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Topic Title: DMPE 4 being discontinued without replacement March 31, 2021 ???
Topic Summary: DMPE 4 being discontinued without replacement March 31, 2021 ???
Created On: 12/15/2020 09:00 AM
Status: Post and Reply
Linear : Threading : Single : Branch
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 12/15/2020 09:00 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 12/15/2020 07:19 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 12/15/2020 08:14 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 12/21/2020 10:47 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 12/21/2020 04:12 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 12/21/2020 07:30 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - R. Wilke - 12/22/2020 12:06 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - csallada - 08/03/2021 07:25 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 12/16/2020 10:23 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 12/16/2020 10:37 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Zig - 12/16/2020 01:00 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 12/16/2020 01:53 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 12/22/2020 11:48 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 12/22/2020 01:53 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 12/22/2020 04:35 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - smeyer - 12/24/2020 02:35 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 12/23/2020 02:04 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 12/24/2020 03:20 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - jgold55 - 01/07/2021 09:22 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - jgold55 - 01/07/2021 09:26 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - jgold55 - 01/07/2021 11:03 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/07/2021 12:18 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/07/2021 03:05 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Mav - 01/11/2021 04:24 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 01/11/2021 07:43 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - smeyer - 01/13/2021 08:11 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Mav - 01/14/2021 10:08 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - holycowdidyouseethat - 03/16/2021 10:39 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 03/16/2021 10:42 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Mav - 03/17/2021 03:28 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/07/2021 12:15 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - jgold55 - 01/07/2021 03:54 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/07/2021 12:10 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - jgold55 - 01/07/2021 03:52 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 01/07/2021 05:53 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/07/2021 05:57 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 01/07/2021 06:03 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ericnixmd - 01/10/2021 08:45 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Charlie - 01/10/2021 10:39 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - jgold55 - 01/14/2021 10:29 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 01/27/2021 01:02 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Mav - 01/28/2021 02:23 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/14/2021 01:49 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 01/14/2021 06:55 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - cjlopez - 04/26/2021 12:45 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - holycowdidyouseethat - 01/19/2021 05:47 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 01/28/2021 10:36 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Mav - 01/29/2021 08:47 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Charlie - 01/30/2021 11:14 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Charlie - 01/30/2021 11:14 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - docmig - 02/28/2021 10:37 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 02/28/2021 04:47 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - holycowdidyouseethat - 03/16/2021 10:37 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 03/22/2021 07:39 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 03/23/2021 01:21 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 03/24/2021 12:28 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ericnixmd - 03/24/2021 11:30 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - tsupport - 07/05/2021 11:44 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 07/05/2021 03:44 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 07/05/2021 04:35 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Mav - 07/06/2021 10:21 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 07/19/2021 04:52 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 04/11/2021 12:59 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - R. Wilke - 04/11/2021 01:16 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 04/11/2021 01:23 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - R. Wilke - 04/11/2021 01:46 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 04/11/2021 02:39 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 04/11/2021 06:20 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 04/12/2021 09:33 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - FootDoc - 04/12/2021 09:53 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 04/26/2021 11:33 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 06/10/2021 02:30 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 06/15/2021 09:11 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - mwarddoc - 07/07/2021 08:18 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 07/08/2021 11:47 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - smeyer - 07/08/2021 03:17 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - mwarddoc - 07/12/2021 04:20 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - smeyer - 07/12/2021 04:28 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - mwarddoc - 07/22/2021 03:07 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - Lunis Orcutt - 07/22/2021 11:01 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - ax - 07/22/2021 05:53 PM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - mwarddoc - 07/25/2021 03:19 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - MDH - 07/25/2021 11:50 AM  
 DMPE 4 being discontinued without replacement March 31, 2021 ???   - mwarddoc - 07/29/2021 03:14 AM  
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 12/15/2020 09:00 AM
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MDH
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Has anyone heard the following? Any truth to this statement?

 

Dragon Medical Practice Edition | Voice to Text Solutions

 

DMPE 4 is being discontinued.

Nuance has announced that Dragon Medical Practice Edition 4 is being discontinued as of March 31st 2021, and no replacement or version 5 will be released. 

 

MDH

 



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 12/15/2020 07:19 PM
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Lunis Orcutt
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The announcement is correct. DMPE 4 will be supported for another year (considerably longer by us) but Nuance wants to limit all Medical sales to DMO which is leased for $525 down and $99 per month. DMO has come a lot further but it should also be noted that Nuance tried this once before and took a financial beating when small practices refused to pay for DMO. Nuance had to bring DMPE 2 back 6 weeks later but this is a different ballgame.



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 12/15/2020 08:14 PM
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MDH
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Lunis,

 

Thank you for confirming this info that I found. I can't say that I am surprised. But the lack of Advanced Scripting capability in DMO makes it a non-starter for me, not to mention the cost.

 

Regarding your note from a different thread:

 

"If you are thinking about purchasing a full copy of DPI 15.61 or a DPI 15.61 Upgrade we recommend purchasing before January 1 when the price is increased from $300/$150 respectively to $500/$250. This is not a typo."

 

Will the price of DMPE 4.3 also be going up after December 31, or possibly down as it will be end-of-life and no longer available for purchase after March 31, 2021?

 

Thanks. 

 

MDH



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 12/21/2020 10:47 AM
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MDH
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Based on above, I took the leap and upgraded from my ancient Dragon Medical version 10.1 (which I loved and had a hard time parting with), and purchased DMPE 4.3. as I had recently learned the following:

 

"DMPE 4 is being discontinued.

