About Wayne Kaniewski, MD

Owner and CEO of Twin Cities EMR Consulting, a Minneapolis-based Information Technology company. We specialize in Medical Speech Recognition Technology for optimizing clinical documentation efficiency and quality, to ultimately improve patient care outcomes.

The Future of Medical Speech Recognition Technology (MSRT)

You are probably hearing about cloud-based medical speech recognition software. This works very similarly to the speech recognition used for creating text messages and emails on your Android smartphone or iPhone.

There are a number of features that distinguish all cloud-based MSRT from computer-installed software (such as Dragon Medical Practice Edition-4). 

Cloud-based medical speech recognition software:

  • Requires little or no installation.
  • Available on any computer that has an Internet connection.
  • Paid by monthly subscription rather than a large up-front cost.
  • Automatic, periodic, no-charge updates and improvements.
  • Technical & user support is included in the monthly fee.

Dragon Medical Practice Edition-4 is the gold standard of MSRT, and it will serve us well for several years to come. However, Nuance (the manufacturer of DMPE-4) is pushing its cloud-based product (Dragon Medical One) very vigorously, and it is my opinion that there will not be a DMPE-5 developed. So, it is likely that all physicians using medical speech recognition software will need to migrate to a cloud version in the next few years.

Although the cloud-resident products from all manufacturers (Nuance, M*Modal, Dolby, and others) appear to be good, SayIt” from nVoq is the product that we recommend above all others. The advantages of “SayIt” are:

  • nVoq has offered cloud-resident MSRT since 2010. This is longer than any other company. This is their only product, so all development work is dedicated to this one product.

  • The monthly subscription fee is about half that of its competitors.

  • There is no contract requirement. You can subscribe on a month-to-month basis. You can also elect at any time to switch to an annual subscription with significant additional cost savings.

  • It is the only product that works on both Windows and MacOS machines.

  • NO installation is necessary.  Competitors’ products generally require a small local app to be installed on each machine.

  • With a subscription, a medical provider can use SayIt on any machine at any location. Thus, if you purchase a SayIt subscription for use in your office, you can also use it (and your ONE voice profile) at home, at the hospital, at nursing homes, on vacation, etc. Competitors’ products may require you to purchase additional subscriptions if you wish to use their product outside of the licensed location (e.g. clinic), utilizing multiple non-synchronized profiles.

  • nVoq is completely dedicated to customer satisfaction, and is very responsive to customer feedback.

  • Some EHR manufacturers are integrating cloud MSRT into their EHR applications. They may lead you to believe that you must purchase both from them, usually at high cost. This is not true. SayIt can be used in any EHR, in any text window that you would normally type into.

  • Your Value-Added Reseller (i.e. Twin Cities EMR Consulting) can monitor your dictations in the background:
    • We can make corrections for misinterpreted words, which improves future recognition.
    • We can make suggestions for improved use of the product.
    • Problems such as poor audio quality can be easily diagnosed.

If you currently have Dragon Medical Practice Edition-2, we highly recommend upgrading to either Dragon Medical Practice Edition-4 or SayIt. The increased speed and accuracy of both these products will amaze you.

If you have upgraded to Dragon Medical Practice Edition-4, there is no need to do anything now. It’s a great product! However, your future plans should likely include switching to a cloud-based medical speech recognition product. Of those available, our recommendation would be that you...

Just “SayIt”

We would be delighted to chat with you regarding any questions that you may have.

SayIt Cloud Medical Speech Recognition

NEW!! Dragon Medical Practice Edition-4 ("Version 15")

By |July 2nd, 2019|Providers, Techies|Comments Off on The Future of Medical Speech Recognition Technology (MSRT)

Capturing the Nuance with Medical Speech Recognition

When documenting a patient encounter, it is essential to record the “nuance” of that particular patient’s history, your findings, and the care that you provided. Every patient is unique, and the “click notes” functionality in today’s EHRs is simply not capable of recording that kind of detail. You don’t want the last 10 headache patients to all sound the same, right?

Creating "generic" notes can compromize patient care provided by us and others. The only way to capture the subtleties for each patient is to add specific text in addition to clicking. This can be done via keyboard or speech recognition software. Typing (no matter how fast you are) is a terrible waste of your time, talents, and efficiency. With the increasing pressures to do more in less time, we also tend to cut corners, decreasing the quality of our documentation.

When using speech recognition software, there are a number of ways to be most efficient:

  1. Make corrections by voice, instead of using your keyboard. This is faster, and also helps the software to become more accurate over time.
  2. Use Custom Commands (macros) to insert chunks of repetitive text into your notes instead of dictating the same things repeatedly for each patient. This functionality works best for standard physical exams, review of systems, procedures, and patient education sections of the notes which can tend to be repetitive. The inserted text can then be easily modified by voice for any variations related to a specific patient.
  3. Schedule an “experienced user class” so you can learn (and re-learn) techniques for using the software most efficiently. These are done remotely, one-on-one, and customized to your current skills and future goals, lasting 1-1.5 hours per session. Our clients almost always experience an ”Ah-Ha Moment” in the first few minutes of these sessions. Just as you attend regular CME sessions to keep your medical skills up to date, you should consider sharpening your medical speech recognition skills at least once a year. See: Dragon Training
  4. Upgrade to the most recent version of the speech recognition software; this will give you noticeably increased speed and accuracy. For Dragon Medical, you can purchase an upgrade to Dragon Medical Practice Edition-4 (version 15) for about 1/3 the cost of a new license. With SayIt, your monthly subscription includes automatic updates on a quarterly basis.

