Monthly Computer Maintenance.

In addition to the usual retinue of reminders, we provide a little advice regarding passwords.

While it is an extreme bother to memorize or keep track of the dozens, and in some cases, hundreds, of passwords we accumulate throughout our computing experience, it is nonetheless vital to choose your passwords carefully.

Password Thieves

First, let’s discuss for a moment the true importance of passwords.  Passwords prevent other individuals with nefarious purposes from hijacking your information and capabilities on any number of websites or computer interfaces.

There are two types of password thieves:

1. Those who run brilliant hacking applications on as many people as possible, capable of achieving success if a person’s password is too simple.
2. Those who target specific individuals for a purpose, and for whom they resort to every technique conceivable in order to successfully glean a password.

Once a thief has your password, depending on the interface, the damage they inflict can be disasterous.  Using your email account to spam and con everyone in your email contact list is minor compared to having your banking information compromised.

Passwords are serious.  Computer crime is escalating exponentially.  Protect yourself.

Choosing a Password

Regardless of the type of thief, you will increase your protection by choosing a complex password.  Please consider the following guidelines when doing so:

• Choose a password that is at least 8 characters in length.
• Do NOT use passwords that contain any personal information, hobbies, favourite words etc.
• Incorporate all of the following in each password:  uppercase letters, lowercase letters, numbers, and non alpha numberic characters (i.e. ~ $ { *).
• There should be at least 2 of each type of character mentioned in the above point.
• Do NOT use the same password for more than one instance.  In other words, do not use the same password for your computer logon as you do for your online banking.

Remembering a Password

Passwords can be difficult for us to remember if we follow the above guidelines.  Obviously if it’s a password you use each day, you will eventually commit it to memory.  However, what to do when we have dozens of passwords, most used infrequently?

• You might consider retaining the most needed in your wallet, scribbled innocuously on a piece of paper (although this is risky).
• There are password keeper apps for your handheld devices although do your research and make sure they are trustworthy.
• Avoid an easily accessible document with your passwords listed.
• There’s also the option of retaining them in a notebook that is normally kept in a safe or VERY hidden locale.

Consider updating you passwords sooner rather than later.

Where to Find the Newsletter

• This specific newsletter can be found here.
• All past newsletters can be found in this archive.
• To receive these newsletters directly in your inbox, subscribe today.

About the Speakeasy Solutions Newsletter

Receive the latest news regarding speech recognition & digital voice dictation product releases, support notes, tips and more from Speakeasy Solutions Inc.

Your Privacy is Important to Us

The Speakeasy Solutions Inc. newsletter & notification service is opt-in. Your information is used only for the purpose of sending you the notices you desire.

You may unsubscribe any time.

Choose the Information You Wish to Receive

• Indicate which products you would like to receive notices regarding.
• Indicate if you would like to receive regular maintenance notices based on your solution.
• Please also let us know if you would like to receive support & tips pertaining to your interest.

In the context of this article, templates refers to boilerplate text, also known as repetitious text. Such repetitious text can be incorporated into Microsoft Word templates, but with respect to EMRs, these text templates may be available within the EMR, or in conjunction with Dragon® Medical as a voice command.

If you’re using Dragon® Medical, the voice command of boilerplate text can also contain variables or fields that can be populated (i.e. exam results with placeholders for values specific to the patient). The advantage of using Dragon® Medical’s text commands with voice fields, is that the field can be populated with a default value (which is very obvious to see in text form, and difficult to overlook), or a simple instructional as to what needs to be dictated at that point. These fields can be quickly toggled through by way of a voice command, keyboard shortcut, or a button on the Philips SpeechMike.

Some EMRs charge for adding every boilerplate text template into a doctor’s EMR solution. This may become quite costly. However, creating such templates yourself within Dragon® Medical is quick, easy and effective.  Edit these commands any time, and add new ones at your whim.

If you wish to share your Dragon voice command templates with your colleagues, merely export the commands for them to import into their own user profile.

From Canadian EMR – Best Practices in Managing Templates

Depending on your style of practice, templates can be an important consideration when selecting an EMR. You should ask yourself the following questions:

• Do you want to be able to design or customize your own templates?
• Will you need to be able to share templates with other members of your practice?
• How many templates do you think you will require?

Generally, the more diverse your practice, the more templates you will potentially require. For example, if you limit your practice to pediatric attention deficit disorder, you may require just a handful of templates, whereas a broad-based general practice or internal medicine practice can require 100 templates or more.

The reason for asking this question is that there are cost and complexity implications. If the EMR that you select provides a library of pre-built templates, but requires your vendor to build new templates for you, it can become very costly. If you are not technically very savvy, you may elect to go this route, but realize that even small changes to a template can have associated costs.

Consider the following when using templates:

• There are a number of different ways to create templates. A more traditional approach is to define which data you would like to collect through your EMR and then use a set of tools to lay out the data fields before saving as a template. Some EMRs allow users to create templates “on the fly”. This means that as the clinician uses the EMR during the clinical encounter, the SOAP notes, medical treatment, and default values can simply be saved at the end of the encounter as a template for a specific examination or condition.
• If you develop a library of templates for your practice or to share with other clinicians, make sure that you have a standard naming convention in place. This is particularly important if the EMR allows you to easily create your own templates. For example, if there are multiple templates for the same condition with different names (e.g. CKD, Renal Failure, Kidney Failure) you will not be able to query the EMR for consistent information if data is not recorded in a consistent manner.
• Templates can either be started blank or can be pre-populated with data. There are some advantages to pre-populating certain templates and then deleting the data that is not relevant before saving the encounter, as it can significantly speed up documentation. A good example is a simple urinary tract infection. Pre-loading the standard symptoms, investigations, and treatment can shave minutes off the encounter; however, be very careful how you pre-load data. It is not a good idea to have standard default values pre-loaded in a yearly complete physical. Unless you go through each symptom and question, you may be tempted to leave the default values checked. From a medical-legal perspective this is not a good practice, as all of your encounters will look exactly the same to the trained eye and you will have great difficulty proving that you actually completed everything documented in the encounter.

Assistance with Dragon® Medical & Templates

Speakeasy Solutions Inc.  provides Dragon® Medical, microphones (i.e. Philips SpeechMikes, Sennheiser headsets), digital voice recorders (i.e. Philips DPM 9600, Olympus DS 5000), installation, training, support and customization services.