Nuance has announced that Dragon Medical Practice Edition 4 is being discontinued as of March 31st 2021, and no replacement or version 5 will be released. "

 

 

Turns out, that this has become a "DUH" moment for me. DMPE 4.3 is insanely accurate! I just dictated a 594 word document with 2 mistakes = 99.7 % accuracy, without it being a trained profile. It doesn't get any better than that.  What are you waiting for? If you don't want to fork over $525 for DMO, then $99 per month until Nuance increases the monthly subscription, then the time is ripe to get an excellent last desktop version. Even if you don't create and use Advanced Scripting custom commands, which are not an option in DMO, it is worth upgrading to DMPE 4.3 just because of exceptional accuracy and cost. You will pay more for DMO in one year than the one-time purchase of DMPE 4.3, then have a significant ongoing monthly expense forever. Even if your hospital pays the monthly expense, why settle for an inferior product (i.e. DMO) ? Although dictation accuracy is exceedingly important for time efficiency, it doesn't come close to the efficiency one gets from creating custom commands for use in beating an EMR to a pulp.Surveys show that 50-60% of physicians in the U.S. are suffering burn-out, and the primary reason being EMR usage. An EMR typically adds 1.5 hours to a physician's workload per day. No wonder physicians are grumbling.  Instead of being a victim, take control, and make life more enjoyable. You will be able to spend more time with family and doing other things you enjoy. (Although MMODAL has the ability to create and use custom commands via their cloud version, the truth is that calling a command works about 20% of the time. That is nothing but an excercise in frustration). Time to take the leap unless you want to be a real April Fool on April 1. Just my 2 cents!

 

MDH



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 12/21/2020 04:12 PM
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FootDoc
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OK....MDH need your perspective here. So I am on DMPE 2.3(or whatever that upgrade was). This is the very first time that I have not jumped on an upgrade. Even though since version 4 I wanted to ido Advanced Scripting (played around with it) and wanted to make great commands I bascially do free speech dictation and I am very good and can be very fast at it......when I am not tired. I get all my charts done daily. I use Nexgen (used to be Healthfusion). 

I have a speech mike 3/1 and when it first came out. I have used the same user for years but just made a new user like 4 months ago. That did the trick and I feel my accuracy is great. I rarely have to fix a mistake but yes, there are those days...LOL.......I only dictate at the office and don't use Dragon at home much but again, always wanted to be a superuser and never touch a keyboard. As I get older (59) and somedays feel it in my hands I know if I every had to I could switch and do more with control.....so..what to do. 

I have tried a sample of 4.3 (thank you Lunis) and it seems I can't get the dictation box to work but it does wirth  2.3 DMPE ....that is why I didn't change. I tried everything that I know to do. When I dictate the dictatation box opens and I dictate and then I press transfer and it goes into the emr. I don't say transfer since I like a combination of mouse and voice. I like to save my voice this way. 

If used to test every version with medical vs non medical with and without add on vocabs. I don't think my emr is registered so not worrried about the mic not turning on if I went with a non medical version and I know how to add words, scan and wonder if I can just grab the current dmpe vocab to dump. It's more about the medication vocab then medical vocab.........but more accurate the better and why I wanted to go to 4.3.....funny thing is I thought version 8/10 were the most accurate versions for a long while.....

 

So what to do...suggestions anyone? No way I am paying a monthly fee for anything.

 12/21/2020 07:30 PM
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MDH
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Never used DMPE 2 so can't intelligently comment. Use what works best for you. This is why I stayed with DNS Medical v. 10.1 so long (my experience with a 6 month trial of DMPE 1 was abysmal). However, keep in mind that you and others only have until March 31, 2021 to make a final decision.

 

MDH



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 12/22/2020 12:06 PM
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R. Wilke
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"Never used DMPE 2 so can't intelligently comment."

 

That is probably true, but anyone else having used and gone through all the speech engine versions between around 2008 and today, all of which went into the various medical versions, probably could.

 

To that end, version 10 was okay. Sometimes I go back to a copy of 10 in a VM, for testing purposes, but I haven't missed it in years in my daily work. Version 11 was a lemon. In version 12, they were back on track. 13 was almost perfect already, very stable and usable. 14 was basically 13 in disguise. And finally, with version 15, the ballpark has changed. And altough a lot of things still remain to be done, no one should look back really.

 

Mark, it is not surprising that you do notice a major difference, now that you have made such a giant leap, and it is good to see you back from the past.

 

 



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 08/03/2021 07:25 PM
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csallada
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The advantages of DMO is that it is easily and quickly installed on multiple computers and as the profile is in the cloud and you can dictate from multiple places easily with your profile. Easy integration by using your mobile phone as the dictaphone is also smart. Accuracy is probably better as speech engine continuosly being updated and new medical words can easily be added by nuance. It is also better integrates into remote desktop dictation. 

 

As stated by the group there are major disadvantages however of DMO other than the forced yearly subscription cost. I dictate about 100 letters a week and and it takes about 20 seconds of mouse clicks to get to the point in my EMR that I can start to dicate a letter. There is then another 20 seconds of mouse clicks at the end of the letter to save this into the EMR and go to the next letter. This is really easy with DMPE 4.3. This however is not possible with DMO as it does not have the ability to write complex commands. For example at the end of this post  is my command for a coronary artery stent report. DMO fails miserably with this and although DMPE 4.3 works fine now it will fail as some time in the future and we need to push Nuance to be able to write complex commands that save us time. Many software providers have moved to subscription based services as it ensures cash flow but why go back in some areas which are essential. My feeling is Nuance thinks 99% of uses do not use complex commands and therefore has created DMO for these 99%. But it is the 1% of users (the smart users) that really use off the features of a product that spur others to get theproduct also. There are experienced Dragon users that are going to go back to typists to save time in doinbg their letters.

 

Sub Main

SendSystemKeys"{Ctrl+k}"

Wait .2

SendSystemKeys"{Ctrl+r}"

Wait .2

SendSystemKeys"{Ctrl+r}"

Wait .2

SetMousePosition 1,453,96

Wait 0.1

ButtonClick 1,1

Wait .5

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Enter}"

Wait .2

SetMousePosition 1,420,193

Wait 0.1

ButtonClick 1,1

Wait 0.5

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Down}"

SendSystemKeys"{Enter}"

Wait 0.2

SetMousePosition 1,393,167

Wait 0.1

ButtonClick 1,1

Wait .2

SendSystemKeys"{Ctrl+a}"

Wait .2

SendSystemKeys"PCI"

Wait .5

SetMousePosition 1,72,154

Wait .5

ButtonClick

Wait 4.0

SendSystemKeys"{Ctrl}"

SendSystemKeys"{F9}"

End Sub



-------------------------

Christopher Allada


Interventional Cardiolgoist


Canberra Heart Clinic


Lidia Perin Medical Centre


1/12 Napier Close 


Deakin    ACT    2600


Australia

 12/16/2020 10:23 AM
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Lunis Orcutt
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The price of DMPE 4 will not change. We suspect that Nuance is raising the price of DPI 15 because DPG 15.61 isn't selling. Notably less than 1% of our Dragon sales are for DPG 15 and half of those sales were to existing DPI 15 users who needed Outlook 2019 support and frustrated with the DPI 15.3 freezing problem.

