Hi!

AFAIK there is not a single headset with button support for DMO.

Almost all handheld microphones with buttons can be used, but with a headset the use case is different:

When you wear a headset, your hands are free and usually on the keyboard and/or mouse. If you want to press any buttons on your headset (or even worse: somewhere on the cable), you have to move your hand a long way to the buttons, which is not very efficient.

 

My suggestion is to use a keyboard shortcut for toggling the microphone on and off (by default, NUM+ does this).

 

hth,

mav

Or,could you just say "go to sleep" to suspend the mic, and "wake up" to turn it back on? Works in the practice edition.

 

Many of us have found that "go to sleep"  can lead to very bad performance, both  real-time stalls  and poor recognition quality. Posts elsewhere on the site explain that while sleeping, Dragon must nevertheless be listening for the wake up" command, and much buffering of sound can queue up, producing delays.

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Many gamer headsets have buttons, but I did not find any such headsets that gave Dragon good recognition accuracy

I wear a media remote on my wrist that has the buttons to turn the Dragon microphone on or off.


the one I am currently wearing has five buttons, although I can only use three via AutoHotKey, the media buttons. Overwriting the volume up/down buttons and AutoHotKey is global and you don't want to do that. there is a way to get around that limitation, but I have not coded it up yet.

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The headset button is not a real option and the Dragon go to sleep command can be problematic; especially when you're on the phone. Consider SpeechStart+ which includes the only Microphone On command. Dragon already includes a microphone off command but it cannot listen for Microphone On for obvious reasons. SpeechStart+ has this capability because it includes its own speech engine which can only listen for Microphone On. When I see the Big Haired Lady coming towards me, I know it's bad news and I don't mess around with half measures like go to sleep. It's full Monty microphone off time. When she leaves, I kick work back into high gear with Microphone On. I'm not disabled; just lazy efficient.

 

You'll find a 15 day trial of SpeechStart+ in our signature tag.

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

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Thanks all for these (old) replies. Go to sleep and wake up are shown in some Nuance documentation as being available, but these commands don't function in our DMO. I'll try SpeechStart+, thanks Lunis.

Go to sleep and wake up are for DPI/DMPE/DPG/DLG only!

DMO is a totally different product and does not support all the features of "regular" Dragon.

With DMO there's no microphone sleep mode, but toggling the microphone using a hotkey is available in both.

hth,

mav

I have found the best way is to make one of the buttons on your mouse function as your mic on/off switch. Works great and highly efficient. I use a gaming mouse with 13 buttons and they all control something. One controls the mic.

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

Dr. Darren K. George,
Corporate Wide AMR Medical Director Community Health Systems

Just to clarify what Mav has said above, there is no "wake up" or "go to sleep" command with DMO or DPA/DLA. Our standard Speechstart+ program which Lunis has suggestedwill do nothing with DMO/DPA/DLA but if you contact us using the signature below we can supply a version of speechstart+ for controlling your microphone from the off state with DMO/DPA/DLA, starting or restarting DMO/DPA/DLA by voice, closing down or restarting windows by voice without using DMO or Dragon e.g. if DMO or Dragon were locked up.

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

Thanks Lindsay; will be in touch.

Hello: I would like to set up a hotkey to turn on the Dragon microphone and to turn it off. I would like to use SpeechStart+ or KnowBrainer or any other effective solution, to create a hotkey that does this. I'm willing to use autohotkey.  Since it looks like SpeechStart+ has a microphone on command, is there a menu that I can access to trigger such command using, for instance, autohotkey? I have SpeechStart+ installed but cannot figure out how to open up its menu in order to access the microphone on/off commands
Thanks, Steve Elster

the below is quoted from above re SpeechStart+

"The headset button is not a real option and the Dragon go to sleep command can be problematic; especially when you're on the phone. Consider SpeechStart+ which includes the only Microphone On command. Dragon already includes a microphone off command but it cannot listen for Microphone On for obvious reasons. SpeechStart+ has this capability because it includes its own speech engine which can only listen for Microphone On. When I see the Big Haired Lady coming towards me, I know it's bad news and I don't mess around with half measures like go to sleep. It's full Monty microphone off time. When she leaves, I kick work back into high gear with Microphone On. I'm not disabled; just lazy efficient."