Speakeasy Solutions is based in Vancouver, and provides products and services across Canada from coast-to-coast. We look forward to working with you.

Please understand that when I entered this business 12 years ago even I was not convinced that Dragon® Medical was necessary. However, it was proven to me even then that it did make a difference. And now over a decade later, as a result of the advances in this speech recognition technology, that is more true than ever.

What I am about to say may seem rather harsh, but it is the honest truth: Nuance would not spend the considerable resources that it has (and continues to) on creating an extremely powerful tool (Dragon® Medical) if it did not make a difference to their target audience – that being medical practitioners. The differences are not borne in marketing, but in actual programming, which does affect the usability and efficacy for doctors. I dislike sales pitches as much as the next person, but these are solid facts, and the benefits quite measurable.

Vocabulary

Dragon® Medical includes over 40 vocabularies. A vocabulary is not just a list of words (which is often a misconception), but it also contains a statistical database of how the words are used, geared towards that specific specialty or practice’s reporting language.

For instance, there are four paediatric vocabularies:

1. cardiology,
2. dentistry,
3. gastroenterology, and
4. general.

Physicians in each of these practices may use very similar words, but their reporting style and word usage will vary. Each Dragon® Medical vocabulary takes into account that particular specialty or practice’s statistical word usage, lending to increase accuracy when using the correct vocabulary.

For this reason, simply adding medical words to a nonmedical vocabulary will not increase the accuracy for the medical practitioner. Words may be easily added to a nonmedical vocabulary, but the context in which they are used, as well as the statistics surrounding the word usage are not incorporated. Nonmedical vocabularies are based on general day-to-day or business usage.

For example, with Dragon® Medical a practitioner may say and achieve: “neck is supply with no adenopathy”, and with a nonmedical vocabulary the following would result: “neck is supple with no known for the” or “neck as supply with no odyssey”.

Quite bluntly, my medical clients do not have the time to try and tease a nonmedical vocabulary into some semblance of compliance and usefulness.

Anatomy of a Vocabulary

For those with a technical interest, please find following what can be deemed as the anatomy or construct of a specific vocabulary.

• Lexicon: list of words (this can be easily modified within each profile)
• Language Model: statistical database (the basis of a vocabulary and the probability in which words are used within the vocabulary)
• Acoustic Model: how specific words are spoken (based on a user’s voice)
• Speech Recognition Engine: ties it all together, and is the very core of Dragon

Bottom Line

In the end, Dragon® Medical vocabularies offer significant accuracy over and above the nonmedical variants, resulting in fewer corrections, less time spent dictating and more time available for patient care (or even leaving the office at a reasonable hour at the end of the day).

Commands

Dragon NaturallySpeaking Premium only offers one basic text command type, whereas Dragon® Medical offers a more robust text command type plus three other command types; all designed to increase efficiencies in a medical office.

I have said this before, and this bears repeating: many people ignore the gains that can be achieved from utilizing Dragon voice commands. Repetitive tasks such as boiler plate text entry (i.e. diet advice, surgery risks and benefits, flu shot given etc.), navigating through an EMR, creating a new document based on a Microsoft Word template, printing to a specific printer etc. amount to considerable time throughout the day – time that can be reallocated to patient care or other activities.

Command Types Available

Dragon® Medical provides the ability to create four different types of commands, each offering different benefits in a variety of situations. Commands can be created with our clients on the spot during training sessions, or after the fact once a client has had an opportunity to assess where time savings could take place. Speakeasy Solutions also enjoys teaching physicians how to create their own custom commands, allowing them to be independent and create commands as needed.

• Text & Graphics: for repetitious text with and without voice fields (voice fields are akin to a form that can be filled out)
• Step by Step: easy to create computer & EMR control commands
• Advanced Scripting: creating new consult letters based on MS Word templates
• Macro Recorder: records mouse & keystrokes

Bottom Line

Dragon® Medical offers tremendous efficiencies over and above Dragon Premium, resulting in less time spent on repetitive tasks, enabling physicians to quickly complete consult letters and encounters, thusly providing more time for other activities.

Medical Formatting Rules

Dragon® Medical provides numerous medically related formatting options, allowing the medical practitioner to customize Dragon’s output according to personal preferences.

For instance, capitalization of medical terms, as well as expansion of acronyms are very simple to modify. Abbreviations can be used or not (the trend is becoming to not using abbreviations). There are options regarding the of ordinals and other numeric scenarios.

Attempting to re-create these rules within nonmedical version of Dragon would be extremely time-consuming, and in some cases quite difficult, if not impossible.

Bottom Line

Dragon® Medical allows very quick and easy customization of medical formatting options, enabling users to have considerable control over how Dragon transcribes a variety of phrases.

Multicomputer Support

Dragon® Medical user profiles can be synchronized across multiple computers.

In other words, Dragon® Medical can be installed on several networked computers, each one accessing a single user profile which is updated from any computer, whenever the user profile is saved. There is no need to create multiple profiles. Maintain one user profile across multiple computers.

This is also extremely useful for third-party proofreading of dictations. A physician may dictate within Microsoft Word or DragonPad, saving their voice with their text dictation. Dragon® Medical would be installed upon an assistant’s computer, with access to the physician’s user profile, and any corrections made while proofreading the dictation would be saved to the master user profile, thereby increasing future recognition accuracy.

The above is not possible with Dragon NaturallySpeaking Premium.

Bottom Line

If a physician intends on using Dragon® Medical on more than one computer, possibly involving a proofreader or correctionist, Dragon® Medical (and not Dragon NaturallySpeaking Premium) will enable synchronization of user profiles and streamline efficiencies.

Multiple Vocabularies

Most medical practitioners have need of more than their specialty or family practice vocabulary. If nonmedical dictation (i.e. general email, meeting minutes, personal correspondence etc.) is attempted with a medical specialty vocabulary, the accuracy is quite poor as it is not designed to function in this fashion. Therefore, utilizing multiple vocabularies within the same user profile ensures increased accuracy regardless of the topic being dictated.