 

For more than 99% of Dragon users, the DPG $600 price tag simply didn't justify paying twice the price of DPI 15. Dragon Premium was discontinued for the same reason. Nuance's solution was to bring the price differences closer by increasing the price of DPI 15 rather than lowering the price of DPG 15. 

 

Another reason for raising the price of DPI 15 is to sell (lease) DPA which is $40 per month. The lease loosely translates to the price of DPI 15 for one year of use and of course doubling the price of DPI 15 in 2 years of use. Bottom line: Cloud software leasing is far more profitable.



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 12/16/2020 10:37 AM
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MDH
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Lunis,

 

Thank you for the info. In that case, time to get myself an early x-mas present. Time to place that order!

 

MDH



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 12/16/2020 01:00 PM
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Zig
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Lunis,

When you said,"the DPG $600 price tag simply didn't justify paying twice as much for DPI 15"

I think you meant to say "the DPG $600 price tag simply didn't justify paying twice as much as for DPI 15"

Zig



 12/16/2020 01:53 PM
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Lunis Orcutt
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My apologies, you are right



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 12/22/2020 11:48 AM
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FootDoc
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Lunis....any suggestions?
 12/22/2020 01:53 PM
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Lunis Orcutt
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Originally posted by: FootDoc Lunis....any suggestions?


We highly recommend upgrading to DMPE 4.3 Upgrade until the end of March. You will still have full support and more capabilities then DMO; not to mention paying a final price of $600 rather than $1600 the 1st year and $1200 every following year for DMO. Now you know why DMO is being aggressively pushed and why DMPE is being discontinued. Software manufacturers make considerably more profit when converting their customer base to the cloud.



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 12/22/2020 04:35 PM
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MDH
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I should thank Nuance for announcing the end of sales of DMPE 4.3 on March 31, 2021, prompting me to purchase it. I just dictated an 888 word note with just 1 error = 99.9% accuracy. That is truly phenomenal! It would be a hard sell saying that one advantage that DMO supposedly has over DMPE 4.3 is greater accuracy.

 

MDH



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 12/24/2020 02:35 PM
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smeyer
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I may be adding physicians next summer.  If I buy DMPE 4.3 now, will I be able to activate it after March 2021?  after March 2022?  Can upgrades be activated after March 2021, and after March 2022?

I have occasionally had to reinstall Dragon.  Will that be possible after these above dates?

Thanks.  Steve M.

 

 12/23/2020 02:04 PM
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ax
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I bought DMPE 2.x back in 2014 for private office use, and just wasn't getting the accuracy that would make speech recognition worthwhile.  After a while and bantering with the regulars here I quietly gave up on Nuance.  After all, at that time we were still paper chart and "backend-dictation"-based at the hospital.

Then MModal became a solution for me in the office, offered as a monthly subscription bundle by my office EMR.

But for over a year now, hospital has plunged into "front-end" ... although haven't entirely gotten rid of "back-end", to which many colleagues are grateful, as nothing beats the good ol' transcriptionist still.  Anyway, I have gone "front-end" entirely because the WYSIWYG sells itself.

Indeed the current Dragon Speech Engine is incredibly accurate.  Even for my husky voice, speaking across a mask with visor, with a reasonable amount of ambient noise, it is working well enough.  Without the mask and in my office/home, recognition is very satisfying. 

With the help of AutoHotKey, I have managed to shoehorn "Dragon Medical Embedded" into a "dictation window" for my own Citrix-based EMR.  Chrome-based DME allows for that even when not in focus.  Anyhow, I am reasonably geting along with Dragon Medical "Embedded" - with some crucial improvisation.

Minus the "Active Scripting" and rich voice commands of course.

The real downside is that I don't have Dragon for daily non-medical use.  Typing out on this board makes me wish otherwise.



 12/24/2020 03:20 PM
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Lunis Orcutt
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DMPE 4 full copy and upgrades can be activated anytime. This is a non-expiring feature. Even NaturallySpeaking 4 can still be activated.



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 01/07/2021 09:22 AM
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jgold55
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I have used Dragon for a number of years but felt that the medical version was overkill for me.

However, it would make my life easier to be able to dictate into my EHR directly rather than my current workaround.

2 questions:

1. Is DMPE 4.3's accuracy and functionality worth the extra $$$$ versus DPI 15.61?

 

2. Will it allow dictation directly into any EHR?  Is there a list of compatible/incompatible programs?

 



-------------------------

HP Pavillion dv7;Windows 10 Home; i7 2670-QM @2.2 GHz; 16GB RAM; DPI 15.61; Knowbrainer 2017; Dragon Capture; SpeechStart +; Sennheiser MB Pro 1 UC/ML;  Addasound SR2701



 01/07/2021 09:26 AM
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jgold55
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Another question:

Is there an upgrade from DPI to DMPE or is it considered a new purchase, i.e., full price?



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HP Pavillion dv7;Windows 10 Home; i7 2670-QM @2.2 GHz; 16GB RAM; DPI 15.61; Knowbrainer 2017; Dragon Capture; SpeechStart +; Sennheiser MB Pro 1 UC/ML;  Addasound SR2701

 01/07/2021 11:03 AM
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jgold55
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I saw that there was some concern about Dragon not getting along with Citrix-based software? I don't really know what that means but I'd like to know how I find out if the software I use is a Citrix-based software?



-------------------------

HP Pavillion dv7;Windows 10 Home; i7 2670-QM @2.2 GHz; 16GB RAM; DPI 15.61; Knowbrainer 2017; Dragon Capture; SpeechStart +; Sennheiser MB Pro 1 UC/ML;  Addasound SR2701

 01/07/2021 12:18 PM
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Lunis Orcutt
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Originally posted by: jgold55 I saw that there was some concern about Dragon not getting along with Citrix-based software? I don't really know what that means but I'd like to know how I find out if the software I use is a Citrix-based software?

