Hi everyone,
I am a physician interested in EHR user interface design.  As you know, some physicians are very comfortable with DNS but others prefer to use the keyboard. 

I am trying to develop parallel designs so that text insertion and editing will have same look and feel whether done by using  DNS commands, or by using a keyboard shortcuts, or by a combination of the two.

1) Is it possible to assign a keyboard shortcut to a DNS voice command to insert text?

2) Is it possible to assign a keyboard shortcut (or hotkey) to a voice command in order to move the cursor or edit the text?  I know that Dragon already has a hotkey for "next field".  Is it possible, for instance, to assign a keyboard shortcut or a hotkey to the voice command "accept defaults", in order to accept the default value of each variable and remove the brackets.

For working on these general problems, I would like to use Microsoft Word 2007.

Thanks

Rick Weinhaus

 

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RickW  

DNS Professional Version 11.0/

Dell Laptop 4GB RAM, Intel Core Duo 2.2GHz/

theBoomO mic/Andrea PureAudio soundcard

 

 

 

I don't think so. But you can use third-party macro software to insert text by pressing a keyboard shortcut. The shortcut can be a key (e.g., F10), a key combination (e.g., Alt + Q), or a text string (e.g., myphone --> 123-555-1234). 

 

I have used macro software to accomplish tasks like these by sending key sequences to activate commands that are on the DNS menu system. 

Alan,

 

Thanks.  I know only a little about third-party macro software which would, for instance, allow me to insert text by pressing a keyboard shortcut.  What I was hoping to do was to keep the exact text (including variable fields) that already exists as a Dragon command, as opposed to having one version of text for Dragon, and another version of text that exists as a keyboard macro.

 

For instance, I have a DNS Text and Graphics command named "Corneal Ulcer Right Eye", which I use for constructing a treatment plan for a patient who comes in with a corneal ulcer.  It consists of the following boilerplate text with variable fields:

 Plan-  discussed serious nature of problem-  no contact lens wear-   [Cyclogyl] 1 drop right eye now  - given-  start [Cyclogyl] 1 drop right eye [2x/day]-  start [Vigamox] right eye [every 2 hours] while awake-  start [Polysporin] ointment right eye [at bedtime]-  start [Maxitrol drops]  right eye [4x/day] - steroid risks discussed-  f/u ASAP for ↑pain  or  ↓vision 

What I was hoping to do was to create a keyboard shortcut, perhaps using macro software as you suggest,  that would send a key sequence in order to activate my "Corneal Ulcer Right Eye" command -- perhaps something like  CTRL + C U R E  (for Corneal  Ulcer  Right  Eye  -- sorry about the pun).  I would then want to have other keyboard macros or shortcuts that would function exactly like the voice commands next field, and

accept defaults. 

 

In other words, the goal would be to have exactly the same workflow whether using Dragon or using the keyboard, as opposed to having two different workflows for the same task.

 

Is this doable using macro software.  If so, is there a particular software program which you would recommend.  I have found the two following companies through a web search:

 

Automation Anywhere, Inc.: Leader in Macro & Automation Software. Keyboard Macro, Mouse Macro, Macro recorder, Windows Macro

               

Macro Express – Macros for your Windows Automation Needs

 

Are you familiar with either of these companies or is there another product that you would recommend?

  

Lunis,

Thanks.

 

The PowerMic  II solution would probably not work because my group would want to have literally hundreds of mnemonic-based keyboard shortcuts or macros, one for each DNS command.  Is it correct that the PowerMic  II limits you to only about 10 commands, one for each button?

  

Rick Weinhaus

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RickW  

DNS Professional Version 11.0/

Dell Laptop 4GB RAM, Intel Core Duo 2.2GHz/

theBoomO mic/Andrea PureAudio soundcard

 

 

 

I've had a program for the past 3-4 years that assigns a small number of keystroke shortcuts to Dragon commands.  See http://www.pcspeak.com/dragkey/

I've also been able to map 100's of shortcuts that were done for Dragon into Word Quick Parts (formerly Auto Text) in a few minutes instead of manually recreating the macros.   These have been done at the request of specific customers, some customization would probably be needed so that they would be applicable in your situation.

So YES to your item 1 and YES to your item 2.

Auto Hot Key is another product which I have used with Dragon and QuickParts and Word-2010 to do something very similar to what you seem to be trying to do.

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Larry Allen
Softnet Systems, Inc.
http://www.pcspeak.com

Another approach: instead of assigning keyboard shortcuts to NaturallySpeaking voice command, do the opposite: create NaturallySpeaking voice commands to trigger the commands that you create with third-party macro software.