Three vocabularies are most common, such as:

• Daily use medical: specialty or family practice
• General medical: medical legal report
• Nonmedical: for email and general correspondence

Dragon NaturallySpeaking Premium does not allow the creation of multiple vocabularies.

Bottom Line

Multiple vocabularies offer higher recognition accuracy and improved efficiencies for those medical practitioners desiring to use Dragon outside of their practice.

Hidden Mode

Dragon® Medical allows medical practitioners to dictate simultaneously while reviewing data or information on the computer. In other words, if a physician needs to review chart notes, lab results or other documentation on the computer while verbally composing their consults or notes, their dictation can accumulate in the background while such a review is taking place. Once the physician has completed their dictation, the results are transferred into a final destination of choice (usually an EMR).

This feature is not available in the nonmedical versions of Dragon.

Bottom Line

If a physician needs to review information on the computer while simultaneously dictating their encounters, Dragon® Medical enables the practitioner to perform such a task efficiently.

In Conclusion

An investment of Dragon® Medical more than pays for itself in terms of productivity. Physicians are deluged and find themselves working later and later in the office (especially with the push towards EMR adoption). Implementing an effective Dragon® Medical solution can be the answer to assist the physician and making the most of their time. Yes, Dragon® Medical is pricier, but the differences between it and the nonmedical versions are considerable.

If you are prospective client of Speakeasy Solutions Inc., please do not hesitate to contact myself, Alexandria Carstens, at 604-264-9109 or 1-888-964-9109 extension 102 (within Canada ONLY). I will be more than happy to explain these differences in more detail, and consult if you on a customized speech recognition solution for your office. Speakeasy Solutions provides Dragon® Medical, microphones (i.e. Philips SpeechMikes, Sennheiser headsets), digital voice recorders (i.e. Philips DPM 9600, Olympus DS 5000), installation, training, support and customization services.

Speakeasy Solutions is based in Vancouver, and provides products and services across Canada from coast-to-coast. We look forward to working with you.

I would like to take a moment and draw this one in particular to the attention of our clients who are in the investigative stages of implementing or updating their dictation solutions.

We are pleased to assist you with transitioning from analogue to digital.

• Philips Professional Dictation Solutions

For more information, please contact us.

Speakeasy Solutions Inc., based in Vancouver, BC, provides digital dictation equipment (such as Philips’ DPM 9600 digital recorders and Philips’ 7277 transcribers) across Canada from Victoria, BC to St. John’s, NL.  We also provide support and services relating to Philips’ SpeechExec Pro and Enterprise workflow software solutions.

We look forward to working with you.  If you are ready to receive an estimate or wish to place an order, you may do so here.  As always, never hesitate to phone us.

Just as a reminder, Speakeasy Solutions Inc. provides products and services in Canada only.

Since the new version, released in Autumn 2011, there have been more questions.

Hopefully the following will clarify, in very simple terms, how the licensing of Dragon Medical Practice Edition works.

Dragon Medical Practice Edition is Licensed Per User

As it always has been, Dragon Medical is still licensed per user, and not per machine/computer. This is an extremely fair licensing arrangement and takes into account the reality that most physicians have a main PC, a notebook, a home computer or may have several exam rooms.

Another example would be a three physician clinic, sharing six exam rooms, but each with their own office as well. Dragon Medical can be installed on each of the three physician’s office computer plus each exam room (that’s nine computers total), after purchasing three licenses.

In some cases, not every physician in a clinic will wish to use Dragon Medical. If that is the case, they simply ignore the Dragon Medical software on any computer that they are using. However, should they, in future, wish to use Dragon Medical, they will be required to purchase their own license of Dragon Medical, even if it’s already installed on a computer that they are using. It’s likely they will wish to install Dragon Medical on their personal computer(s) as well.

A Proofreader’s Need to Use Dragon Medical Falls Under the Physician’s License

In some scenarios, a proofreader (MOA, secretary, assistant) will proofread a physician’s dictation with Dragon Medical.

The physician may dictate into MS Word, and save their voice with the resulting dictation to the server. The proofreader, with Dragon Medical installed on their computer, will open the MS Word file with voice attached and perform the necessary proofreading. While the proofreader is not actively using Dragon Medical by voice themselves, they are loading the physician’s Dragon user profile in order to make corrections and edits. This license falls under the physician’s license and therefore an additional Dragon Medical license is not required.

Again, if a proofreader is performing proofreading tasks using a physician’s Dragon user profile, the license used is associated with the physician’s Dragon Medical license.

If, however, a proofreader desires to use Dragon Medical with their own user profile, they will require their own license.

Dragon Medical Practice Edition Allows for Four (4) Installations

Dragon Medical version 10 and previous allowed the user to have up to 10 concurrent installations. The new version, Dragon Medical Practice Edition, permits up to four concurrent installations – this includes an installation that may be required by a proofreader.

If you are retiring a computer or no longer require Dragon Medical on a specific computer, ensure that you uninstall Dragon Medical from that computer to effectively de-register that license’s use so that it may be installed on another computer. Every time Dragon Medical is installed or uninstalled, Nuance records the computer(s) associated with that license’s installation.

About Speakeasy Solutions

Based in Vancouver, BC, Speakeasy Solutions Inc. provides Dragon Medical software/licenses, along with support and training services across Canada from Victoria, BC to St. John’s, NL. We are in our 12th year of assisting physicians, expertly utilize this amazing software that aids in EMR adoption and streamlining office efficiencies.

• Contact us any time for your Dragon Medical Practice Edition speech recognition needs.
• Learn more about Dragon Medical Practice Edition.
• Read the PC minimum specifications.
• Place an Order.

Dragon Medical EULA (End User License Agreement)

Dragon Medical Practice Software License

Nuance Communications, Inc.