-------------------------
Steven Elster

                    Welcome (See Mission Statement)

 

When you installed SpeechStart+, you were prompted to go through verbal training. If you went through verbal training, you will be able to say Microphone on to turn the Dragon microphone on; even when it is completely off. If this capability isn't already engaged, you can turn it on by right-clicking on the hidden blue Apple and left clicking on Options. Now put checkmark in Use Microphone On Utility.

 

SpeechStart+ does not have the ability to assign a hotkey but KnowBrainer does. Left click on the KnowBrainer Sidebar gear (to the right of the Add Command button) followed by clicking the Hot Keys tab (at the top).

 

HOWEVER, our preference is to use the Dragon hotkey to turn the microphone on and off. The default setting is the PLUS (+) key on extended keyboards (calculator keyboard). If you don't have an extended keyboard, you can open Dragon Options/Hotkeys and assign a different key

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This is an FAQ: https://github.com/AndyGlew/manx-UI--Speech/wiki/Ability-to-Turn-Microphone-On-and-Off-Easily-Is-Important


Short answer: DragonBar > Options > Hotkeys. However, apparently not available in some Nuance Dragon configurations like DMO


Other approaches


PTT (Press-to-Talk) keys are highly recommended by people who are lucky enough to have them - whether a PTT key on a handheld microphone, or whether they have a key suitable for PTT use on their normal keyboard. Unfortunately, many of us do not have such keys available because of [[hotkey saturation]]


SpeechStart+ microphone on/off highly recommended.


I have AutoHotKey commands to turn the Dragon microphone on/off, which I bind to things including (a) multi clicks of trackball buttons, and (b) generic AutoHotKey menus, similarly bound. all in the interest of avoiding [[hotkey saturation]] and [[hotkey conflicts]]

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Hello, thank you. Would you be willing to share your autohotkey script. I don't just want to turn the Dragon microphone on and off. I also want to include some other commands, within the script, such as telling Word to save its file. The reason I ask if you would be willing to share your autohotkey script is that I have been unable to figure out how to identify the Dragon bar window, thus cannot tell autohotkey to go to that window and do something. I have figured out how to use the hotkey within Dragon to turn the microphone on and off. So if I could tell autohotkey, for instance, how to get to the Dragon bar, then I could issue that Dragon key combination. I hope I'm making sense?

In the same vein, it's great that KnowBrainer has the ability to turn dragon's microphone on and off. But how do I tell autohotkey to go to the window inside Knowbrainer and issue the keystrokes that will tell KB to turn the Dragon microphone on or off? So, for instance, of course, to get to the window for Word, I tell autohotkey to use winword.exe. That's the kind of information I'm trying to figure out for KB or for SpeechStart+.

Thank you, Steve Elster

-------------------------
Steven Elster

Of course I am willing to share my AutoHotKey code. 

https://github.com/AndyGlew/manx-UI--Speech/wiki/snippet%3A-Dragon-microphone-on-off

 

I hesitate in part because of embarrassment, but also for the other reasons in https://github.com/AndyGlew/manx-UI--Speech/wiki/FUD%2C-Blush%2C-Rush

 

For these reasons I am sharing code snippets rather than full scripts -  since the full scripts will use many files.

https://github.com/AndyGlew/manx-UI--Speech/wiki/Code-Snippets

 

I spent much too time  preparing and explaining the code snippets...  

 

 

 

https://github.com/AndyGlew/manx-UI--Speech/wiki/snippet:-Dragon-microphone-on-off

 

 

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DPG15.6 (also DPI 15.3) + KB, Sennheiser MB Pro 1 UC ML, BTD 800 dongle, Windows 10 Pro, MS Surface Book 3, Intel Core i7-1065G7 CPU @ 1.3/1.5GHz (4 cores, 8 logical, GPU=NVIDIA Quadro RTX 3000 with Max-Q Design.

My post and code snippets are probably overkill, since rereading your post I see that you have a misunderstanding that got in your way.

You don't need to get to the  DragonBar and then issue the hotkey.

The Dragon hotkeys are global. You can issue them anywhere.

Similarly, my AutoHotKey code bound microphone on/off to trackball or menus are also global. The main thing  my code gives me is to have the ability to turn the microphone unconditionally off (press and release PTT) and unconditionally on (press PTT then toggle).


The problem with hotkeys is that you never have enough of them - they  often conflict with hotkeys that you want to use in other apps. especially global hotkeys. there are just plain not enough  hotkey possibilities.   Users frequently have different hotkey settings, depending on what they want to make most convenient.  speech commands, on the other hand are much more high valency -  you can easily create and remember a much larger number of speech commands than you can have hotkeys.