 



Other than speed issues, previous Citrix problems have been resolved. As far as the speed issues are concerned; your DragonCapture utility turns it into a nonissue.



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 01/07/2021 03:05 PM
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Lunis Orcutt
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UPDATE: Here is your EMR No Fly Zone



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Simply speaking, CITRIX allows you to work on your Desktop (running on a server in your company/hospital/whatever) from almost everywhere (including thin clients also placed in your organization).

 

DMPE cannot be run in such an environment, Nuance has explicitely blocked it (even though Citrix itself goes through some lengths to provide applications with an environment very similar to being run on a "Fat" client).

 

hth,

mav

 01/11/2021 07:43 AM
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"DMPE cannot be run in such an environment"

 

Unless I am not understanding what you are saying, this is not true as I and many use DMPE and Citrix to access their EMR..

 

MDH



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 01/13/2021 08:11 PM
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The Citrix issue discussed is, I think, actually a network issue.  I can use Dragon on my own computer within a citrix window and AllScripts, although there is minor difficulty.  Commands also work, including scripting.

Dragon will not run on a thin client in a hospital system unless using Dragon Medical Network Edition.  Dragon will run in a citrix environment if you use the same computer all day with DMPE and your profile both installed on it (fat client).  If you migrate to different computers at different locations in a hospital, Dragon Network Edition allows cloud storage of profiles which download to your thin client in 30-60 seconds.  The citrix issue is actually a network issue.  My hospital abandoned Dragon medical network in favor of M-Modal.  Very disappointing.

 01/14/2021 10:08 AM
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Mav
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The Citrix issue I witness can stem from different versions for the US and EMEA market.

Our German DMPE 4.3 requires a login to an NMS at start, other than the US version.

 

Chances are that Nuance took the opportunity and introduced their Citrix-block for non-US in that part of the code as well.

 

Probably so that they can claim that DMD/DMO is the only solution working with Citrix and thus enforcing migration to DMO.

 

mav

 03/16/2021 10:39 AM
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holycowdidyouse..
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Publish DMO on the Citrix server alongside the EHR.  Works everywhere then 

 

 03/16/2021 10:42 PM
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We are using DMO and DMPE 4 simultaneously. DMO is fast because Nuance's stripped out a lot of functionality like Active Accessibility and Select-&-Say in most environments. The Dictation Box (now referred to as Text Input) default setting is a real pain in the keister when it pops up every time you dictate and you have to transfer the text. Fortunately, you can add a checkmark to Use Basic Text Control: Dictate at the cursor without the ability to format, correct and navigate using your voice

 

DMO removes a good deal of functionality at a premium price. By the way, if we strip out some of the functionality in DMPE 4, it is just as quick and it seems like the freezing issue has resolved itself. We began by removing nearly every function and now putting things back one function at a time. Unfortunately, it takes hours to test each move



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While I agree that DMPE has a lot more functionality and doesn't follow the subscription pricing model, one fact in favor of DMO/DMD remains:

It scales a lot better for larger installations.

 

The client has a very small footprint and can be XCOPY-deployed (meaning you can simply copy a directory to the target machine and run the client from there, no need for admin permissions or lengthy installation).

 

From an IT department's POV the maintenance effort is pretty much reduced to zero in that case...

 

Personally, I also prefer the integration possibilites of classic Dragon, but these advantages of DMD/DMO can hardly be denied, but there are different target groups for DMPE and DMO.

Dumping a much beloved solution for one of these user groups without an adequate alternative is really disappointing for me.

 

mav

 01/07/2021 12:15 PM
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Lunis Orcutt
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Originally posted by: jgold55 Is there an upgrade from DPI to DMPE or is it considered a new purchase, i.e., full price?

 



Unfortunately, Nuance has no upgrade path to DMPE 4.3; other than from DMPE 2.



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That wasn't so nice of them, but I guess business is business. 

Money is no problem for us "rich" doctors.  Not.

 



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 01/07/2021 12:10 PM
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Lunis Orcutt
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Originally posted by: jgold55  

 

1. Is DMPE 4.3's accuracy and functionality worth the extra $$$$ versus DPI 15.61?

2. Will it allow dictation directly into any EHR?  Is there a list of compatible/incompatible programs?



1. Both utilities include the same algorithms so in theory, both general large vocabularies should be equally accurate. We are running DMPE 4.3 on one computer and DPG 15.61 on another computer. We use the same general large vocabulary with our additional 3000 words. Interestingly enough, our DPG accuracy is higher than DMPE. We may simply be imagining this but wonder if the opposite results would be true for physicians. Your guess is as good as ours on this answer.

2. Nuance removed the original EHR no-fly zone. It depends on your EHR. Nuance's intention is to prevent you from using anything other than Dragon Medical in the 70 most popular EMR/EHRs, so that you will be required to purchase Medical. You will have to install a nonmedical version of Dragon and test for yourself. You will find a trial in our signature tag



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My EHR is not on the list.  Dragon just probably recognizes "SOAP Notes" and closes the mike.

It used to be I could dictate without a problem into a section one tab over called "Patient Notes".  Recently that ability seems to have disappeared as well.  Now requires DragonCapture.  But it doesn't directly close the mike.



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 01/07/2021 05:53 PM
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Originally posted by: Lunis Orcutt 

...

2. Nuance removed the original EHR no-fly zone. It depends on your EHR. Nuance's intention is to prevent you from using anything other than Dragon Medical in the 70 most popular EMR/EHRs, so that you will be required to purchase Medical. You will have to install a nonmedical version of Dragon and test for yourself. You will find a trial in our signature tag



I am a little confused.  Did Nuance remove or still keep the very dubious "EHR 'no-fly zone'" practice?  I recall back in 2014 that this was highly controversial.  It's one thing to withhold features such as "hidden dictation box / speech focus anchoring", which even though regrettable, most can understand the business logic.  It is quite another to still practice user intrusion in such a manner as "auto mic-shutoff-upon-EHR-detection".