DRAGON MEDICAL (“Software”)

END USER LICENSE AGREEMENT

IMPORTANT-PLEASE READ CAREFULLY: Your acceptance of the terms of this End User License Agreement (“Agreement”) is required before your use of the Software. This Agreement is between you (either an individual or a single entity, hereinafter referred to as “Licensee” or “you”) and Nuance Communications, Inc. (collectively, “Nuance”). BY OPENING THE SEALED SOFTWARE PACKAGE AND/OR BY INSTALLING OR OTHERWISE USING THE SOFTWARE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS OF THIS AGREEMENT. IF YOU DO NOT AGREE TO THE TERMS AND CONDITIONS OF THIS AGREEMENT, DO NOT INSTALL OR USE THE SOFTWARE, and present your receipt or other proof of purchase, together with the Software Package, to the entity from which you obtained the Software Package within 30 days to request a refund. THIS AGREEMENT IS ENFORCEABLE AGAINST ANY PERSON OR ENTITY (E.G., SYSTEM INTEGRATOR, CONSULTANT OR CONTRACTOR) THAT INSTALLS OR USES THE SOFTWARE OR ANY COMPONENT OF THE SOFTWARE PACKAGE ON ANOTHER PERSON’S OR ENTITY’S BEHALF.

THIS IS A LICENSE TO USE SOFTWARE AND NOT A SALE OF SOFTWARE CODE.

Your rights under this Agreement may be subject to additional terms and conditions in a separate written software license agreement with Nuance or with any of Nuance’s authorized resellers, intended to govern the use of the Software Package, which supplements or supersedes all or portions of this Agreement.

Definitions

“Authorized User” means an employee or contractor of Licensee who is permitted to access and use the Software subject to the terms and restrictions contained in this Agreement.

“Authorized User License” means Licensee’s limited right to allow a single employee or contractor (for each such license purchased, as indicated in the Order) to use the Software in a manner commensurate with its intended use.

“Device” means a personal computing device as specified in the accompanying Documentation.

“Documentation” means the user manuals and/or technical publications, as applicable, supplied with the Software in printed or electronic form, relating to the installation, use and administration of the Software.

“License Duration” means the duration of the license grant specific to a particular Software license, which duration is either a Perpetual License or a Term License.

“Maintenance Services” are services that Nuance provides pursuant to an Order to maintain the Software and equipment (as applicable). The description of these Maintenance Services purchased by Licensee is posted online on Nuance website at the URL- http://support.nuance.com/healthcare under “Hardware and Software Maintenance Options Terms and Conditions”. Nuance may update the URL from time to time.

“Non-Physicians” means employees or contractors of Licensee who are not Physicians, but provide medical services on behalf of the Licensee, including, but not limited to, nurses, physician assistants and psychologists.

“Non-Physician Client License” means a license grant as per Section 1(a) of this Agreement, limited for use to only a Non-Physician, as indicated in the Order, pursuant to the terms of this Agreement. For the avoidance of doubt, Software licenses pursuant to a “Non-Physician Client License” cannot be used by Physicians.

“Order” means a purchasing document placed by Licensee hereunder for Software licenses, equipment and Maintenance Services, which indicates, among other things, the number and type of Software license(s) and services purchased by you.

“Perpetual License” means a license grant that is not limited in duration, subject to early termination pursuant to this Agreement.

“Physicians” means physicians (including, but not limited to: full time and part time physicians, attending physicians, D.O.s and residents working on behalf of the Licensee.

“Physician Client License” means a license grant as per Section 1(a) of this Agreement, limited for use to only a Physician, as indicated in the Order, pursuant to the terms of this Agreement.

“Run-time Engine” means the programmed access of the Software by a Licensee application or a third party application integrated with the Software.

“Software Package” means the Software, the associated media, and the Documentation.

“Speech Data” means the audio files, associated transcriptions and log files provided by you hereunder or generated in connection with the Software.

“Term License” means a license grant that is limited in duration, which duration is as indicated in the Order, subject to early termination pursuant to this Agreement.

“User Profile” refers to the record of speaker-specific data that provides a consistent dictation experience across successive dictation sessions.

“Software” shall also include any modified versions, updates, or upgrades of the Software licensed to you by Nuance. You may install and use a modified version, update, or upgrade of the Software only if you have a validly licensed existing version of the Software being modified, updated, or upgraded. If you download, install, copy, or otherwise use a modified version, update, or upgrade of the Software, then your license terminates as to the previous version or edition of the Software that was the basis for your eligibility to such modified version, update or upgrade, and you have a license only to such modified version, update, or upgrade or edition of the Software under the terms of this Agreement.

1. Grant of License

Subject to the terms and conditions of this Agreement, Nuance grants Licensee a non-exclusive license to use the Software subject to the following:

(a) Software. Licensee may allow a single employee or contractor, for each Authorized User License purchased, to use the Software on a Device, in a manner commensurate with its intended use and solely for Licensee’s internal business purposes. Pursuant to such right, you are authorized to install one copy of the Software for each Authorized User License purchased on a maximum of four (4) Devices, for use solely by the Authorized Users.

A separate Authorized User License must be purchased for each user whose User Profile(s) is/are being used by the Software. An Authorized User is permitted to create and use multiple User Profiles under a single Authorized User License.

Licensee may authorize a third party to use the Software in connection with any of Licensee’s User Profiles solely for the purpose of performing editing or correcting functions for Licensee; however, such third party must purchase a separate Authorized User License to create his or her own User Profile.

(b) Documentation. Subject to the terms and conditions of this Agreement, Nuance grants to Licensee a non-exclusive license to make copies of the Documentation in connection with its use of the Software in accordance with this Agreement, but no more than the amount reasonably necessary to support Authorized Users. Any permitted copy of the Documentation that Licensee makes must contain the same copyright and proprietary notices that appear on or in the Documentation.

2. Nuance’s Rights

Licensee acknowledges that the Software Package consists of proprietary information and products of Nuance (or other third parties) protected under United States or other patent, copyright, or trade secret laws. Licensee further acknowledges and agrees that all right, title and interest in and to the Software Package, and each component thereof, are and shall remain with Nuance. This Agreement does not convey to Licensee an interest in or to the Software Package, but only a limited right to use, revocable in accordance with the terms of this Agreement. Nuance reserves all rights not expressly granted to you in this Agreement.

3. Term and Termination

(a) This License is effective upon Licensee’s first installation and/or use of the Software and shall continue for the License Duration. Licensee may terminate this Agreement at any time by uninstalling the Software and returning the Software Package to Nuance. Nuance may terminate this Agreement at any time upon breach by Licensee of any terms hereof including non-payment of applicable fees, as indicated in the Order, to Nuance or its reseller, as applicable. Upon such termination by Nuance, Licensee agrees to uninstall the Software and promptly return the Software Package to Nuance.

