Having recently committed to using my EMR, Dragon is an important part of my workflow. Response latencies have been annoying and I hope the community can assist me in eliminating them. 

I am using DNS medical with Knowbrainer 2011. My EMR, Allscripts, does not work well with Dragon.  Therefore I dictate into dragonpad, using macros for boilerplate, and cut/paste into the EMR. The worst latencies occur when I have been using another program and command Dragon to bring up a boilerplate macro.  Sometimes I sit and watch for 10 seconds while the computer sorts out how to proceed. Another source of annoying latency is Dragon trying to recognize typing and soft sounds as speech.  This can occupy the program for up to thirty seconds if I have been typing and forget to put the program to sleep.

Microphone is Plantronics CS55. Computer is Vista-32, 4gb memory intel Q9650.  

My first step was to convert my system disk to solid state drive.  I often see the opinion that SSD won't help DNS run faster, but that cannot be the case.  DNS is continually writing small files to disk while recognizing "utterances."  My workflow does include reviewing images off a PACS, so there was plenty of competition for disk access and that has been resolved with the SSD. I also let Vista run a page file on the SSD and that seemed to satisfy anti-virus software that gets frisky at random times. These steps noticeably reduced the latency of response to my first utterance when sitting down at the computer.

 My second step was to convert from direct use of my computer's sound card to a USB sound card. I saw some improvement in rejection of keystroke noise and possibly in accuracy.  Indeed, I can no longer hear keystroke noise in the sound file but I can certainly see the keystrokes in the sound file spectrum. 

 With respect to the computer itself: Dragon never seems to bring the CPU utilization above 15% with speech, although it will bring one or two of the four cores above 50% when it is struggling with keystrokes. Indeed, keystrokes will keep DNS occupied for 30 seconds after I stop typing! My usual speech is written to Dragonpad almost instantly. 

 Speech recognition is critical to my new workflow, so I am open to anything from a new headless microphone to a new computer with Windows 7-64 bit and hyperthreading. 

 I would appreciate your thoughts regarding next steps to consider.

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I'm just throwing these two ideas out there. If it is keystrokes you are having a major issue with you can purchase a silent keyboard. I have not done this myself but I've heard several people on the forum say they have had success with it.

Also if you are interested in buying a new microphone, the second-generation speechwhere 3-1 desktop microphone contains a circuit board that has a special algorithm specifically to help the microphone filter out the noise of keystrokes. The desktop microphone cost $279 but it is also very accurate so long as you are working in a quiet environment.

If you are willing to wait a little while, the same company that makes the microphone I mentioned above is coming out with an external sound card that should contain the same technology to filter out background noise and keystrokes in particular.

Which Allscripts EMR are you using?   The three major EMR's sold by Allscripts are quite different in how they work with Dragon.

Are you using the EMR via Terminal Services?  This is common with Allscripts Pro and Allscripts MyWay, but each can also be run with the software installed on the desktop.

 

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

Thanks for the advice.  All seems very helpful and I will switch to the Sansom wireless system and then see if I need to move up to Windows 7 64 on an I7 Ivy Bridge system.

 I am using Allscripts Enterprise EHR: not through terminal services. 

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We see a few possible problems:

1. A solid-state drive doesn't help NaturallySpeaking run faster. NaturallySpeaking runs almost fully from RAM and all SSD does is launch NaturallySpeaking faster. Once it is in RAM, it's not going to run any faster.

2. You could pick up a little speed by turning off your Windows page file and additional removing the checkmark from Conserve disk space required for user profile and changing Disk space reserved for playback to 0.

3. The biggest problem, we see, is your CS55 microphone which has very little noise filtering. The problem is further exacerbated by new Ver. 11 feature which listens for noise. Many consumer microphones, like the CS55, include very little noise filtering and in Ver. 11, this can spell disaster because of this new feature Nuance added to discriminate environmental noise from actual dictation. In theory, this is an impressive concept but in practice, it would be better to turn this feature off until it's finished. The problem with the new “Nothing But Words” algorithm - YES we gave it a name since Nuance didn't , is that it takes too long. Try turning on your CS55, squeaking a chair, pursing your lips and clinking your coffee cup. You just lost 12 or more seconds of your life. Short of the new de-clicking algorithm in the SpeechWare 3-in-1 TableMike, your best option is to get a high-end noise filtering microphone and combine it with a USB soundcard. The 1 you currently own will probably suffice.