Using the COM object to turn the microphone on and off is independent of hotkeys.

For my purposes that was only relevant in the "timeout to turn the microphone off" script.

... well, I suppose it's also relevant if you have only a single hotkey or trackball event that you bind to a menu system. Reducing hotkey contention. But I found that I want to turn the microphone on and off often enough that I prefer not to have to navigate a menu. It's bad enough having to press a key or button when you want to do as much as possible by voice. 


SpeechStart+ of course allows you to turn microphone on by voice, without messing with any effing hotkeys.


But using the COM object approach to avoid hotkeys, global or otherwise, is relevant to just about every other speech command you might ever want to write. If you can use actual code rather than emitting hotkeys or mouse events, your speech commands will be much more reliable. much more likely to work both on your system,  and more likely that you can share with somebody else.

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

DPG15.6 (also DPI 15.3) + KB, Sennheiser MB Pro 1 UC ML, BTD 800 dongle, Windows 10 Pro, MS Surface Book 3, Intel Core i7-1065G7 CPU @ 1.3/1.5GHz (4 cores, 8 logical, GPU=NVIDIA Quadro RTX 3000 with Max-Q Design.

I'm an FP using hospital supported DMO from my office via network and at home by remoting in. Almost all of my chart work is done after hours when I'm away from patients, staff and phones. 

My problem is not how to toggle the mic on and off but how to keep it on. If I pause for more than 90 seconds (while looking up info, etc.) the mic turns off automatically. I usually don't recognize this until several sentences into the next dictation. I have no need to turn off the mic, just the need to begin dictating at will.

I can say "Wake up" but I have to yell louder at the mic than I do at my teenage son in the morning. I have programmed the hot key CTL + UpArrow as a toggle but the same auto-sleep problem exists.

I've contacted both the hospital Dragon/Epic team as well as Dragon and Epic. They all say it's hard coded to go to sleep at ~90 seconds. If it's set at 90 seconds, why can't one set it at a different interval?

 

Thanks for any and all help!

Sorry! I should also add that I'm using a Speechware Travel Mike. Arthritis prevents using a hand mike and I'm uncomfortable using a headset. I'm also a lousy keyboardist and have absolutely no programming skills.

--Lance Bridgeman

"I wear a media remote on my wrist that has the buttons to turn the Dragon microphone on or off."
AG,
Back in 2020 you mentioned this. Which one do you use?

 I have the following wristband remote control in my headset case:

 

 

GitUp Bluetooth Remote Control Watch.  The only downside to it being a camera remote rather than a media remote control  is that only two of the three buttons were usable. The third button seems to be special and possibly company proprietary.

 

That was the best actual wristband I found. Prior to this I used things like Satechi Bluetooth media button -  steering wheel mounted -  which I adapted to fit on a NATO  watchband.  at one time I used two-sided tape to stick such a media remote onto my old pebble classic watch.

 

 

 

However, I no longer do this  most of the time.  I wear my Apple watch all the time, and I don't like wearing two watches on my left hand, and wearing one on my right hand increases my computeritis.

 

 "most of the time" sometimes I'm doing things that involve a lot of repetitive actions,  like processing 1000 intellectual-property packages with buy/don't buy recommendations. so I will do an ad hoc binding  to a button on the wristband.   but I don't do that very often anymore.

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

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Thank you Ag

 

To bypass such "hard-coded" interval, if indeed it is so, would be quite tough if one isn't allowed some form of under-the-hood access.

I'd imagine the most brutal and least "intelligent", but also the most universal method of achieving a semblance of what you need, through the likes of AutoHotKey (among others), would be along the line of the following:

1. Set up a loop.
2. Monitor the pixel colour of the Dragon bar record button at a known set of coordinates.
3. Send your hotkey to activate the record button or mouseclick/"control-click" it as soon as the pixel changes colour (indicating a change of state).

 

Depending on details, it is possible that it could be fairly "easy" in the sense that you don't even need to know which pixel colour you should monitor for.  Instead you just need to activate the record button when the pixel colour changes.

P.S., I'd also imagine there is valid reason for Nuance or any online resource provider to hard-code such a timeout.  Every time your DMO / my DME button is green, it is establishing a data/listening "stream" to a server wherever, and eating up some bandwidth and resource.  Apart from the "privacy" concerns over this and that, resource conservation would be a consideration.  90 seconds do seem short.  Of course, for PTT users like most of your colleagues, that's probably moot.