(b) Termination of this Agreement shall not relieve Licensee of its payment obligations incurred prior to such termination, including all remaining (and subsequently invoiced) monthly payments of license fees with respect to a Term License purchased under this Agreement.

4. Other Restrictions

(a) Licensee may not sub-license, rent, lease, lend, or otherwise commercialize the Software Package or any portion of the Software in any manner including rights (such as use or access rights) on a membership, subscription or pay per use basis.

(b) Except as expressly authorized under this Agreement, Licensee is prohibited from providing use of the Software in a computer service business, third-party outsourcing facility or service, service bureau arrangement, or time sharing basis.

(c) Licensee may not reverse engineer, decompile, modify, create derivative works (except for User Profiles or custom vocabularies as set forth in the Documentation) of, or disassemble the Software, except to the extent that the foregoing restriction is expressly prohibited by applicable law.

(d) Licensee may only use the Software for its internal use only, in accordance with and in the manner intended by the Documentation.

(e) Licensee may not publish the results of benchmarking the Software against competitive software, except to the extent that the foregoing restriction is expressly prohibited by applicable law.

(f) Licensee may not transfer or assign this license or the Software Package to any third party without the prior express written consent of Nuance. Any changes to, modifications to, or derivative works (except as set forth above) of the Software shall become the exclusive property of Nuance, except to the extent that the foregoing restriction is expressly prohibited by applicable law.

(g) This license for the Software Package does not allow Licensee to use the Software as a Run-time Engine.

(h) Licensee shall immediately notify Nuance upon learning of any third party’s unauthorized possession or use of any Software supplied under this Agreement.

5. Proprietary Rights

Title, ownership rights, and intellectual property rights in the Software Package shall remain in Nuance and/or its suppliers or licensors. Licensee acknowledges such ownership and intellectual property rights, and will not take any action to jeopardize, limit, or interfere in any manner with Nuance’s or its suppliers’ or licensors’ ownership of or rights with respect to the Software Package. The Software Package is protected by copyright and other intellectual property laws and by international treaties.

6. Limited Warranty

Nuance warrants that the Software will perform substantially in accordance with the accompanying Documentation for a period of 90 days from the date of receipt (“Limited Warranty”).

If an implied warranty or condition is created by your state/jurisdiction and federal or state/provincial law prohibits disclaimer of it, you also have an implied warranty or condition, BUT ONLY AS TO DEFECTS DISCOVERED DURING THE PERIOD OF THIS LIMITED WARRANTY (90 DAYS). AS TO ANY DEFECTS DISCOVERED AFTER THE NINETY (90) DAY PERIOD, THERE IS NO WARRANTY OR CONDITION OF ANY KIND. Some states/jurisdictions do not allow limitations on how long an implied warranty or condition lasts, so the above limitation may not apply to you. Any modified versions, updates or upgrades to the Software provided to you after the expiration of the 90 day Limited Warranty period are not covered by any warranty or condition, express, implied or statutory.

LIMITATION ON REMEDIES; NO CONSEQUENTIAL OR OTHER DAMAGES. Your exclusive remedy for any breach of this Limited Warranty is as set forth below. Except for any refund elected by Nuance, YOU ARE NOT ENTITLED TO ANY DAMAGES, INCLUDING BUT NOT LIMITED TO CONSEQUENTIAL DAMAGES, if the Software does not meet Nuance’s Limited Warranty, and, to the maximum extent allowed by applicable law, even if any remedy fails of its essential purpose. The terms of Section 8 below (“Exclusion of Incidental, Consequential and Certain Other Damages”) are also incorporated into this Limited Warranty. Some states/jurisdictions do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation or exclusion may not apply to you. This Limited Warranty gives you specific legal rights. You may have others, which vary from state/jurisdiction to state/jurisdiction.

YOUR EXCLUSIVE REMEDY. Nuance’s and its suppliers’ liability and your exclusive remedy shall be, at Nuance’s option from time to time exercised subject to applicable law, (a) return of the price paid (if any) for the Software, or (b) a repair or replacement of the Software that does not meet this limited warranty and that is returned to Nuance with a copy of your receipt. You will receive the remedy elected by Nuance without charge, except that you are responsible for any expenses that you may incur (example: cost of shipping the Software to Nuance). This Limited Warranty is void if failure of the Software has resulted from accident, abuse, misapplication, abnormal use or a virus. Any replacement software will be warranted for the remainder of the original warranty period or thirty days, whichever is longer.

7. Disclaimer of Warranty

THE LIMITED WARRANTY THAT APPEARS ABOVE IS THE ONLY EXPRESS WARRANTY MADE TO YOU AND IS PROVIDED IN LIEU OF ANY OTHER EXPRESS WARRANTIES (IF ANY) CREATED BY ANY DOCUMENTATION OR PACKAGING. EXCEPT FOR THE LIMITED WARRANTY AND TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, NUANCE AND ITS SUPPLIERS PROVIDE THE SOFTWARE PACKAGE, MAINTENANCE SERVICES OR OTHER SERVICES (IF ANY) ON AN “AS IS” BASIS, AND DISCLAIM ALL OTHER WARRANTIES AND CONDITIONS, EITHER EXPRESS, IMPLIED OR STATUTORY, INCLUDING, WITHOUT LIMITATION, WARRANTIES THAT IT IS FREE OF DEFECTS, MERCHANTABLE, FIT FOR A PARTICULAR PURPOSE, OR NON-INFRINGING, as well as WARRANTIES OF ACCURACY, COMPLETENESS OF RESPONSES, RESULTS, WORKMANLIKE EFFORT, LACK OF VIRUSES, AND OF lack of NEGLIGENCE, ALL WITH REGARD TO THE SOFTWARE PACKAGE AND THE PROVISION OF OR FAILURE TO PROVIDE SUPPORT SERVICES. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE SOFTWARE AND any MAINTENANCE SERVICES OR OTHER SERVICES IS BORNE BY LICENSEE. SHOULD THE SOFTWARE PROVE DEFECTIVE IN ANY RESPECT, LICENSEE AND NOT NUANCE OR ITS SUPPLIERS OR RESELLERS ASSUMES THE ENTIRE COST OF ANY SERVICE OR REPAIR. THIS DISCLAIMER OF WARRANTY CONSTITUTES AN ESSENTIAL PART OF THIS AGREEMENT. NO USE OF THE SOFTWARE IS AUTHORIZED HEREUNDER EXCEPT UNDER THIS DISCLAIMER. SOME STATES OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES OR LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY MAY LAST, SO THE ABOVE LIMITATIONS MAY NOT APPLY TO YOU.