If you require a combination telephone/speech recognition microphone, our 1st recommendation would be the Jabra Pro 9470 (w/KB PLUS PACK) 1.9 GHz DECT 6 + Bluetooth wireless microphone but it's not as noise canceling as the advertising would lead you to believe. If you don't need the telephone aspect, we recommend using a dedicated headset for your phone and switching to the Samson Airline 77 if you need wireless connectivity. If you don't need wireless connectivity, you can save some $$$ with the Audio-Technica Pro 8HEmW wired headset.

Also note that 4 Gb of RAM and Windows Vista is a bit light for your work. We now recommend Windows 7 64-bit with 8 Gb of RAM.

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Opinions on turning off the page file in Windows 7, based on comments on the Internet, seem wildly varying.

Some say it makes no difference, some say you should have a page file or bad things might happen, and others say it helps speed a little bit.

I just upgraded my i7, first-generation, from 6 GB to 12GB, with a slightly faster memory still within the specs for the motherboard, and it seems to be running slower, both on DNS and everything else!  Page file is at 1.5 x memory, or 18G

So I will turn off the page file and hope for the best.

Lunis, I take it you turn off the page file, and nothing bad happens due to that, In your experience?

G.J.,

First, the reason that turning off the pagefile tends to speed up Windows performance is because Windows doesn't have to check the pagefile. However, even if you turn off the pagefile performance can vary. That is, it can improve in some cases and not in others. It basically depends on your overall system configuration.

Second, with regard to DNS, the primary reason why the Windows pagefile interferes with performance is because, by default, it is set up to be controlled by Windows (dynamic). Under that condition the size of the pagefile can vary from condition to condition because the minimum and maximum sizes are different. That is, you have a minimal setting and a maximum setting and Windows has to check the pagefile size any time that applications are loaded or unloaded. That slows Windows performance down. However, if you set the pagefile to static, or fixed, you use the custom setting to set the minimum and maximum size to the same number, in your case 18 GB. This prevents the pagefile from getting fragmented and also means that Windows doesn't have to check the size whenever it needs to use the pagefile.

Dumping the pagefile has no known negative effects as long as you don't run out of memory (RAM). When searching the Internet for information regarding the use and necessity of a pagefile, you will always get conflicting answers. That simply because there are many, many anything experts who are more than willing to share their alleged expertise whether or not it is correct.

The bottom line is that Windows was designed to use a pagefile by default, but by default it doesn't set the pagefile up properly, especially in the case of DNS. Also, the pagefile, if you decide to keep it, should always be set to be installed on your fastest hard drive. For example, if your C drive is an SATA II 3 GB/sec and you have a second hard drive that is running as a full SATA III 6 GB/sec, then you should put your pagefile on the SATA III drive. There are two reasons for this: (a) Windows can read and write simultaneously to and from two different physical drives, and (b) having your pagefile on your fastest drive means that Windows will read from and write to the pagefile faster. Regardless, the biggest problem that most people have with pagefile setups is that they leave it as dynamic, which has the greatest negative impact on overall system performance, especially with DNS.

Lastly, as long as there is sufficient RAM on your system to support disabling the pagefile, there are no known negative consequences. As long as Windows has access to sufficient RAM, it doesn't need to use the pagefile and 99% of the cases. Under this condition, the most common use of the pagefile is dumping the results of a Blue Screen of Death (BSOD), which is not information that is generally user friendly and almost always unreadable except by those technically trained to read such. Most of those people are Microsoft engineers anyway. Other than what is already been mentioned, the only real advantage of disabling the pagefile is removing any potential for performance hits with Windows, and it's important to keep in mind that as goes Windows so goes DNS, and freeing up hard drive space. Nevertheless, everybody's experience is going to be slightly different because everybody system configuration is slightly different. It is extremely rare, and I stress extremely, that a user will experience any negative consequences by disabling the pagefile in the presence of sufficient RAM to do so.

