcode Support. (New) The PowerMic with integrated barcode scanner can be used to scan MRN’s, Patient ID, or accession numbers… in your EMR.

How Is Dragon Medical Licensed?
Dragon Medical 10 and Dragon Medical small Practice 10 are purchased for use on a per-user basis. A user is de- fined as one (1) individual who dictates in Dragon Medical. A licensed user may install Dragon Medical for use on multiple machines by that same user only. A Dragon Medical box license may not be used by more than one user even if users use the same PC.

What Benefits Should Physicians, Practices and Hospitals Expect From Using Dragon Medical 10?
Dragon Medical 10 is used by clinicians to navigate indus- trial-strength EMR packages quickly to review lab tests or past medical history while documenting care anywhere in the record.

Healthcare organizations that rely on Dragon Medical 10 will provide more efficient, profitable, and effective care. Clinicians will dictate patient records faster, more accu- rately than ever. Dragon Medical 10 and Dragon Medical Enterprise 10 are the only members of Nuance’s Dragon family that are specially developed to support dictation directly into an EMR system; capabilities not supported by Dragon 10 standard, Preferred, Professional, or Medical small Practice editions. Dragon Medical 10 frees clinicians up to spend more time with patients, increasing patient and clinician satisfaction. Dragon Medical 10, Dragon small Practice 10 and Dragon Medical Enterprise 10 are the only members of the Dragon product line to support HIPAA patient confidentiality standards.

Using Dragon Medical 10, practice economics are sub- stantially improved. Patient notes dictated using Dragon Medical 10 are more complete. More detailed physician decision-making supports higher levels of reimbursement than simple notes created by “point and click” EMR tem- plates. Denial rates are reduced as coding is improved. Transcription is eliminated with Dragon Medical 10 adop- tion. Finally practice volume is increased, as physicians can see more patients and get home on time for dinner, with paperwork completed before they leave the office.



Do Clinicians Still Need to Use A Keyboard and Mouse?
Although clinicians can use Dragon Medical 10 to do almost everything on their computer by voice, some tasks are still easier to do by mouse or keyboard. Dragon Medical 10 allows clinicians to develop powerful speech commands and macros, which automate naviga- tion and other repetitive tasks, saving countless clicks and keystrokes.

If using a mouse and keyboard are an option for clinicians, they should try experimenting with using their voice and hands for different tasks to see what works best.

What are the System Requirements?
To run Dragon Medical 10, a system must meet the following requirements:
• Intel Pentium / 1 GHz processor or equivalent AMD processor. Faster processors will yield faster performance – Dragon Medical 10 requires the ssE2 instruction set. Processors without ssE2 are "Intel before Pentium 4" and "AMD before Athlon 64"
• 512 MB RAM or 1 GB RAM for Windows Vista
• Free hard disk space: 2.5 GB
• L2 Cache: 512 KB
• supported Operating systems: -Windows server 2000, Windows server 2003 - Windows XP, sP2 or higher—32 bit—Home & Prof - Windows 2000, sP4 or higher - Windows Vista™ or Windows Vista™ sP1, 32-bit - Citrix MetaFrame Presentation server 4.0 or 4.5
• DVD-ROM drive (required for installation)
• Microsoft Internet Explorer 6 or higher (free download available at www.microsoft.com)
• Nuance-approved noise-canceling headset microphone (included)
• For Bluetooth wireless microphone support, please visit http://support.nuance.com/compatibility/
• A web connection is required for activation During the installation process, the software checks to make sure the system meets these minimum require- ments. If they do not meet the requirements, the software will not be installed.

Recommended specifications
 • Intel Pentium / 2.4 GHz processor (1.6 GHz dual core processor) or equivalent AMD processor. Faster proces- sors will yield faster performance
• 1 GB RAM • Free hard disk space: 2.5 GB
• L2 Cache: 1 MB

Coexistence With Previous Versions of Dragon Medical?
Only one version of Dragon Medical can be installed on the system. NOTE: Running Version 8 or 9 concurrently with Version 10 is not supported.

Coexistence With Dragon Medical SDK Client Edition?
Dragon Medical SDK Client Edition 10 can be installed on the same machine where Dragon Medical 10 is installed. In addition, Dragon Medical 10 and Dragon Medical sDK Client Edition 10 can share vocabularies and users. Only one product can run at a time. For example, running Dragon Medical means that none of the sDK Client tools or samples can run at the same time. NOTE: Coexistence with Dragon Medical SDK Client Edition Version 9 is not supported. UPgrADIng FrOM VersIOn 8 Or 9? Clinicians can upgrade from any edition of Dragon Medical Version 8 or 9 to Version 10. When upgrading from Version 8 or 9, clinicians can choose to migrate their user files and vocabularies to Version 10. Once Version 10 is installed, Version 8 or 9 will no longer be functional. If clinicians choose not to upgrade their user files and vocabularies during the upgrade, they can do so at a later time by running the Version 10 Upgrade Tool.

What Do I Need to Know About Vocabularies?

Dragon Medical and Dragon Medical Enterprise contain vocabularies covering nearly 80 medical specialties and subspecialties, so chances are, your specialty will appear on the list. Dragon Medical small Practice 10 contains vocabularies covering 75 medical specialties and sub- specialties. If your specialty is not covered, you should choose either the general medicine or the specialty vo- cabulary which is closest to the specialty you perform. © 2008 Nuance Communications, Inc. All rights reserved. Nuance, the Nuance logo, Dictaphone, the Dictaphone logo, Commissure, RadWhere, RadCube, RadPort, Vocada, Veriphy, Powerscribe, PowerMic, iChart, EXspeech, Enterprise Workstation, Enterprise Express, Dragon, DragonBar and Naturallyspeaking are trademarks and/or registered trademarks of Nuance Communications, Inc., and/or its subsidiaries in the United states and/or other countries. All other trademarks are properties of their respective owners.