8. EXCLUSION OF INCIDENTAL, CONSEQUENTIAL AND CERTAIN OTHER DAMAGES. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, IN NO EVENT SHALL Nuance OR ITS SUPPLIERS BE LIABLE FOR ANY SPECIAL, INCIDENTAL, INDIRECT, PUNITIVE OR CONSEQUENTIAL DAMAGES WHATSOEVER (INCLUDING, BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS OR CONFIDENTIAL OR OTHER INFORMATION, FOR BUSINESS INTERRUPTION, FOR PERSONAL INJURY, FOR LOSS OF PRIVACY, FOR FAILURE TO MEET ANY DUTY, INCLUDING OF GOOD FAITH OR OF REASONABLE CARE, FOR NEGLIGENCE, AND FOR ANY OTHER PECUNIARY OR OTHER LOSS WHATSOEVER) ARISING OUT OF OR IN ANY WAY RELATED TO THE USE OF OR INABILITY TO USE THE SOFTWARE, THE PROVISION OF OR FAILURE TO PROVIDE SUPPORT SERVICES, OR OTHERWISE UNDER OR IN CONNECTION WITH ANY PROVISION OF THIS AGREEMENT, EVEN IN THE EVENT OF THE FAULT, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, BREACH OF CONTRACT OR BREACH OF WARRANTY OF Nuance OR ANY SUPPLIER, AND EVEN IF Nuance OR ANY SUPPLIER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

9. LIMITATION OF LIABILITY AND REMEDIES. Notwithstanding any damages that you might incur for any reason whatsoever (including, without limitation, all damages referenced above and all direct or general damages), the entire liability of Nuance and any of its suppliers under any provision of this Agreement and your exclusive remedy for all of the foregoing (except for any remedy of repair or replacement elected by Nuance with respect to any breach of the Limited Warranty) shall be limited to the amount actually paid by you for the Software. The foregoing limitations, exclusions and disclaimers (including Sections 6, 7 and 8 above) shall apply to the maximum extent permitted by applicable law, even if any remedy fails its essential purpose.

10. Assignment

In no event may Licensee assign its rights or obligations hereunder or subcontract any portion of its performance hereunder without Nuance’s prior written consent.

11. Remedies

If Licensee breaches this Agreement, Licensee shall promptly return the Software Package to Nuance. A breach by Licensee will irrevocably harm Nuance, and Nuance shall be entitled to injunctive and/or other equitable relief, in addition to any other remedies afforded by law.

12. Governing Law

This Agreement shall be governed by the laws of the Commonwealth of Massachusetts.

13. Severability

Should any term of this Agreement be declared void or unenforceable by any court of competent jurisdiction, such declaration shall have no effect on the remaining terms hereof.

14. No Waiver

The failure of either party to enforce any rights granted hereunder or to take action against the other party in the event of any breach hereunder shall not be deemed a waiver by that party as to subsequent enforcement of rights or subsequent actions in the event of future breaches.

15. United States Government End Users

This Section applies to all acquisitions of the Software by or for the Federal government or by any prime contractor or subcontractor (at any tier) under any contract, grant, cooperative agreement, or other activity with the Federal government. By accepting delivery of the Software, the government hereby agrees that this software qualifies as “commercial” computer software within the meaning of the acquisition regulation(s) applicable to the procurement. The terms and conditions of this Agreement shall pertain to the government’s use and disclosure of the Software and shall supersede any conflicting contractual terms or conditions. If this Agreement fails to meet the government’s needs or is inconsistent in any respect with Federal law, the government agrees to return the Software, unused, to Nuance. The following additional statement applies only to acquisitions governed by DFARS Subpart 227.4 (October 1988): “Restricted Rights-Use, duplication, and disclosure by the Government is subject to restrictions as set forth in subparagraph (c)(1)(ii) of the Rights in Technical Data and Computer Software clause at DFARS 252.227-7013 (Oct. 1988).” In the event any of the above referenced agency regulations is amended or replaced, the equivalent successor regulation shall apply instead.

16. Licensee expressly agrees that Nuance is not a licensed health care provider and that the Software is not a substitute for independent medical decision making by a qualified health care practitioner. Licensee is solely responsible for its own conduct with respect to patient care and any reliance upon the Software shall not diminish License’s responsibility for patient care that you may be involved or associated with.

17. Export Restrictions. You acknowledge that the Software Package is subject to U.S. export jurisdiction. You agree to comply with all applicable laws that apply to the Software Package, including the U.S. Export Administration Regulations, as well as end-user, end-use and destination restrictions issued by the U.S. government.

18. Consent To Use Of Speech Data. The Software has a feature by which you may enable Nuance to collect Speech Data. By turning on the feature to provide Nuance with Speech Data, you acknowledge, consent and agree that Nuance may collect and use the Speech Data as provided hereunder. The parties agree that Speech Data shall only be used by Nuance or third parties acting under the direction of Nuance, pursuant to confidentiality agreements, to tune, enhance and improve the speech recognition and other components of the Software, and other Nuance services and products. Nuance will not use the information elements in any Speech Data for any purpose except as set forth above.

19. Activation. Nuance has designed the Software to prevent unlicensed use of the Software. Licensee agrees that Nuance may do so. In particular, use of the Software requires that Licensee activate the Software as described during the installation of the Software. During such activation, Nuance may collect certain non-personal technical information from Licensee’s computer concerning Licensee’s computer or network. Licensee agrees that Nuance may do so. Licensee may be required to reactivate the Software if Licensee modifies its computer hardware, the Software, or the operating system.

20. Notifications. From time to time, Licensee may receive notices about the Software or other information through an Internet connection initiated automatically by the Software. This connection will be made using the Internet connections and telephone lines under Licensee’s control. By installing the Software on Licensee’s computer, Licensee hereby consents to have the Software initiate a connection through the Internet to Nuance’s website and to receive notices about the Software and other information through Licensee’s Internet connection.

