Using the Dragon Dictation Software with Electronic Health Records

The main campus of the health system where I work recently started rolling out the enterprise version of the Dragon dictation software (the medical version).  We are using the PowerMic II with the dictation software. We use Epic Systems Ambulatory and Inpatient EMR.  I have had the system installed for barely a day and I am totally hooked.
First impression is that the accuracy of the system for medical dictations is close to perfect.  It also does some pretty smart things like:

• When I say cat scan it changes it to CAT scan
• When I say milligrams it changes it to mg 
• When I say qd it changes it to once a day.

This was with about 15 min of training on the general (non-medical) text sample.  Even though I can type pretty fast, there is no way that I can type at the speed I can speak.  The only rate limiting step is thinking of what I want to say!

Immediate benefits:

• Notes read better, HPI (history of present illness) is more detailed and the A/P (Assessment and Plan) truly begins to reflect my thought process as I don't hesitate to elucidate due to time constraints.
• The software supports voice macros which overcome a lot of the GUI challenges of the EHR.  Thus instead of constantly going from the keyboard to the mouse to do mundane tasks like approving a refill and routing it to my secretary, I just say "approve and sign" and it take care of all of the approximately 15 mouse clicks and keystrokes.  I was able to incorporate my password into the macro and close the encounter using the same macro. 
• I find I am not hunching over the keyboard as much and I am sure my poor neck, shoulders and wrists will thank me for this.

What next:

• The PowerMic II comes with several programmable buttons, e.g. tab forward and tab back.  Will explore the best way to make use of these to improve efficiency
• Develop more efficient work flows for using this in combination with smart links, smart texts and smart phrases.  By programming "dot phrases" and saying "press F2" most of the functionality I use regularly can be met without touching the mouse or keyboard.
• Search for information on the web about people using this with Epic to see if they have posted tips, tricks etc.
• Use the system from within regular Microsoft Office applications like Outlook and Word.  My first foray into this, I found that the accuracy with regular English was not as good as that with medical terminology.
• We are moving to the Summer 09 version of Epic next month.  Wait to see how this will affect the work flow.  Quite possibly some of the voice macros will need to be reprogrammed - bummer!

I think this will be a great step forward towards getting more meaningful notes with people transcribing their own thoughts rather than copy-pasting existing notes.

Interactive Mind Maps on the Web

I have written about mind maps before.  These are great tools to summarize complex information and relationships between concepts.  In the past I have created a flowchart with bubbl.us and a few mind maps with Vue.

I really like Vue as it gives you the greatest flexibility in the look and content of your mind map.  It also is a tremendous tool for presentation with the use of pathways.  Combining hover zoom and pathways, one can create a very customized flow or a presentation and focus attention on specific nodes or groups of nodes.
The biggest draw back I have found with Vue is a non intuitive collapse and expand function for nodes.  The other drawback is the difficulty in publishing it to the web in an interactive format where a user can click on a node to collapse or expand it.  This functionality is helpful when a map gets really large or when a user is looking at it with a small screen device.

After a very brief search (meaning I probably missed some other good tools), I decided on Freemind for these 2 reasons:

1. Easy collapsing and expanding of nodes
2. Maintaining this functionality when publishing to the web.
3. It does have some formatting options that are quite sufficient for my purpose.

How do you go about this?

1. Download and install Freemind (Freemind.sourceforge.net)
2. Create your mind map
3. Save the mind map (*.mm) and upload to your web server.
4. Download the Freemind applet (zip file which includes an HTML template) (freemindbrowser.jar).  You need this hosted on your web server.
5. Create a HTML wrapper using a template included with the freemind applet zip file that points to the location of your freemindbrowser.jar file and your *.mm mind map file.
6. Upload this HTML file to the web server.
7. Make sure the MIME types on the web server for .mm are set to application/freemind.  You may need your server administration to do this for you.
8. Point your browser to this HTML file and you are all done.

Static Image exported from Freemind

Just to test out this functionality, I summarized this information HERE using Freemind as an interactive mind map.

Caveat - needs JRE to work.  User will be prompted to download this if they don't have it

Caveat - this means it will NOT work on iPad or other iOS devices as they don't support Java :-(