Using Dragon Medical One With Citrix XenApp

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Does Dragon Medical Work With Citrix?

Now, it does. With the release of Dragon Medical One, Nuance developed ground rules for Citrix environments. Because of its immense complexity, Citrix usually requires a dedicated administrator—someone who can configure it to operate within a specific environment. In light of that complexity, we’re going to focus on two particular Dragon Medical / Citrix scenarios. Please note that in both of these cases, the EHR is published in a Citrix XenApp session: 

  • Dragon Medical installed on a local machine
  • Dragon Medical published with Citrix XenApp

While this guide isn’t going to cover the use of Dragon Medical with Citrix XenDesktop or Wyse terminals, if you need assistance with a Citrix project involving those elements, we’d love to hear from you.   

Dragon Medical Requirements

In order to use Dragon Medical in a Citrix environment, you must be running Dragon Medical One for Windows. Dragon Medical for Mac does not currently support Citrix. Here are the system requirements for Dragon Medical One: 

CPU

2.4 GHz processor – We find that most Dragon Medical users run an i3, i5, or i7 chipset. 

RAM

At least 4 GB – If you use multiple applications with Dragon Medical, we recommend 8 GB. 

Operating System

Client:

  • Windows 10, 11 32-bit
  • Windows 10, 11 64-bit

Server:

  • Windows Server 2012 64-bit R2*
  • Windows Server 2012 64-bit*
  • Windows 2008 R2 64-bit SP2
  • Windows Server 2008, SP1, SP2, and R2, 32-bit and 64-bit

*While Nuance does not list these operating systems as being supported with Citrix, we have customers who are currently using them with no trouble.   

Citrix Requirements

Citrix virtualization can involve multiple applications in multiple environments. For the sake of brevity, please check the Citrix Admin Guide for your particular Citrix environment requirements. If you implement Dragon Medical as a published app in Citrix, you will also need the Citrix Client Extension, which is included with the Dragon Medical installation package. Check the Citrix Client Extension folder for a file called vddnspatch2.exe. 

***Of special importance… If you work with eDist Support on your Citrix / Dragon Medical project, you will need to have a Citrix administrator available, and your Citrix environment must already be installed and configured. We will not be able to assist you otherwise.***   

Dragon Medical on a Local Machine

If you have Dragon Medical installed on an exam room workstation, and you need to use an EHR hosted in Citrix, you will need to take a few things into account before you decide to make that your day-to-day dictation scenario. First of all, using speech recognition in that environment will only provide what Nuance calls “basic text control,” rather than the full text control you have when dictating in supported applications. This means that you could have problems getting Dragon Medical to recognize your speech; commands and correction may not work; and your text might not be formatted correctly. If you’re going to dictate with this setup, we highly recommend using the Dictation Box in Hidden Mode

What Are the Benefits?

  • If you decide to use Dragon Medical locally, you free up the server to run other applications.
  • Installing Dragon Medical on your computer is relatively easy.
  • Your dictation doesn’t affect network bandwidth availability.
  • You have Dragon Medical available to use with other programs on your computer.

What Are the Limitations?

As we mentioned earlier, you will have problems with dictation outside of the Dictation Box (when working with the Citrix published application).   

Dragon Medical as a Published Application

If you and your IT team, including the Citrix admin, decide that running Dragon Medical One as a published app is the best way to go, you’re going to gain some significant functionality when dictating into your Citrix-hosted EHR. That being said, the installation and configuration are much more complex, and you will lose some functionality (with Dragon Medical) on your local machine. In the main, you should get your full-text control back—but it is not guaranteed. If you were to install your EHR on your computer, along with Dragon Medical, and you had full text control in that configuration, you would have it in this Citrix XenApp setup. You could dictate directly into your EHR. If in our example, you didn’t have that control, you wouldn’t have it using Citrix. If this is the case, turn back now and rely on the Dictation Box for your speech recognition needs. 

What Are the Benefits?

  • Barring any complications (see above), you can dictate without the Dictation Box.
  • You don’t need a very robust computer to use Dragon Medical, since the server is doing all the work.
  • Any computer that can access Citrix XenApp published applications, and has the Citrix client extension installed, can use Dragon Medical. There’s no need to install the full program on exam room computers. See below for more information.
  • Your IT team can regulate who can use Dragon Medical.

What Are the Limitations?

  • Dragon Medical uses the Citrix server, so your admin should make sure that it has the ability to handle the extra load generated by each user.
  • Your network should have at least 1.3 Mbps of bandwidth per Dragon Medical user, to transfer audio from your microphone to the Citrix published application.
  • You will lose the ability to use Dragon Medical directly with programs installed on your computer, such as Microsoft Word. You’ll need the Dictation Box in these situations.

Installation Tips

Because of the complexity of Citrix environments, we want to share some tips that will help you as you set up your Dragon Medical workflow. These shouldn’t be considered instructions, per se, but rather some helpful guidelines for your Citrix admin.

Server Side

  • Perhaps first and foremost, in order to use Dragon Medical with a XenApp published EHR, it has to be published in the same session.
  • In addition, your IT team will need to install Dragon Medical on the same server cluster as the EHR.
  • You need to install the 12.52.350.048 build of Dragon Medical, also referred to as Dragon Medical One. If you need access to this build, please contact your Dragon reseller.
  • Make sure to give your clients policy rights so that they can run Dragon Medical on the server.

Unique Citrix Features

Load balancing

Nuance recommends that if you use Citrix Load Balancing, Dragon Medical and your EHR should be on the same server. 

Citrix Application Isolation Environments

Nuance recommends that if you use Application Isolation Environments, Dragon Medical and your EHR should be in the same AIE. 

Citrix User Profile Manager

Nuance recommends that if you run a User Profile Manager: 

  • Turn off Active Write Back
  • Turn off Profile Streaming
  • Alternatively, add this exclusion to the UPM: C:\Users\%Username%\AppData\Roaming\Nuance

Client-Side

  • Install the Citrix Client Extension, included with the install package. The executable filename is vddnspatch2.exe.
  • Configure the XenApp client for “High definition audio.”

Nuance PowerMic

If you have a Nuance PowerMic, you will need to install drivers on both the server and the client. These are available in the installation package: 

  • PowerMic Citrix Extension Client.msi
  • PowerMic Citrix Extension Server.msi