Have you been merrily using Dragon and then whilst shutting down for the day encountered the following warning message: “You need to increase the size of the acoustic archive to store the data from your corrections. This data will be used by the Acoustic Optimizer to increase your recognition accuracy. Do you want to increase the size of the acoustic archive?”

Well this is it!

First: Don’t Panic!

Second: It’s a warning message only.

What to Do

Click [ Yes ], that you wish to increase the acoustic archive size. This may or may not work. If it doesn’t, it’s not the end of the world and you’ve only lost whatever training or correcting you performed in this session of use with Dragon. Any new words added as a result will be saved with your user profile, IF you save your user profile.

Sometimes after clicking [ Yes ], Dragon becomes indignant and defies your desire to expand the archive and even save your user profile. To force its hand, as it were, save your Dragon user profile manually via the menu and then exit.

When you next have time, you will need to run the Accuracy Tuning feature.

And that’s it.

What is It?

The acoustic archive stores your corrections and voice training, and also has a defined limit of how much data can be stored. Once this limit has been reached, the above mentioned warning message will appear.

While performing Accuracy Tuning every 3-4 months is preferable, you can always wait until you see this warning message. If you see this message prior to a regular 3-4 month maintenance point, this would indicate that you have been performing numerous corrections and training with Dragon (well done!), and should likely proceed with Accuracy Tuning ahead of schedule.

Receive Regular Notices

Speakeasy Solutions sends out regular newsletters, including notification of Dragon maintenance practices. If you are not yet on this list, please consider signing up today.

About Speakeasy Solutions Inc.’s Services

Based in Vancouver, BC, we provide support and training services across Canada from Victoria, BC to St. John’s, NL. We are in our 12th year of assisting physicians, legal practitioners and professionals.

Contact us any time for your speech recognition (Dragon NaturallySpeaking Professional, Legal and Dragon Medical Practice Edition) needs.

General Computer Support & Tips.

Re-position your cursor quickly, maximize the use of the < tab > key, set up & use multiple signatures in MS Outlook, and set your default saving location in MS Word.

Keyboard Shortcut of the Month

< Ctrl + Home > & < Ctrl + End >

This keystroke sequence will re-position the cursor to the top & bottom of the text field in focus.

Sometimes you need to move the cursor to the very top or bottom of a document, or to the beginning or end of a text region in an application (i.e. EMR, website etc.). Most people grab their mouse, hover and then left click (sometimes not even positioning the cursor where desired).

It’s much faster to simply press the < Ctrl + Home > keys to position the cursor to the top or the < Ctrl + End > keys to position the cursor to the bottom.

Efficiency Tip of the Month

< Tab > is Your Friend

The < Tab > key is perhaps one of the most undervalued keys on the keyboard. Most people use it to insert a blank space at the beginning of a line or paragraph, or to break up text with a blank space. The reality is that it’s best designed to take you from one text region to the next much faster than you could with a mouse.

For instance, if you are logging in to your computer or a website or an application, the cursor is blinking in the Username field. At that point you enter your logon name. Here is where most people pick up their mouse, move it to the Password or next field, click and then type. You can save time by simply pressing the < Tab > key to move the cursor focus into the next field; your hands are already on the keyboard, after all.

Should there be a check box, radio button or list box between text areas, press the < Tab > key as many times as necessary to move the cursor to its intended text field. It will likely still be faster than taking your hands off the keyboard, using the mouse and then back to the keyboard again.

The < Tab > key is your friend and very helpful indeed.

Outlook Tip

Set Up & Use Multiple Signatures

While some of us use the same signature for all our email purposes, others may benefit from a variety of signature sign-offs such as:

• business
• personal
• informal
• formal
• complete with all contact information
• brief with only necessary information

The default signature you choose in the options should be the one you use most often. However, create and use additional signature blocks for other occasions.

Be aware of a bug in some versions of MS Outlook where changing the signature AFTER you compose or begin replying to an email may result in removing your composition. Therefore, choose your signature BEFORE you begin your composition.

Read more on the Microsoft website here: Create and add an email message signature.

MS Word Tip

Set Your Default Saving Location

Unless set up for you, MS Word’s default saving location for files will be your Documents directory. If you seldom save documents to this directory or if you mostly save your documents to a sub-directory within the Documents directory, you would benefit from changing the default save location within MS Word’s options.

Choose a directory that you save to most frequently. This could be a client drive on the network or it could be a special directory that your assistant accesses.

In MS Word 2010, click on File> Options> Save.

Change the Default file location (click [ Browse... ]) to the appropriate directory.

Click [ OK ] and [ OK ].

Now all your future documents will prompt you to save to this location. Obviously you may wish to drill down to a further directory as is appropriate or change directories completely.

If you are using Dragon NaturallySpeaking or Dragon Medical, create custom voice commands to save to your top 10 (or more) file locations; this improves efficiencies even further.

Where to Find the Newsletter

• This specific newsletter can be found here.
• All past newsletters can be found in this archive.
• To receive these newsletters directly in your inbox, subscribe today.

About the Speakeasy Solutions Newsletter

Receive the latest news regarding speech recognition & digital voice dictation product releases, support notes, tips and more from Speakeasy Solutions Inc.

Your Privacy is Important to Us

The Speakeasy Solutions Inc. newsletter & notification service is opt-in. Your information is used only for the purpose of sending you the notices you desire.

You may unsubscribe any time.

Choose the Information You Wish to Receive

• Indicate which products you would like to receive notices regarding.
• Indicate if you would like to receive regular maintenance notices based on your solution.
• Please also let us know if you would like to receive support & tips pertaining to your interest.

As a matter of efficiency, daily used applications are best pinned to the Taskbar (the bar at the bottom of your screen where the time is cited on the far right), and frequently used applications are best pinned to the Start Menu (beneath the Windows button on the far bottom left). Such applications might include:

• WordPad
• Calculator
• Microsoft PowerPoint
• And even regularly used system tools such as Disk Defragmenter.