 01/07/2021 05:57 PM
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All we can tell you is that disabling the Dragon microphone is not illegal and this practice has been conducted for a long time.

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ax
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Originally posted by: Lunis Orcutt All we can tell you is that disabling the Dragon microphone is not illegal and this practice has been conducted for a long time.

 

Wow.  So if this upon-EHR-"detection"-we-will-break-your-mic practice is still alive and kicking, then Nuance really hasn't improved its ethics during the last umpteen years despite a commendable betterment on recognition accuracy.

 

But then again, from the history you gave earlier, we should credit the improvement in recognition really to Philips' technology.  No?  

 

At least your forum is still here and carrying on, Lunis!  For that I am thankful.



 01/10/2021 08:45 AM
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I used DMO for a little while and absolutely hated it. It's expensive and not as accurate. Functionality is limited. My health system went with M*Modal Fluency Direct instead of DMO because of the cost. I suspect many others will do the same. M*Modal Fluency Direct is much better than DMO, but not as good as DMPE.

By Nuance doing this, they're doing a disservice to their company and their customers. This will go down as being a huge mistake in their record. Some people never learn their lesson.
 01/10/2021 10:39 PM
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Charlie
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OK I was forced to change to the nuance online version after years of using DMPE.

 

It was in a word, a horrible, experience.

 

Lack of functionality, poor response just made it worthless.

Why no scripting support boggles my mind.

 

I would rather use professional and make due then ever try the online version again.

It is almost evil to cripple professional concerning EMR use to try to force docs to use a substandard product that doesnt meet our needs.

 

Is nuance trying to lose market share? At least amongst physicians, most of whom are not working in large organizations that can afford an online version, if it met needs anyway.

 

 

 

 01/14/2021 10:29 AM
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I agree.  When I have time I will trial DMPE to see if it is significantly better/more convenient than the workaround I have now with DragonCapture/DPI.

There is no question in my mind that paying for a cloud version of Dragon on a monthly basis that doesn't even have scripting capability is not even a consideration for me.  If it's Nuance's plan to force everyone to the cloud version, as long as I can type manually I would get a better EHR than submit to their vision.  This is the final blow that started way back when in v.9.5 I believe, that regular Dragon could not be used with EMR. Bothered me back then, and bothers me more now.  

Instead of improving functionality and usability, Nuance keeps making it worse.  Fortunately, we still have workarounds with Knowbrainer, DragonCapture, et al.



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 01/27/2021 01:02 PM
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Time for an update--after a "breaking-in period" with DMPE 4.3, and developing a few work-arounds, I am pleased to say that using it has been very beneficial. It's accuracy is nothing short of superb. Anyone considering upgrading their desktop Dragon Medical should certainly do so without hesitation, especially given that this will no longer be an option after March 31, 2021. 

 

MDH



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 01/28/2021 02:23 AM
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While DMO does offer excellent accuracy out-of-the-box for me and everyone I've talked with, I think it's worth mentioning that advanced scripting is not the only thing DMO is lagging behind DMPE with.

With DMO you cannot influence word formattings at all, neither on a word-by-word basis nor with user-specific rule sets (e.g. how you want your dates or currencies to be formatted).

Fluency Direct offers the latter, I'm being told.

 

hth,

mav

 01/14/2021 01:49 PM
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Sadly, Nuance could create local plug-ins to support DMO such as Advanced Scripting, third party command utility support, the ability to transcribe recordings and Philips Premium handheld programmable microphone support; a major Dragon Medical staple. According to our contacts Nuance is already working on a Philips plug-in. If you assume that Philips makes the Dragon speech engine, it's not hard to imagine why Philips would additionally require full compatibility; assuming this cannot be handled on the cloud.

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 01/14/2021 06:55 PM
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"Sadly, Nuance could create local plug-ins to support DMO such as Advanced Scripting"

 

MMODAL is cloud-based and has a scripting language similar to Advanced Scripting. That said, it is primitive compared to Advanced Scripting in desktop Dragon.

 

MDH



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 04/26/2021 12:45 AM
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cjlopez
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Any chance of a future KB local plug-in for Advance Scripting and other features add-one?

 01/19/2021 05:47 PM
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holycowdidyouse..
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I use DMO for many things I then use AUTOIT for what were the advanced scripting commands that were in DMPE. Works great for me only minor changes to the VB scripts then a SBS to trigger by voice
 01/28/2021 10:36 AM
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Lunis Orcutt
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You cannot transcribe recordings either but note that Nuance support will not end until March 31, 2022



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 01/29/2021 08:47 AM
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Mav
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DMO doesn't allow for deferred recognition, neither.

Unfortunately.

 

Nuance claimed they haven't (and probably won't in the forseeable future) added because they fear that their servers will get flooded...

 

Regards,

mav

 

 

 01/30/2021 11:14 AM
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Charlie
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I have been using professional 15.51 at home and DMPE 4.3 at work. I have started doing some things at home so I dont have to stay in the office all hours and surprisingly cloud based EMR is allowing alot of functionality to professional I didnt expect.

 

Maybe its because its a cloud based EMR?

 

In any case I am going to change to using my DMPE 4.3 at home also.

In my experience they should be proud of professional and DMPE, great products.

 

In future what do we do with aging software that we need?  uncertain. 

 

Do people still do market research?

 

Another reason cloud will not go over well for many, the cost is far to high. Most docs dont work for big organizations with deep pockets.

Even if the cost was lowered, and it would have to be lowered a lot for most docs, the functionality issue needs fixed.

 

In my experience you cant beat funtionality of DMPE coupled with KB products.

 

I guess we just hope for competition to come along for our market segment.

Else someone decides long term customer growth/support better then limiting options to leverage customers along a path many dont want. Because that always works well.

 

So my advice buy DMPE and KB. Unless professional canwork easier with EMRs in future.

 

 

 

 

 

 01/30/2021 11:14 AM
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Charlie
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I have been using professional 15.51 at home and DMPE 4.3 at work. I have started doing some things at home so I dont have to stay in the office all hours and surprisingly cloud based EMR is allowing alot of functionality to professional I didnt expect.

 

Maybe its because its a cloud based EMR?

 

In any case I am going to change to using my DMPE 4.3 at home also.