AutoHotkey would be a good candidate, and it's free. You could make it work using Macro Express, which is easier to learn, and costs about $40. AutoHotkey may be the better candidate, despite its steep learning curve, as the program itself need not be on your PC to run its scripts, whereas Macro Express must be loaded for the scripts to run.

(In general, I prefer Macro Express because I can develop reliable scripts very rapidly. I only use AutoHotkey when the situation warrants it. AutoHotkey is a more powerful program, although for 95% of the tasks I perform, Macro Express is more than adequate.)

AutoHotkey or Macro Express scripts can be triggering programmatically via DNS, i.e., each script is an executable. (AutoHotkey executables are free standing .exe files, whereas Macro Express "executables" require the program be running.)  Programmatic execution is theoretically reliable, but in practice, I find it no less reliable to force DNS to send hotkeys, so that's what I usually end up doing. In the situation you are describing, you could end up with two different activations for each script. This is not as confusing as it sounds, as multiple activations is straightforward in both programs.

In Macro Express, you cannot create hotkeys like Ctrl + C + U + R + E. In AutoHotkey It may be possible. On the other hand, both programs support macros that are activated by typing a string. In Macro Express this is called "ShortKeys;" in AutoHotkey it is called "hotstrings." Macro actviation by typing is like using AutoCorrect in Word: when you type "htis," the typo is changed to "this" on-the-fly.

Assuming you are using Macro Express, you would likely create two activations for each script:

1. A prefixed ShortKey, say, qcure. (The prefix is set globally to a one to three character string, and works for all Shortkey commands. Here I am using a single Q); and
   
   
2. A hotkey, say, Shift + Alt + Ctrl + C.

The NaturallySpeaking command -- let's call it Eye Cure -- sends the key sequence Shift + Alt + Ctrl + C, which activates the Macro Express script; the same Macro Express script can be activated by typing qcure. (Unfortunately, NaturallySpeaking cannot activate Macro Express Shortkey commands, or at least, I have not found a way.)

I use MacroExpress. I set my shortkeys options to "Use Suffix Keys".

I regularly use  SendDragonKeys to  activate more than 50 MacroExpress shortkeys. I am using DNS Medical 10.

ken

Ken,

Thanks!

Rick Weinhaus

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RickW  

DNS Professional Version 11.0/

Dell Laptop 4GB RAM, Intel Core Duo 2.2GHz/

theBoomO mic/Andrea PureAudio soundcard

 

 

 

Rick, what about using variations of your existing technology. For example, if you wanted to deploy your Corneal Ulcer Right Eye command and accept the default variables you could create a Normal Corneal Ulcer Right Eye command that would deploy the command and accept the defaults. In DNS Pro, you would crearte an Advanced Scripting command that looks like the following:



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Larry, Alan, and Lunis,

 

Thanks so much!

 

While it is clear that it will require some programming to have exactly parallel keyboard macro and Dragon methods for inserting, navigating, and editing boilerplate text,  and also that there are several possible solutions, it is also clear on the basis of your posts that the problem is quite doable.

 

One of the problems with EHR user-interface design is that a solution that works for one doctor may not work at all for another.  Different clinicians have very different cognitive styles.   Usually an EHR only supports one cognitive style.  So it's not unusual that one physician loves the EHR used by her practice and another physician in the same practice hates it.  Unfortunately, I think that there are some physicians who are never going to be comfortable with speech recognition software, and especially, who are never going to be comfortable using it in front of a patient. 

 

What is exciting to me about this parallel approach (keyboard macros and/or Dragon) is that the interface can have the same look and feel and employ the same gestures and idioms.  Therefore, a physician could just use keyboard macros, just use Dragon, or use a combination of the two without having to learn two different user interfaces.  Also, this parallel approach would facilitate a smooth transition for physicians who want to move from just using keyboard to also using speech recognition.

 

 I believe that this parallel design paradigm would help individual physicians, whatever their cognitive style, use their EHR more effectively.

 

Thanks so much for sharing your expertise.

 

Rick Weinhaus

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RickW  

DNS Professional Version 11.0/

Dell Laptop 4GB RAM, Intel Core Duo 2.2GHz/

theBoomO mic/Andrea PureAudio soundcard

 

 

 

If this is an Word-based application, I'd think the most rational approach would be to store all of the actual programming in a Word template that resides in Word's startup folder. You can assign the keyboard shortcuts directly in Word, while Dragon can use Word's Application.Run method to trigger the same macro. I think you'll find it much easier to modularize your programming in Word, and execution is much quicker too. (Not that Word is that quick, but Dragon tends to be painfully slow when asked to do anything the least bit complex.)