I don't recommend disabling the pagefile if you're running Windows 7 64-bit and you only have 4 GB of RAM. However, if you're wanting Windows XP and you only have because you can only use 4 GB of RAM, Windows XP is less resource intensive and turning off the pagefile does and generally do any harm. Nevertheless, under 7 64-bit you can find your RAM usage very quickly exceeding 5 to 6 GB because Windows 7 64-bit is a serious memory hog. That is, the more memory you have, the more memory Windows 7 64-bit will use. When I had only 12 GB of RAM installed on my Windows 7 64-bit Core™ i7 980X Extreme, Windows was generally using about 4.7 GB on average, give or take a couple of gigabytes depending upon how many applications I had open. As soon as I installed 24 GB of faster RAM (1866 MHz), all of a sudden Windows 7 64-bit suddenly jump to using 5.3 GB to 6.7 GB on average. Your mileage may vary, but I've seen that increase maintain itself across the board ever since I installed the additional 12 GB of RAM. Windows 7 64-bit eats RAM for breakfast.

The only way that anyone can determine what the effect of enabling or does enabling the pagefile or setting it up in any of the ways that I've described above is to experiment. For the most part, if you listen to most of the experts, you're wasting your time. In short, try it before you buy it. Only after seeing how it works on your system can you make an informed decision as to how to set your system up relative to using or not using a pagefile. Note also that I include myself in that set of "experts". So take what I have to say and use it, but don't take my word for it. Test it out for yourself.

Chuck Runquist
Technical Project Manager
VoiceTeach LLC
Home of VoicePower®: Simply powerful, powerfully simple

An expert is a person who has made all the mistakes that can be made in a very narrow field. - Niels Bohr

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G.J.Premo, when it comes to NaturallySpeaking, we prefer disabling the page file. A few days ago we spoke with the president of M-Tech and they are considering disabling virtual memory on all of their computers. Apple has been disabling virtual memory on systems with more than 4 Gb RAM for years. Just because Microsoft set your computer up a certain way and recommends against disabling the page file, doesn't mean that they are always right. An excellent example of a silly Microsoft setting is their UAC, which should be disabled.

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Lunis,

Don't you mean, "eliminate it"!!! That feature has to be the most useless and aggravating piece of nonsense that Microsoft ever introduced.

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

There is nothing so useless as doing efficiently that which should not be done at all. - Peter Drucker

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Occasionally — usually shortly after startup in the morning — I experience some delays with DNS.

Although I don't have any suggestions or technical advice to add to this discussion, I will share that my experience with DNS improved exponentially after I consulted with Chuck Runquist, and he custom-built my current desktop. The relevant specs should appear in my signature block.

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DNS Pro 11.5 w/ VoicePower & ShowNumbers Plus!; Windows 7 Pro (64-bit); Intel Core i7-2600K @ 3.40 GHz, 16 Gb, Grundig DigtaSonicMic (corded)

When it comes to computers, we recommend specialists like Chuck Runquist, M-Tech and the local guy down the street that's been in business for at least 3 years and might even be a gaming expert. The problem with many white box consumer offerings made by Dell, Gateway, Sony, HP (you know the rest), is that these computers typically use the cheapest parts and include a ton of bloat ware that they are paid to install onto your computer. After removing all of the bloat ware we could find, on the Big Haired Lady's i7 HP with 8 Gb of RAM, it still runs a bit slow while our 9 month old M-Tech office computer drops dictation into the document almost before we finish saying it .

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On Lunis' advice I switched to a Samson airline 77.  I also had to switch USB cards.  Dragon is no longer hearing and responding to keyboard, printer sounds or voices at the door.  While the headset is uncomfortable to wear, doesn't have an earpiece for playback, and needs the battery changed frequently the system is quite a bit more responsive.