In my experience they should be proud of professional and DMPE, great products.

 

In future what do we do with aging software that we need?  uncertain. 

 

Do people still do market research?

 

Another reason cloud will not go over well for many, the cost is far to high. Most docs dont work for big organizations with deep pockets.

Even if the cost was lowered, and it would have to be lowered a lot for most docs, the functionality issue needs fixed.

 

In my experience you cant beat funtionality of DMPE coupled with KB products.

 

I guess we just hope for competition to come along for our market segment.

Else someone decides long term customer growth/support better then limiting options to leverage customers along a path many dont want. Because that always works well.

 

So my advice buy DMPE and KB. Unless professional canwork easier with EMRs in future.

 

 

 

 

 

 02/28/2021 10:37 AM
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docmig
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How can I tell what version of DMPE I have. The About screen just says version 4. Then below it, version 15.10.350.049.
 02/28/2021 04:47 PM
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Lunis Orcutt
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Originally posted by: docmig How can I tell what version of DMPE I have. The About screen just says version 4. Then below it, version 15.10.350.049.


You have probably noticed that Nuance changed the numbering scheme for DMPE which seems to only make sense to Nuance. Fortunately, they also include the real version number which in this case is 15.1. This means you are using DMPE 4.1. DMPE 4.3 is Ver. 15.5. The Dragon “Check for Updates” doesn't work either. That's why we offer a full copy of DMPE 4.3 Download with a non-expiring automatically updating Installation/User Guide (including details on fixing 3 dozen sandtraps) and lots of other perks



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 03/16/2021 10:37 AM
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holycowdidyouse..
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In my experience I find the Dragon Medical One does agree job with speech recognition compared to the processor and memory needs of the versions of thick dragon clients. PC to install easy upgrades no correct profile no
Backup strategy needed. Yes it is an annoying subscription but I love it.
 03/22/2021 07:39 PM
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ax
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Seems as though they waived the $500 gouging, activation fee?  That's a start.  Just landed in the Inbox today.  Not that I have immediate use for it.  But at least they are trying to make it a little more appealing.

 



 03/23/2021 01:21 AM
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Lunis Orcutt
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Nope, Nuance has not waived the $525 activation fee. The $79/$99 is an additional charge. Without upgrading, about $1600 for the 1st year and $1200 per year until retirement.


PS: Our contact says that promo pricing doesn't expire at the end of this month or anytime in the foreseeable future.

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 03/24/2021 12:28 PM
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Bottom line:

 

If some entity such as your hospital is paying the DMO upfront and eternal monthly fees, or those of MMODAL Fluency Direct, and you are willing to accept some limitations, you may decide to go with one of those choices. But if that is not the case, and you want maximum functionalty and customization, best to go with DMPE 4.3. Factor in that which direction you decide impacts your time spent daily to do all of the documentation and tasks required to take care of patients and practice medicine. Even though my hospital provides MMODAL Fluency Direct for all, for me, the $1600 one time expense of DMPE 4.3 was a "KnowBrainer"--excuse the intended pun. This was money very well spent as I would have been a VERY UNHAPPY camper with MMODAL Fluency Direct (or DMO) and would have forever regretted having to deal with that compromise. Time is money, and happiness is all important. My strong advice--get DMPE 4.3 before no longer available after March 31.

 

MDH



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 03/24/2021 11:30 PM
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ericnixmd
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I will continue using DMPE 4.3 until it is non-functional. I will purposefully not upgrade Windows to keep from breaking it (unless I'm forced to).

Nuance made a bad decision moving to DMO, and I think they will find that their business goes elsewhere. It's expensive and I hate it. I would rather use M*Modal if I had to purchase something online.
 07/05/2021 11:44 AM
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tsupport
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Originally posted by: ericnixmd I will continue using DMPE 4.3 until it is non-functional. I will purposefully not upgrade Windows to keep from breaking it (unless I'm forced to). Nuance made a bad decision moving to DMO, and I think they will find that their business goes elsewhere. It's expensive and I hate it. I would rather use M*Modal if I had to purchase something online.

 

I purchased 30 licenses of DMPE 4 when it was announced that it would be discontinued to replace v10.1 licenses. I assumed at the time that we would continue to be able to activate existing licenses even after the product support stopped but I have recently learned that this will not be possible after Mar 31 '22.  Can anyone confirm this?

Disabling the activation of previously purchased software licenses seems wrong and not in keeping with other software. I can still activate Windows 7 for example.

 

 07/05/2021 03:44 PM
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Lunis Orcutt
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We are predicting that Nuance will officially reinstate DMPE 4 within a few months. We predicted the same thing, on this forum, about DMPE 2 because small practices simply couldn't justify the $1600 lease on DMO ($1200 per year after the 1st year). We are making the same prediction for DMPE 4 but suspect that Microsoft might change the name to Small Practice Edition 2022. 

 

As to your question… Nuance cannot prevent you from activating Dragon because it would be illegal in the US. If you have any doubt, how come you can still activate Ver. 10 which Nuance does not support. This is true with all software.

 

We just purchased 45 licenses of DMPE 4.3.1 (Build 15.51) (digital download) for resale; in case we are wrong. You might want to keep in mind that while the Nuance official end of cycle finish date was March 31, you have to ask yourself why Nuance $pent on Ver. 4.3.1, which they didn't make a dime on. This was a minor release but Nuance doesn't typically patch or update discontinued utilities when they want you to upgrade to DMO or a future release.



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"...Small Practice Edition 2022."

 

This sounds like reliable insider information to me!

 

MDH



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Mav
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Nuance claims that a problem is fixed with DMPE 4.3.1 where the microphone would record audio even though it's supposed to be turned off.

 

We have witnessed this behavior ourselves, where suddenly Dragon would type things we said while the mike was off after turning it back on.

We couldn't find out precisely under which circumstances this happened, but such a behavior (even if it happens intermittently) poses a serious privacy risk.

 

My guess is that Nuance wanted to fix this bug before they get sued big time...

 

mav

 07/19/2021 04:52 PM
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FootDoc
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Please put me down for notice when this hypothetical program is available. 