By |January 25th, 2019|Providers|Comments Off on Capturing the Nuance with Medical Speech Recognition

Dragon Medical Versions Explained

There is, understandably, a lot of confusion surrounding the various Dragon Medical versions that have been released through the years. For one thing, the name was rebranded between versions 10 & 11, and the version numbers are referenced in various inconsistent ways. To clarify, here is a summary:

Dragon Naturally Speaking Medical 10..........10.x
Dragon Medical Practice Edition..................11.x
Dragon Medical Practice Edition-2................12.0
DMPE 2.1 Patch.......................................12.50
DMPE 2.2 Patch.......................................12.52.350.048
DMPE 2.3 Patch.......................................12.53.350.033
DMPE 2.3.1 Patch.....................................12.53.350.038

DMPE-3:  Never released in the U.S.

DMPE-4.0 (Major version release).......15.10.351.002

DMPE-4.1 (Patch or Full Client)............15.30.350.107

If you purchase DMPE-4, we will send you a Flash Drive with the latest release, instead of using the DVD sent in the box (which usually is an older version).

The version that is running on a particular machine can be determined as follows:

  • Start Dragon Medical
  • On the DragonBar click: Help --> About Dragon

If you're running version 10.x, or 11.s there is no upgrade path, since these versions are very old.  You need to purchase new licenses of DMPE-4.

If you are running DMPE-2 (12.x), you should strongly consider upgrading to DMPE-4 (15.3). The improved speed and accuracy of this version is very significant and you will be delighted with the change! Upgrades are available from us. The MSRP for upgrades is $599 as opposed to $1599 for a new purchase. We always discount below the MSRP, so please contact us for a quote.

The remainder of this article applies only to DMPE-2.x (12.x)

If you're running Dragon Medical versions 12.0 or 12.50, you should consider patching up to at least 12.52. There are significant bugs in 12.0 & 12.50 that adversely affect some EHRs & some functions. HOWEVER... You should seek our assistance to do this. User profiles created on 12.0 or 12.50 will not run on 12.52 or higher. 12.52 profiles will run on 12.53 without change. There is no charge for downloading patches 12.52 - 12.53.

We regularly get calls from clients where a user has patched their version up to 2.3.1, and then receives error messages about an outdated user profile. For this reason, we now recommend that IT departments turn off end-user notifications regarding new patches. For assistance in doing this, please contact us.

If a user is having no problems with their 12.x version, and they will never use another machine (that may have a newer or older version installed), you can leave well-enough alone.  Problems arise when a user has to switch to another machine and the software versions / profile versions are incompatibile.

Unfortunately, there is no one download that will take you automatically through several of these patches. You need to download/install each of them in turn on each machine. You can save significant time by saving each download to a shared drive, or a RAM drive.

You should patch (and upgrade all profiles) all the way up to 2.3.1 (12.53.350.038) if any of the following conditions exist:

Otherwise, you should consider patching all machines (and upgrade all profiles) to 2.2 (12.52.350.048):

  • Windows 7 or 8
  • Office 2010

If you have questions, or would like to request Dragon Medical Training, please email support@tcemr.com.

Twin Cities EMR Consulting, Minneapolis, MN
 Medical Speech Recognition Products – EHR Consulting Services – Training – Support
By |June 14th, 2017|Techies|Comments Off on Dragon Medical Versions Explained

Dragon Medical – Selecting & Correcting by Voice

This article is intended to refresh some key concepts since you completed your Dragon Medical Training.

SELECT is Dragon’s MOST important command.  We are all in the habit of reaching for our mouse to delete an incorrect word, then typing the correction.  Two problems with this:

  • It wastes time
  • Dragon doesn’t “learn” from these corrections

If you gradually switch to correcting by voice, you will become more efficient and Dragon will become more accurate!

Using the “Select” command:

  • Select/highlight the incorrect word (or phrase) to be edited by saying “Select” followed by the incorrect word (or phrase) e.g. “Select disgust”; Don't pause or hesitate between the command and the word
  • Nice feature: If there are multiple occurrences of the word (e.g. “disgust”), then Dragon will number all of them for you.  Simply say “Choose 3” (for example) to highlight the one that you want.

The Correction Menu appears with a number of options:

  1. You can immediately say another word or phrase (e.g. “discussed”)


  1. If one of the menu options is what you want, say “Choose” followed by the number of that option, e.g. “Choose 2”.


  1. If none of the listed options are correct say “Spell That” to spell the correct word or words into the Spell Dialog Box. Unfortunately, since many letters sound the same (e.g. “s” vs. “f”), it is easier to just type the correct spelling using your keyboard, rather than trying to spell by voice.