I may switch to Windows 7 64 to take advantage of increased memory when Ivy Bridge i7 becomes available.  But system latency is now quite acceptable to me.

 Thanks for your help.

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urospeech,

I've been using the Samson Airline 77 wireless microphone for years beginning with the first release almost 6 years ago and currently working with the latest Samson Airline 77 wireless microphone.

A couple of quick points regarding the battery:

1. Don't use cheapo alkaline batteries and I generally don't recommend using rechargeables: (a) they don't last very long, and (b) rechargeable batteries only put out 1.2 V vs. the standard AAA off-the-shelf alkaline battery which puts out 1.5 V. Although 1.2 V doesn't affect the performance, it definitely affects longevity of the battery.

2. Always use top-of-the-line AAA batteries. They last longer (e.g. pay attention to the Energizer Bunny).

3. If you're not using your microphone or if you're not going to use the Samson Airline 77 wireless microphone for any extended period of time, turn the power switch on the transmitter on the headset off. If you leave the power switch on, you are draining your battery and the battery won't last more than 6 1/2 to 7 hours if you leave the power switch on all the time. If you turn the power switch on when you need it and off when you don't, your battery will last significantly longer. I generally get two or three days out of one standard Energizer alkaline AAA battery. Note also that the "mute" switch does not turn the transmitter off. It only mutes the microphone.

4. For the longest battery life, use the e² Lithium extended life AAA batteries. One of these batteries, used properly as noted above in #3, will generally last anywhere from one to two weeks.

5. You don't have to look at the battery like to know that the battery is low. When you start getting bizarre results, your battery is probably close to needing replacement.

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

"What you are aware of you are in control of; what you are not aware of is in control of you." - Anthony de Mello

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Urospeech, Ivy Bridge is supposed to be available, at least on M-Tech notebook computers, as of April 9.

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Chuck, Lunis, etc. –

Does anyone think that DNS' response time would be improved for me with a microphone with better noise canceling? My current microphone is a wired, handheld Grundig DigtaSonicMic, which I bought from Lunis a number of years ago and which I like very much.

Thank you.

Russell

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DNS Pro 11.5 w/ VoicePower & ShowNumbers Plus!; Windows 7 Pro (64-bit); Intel Core i7-2600K @ 3.40 GHz, 16 Gb, Grundig DigtaSonicMic (corded)

Russell,

Our somewhat vague answer is a new microphone might eliminate sluggish responses because the Achilles' heel of any handheld microphone is the fact that it is made to pick up over a distance which, in the case of the Digta SonicMic II, can range up to 18 inches. Those delays will likely be more noticeable in an all but quiet environment. However, there is no way to be absolutely certain without trying another microphone. Of course you have up to 30 days to test any microphone which you can return for a full refund.

It seems that NaturallySpeaking Ver. 11 is more sensitive to this issue and the last thing you want to do is trip the Nothing But Words algorithm because that creates an additional 4 second or so delay and unfortunately, those delays can combine into longer delays. However, the problem may not even be related to your sound system.

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I have been using a Samson 77 head phone for the past6 months or so. Recently, I have been experiencing problems with DNS 11 medical typing out "him him him..." when I have the transmitter on my headset turned off. There has also seems to be a considerable delay in response time when I turn the microphone back on and start to dictate. The battery seems to be okay and all the lights on the receiver box are on. I have seen some discussion about him him him... on other posts and it seems to be related to the microphone. Since the Samson 77 is highly rated, and why I bought it the first place, I am wondering why this is happening. It has slowed down my work flow in my electronic medical record. Could there be some other type of outside interference?  I try to dictate in a quiet environment. I am using an MTech server running Windows 7 with 16 GB of RAM.