Thx

 04/11/2021 12:59 PM
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FootDoc
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I still have 4.1 and just made a new user which I do almost yearly and import somethings into into it. It actually works very well when I enunciate at normal speed not my usual hyperspeed. But I have a newer laptop and I didn't put anything on it. Maybe I will put a demo of 15. x on it and play with it to add vocab and see if I can get it to work with my ehr that is not on any hit list. I mostly use it for dictating which is almost at the office anyway but just might be a good opportunity to play.
 04/11/2021 01:16 PM
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R. Wilke
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Anyone around who can confirm that DMPE has been discontinued on 03/31/2011?



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FootDoc
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2021....LOL
 04/11/2021 01:46 PM
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R. Wilke
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Originally posted by: FootDoc 2021....LOL

 

Glad I could keep you amused. But do you have an answer, or just anything substantial to report, for a change?



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 04/11/2021 02:39 PM
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FootDoc
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Really R. Wilke?
 04/11/2021 06:20 PM
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Lunis Orcutt
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DMPE 4 was manufacturer discontinued on March 31, 2021. Nuance support will be continued through March 31, 2022. Nuance licensed vendors are permitted to offer DMPE 4 until stocks are depleted. We are stocked up and will not be expiring our support.

DMO is not very popular with small practices. Rumors have it that many physicians will be cutting and pasting from DPI 15.61 rather than leasing DMO. Nuance tried to discontinue DMPE 2 at one point but potential customers purchased Dragon Professional 13. We wouldn't be surprised if Nuance has to reissue DMPE 4 in a few months.



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 04/12/2021 09:33 AM
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FootDoc
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Just heard that Microsoft is in second stage talks with Nuance to buy them out. They have been working closely since 2019. That could be interesting. Wonder if you heard anything in the pipeline Lunis?
 04/12/2021 09:53 AM
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FootDoc
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It already being discussed on the Dragon speech page and it's real since it's happening today

 04/26/2021 11:33 AM
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Lunis Orcutt
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While KnowBrainer 2017 does not currently work in DMO, Nuance is receiving a lot of requests for the 75% of the DMPE 4 features that were dropped in order to make DMO work quickly enough. All we can tell you is that an Advanced Scripting local plug-in is at the top of the Nuance consideration list. Since Microsoft is taking over at the end of this year, we suspect there is a good chance that Advanced Scripting will be added back in because Microsoft is keenly interested in DMO and want every possible feature. It would also look bad if Advanced Scripting was available in the upcoming Windows included speech recognition engine but not DMO.

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 06/10/2021 02:30 PM
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ax
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Clearly in retrospect Nuance killing off DMPE has absolutely zilch, nada, nothing to do with wealthy suitor from Seattle wanting to take their hand while monetizing the union in the blue Azures.

Ask any slumlord respected property owner who has this creaking "investment" property now suddenly doubling or tripling in value.  Now you have an "investor" who wants it, with a small condition being that you toss out these irksome stingy tenants who complain more often than they pay ... also to avoid any potential inconvenient "optics" issue if the big-branded gilded investor has to get own hands dirty by tossing them out ... after all, some of those tenants apparently call themselves "doctors".

So the "respected property owner" has to get it done before sealing the deal.

Plausible?

Nah. They would never do that.

And I don't understand why anybody could even think they would do that.



 06/15/2021 09:11 PM
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ax
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Continuing off of Lunis's Comment.

IMHO, entities such as American Medical Association (I am in Canada so at best at an "arm's length") needs to step up (not necessarily publicly) and mutter something, in this, what is still the pandemic year.

When it was "just Nuance", which was/is a Big Company in its own right, but not quite a behemoth, applying institutional pressure might have seemed ... unseemly.

But now that Nuance has fully betrothed itself to Bad Apple Goliath, I don't see why AMA or the likes should continue to stay mum with such anti-small-holder practices.

Anyway, my own 2 cents only.  I have not personally even gone near DMPE for a few years.  But I'd like to know options and fallback exist, especially with Agent Smith still diligently maintaining DragonCapture and what not.



 07/07/2021 08:18 PM
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mwarddoc
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I was visiting a physician at a military base, in USA, a couple of weeks ago, they use integrated dragon in their Cerner system.

I'm not sure what "version" it is, but it was immediate and flawless. Without any setup whatsoever, it gave me near perfect voice recognition and transcription. Equal to what I get with DMPE 4.x.

I don't get anything at all like that at my current employer and use DMPE 4.x.

However, if what I saw was DMO, or any iteration of it, it was tremendous and I'm sold.

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 07/08/2021 11:47 AM
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Lunis Orcutt
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DMPE 4.3.1 should work as well anywhere and we recommend exploring possible solutions with your current employer. It seems more likely that the version of Dragon Medical that is integrated with Cerner is Ver. 12 rather than Dragon Medical One (DMO)



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 07/08/2021 03:17 PM
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smeyer
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Cerner uses Dragon Medical Enterprise Edition (as opposed to practitioners using DM Practice Edition).  It is the same functionally as DMPE with the same vocabularies and same commands including scripting.  I have used both and they work identically.

DMEE runs from a Nuance on-site server rather than individual workstations.  The technical tricks of enterprise edition involve using roaming profiles so a user can access from any computer in the hospital, an extra 30-40 seconds to load DMEE and your profile at any given location.  Also a special Nuance background application runs to allow DMEE to run in a citrix environment.  Otherwise the softwares are virtually identical.

My hospital dumped DMEE for less expensive software.  I miss DMEE.



 07/12/2021 04:20 PM
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mwarddoc
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Well, just may not matter anyway, I'm soon to be changing jobs and the leading contender recruitment wise uses M Modal, just found that out today.

Documentation challenges just suck and have since we could scribble illegibly in a paper chart and use all sorts of crazy abbreviations that made it possible to do an entire history and physical on a 3x5 card. Of course, the records were largely useless.

Just to do my job, in the last 10 years, I"ve had to learn 5 new EHR's, a new dictation system, and now I've got to learn yet another if I am offered the job.





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 07/12/2021 04:28 PM
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smeyer
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I could never get M*Modal commands to work, script commands and even text commands failed.  The recognition was good, not quite up to Dragon though, and I missed commands dearly.