A quick word on what I consider to be salient points on "PTT" through AutoHotKey:

1. The keyword is "keywait".

2. It is not generally Mic-dependent, but program dependent.  If a program using the Mic (desktop dragon, DMO, or my 100% cloud, hospital-provisioned SDK embedded Dragon, Teams, games, dreams) provides built-in hotkeys for activating and deactivating the mic (which is really turning on/off the audio stream to that program), then one can easily use AHK to remap these hotkeys (usually in user-unfriendly keyboard combo) to a single PTT key.

2. For everyone - I do mean everyone, who has reasonable hand/wrist function and who tends to use mouse on their right hand, and assuming a standard American keyboard layout, the best key - bar none, for PTT use is the CapsLock.  The reasons are self-explanatory.  Forum oldies such as PG pointed this out long ago.  Tilde is the second best.  I use that one, too.  Yes I have 2 PTT buttons on the left side of my keyboard to control 2 different DME sessions.  I could use a 3rd for VoiceMacro but I choose not to.

Below is an actual example for my primary PTT button (CapsLock):

SC03A::                                           ;Scancode for Capslock
              Process, Exist, VoiceMacro.exe
              if errorlevel
                  Send, {NumpadSub}     ;Pause VoiceMacro
              ControlFocus,, ahk_id %WinID%
              ControlSend,, ^!+r, ahk_id %WinID%    ;Turn on mic
              Keywait, SC03A
              Sleep, 500                          ;Keep audio stream open for 0.5s after turning mic off
              ControlFocus,, ahk_id %WinID% 
              ControlSend,, ^!+s, ahk_id %WinID%    ;Turn off mic
              Process, Exist, VoiceMacro.exe
              if errorlevel
                  Send, {NumpadAdd}                  ;Resume VoiceMacro
              SetCapsLockState, Off                    ;Optional
              Send, {Ctrl up}{shift up}{alt up}   ;So that the keys don't get stuck in a down state
Return


For most people, all that's needed for PTT are just 3 lines of pseudo code in AHK (difference between code and pseudo code in AHK V1 is kind of blurred):

Key A (in Scan Code or Key Name)::
              Send, Global Hot Key to Activate Your Mic for That Program
              Keywait, Key A
              Send, Global Hot Key to Turn Off Your Mic for That Program
Return

 

The rest would be fine-tuning, such as when to use ControlSend vs Send vs SendEvent, etc.  Not that I particularly know the intracacies.  To make it 100% reliable on your particular system, it will take some tweaking and trial-and-error.  Right now I can use the same PTT script on my home/office rigs, laptop, hospital PC (pathethically spec'd), and VDI server (more genererously provisioned).  It is 100% reliable everywhere.  For now.

 

P.S., in terms of tweaking, obviously AHK documentation is where one needs to delve into.  I also mentioned my settings in one of the previous posts on DME under Meditech.  Mainly SetKeyDelay.

I should mention that I am always interested in real-life feedback/experience of P.I. Engineering's X-keys type of buttons/devices, and how their control software (MacroWorks etc.) operate.

The biggest attraction X-keys type of buttons hold for me is that they seem to allow for "portable" plug-and-play use once the buttons themselves have been programmed at home through X-keys software.  This is where gaming mice and other similar external devices that are dependent upon proprietary "client software" could not meet my needs, since I can't manually install their drivers and control software at work.

Octopus USB controller is also quite nice and could implement PTT on a variety of USB interfaces (but not the keyboard).  However, that also requires full local installation.

 

I have two X-key  keyboard sticks, an X-key 4 and an X-key 16.

 

I do NOT use MacroWorks.   Instead I use  X-keys Basic Setup, mapping each key to a unique[*] keycode that both the X-keys hardware and AutoHotKey understand, And then having AutoHotKey map that to whatever I want for different apps.

 

I do this because I use AutoHotKey for a lot of other reasons,  e.g. for my trackball, so it's just easier to do everything in the same place.

 

---

 

At the moment I am not using my X-keys  on a daily basis. I went through several years of intense use of X-keys  and other extra key devices,  but I basically stopped doing that when I started using Dragon again.  

