Troubleshooting Common Problems in Dragon Medical

Solving Common Dragon Medical Issues

This article will look at some of the issues we have seen clinicians struggle with, whether you’re a surgeon, dentist, radiologist, neurologist — or one of their tireless assistants. We have seen the following obstacles and can often resolve them in a short amount of time. The idea here is to save you frustration and downtime by teaching you how to address or circumnavigate these basic problems. *** Reminder: Dragon Medical One is only available for Windows®. You must use Parallels for Mac®. EHR Issues First of all, we should mention that Dragon Medical has some documentation regarding EHRs that you may want to consult. Second, be aware that Nuance® considers the Dictation Box as a go-to solution for issues with EHR compatibility. You may find that you need to hone your skills in that particular area. More on that later in the article.

Full-Text Control—or Lack Thereof

The full-text control indicator is a little green checkmark at the far left of the DragonBar. When it is lit, you have 100% capability to utilize all of Dragon Medical’s editing, selection, and dictation functions. If you notice this checkmark is absent (grayed out) in any of the fields of your medical record, you’re probably also experiencing a strange change in functionality—including spacing issues, capitalization problems, or not being able to dictate at all. Here are some possible answers to this issue:

If your EHR is web-based, you may need to enable the Dragon Web Extension. Look for the add-ons section in the browser of your choice.
Some EHRs respond to turning off the HTML support feature. From the DragonBar, go to Tools > Options > Commands and uncheck the “Enable HTML support” box. Restart Dragon Medical One and test it out. Although you won’t see a change in the checkmark, you may see an improvement in functionality.
Use the Dictation Box in Hidden Mode. When properly configured, it’s an effective way to dictate, providing full-text control anywhere you need it.
Download all available updates. Sometimes, that’s all you need for your particular EMR.
Consider purchasing an upgrade of Dragon Medical One. Strong caution here: We don’t guarantee that it will change your interaction with your particular EMR. We’re just saying that it might.

Usage Issues

Getting Dragon Medical to Recognize a Certain Word

If you’re consistently having problems with one or two words being misrecognized, your best bet is to add them to the Dragon Medical custom vocabulary. Click Vocabulary > Add new word or phrase and type the word in the box on the left. In general, you’ll want to leave the one on the right empty. It’s a good idea to check the box next to “I want to train…,” because if Dragon Medical isn’t getting the word, it probably needs to know how you pronounce it. Then click [Add]. When the training window pops up, click [Go] and speak the word as you normally would. There is no need to press any of the buttons on your mic (if it has buttons). Click [Done] after training the word. The word you just added should work for you now, but before you test it out, it’s a good idea to save your profile. Click Profile > Save User Profile.

Commands Run Amok

We have seen some cases where a dictation will break into all capitals; or all lowercase; or spaces disappear entirely. This might be because you said something that sounded like one of these commands:

Caps on/caps off
All caps on/all caps off
No caps on
No space on

If this is happening in Microsoft Word or Excel, start with this tip:

Check under File > Options > Add-Ins in either application, and make sure that the “NatSpeak Word/Excel AddIn” is enabled.

If that doesn’t apply, or doesn’t fix the problem, then continue below: Go to Tools > Recognition History to determine when Dragon Medical thought it heard one of the bulleted phrases above. Either change the pronunciation of the word/phrase that triggered the issue, or train it by going to Audio > Improve recognition of word or phrase. If after a few attempts, that doesn’t seem to work, you may want to test the waters and create a new profile. Click on Profile > New User Profile, complete the wizard, and see if you have better luck. If so, your other profile may have been corrupt. You can either proceed with the new profile, or restore the old one. To restore your profile, go to Profile > Manage User Profiles, and then click on [Advanced] and choose “Restore.” If none of this seems to help, you might have a situation where Dragon Medical does not have full text control within the application you are dictating into. We already addressed what to do when this happens in an EMR. If all else fails, use the Dictation Box, which can be found under Tools > Dictation Box.