There is even a trick to trigger Advanced Scripting commands from within Word.

You can then assign keyboard shortcuts to Word macros that launch Dragon NaturallySpeaking macros. I hope you get the idea. It's all in Larry's book "Advanced Scripting for Dragon NaturallySpeaking". At least that is where I think I got it from.

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DNS 12 Pro, Medical, Premium - German, English, French - Dragon Dictate 3.0, dns.comfort

 

Core i7 950, Windows 7 Ultimate 64-bit, Intel Core i7 950, 12 GB RAM, L2 2MB; Mic: Jabra Chromo NC 2400 USB.

 

www.in2comp.ch 

RichardW and bk82,

Thanks so much for your posts! 

 I initially wanted to use MS Word because I knew that it had reasonably robust macro capabilities and I wanted to learn what was possible.  The eventual goal is to have an exactly parallel set of Dragon commands and keyboard macros which can be used to insert, navigate, and edit boilerplate text with variable fields, while working directly within a networked electronic health record application running over Citrix.

Rick Weinhaus

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RickW  

DNS Professional Version 11.0/

Dell Laptop 4GB RAM, Intel Core Duo 2.2GHz/

theBoomO mic/Andrea PureAudio soundcard

 

 

 

Hello Rick

it would take a few hours to explain my reasoning, but for various reasons I don't think that creating these universal macros in Advanced Scripting or in Word VBA is a very good idea. First of all, creating forms for boilerplate text is a rather tedious task with Advanced Scripting. It might be worth the trouble, if everybody were using Dragon for creating their text.
But you want to have a set of tools that can be called either by voice commands or keyboard shortcuts or menus.

For this purpose you will need a macro tool, that is able to function within your network and that is easy for creating forms and managing those forms across the network.

The three tools that meet this requirement are Automation Anywhere, Macro Express and PhraseExpress. I have never seriously considered using Automation Anywhere because it is extremely powerful and also rather complex and expensive. It might also be overkill for creating simple text forms. I have some experience with Macro Express and lots of it with PhraseExpress. Macro Express is good for creating macros that interact with applications, PhraseExpress is very good for working with text substitution. The advantage of Macro Express is that you can create standalone scripts that you can launch easily from within Dragon NaturallySpeaking. The advantage of PhraseExpress is its ease of use.

I suggest you try both these tools out and you may want to consult someone who has experience with this sort things.

Boris

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DNS 12 Pro, Medical, Premium - German, English, French - Dragon Dictate 3.0, dns.comfort

 

Core i7 950, Windows 7 Ultimate 64-bit, Intel Core i7 950, 12 GB RAM, L2 2MB; Mic: Jabra Chromo NC 2400 USB.

 

www.in2comp.ch 

Hi Boris,

 

Thanks so much for your last post.  You are definitely right that I will need to consult someone with experience in this area before actually implementing a parallel design.

 

I was unaware of  PhraseExpress.  It sounds like a fantastic resource for me, as my interest is primarily in the user interface design.  I will definitely start working with it.

 

The fact that the parallel design is doable, even if it will take some work, makes me very happy.  I hope this paradigm will eventually contribute to the usability of EHRs.

 Rick Weinhaus

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RickW  

DNS Professional Version 11.0/

Dell Laptop 4GB RAM, Intel Core Duo 2.2GHz/

theBoomO mic/Andrea PureAudio soundcard

 

 

 

The Dictaphone PowerMic II USB microphone would be perfect because you can program any NaturallySpeaking Natural Language, personal or third-party command into any available button by simply typing the name of the command you wish to deploy. UNFORTUNATELY, Nuance deliberately chose to make the PowerMic II programming option exclusive to the Medical versions of NaturallySpeaking.

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Lunis,

Are you saying that i will be unable to program the buttons on the Powermic II directly, using my own software and the Nuance SDK?  This could explain why so far, i havent been able to find out how to do it.

 

ron

Ron,

What you can and can't do with the PowerMic™ and PowerMic™ II is basically spelled out in the DNS 10-10.1 Medical Dragon Help. However, you basically answered your own question. That is, no you can't use your own software and the Nuance SDK program to customize (program) the buttons on the PowerMic™ II

Chuck Runquist
Technical Project Manager
VoiceTeach LLC
Home of VoicePower®: We don't make Dragon NaturallySpeaking, We make it better!

Education is when you read the fine print. Experience is what you get if you don't. - Pete Seeger

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