 

Reasons -  for me not using X-keys and/or recommending other vendors

 

*  Dragon speech recognition has eliminated much of the need for me to use X-key devices.   I mostly only use them now when I'm doing repetitive tasks that require so much speaking  that my mouth dries up, even for simple words like "buy"/"sell" that my mouth dries up

 

* Insufficient desk space  and/or insufficient keyboard tray space.

 

* Related:  the X-keys are big and clunky.

 

** e.g. the sticks have a circa 1.5"  region that is not  under a button, just wastes space. (see https://xkeys.com/xkeys/keys/stickkeys.html)

 

* The X-key switches  are pretty crappy.  if you are the sort of person who likes a nice mechanical key switch, the X-key is not for you

 

*  overall, I still hope to be able to use laptops/convertible/portable PCs for a while.  the headset mic is portable.   The trackballs are not really very portable, but  it's much easier to get a trackball or good mouse at more than one site than it is to get an expensive device like the Elgato.   becoming dependent on fancy devices restricts a number of places that you can work.

 

---

 

For many of  my use cases for such devices, I do not really want " keyboard keys",  but instead want big buttons.

 

For many years such big buttons were extremely expensive to purchase, as for t.hat matter is X-keys, starting at 100$US for  the X-keys for.

 

Now we start seeing vendors like KatiesGadgets on Etsy selling button boxes - https://www.etsy.com/shop/KatiesGadgets  e.g. https://www.etsy.com/listing/928732260/3-button-shortcut-for-2-programs for much more reasonable prices like 20-25$ for 1x3, 1x4, or 2x2 Sticks of buttons or keys.

 

Note that I have NOT tried  any of Katie's gadgets,  I only noticed them when I googled for somebody  a few days ago. 

 

I think that the price for such external devices might going down one because of  (1) kit providers like Adafruit, and (2)  because COVID meant that a lot of people wanted mute buttons etc. resume.

 

I am tempted to get one of Adafruit's kits and make my own  button bar.

 

Unfortunately, from the photographs it appears that Katie's gadgets are  not exactly svelte. Exactly how they compare to the X-keys with regard to  clunkiness is TBD.

 

Amazon shows quite a few similar devices  from what look like the usual Chinese vendors with a randomly chosen names. E.g. https://smile.amazon.com/Ecarke-Mechanical-Keyboard-Programming-Software, 17$US, 1x3 keys,  programmable  apparently both with respect to  keyboard events but also wrt the LED lighting  under the keys.  so you might be able to change the color according to what the action performs at any time.

 

===

 

As I said, If I did not already have the X-keys, I probably would not purchase the X-keys again.  But since I have the X-keys, I keep them on the shelf, and take them out from time to time when I have a lot of repetitive work to do.  e.g.  sometimes I need to do things like go through 10,000 email messages or papers or patents, making simple decisions like good/bad/hw/sw - tasks where a simple button  suffices to mark the item, and then go on to the next item, which in the case of patents often involves opening up to databases and a PDF reader.

 

 

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If you're going to spend circa 100$ on an X-key 4 or X-key 16, Or much more for the larger X-key keypads, I would seriously consider a Elgato Stream Deck - $75 for 2x3=6 keys, $133 for 3x5=15, and $250 for 4x8=32 keys. and the keys have LCD displays that you can reprogram to indicate what happens when you press them :-)

This being said, I have no experience with the Elgato. I assume that you can program it for just about anything, which is often not true for vendor software unless you can escape to AutoHotKey. I just lust for it.

 

===

 

Or $$$, the Dumang DK6 keyboard: http://xahlee.info/kbd/dumang_dk6.html

 

Each key is fully programmable,  both for keycode and lighting. Independently placeable.  circa $250 for a single 7x9=64 Keypad,  but you choose how many keys you want what their orientation is.  Many people seem to be buying two,  to create a full (split)  keyboard that they can arbitrarily orient.

 

Nice  choice of mechanical switches,  much better than the crappy  keyboard switches in the X-keys.

 

===

 

If I were willing to give up on using laptop/portable computers, I would probably go for the Elgato over the Dumang.  LCD  keytops look very nice for people who cannot remember key-bindings.

 

 

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

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Thanks Ag for chiming in your experience! Plenty of food for thoughts. X-keys do seem "overpriced" although that's relative these days. Precisely I am looking to use them for certain "super-repetitive" tasks, whereby even speech is too onerous and slow and inefficient. Precisely it is the fact that X-keys could be programmed by their vendor software to some arbitrary code (scancode?) which is in turn recognized by AHK that is attractive to me.