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DNS Medical 11, MTECH M8700 16GB RAM Intel Mobil Core i7-2820QM, 2.3 GHZ

I am at my office today and am again experiencing problems with my DNS putting in the word "him" repetitively with the Samson 77 headset turned off. Dragon is also sending the pop up screen stating that it is receiving poor audio input but this is with the microphone off and being logged out of my EMR.  I am not having this problem with my laptop, only the DNS installed on my server.  I am using the server as a desktop, so to speak, as it is in my office and also hosts the EMR for my employees and myself in addition to DNS Medical for me to use.  This seems to be a relatively recent development.  Is there the possibility of interference from something?

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DNS Medical 11, MTECH M8700 16GB RAM Intel Mobil Core i7-2820QM, 2.3 GHZ

You might try additionally clicking the mute switch on your headset or just powering down the Airline 77 base station but it sounds like some sort of AC current leakage.

1 last note: Do you experience the same problem if you unplug the output of the Airline 77 into the USB soundcard. Obviously you wouldn't want to do this every time but it might help identify the culprit.

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Dr. Mel,

I respect Lunis' response but it requires some additional information.

First, if you are still getting the spontaneous "him" display even with your headset turned off (i.e., the power switch turned off), then the problem is not coming from the headset or the transmitter on it. The problem is coming from your base station (i.e., the Samson Airline 77 wireless microphone receiver unit). Try the following in the following order:

1. Check all the base unit connections and settings. The squelch knob should be turned all the way to the left (off). To switch on the back of the receiver unit (base unit) should be set to -20 dB not -40 dB. Make sure that the volume is properly set. There are occasions when the volume is set too high that this kind of result can occur. Your volume settings will be different if you're using the same Samson Airline 77 wireless microphone base and microphone for both your desktop and your laptop.

2. Disconnect the cable from the base unit and reinsert it. Disconnect the cable from the input side of your soundcard or USB SoundPod. If you're not using a USB SoundPod with your desktop ( i.e., workstation/server), then I would suggest that make sure that you use your USB SoundPod. Internal soundcard's on desktop systems are notorious for producing interference. By the same token, I assume that you're using your USB SoundPod anyway, but I point this out just in case.

3. If you're using your USB SoundPod, try disconnecting it and wait for Windows to respond indicating that you have removed the USB SoundPod. Then reinsert it and ensure that Windows is now re-recognizing it. Also, make sure that you are recording device and playback device settings are correct in the "Sound" dialog.

Follow these suggestions one at a time. Don't do them all at once because that won't tell you whether or not one of them (i.e., which one) is the source of the problem if one of them fixes it. Start with #1 and then check and see whether you're getting the interference again. If so, then go to #2 and recheck. Then go to #3 and recheck. If done properly one at a time, and one of these fixes the problem, then you know what the underlying cause was the next time that you have this problem. One of the key indicators in your post is that it is only recently that this is started occurring. In general, this smacks of poor or intermittent connection issues which are often resolved by disconnecting cables and reinserting them. Connections can oxidize over time because you're running an electrical current through them and and this can cause oxidation between the contacts, thus producing interference via intermittent connections resulting from the oxidation. This is particularly true if you're working in a dusty environment or an exceptionally dry environment.

Lastly, if none of these fixes the problem, then you're likely getting some form of outside interference. Possibly from poorly grounded electrical outlets, although this is highly unlikely, or possibly something that is producing an electromagnetic field in the same frequency range as the frequency used by your Samson Airline 77 wireless microphone. However, your symptoms generally smack of connection problems or settings. Nevertheless, always make sure that your base station is not positioned anywhere near anything that can produce a strong magnetic field, such as setting it right over the top of your power supply on your desktop system.

The fact that you're not having a problem with your laptop indicates that, in general, the problem is not with the Samson Airline 77 wireless microphone itself, but with the way that you are using the Samson Airline 77 wireless microphone with your desktop and/or the desktop itself. Look at the clues that you're getting. In your post you say that the problem is only occurring with your "server" and not with your laptop. That's a key clue that points the finger at your "server" or something related thereto.

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

If you hear the sound of hoofbeats, think horses not zebras.
variation on Occam's Razor (Law of Parsimony)

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