The reason this topic has arisen is because when I work with clients, I speak to them about much more than harnessing the power of Dragon NaturallySpeaking, but also how to take advantage of certain facets of computer use. For those who perform their own maintenance, disk defragmentation is highly suggested once per month and for some clients, this process is not always best automated as the computer is not always reliably on at the same time every month.

Rather than digging through the Start Menu for the Disk Defragmenter, I often place a shortcut to this useful process by pinning it to the Start Menu. This enables clients to see it regularly, serve as a reminder that this task should be performed, and of course give them ease of access to this feature.

Please find below instructions to this effect, with some additional information.

Clicking on the Start Menu will reveal either one or two segmented areas on the far left hand side:

1. Pinned items
2. Recent applications

If you have never pinned any items to the Start Menu, this area will be empty. Unless you have changed the defaults, you will see a number of Recent Applications just above the All Programs submenu. Personally, I find the list of recent applications cluttering, as well as inaccurate. Because it is unreliable, I remove it completely from view. If you desire, you may do so as follows:

Right-click on the area next to the list of applications and then click on Properties.

Within the Taskbar and Start Menu Properties dialogue box, click on the Start Menu tab, and then click on the Customize button.

On the Customize Start Menu dialogue box, set the “Number recent programs to display” to 0 (this will remove the recently listed applications from just above the Start Menu). Set “Number of recent items to display in Jump Lists” to a maximum number that you are comfortable with (I find 20 is sufficient – I tend not need to access any further documents).

The term “Jump List” refers to items listed beneath the main application used to open our access these items. For instance, in the example below, hovering over Adobe Acrobat 9 Pro provides me with a submenu of PDF documents I recently opened.

Returning to the entire purpose of this blog post, you can find the Disk Defragmenter by clicking on Start> All Programs> Accessories> System Tools> Disk Defragmenter. Once you have found this application, right-click over top of it…

From the alternative menu, click Pin to Start Menu.

This will position the pinned Disk Defragmenter to the bottom of the pinned items listed. My suggestion would be to organize those applications that you pinned to the Start Menu. Reposition these items by clicking and dragging to a new location in the list.

Release with your mouse and it will slide into place.

It is suggested that you pin your commonly used applications to your Start Menu so that all you need do is make two mouse clicks (one for the Start Menu, and the second for the application desired).

Obviously if you have Dragon NaturallySpeaking, you simply need only say “open (name of application)”. However, we do not always have Dragon open every time we are using the computer.

Not everyone may encounter these issues, but for those who do, they may wish to read below:

Amicus Attorney may un-register Dragon NaturallySpeaking’s compatibility module for Microsoft Outlook. In such instances, the computer and/or Dragon will freeze, Outlook may be inoperable etc.

A potential remedy is to reregister the compatibility module for Microsoft Outlook. This is by no means a permanent fix, and Nuance is aware of the issue. They’re working steadfastly towards a resolution, and hopefully there will be one soon. In the meantime, instructions for reregistering the compatibility module are as follows:

How to Register and Unregister Dragon NaturallySpeaking Compatibility Modules

Information:

Dragon NaturallySpeaking uses compatibility modules (also known as application add-ins) to directly integrate with certain applications (such as Amicus Attorney). It may be necessary to register or unregister certain add-ins to enable or disable certain functionality. To register or unregister the Dragon NaturallySpeaking compatibility modules, refer to the commands below.

To register or unregister a compatibility module:

1. Close all programs.
2. Click “Start > Run” on Windows XP, or click “Start > All Programs > Accessories > Run” on Windows Vista and Windows 7.
3. Execute the corresponding command in the Run dialog box (see the list of commands below).

Note: It may not be possible to register or unregister files from the Run dialog box when running Windows 7. Please refer below for steps on registering files using an Elevated Command Prompt on Windows 7.

Registration Commands:

Microsoft Outlook:

regsvr32 “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnoutlook.dll”

Microsoft Word:

regsvr32 “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnword.dll”

Microsoft Excel:

regsvr32 “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnexcel.dll”

Unregistration Commands:

Microsoft Outlook:

regsvr32 /u “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnoutlook.dll”

Microsoft Word:

regsvr32 /u “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnword.dll”

Microsoft Excel:

regsvr32 /u “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnexcel.dll”

How to Register and Unregister Files from an Elevated Command Prompt

Problem:

When attempting to execute the “regsvr32″ command from the Windows Run box to register or unregister a DLL or OCX file, one of the following errors may appear:

The module “C:\[file being registered]” was loaded but the call to DllRegisterServer failed with error code 0×80040200.

The module “C:\[file being registered]” was loaded but the call to DllUnregisterServer failed with error code 0×80040200.

Cause:

This message may appear when registering or unregistering a file on Windows 7 when User Account Control (UAC) is enabled on the computer. User Account Control may limit or prevent certain tasks that the Windows User Account does not have permissions to.

Solution:

If the security settings do not allow registering or unregistering a file from the Windows Run box, it is necessary to register or unregister the file from an elevated Windows Command Prompt. Please follow the steps below to register or unregister the necessary file from an Elevated Command Prompt:

Close all programs.

1. Click “Start > All Programs > Accessories”.
2. Right-click on “Command Prompt” and select “Run as administrator”.
3. Execute the necessary regsvr32 command to register or unregister the corresponding DLL or OCX file.

Example of the commands that could be used in the Elevated Command Prompt are:

To register the Microsoft Word compatibility module in Dragon NaturallySpeaking 11:

regsvr32 “C:\Program Files\Nuance\NaturallySpeaking11\Program\dgnword.dll”

Note: If the Windows User Account is not part of the administrator group on the computer, it may be necessary to enter the administrator’s username and password to open the Elevated Command Prompt window.

And more often than not, the sound output is not in accordance with the device that you prefer.

For example, you have Dragon installed on multiple computers and move your single Philips SpeechMike from computer to computer. You may find yourself frustrated that every time you plug the SpeechMike into your computer you note that the audio output/playback occurs through the SpeechMike rather than your speakers.

The fix is fairly simple and is as follows:

Set the default sound playback while all devices are connected to your computer.

From within your Control Panel, open up the sound and audio device settings.

Under the Playback tab, click on the device that you would prefer the sound output to emanate from, and then click Set Default.

Click Apply, then OK.

And that is it.

You have now successfully set one device to always handle the sound playback regardless of the devices connected to your computer.