Don't know if any of the other devices you listed could be programmed for use independent of their vendor software. Will check with Katie.

Anyway, I don't yet have any dire need for them. But it is an avenue I want to keep open.

Alright I am here as an MD trying to find a solution to the 90 second time out on DMO. Here is my latest idea that I will try out this week: Use either rubberbands or a standard tablecloth picnic table metal clip padded with some silicone to keep the record button down on the Nuance PowerMic III like I am pushing on it with my thumb. I use a surface pro without a number pad, and yes I have hotkeys to start and stop recording (I use Alt X) BUT nothing stays on for more than 90 seconds idling. This does not work for my workflow when I am looking up data or could be interrupted. Of course this will not work on nuance mobile with Airpods or my Jabra wired headset. There does not seem to be a solution to the headset. My laptop is owned by the hospital so I cannot really download much to it. I guess I have to remember to remove the clamp after use since that might ruin the record button. Does this sound like a hairbrained idea or is it the only solution?

-------------------------
Joyriverside, MD, corridor warrior

                    Welcome (See Mission Statement)

 

JoyRiverside,

You have probably already tried this but we just want to double check. 

 

Did you try changing your PowerMic III Record button from the unpopular default Press-To-Talk setting to Microphone On/Off so that you can use the Record button to toggle your microphone on and off; without a time limit?  We have DMO installed, for test purposes, but prefer to use a TableMike, which can additionally be physically turned on and off.

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

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Clever contraption doctor! "Desperate" but quite the opposite from "harebrained". Except my guess is that the Molotov method won't work.

For the simple reason that the DMO programmed listening time-out is probably server-sides-scripted, contingent upon not sensing audio input for 90 seconds, irrespective of button presses.

That's my guess and I am sticking to it (notwithstanding that I don't even use DMO).

But you will know one way or another as soon as you test it.

Yeah...found that out today...it times out like you said, so much for my picnic table clip...seems they will not allow anyone to jam up the airwaves listening for nothing. They should at least let us control the time out to more than 90 seconds. It's very unfriendly to a doctor's workflow. Doctors are already burning out everywhere due to the EMR and you remove their control over the speech recognition software? Really??? I also still own Dragon Medical practice but it is on a personal laptop. Pretty sure my workplace will not let me install it. I have Augnito since it was affordable to pay for but it is tied to Chartnote, and is not as accurate as Dragon. As with many things in Medicine, the solution is "suck it up" or change career paths. 

-------------------------
Joyriverside, MD, corridor warrior

I use DMPE with my laptop and it works fine with Advanced Scripting commands with CITRIX using a portal to EPIC.  Might depend on what your hospital is using.  I use DMO a little bit inside of EPIC for corrections because I am required to have it anyway.

In DMO, not 100 percent sure but if you are frustrated by the mic turning off and wasting your time having to re-dictate,  you could try to turn on from the "blue" sleep mode or keep it on if it is already on 'green" on by making a "Microphone On" single line step-by-step command in DMO.  You can name it tfor you to say something short like "say'  or"mike" and it will turn the mic on or keep it on longer,  then you can dictate without pressing any buttons and or having to always look before you dictate to see if it on or asleep.

^^^Agree with every single thing you said above!

Btw, I was kind of spouting off regarding the timeout being scripted on the "server-side".  While entirely possible, I don't have any solid technical knowledge to base that statement on.  DMO does have a local footprint on the client, unlike the browser-hosted DME ("embedded Dragon) that I use.

Moreover, the "no-sound timeout" for my DME is a paltry 60 seconds!  Just that I am more of a PTT user so as not to be quite as affected by that, yet.

I fully concur that it would be a cinch for Nuance to make that timeout a configurable option up to 5 minutes, which shouldn't significantly clutter up their bandwidth.

Appeal to Nuance might gain more traction from an accommodation angle if PTT is contraindicated due to joint issues, etc ...

Otherwise meaningful physician advocacy is regrettably just as absent here in Canada.

Finally, VA hospitals apparently allow usage of AutoHotKey, under some circumstances.  AHK is also portable, which means that it could run from a USB thumbdrive - unless the laptop is "locked down".

 

And if AutoHotKey is a bit too "blue-collar", your institution might let you use MacroExpress, which also could be portable while letting you check pixel color at any given coordinates, AFAIK.