Then say “Go Back”, and your cursor will return to where you left off so that you can resume dictating.

Variation:  The “Select [first word] Thru [last word]” command:

What if you need to select a phrase, sentence, or whole paragraph?

Example:  Assume that you have a command for a normal Review of Systems for a level 3 visit:  “ROS 6”, and the CV history is NOT normal:


Constitutional:  No chronic fatigue, unexpected weight gain or weight loss.

Eyes:  No visual impairment, no pain, watering, discharge or itching.

ENT:  No ear or sinus infections.  No recurring nosebleeds, no chronic nasal congestion.  No  mouth lesions or dental pain.  No throat pain or dysphagia.

Respiratory:  No wheezing, dyspnea on exertion, or chronic cough.

CV:  No chest pain, cyanosis, palpitations, dizziness, or fainting.


Just Say:  Select No Thru fainting”  (Use THRU not TO)

The whole CV review will be selected.  Then dictate the abnormal history, such as:

“3 month history of substernal pressure during exertion”…then say:

Go Back

It’s as easy as that!

Twin Cities EMR Consulting, Minneapolis, MN
 Medical Speech Recognition Products – EHR Consulting Services – Training – Support
By |April 27th, 2017|Providers|Comments Off on Dragon Medical – Selecting & Correcting by Voice

Dragon Medical – How To Improve Accuracy

Wayne Kaniewski, MD

This article is intended to refresh some key concepts since you completed your Dragon Medical Training.

For clinicians who were accustomed to dictating to a human transcriptionist in the past, you discovered quickly that you cannot dictate at “warp speed” when using medical speech recognition technologies (MSRT).

Q:  Must I dictate very slowly when using Dragon voice recognition software?

A:  No.  But you must e-nun-see-ate more than you may be used to.  Dragon™ Medical “listens” for patterns of sound (phonemes).  So, you must pronounce some words more distinctly that you may be used to.  When you speak to another person, they can usually “fill in the blanks” if you are not speaking clearly; with Dragon, enunciation is more important.  Examples:

  • Sound-alike words
    • he vs. she
    • an vs. and
    • is vs. it
  • Terminal syllables
    • discuss vs. discussed
    • depress vs. depressed
    • patient vs patients

Generally, you are able to dictate as fast as you are able to enunciate clearly.  When you start “tripping over your tongue”, Dragon Medical will start making misrecognitions.

The more “sound data” that you provide, the more that Dragon will be able to decide, using complicated mathematical algorithms, between several words that sound alike.  These algorithms also look for word pairs that commonly occur together, and these pairs may vary greatly depending on the vocabulary (e.g. casual speech vs. medical terms) and the user.

For instance, if you dictate “an EKG” and the software repeatedly transcribes “in EKG”, it won’t accomplish much to correct or train “an" vs. "in” since these words each consist of very little sound data to allow distinguishing between them.  You will be more successful by training the phrase “an EKG”.

Just as Dragon will have difficulty distinguishing between monosyllabic words, it also has no way of knowing what homonym forms you intend if those words are used in isolation.  For instance, how can you distinguish between these words, when they are all pronounced the same?

  • their, there, they’re
  • two, too, to, 2
  • past, passed

The solution is to dictate in complete sentences, with the period (or ! or ?)  The software engine “looks” at the context of a sentence, and is thus able to be more accurate in determining the correct word form to use.  The speech engine for medical specialties actually looks at the medical context of a sentence, and that is one reason why the medical versions of speech recognition software are going to work better for medical documentation than available non-medical products.  It’s not just the difference in the software vocabularies!

We’re not used to dictating in complete sentences.  It’s a bit easier if you first think about what you are going to say in the next sentence, then dictate it.

When a misrecognition occurs, try to avoid the habit of correcting it using the mouse & keyboard.  Instead, follow these steps:

  • Use the “Select” voice command to highlight the misrecognized word(s)
  • Speak the correct word(s), or "Choose" from the Corrections Dialog Menu
  • Use the"Train That" command

The software will “learn” and be less likely to make that misrecognition in the future.  It’s a difficult habit to break, but it will pay off in the long run!  This process, once mastered, will be faster than always reaching for your mouse & keyboard, and will also decrease the chances of repetitive stress injuries.   Also, selecting then correcting 2-3 words together may be more effective than just one word, particularly if that one word is a monosyllable.

Despite your best efforts, you will sometimes have unexpected, nonsensical, and even hilarious things transcribed into your notes.  So, the final and most important point is to always read your notes before you sign them.  Putting a disclaimer in your electronic notes that “Speech recognition software was used to create this note.” will not protect you in a court of law.  Not reading your notes can also, more importantly, potentially impact patient care.  How about this one?

Dictated:  “Questions were invited and addressed.”

Transcribed as:  “Russians were invited and undressed.”

In summary:

  • Enunciate
  • Dictate smoothly at an even, moderate pace
  • Speak in complete sentences with punctuation
  • Make corrections by voice, not keyboard
By |January 20th, 2017|Providers|Comments Off on Dragon Medical – How To Improve Accuracy