 07/22/2021 03:07 AM
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mwarddoc
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"...and I missed commands dearly"

Yes, I expect I will be missing mine as well, all 3000+ of them.

There I was, thinking I would be worshipped as a Dragon God, only to find out that I will be really starting over from scratch.

Well, I might just pony up and pay for DMO myself if and when the time comes.

Multistep voice commands just make life so much more clickless. That may be why I'm not going crazy like some of my colleagues, the sound of the mouse clicks must be doing it to them!



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 07/22/2021 11:01 AM
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Lunis Orcutt
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mwarddoc,

Are your 3000 commands step-by-step or boilerplate text (text and graphics)? If so, they can be used in DMO but we are not recommending DMO at this time. We recommend staying with DMPE 4.3.1 as long as possible.

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 07/22/2021 05:53 PM
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ax
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Very interesting thread on the VA and its decisions.  It's relevant for even those of us working in community hospitals in Canada.  A colleague of mine who has done fellowship in the US is fond of saying that the Canadian System is most comparable to the VA ... in terms of "good" and "bad".

Anyhow, I just went on VA's searchable "allowed list" database:



https://www.oit.va.gov/Services/TRM/SearchPage.aspx


Macro Express is indeed "approved with constraints".  So is Autohotkey 1.3x - "approved with constraints".

Then Autoit is "unapproved".  And surprisingly the arm-and-a-leg WinAutomation (now aka Microsoft's own "Power Automate" RPA suite) is also unapproved.

I wonder if there are "rhymes and reasons".  Not that these folks usually feel obligated enough to disclose them, I suppose.

But it is still good to know what the VA considers Kosher.  I use an EMR (Accuro) and an EHR (Meditech), largely depending on which side of the hospital I am at.  The former is an "ASP"-hosted SaaS ... basically a botched implementation of "Windows 365", AFAIAC, through that devil Citrix.  It is completely locked down so as not to allow me to use AHK on the server side.  Ditto MEX (Macro Express).

Even a governmental behemoth such as the VA is more accommodating than these jokers.  And here is the biggest joke (on me): I am paying them monthly!  Having said that, as an EMR, Accuro remains one of the better implemented solutions currently on the Canadian market.

 

It's hard for any doctor to catch a break from this relentless pace of information technology "make-work" indeed.

 

I do feel for you, mwarddoc.  But I think you are a role-model on adaptability.  There is no doubt about that!



 07/25/2021 03:19 AM
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mwarddoc
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"Are your 3000 commands step-by-step or boilerplate text (text and graphics)?"

They are a mix of all types, most are step by step.

I met with the future probable employer two days ago and they actually have very restrictive measures in place that will prohibit any use of DMPE, or Dragon Medical One, unless I can convince their IT people to make an exception.

No use of personal laptops or desktops to access the medical record system, no use of ancillary software, and despite them having networked M*Modal everyone I spoke to was largely typing their notes.

I'm puzzled because they use Epic, just like my current employer, but for security reasons they are much more restrictive.

"It's hard for any doctor to catch a break from this relentless pace of information technology "make-work" indeed."

Ax's comment is spot on, and it is driven by the historical persistent resistance of the medical profession changes in how things are done.

Take for instance checklists, which are considered the "gold standard" now were completely considered unnacceptable 30 years ago, as were standard order sets that could be easily and consistently implemented, so physicians had to hand write everything over and over every single time, at great time expense, with tons of errors, horrible handwriting, and misinterpretations flowing from all that. I started using an EMR 20 years ago, the hospital that I then admitted to was still using clipboards for inpatient charts, just like they had been in 1991, when even in 1984 other places I had worked were using a much more scientifically advanced 3 ring binder for charts (yes, the clipboards would fall out of the pocket holder, or get dropped, and spill papers of all types all over the place, which would mean that they had to then be picked up and put back on the clipboard in some semblance of order). They finally transitioned to three ring binders just a few years prior to transitioning to an EHR. I still wonder who it was that was so vested in keeping the old clipboards around.

Anyway, no need to borrow trouble, I may end up working for the VA.



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mwarddoc
 07/25/2021 11:50 AM
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MDH
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"...unless I can convince their IT people to make an exception."

 

For many years our hospital and associated medical clinics were using Dragon Medical Enterprise. Several years ago they switched to MMODAL. However, I was the only one of about 100 providers in the outpatient setting that did not switch to MMODAL. The reason I did not want to switch was the primitive command functionality compared to Dragon, and not wanting to give up my custom Dragon commands. The reason that I was able to refuse switching was that I was the only doc that had actually purchased my own Dragon Medical copy years prior to the MMODAL switch. (Everyone else was using Dragon via license prior.) The CIO/VP of the hospital was well aware of what I had accomplished with custom commands and of my resistance to change to MMODAL. So he proposed a deal where I could keep using my Dragon with the understanding that I would receive no IT department help with Dragon issues should a problem arise. This was fine with me as I knew lots more about Dragon than anyone in the IT department--and that is not saying much. Later upon wanting to update to DMPE 4.3, they additionally took away my administrative rights (was last and only one to have those), thus necessitating in return for IT to install DMPE 4.3 for me at work (I could do on my home computer).

 

MDH

 



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 07/29/2021 03:14 AM
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mwarddoc
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"So he proposed a deal where I could keep using my Dragon with the understanding that I would receive no IT department help with Dragon issues should a problem arise."

I think I got the same deal where I work now with their Dragon Medical 360, but if it doesn't work (which it didn't, and still doesn't), I get no help.

In fact at one point was told by a support person, when reporting problems and trying to troubleshoot, that theirs "is working well on my computer", so I asked, surprised that this was a medical provider "how many patients did you dictate on today" or something similar.

I then found out that they were not using it at all (but apparently it was working well on their computer, they just didn't use it), because they didn't use Epic, or Dragon Medical 360 at all, but were the primary support person.

This key fact, very interesting fact indeed, was a turning point for me and my solution to the problem arose from this, as I also found out that my networked and Epic interfaced Dragon Medical 360 worked much, much, much better when I used DMPE 4.x and Dragon Capture on my own computer and didn't use Dragon Medical 360 or any of the company computers.

Amazing IT support. I might never have figured it out if they had not been there.



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mwarddoc
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