Dragon Medical Is Freezing or Lagging

For a computer that struggles to keep up, you may consider a hardware upgrade. We recommend consulting your IT department before making any purchases. In the meantime, you always have the option to optimize your Dragon Medical One experience. There is also the possibility that something is wrong with the installation of the software. Try running a repair of Dragon Medical One by putting in the disc and choosing “Repair” when the install wizard pops up. Your profile could also be the culprit; try to restore it or create a new profile as we directed earlier.

Dragon Recognition Is Inaccurate

As this topic could be extensive, we won’t be able to cover every reason why you might be having accuracy issues. But, there are definitely some best practices that you’ll want to employ. First of all, check the vocabulary that you have loaded:

Expand the DragonBar by clicking the double-down arrows on the far right. When the bottom panel expands, look for the name of your profile, followed by the name of your vocabulary and the name of your microphone source.
Alternatively, click on Profile > Open User Profile and look at the vocabularies that you have available there.

If you are a neurosurgeon dictating a medical note, but you aren’t using neurosurgery vocabulary, you’ll probably have several misrecognitions in your dictation. To add the appropriate vocabulary, click Profile > Add vocabulary to current User Profile. Pro tip: When using Dragon Medical for non-medical purposes, choose a general vocabulary. In the same vein, make sure that you have chosen the source appropriate for the microphone you have plugged in. This information is located in the same places as the vocabulary. As a general rule of thumb, the connection between the mic and the computer determines what type of source to use, though there are exceptions. If you’ve passed those tests and are still having issues, try doing some training. Go to Audio > Read text to improve accuracy, and do 10-15 minutes of reading. Also verify that you are regularly running the Acoustic and Language Model Optimizer. If, after all of this, your recognition is still poor, try a restore or a new profile, as outlined in previous sections.

Dragon Profile Issues

My Profile Won’t Open

Again, this issue could have a number of root causes, but there are certain tactics you can employ to try and address it:

Verify that your microphone is plugged in.
Check that the source you have selected matches the source you are using.
If you have multiple profiles, make sure you are opening the right one. We have seen some clinicians with old, corrupt, or otherwise unusable profiles in their system, right alongside the serviceable one(s).
Create a new profile or restore the one that won’t open.

Software Issues

Dragon Medical Won’t Open

If you find that Dragon Medical won’t open, despite multiple attempts to open the application—and especially if it seems to just “disappear” when you run it, there are a couple of easy checks you can make. The program might already be running in your system tray, which is located at the bottom right of your screen, where all of the small icons are huddled up next to the clock. Expand that area and look for the red Dragon Medical microphone icon. We’ve also found instances where Dragon Medical One doesn’t appear to be open, yet its main process is listed in the Task Manager.

Press [Ctrl] + [Alt] + [Del] to bring up the Task Manager.
Click the “Processes” tab, or “Details” and find “natspeak.exe.”
Select that row and then click [End task] at the bottom right of your window.
Try starting Dragon Medical again in the way that you usually do.

Microphone/Source Issues

These issues don’t all have a direct connection to Dragon Medical, but it’s likely you’ve encountered one of them while trying to set up or use the application.

My Microphone Won’t Load

When we diagnose these issues, one of the first things we check is if the computer sees your device. If it doesn’t, there are two likely explanations:

For some reason, the drivers did not load properly. Plug the mic into another USB port, preferably in the back of the computer (if you have a desktop).
Make sure that the port does not use USB 3.0 protocol. There are some mics that support it, but if you’re already having problems, yours probably doesn’t. You can identify the port by a small SuperSpeed (SS) logo and/or a blue color on the inside.

I Don’t See My PowerMic in Dragon Medical

The PowerMic II is a special USB microphone, made by Nuance to work specifically with Dragon Medical One. Its buttons can be programmed within the application, but only if you’ve got the PowerMic indicated as your source. If you didn’t have the mic plugged in when you first created your profile, you wouldn’t have been able to select it as a source. It only appears as a possible source when it’s been plugged in and the drivers have loaded. Sometimes you even need to reboot the computer after the driver’s install. If you’ve done all that, you should be able to click Profile > Add audio source to current User Profile and select the “PowerMic II Microphone.”