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Latest Nuance Word on DNS 10/EMR Contretemps
Submitted by BruceCyr on Thu, 08/21/2008 - 19:10.
From David Pogue's Reader Complaints Mailbag (http://www.nytimes.com/indexes/2008/08/21/technolo..., n.b.: its a subscription-only link):
"I am a doctor, but not a good typist, and I have found that Dragon NaturallySpeaking (DNS) is indispensable in making entries into my Electronic Medical Record (EMR) program; DNS has saved me literally thousands of hours in the last few years in updating my patients' records. But I purchased a copy of DNS version 10 as soon as it was available--and tried to begin dictating into my EMR. DNS stopped dead. A dialog box appeared stating that the only version of Naturally Speaking 10 that would dictate into an EMR was the Medical version of Dragon, which costs 10 times the price! Very sad that Nuance has chosen to take the low road in dealing with its new and established customers."
Nuance replies: "You are correct that we decided to remove EMR support from the non-Medical versions of Dragon. We found that some large hospitals were using the consumer editions of Dragon and not getting the accuracy, quality and manageability that would be achieved when using Dragon Medical. It is also a common practice in the software industry to create feature packages for several markets and sell them at different prices (e.g. Microsoft Office). That practice allows us to maintain a low consumer price for Dragon, while offering higher value solutions for our Medical customers.
"Having said that, please note that along with the launch of Dragon Medical 10 in September, we will announce attractive upgrade offers for customers who have been using non-medical Dragon versions in medical settings."
So there. Do you suppose Nuance sees the imminent end of their desktop and related uses market so they're trying to extract as much value as possible before the inevitable happens?
Bruce
With version 10 it requires
With version 10 it requires a fairly new processor as well. This hasn't really been talked about. They are willing to leave their customers with older machines in the archives as they won't be able to move up to DNS 10 in any edition.
The upshot is that all AMD CPUs prior to Athlon 64 (all socket A-based CPUs) and all Intel CPUs prior to Pentium 4 (plus a few others) won't run DNS10.
See: http://www.speechcomputing.com/node/2031#comment-8...
Thus a 1.2Ghz Pentium III or the AMD Athlon XP even though they run at 2Ghz won't run the code in DNS 10.
So for these people it requires the purchase of at least a new motherboard and CPU, more likely an entire new machine for most.
As a result, I doubt I'll be able to move to DNS 10.
To me this says "We don't want you unless you can afford the later machines". Along with the EMR requirements, it pretty well says they are moving towards higher income brackets for DNS. I would start expecting to see price increases in the product as a result.
To me it's like a tire company only making tires for a Lincoln Navigator.
Skip, Among all of the DNS
Skip,
Among all of the DNS users, those having these CPUs are in the minority. These CPUs haven't been distributed or sold for almost 4 years and any user using one of these has a machine that's at least 5 to 6 years old. These machines should be in museums.
Chuck Runquist
Former Dragon NaturallySpeaking SDK & Senior Technical Solutions PM for DNS
If computers get too powerful, we can organize them into a committee - that will do them in. - Bradley's Bromide
Chuck Runquist wrote: These
These machines should be in museums
I probably should have a room in a museum as well.
Skip, I think that I saw one
Skip,
I think that I saw one of these systems in the Smithsonian last week.
Chuck Runquist
Former Dragon NaturallySpeaking SDK & Senior Technical Solutions PM for DNS
If computers get too powerful, we can organize them into a committee - that will do them in. - Bradley's Bromide
BruceCyr wrote: It is also
It is also a common practice in the software industry to create feature packages for several markets and sell them at different prices (e.g. Microsoft Office).
Bruce
Um, yes. But correct me if I'm wrong. Microsoft's software doesn't cripple itself if you open a document with a questionable title or an email with a questionable subject line. Disabling select & say was one thing (and probably suitable enough) but the mic...??? I can go on about what I think ethics are. But it's only my point of view. So, I won't.
kremesch wrote: BruceCyr
It is also a common practice in the software industry to create feature packages for several markets and sell them at different prices (e.g. Microsoft Office).
Bruce
Um, yes. But correct me if I'm wrong.
OK, I'm correcting you, although I admit that if you read my post quickly it was confusing. I'm correcting your mistaken attribution of the comment you quote to me. That comment was actually made by Nuance in response to Mr. Pogue's query Re: his correspondent's complaint.
Yes, that should be perfectly clear now
BTW, while I think Nuance's action is cynical and self-serving, I don't think it unethical -- its very business-like, and we all know that in America its unethical to criticize business, at least for another five or six months
I think its perfectly legitimate, however, to accuse Nuance of unethical behavior because it expresses user discontent with its business policies. Whether it will be effective or not remains to be seen.
BTW #2, from what I've read elsewhere, this step might not be nearly so drastic nor harmful as the restriction to P4 or better CPU's with the SSE2 instruction set. I say this because apparently its fairly easy to circumvent the EMR crippling, but so far I haven't heard of a work-around for the SSE2 cripple.
Bruce
Not a problem. Or at least,
Not a problem. Or at least, I hope it's not. I didn't mean to make the quote come across as your own words - I understood it was direct from Nuance, and it simply birthed my opinion. But I can see how that mistake can be made from the way I posted it. I'll apologise for that, and I hope you didn't take it as anything personal.
Also, you may be correct about ethics, since ethics are pretty much in the same category as art these days (individual interpretation). Maybe distasteful would have been a better choice, or maybe not - it's hard to tell anymore (of course, that's a personal opinion - my own, and as far as I know, I'm still entitled to that).
Mind you, I'm not dissing the program, programmers, Nuance, or anyone else for that matter. I can come across wrong sometimes because I try to keep things short without too much explanation because I can be rather long winded if I don't. But back to my dissing:
it's not because it was a business choice of Nuance's that I made that comment. I understand the business world. It's the method. I just feel there were better ways to attempt to disable the use of EMR programs, or to entice the usage of DNS medical rather than disabling the mic. I see a problem here because of the fact that the program can misinterpret (there's the interpretation problem again) a user's intentions due to a simple innocence of someone who isn't even part of the medical community. However, the chances are probably slim.
It just strikes me as a mistake, albeit, a small one. Like you said, there were/have been worse mistakes.
Ah, maybe mistake is a better word...
Oh well, I doubt it's the end of the world.
Take care.
kremesch wrote: I
I understand the business world. It's the method. I just feel there were better ways to attempt to disable the use of EMR programs, or to entice the usage of DNS medical rather than disabling the mic.
I agree -- it seems both cold and sneaky the way they did it. Its not that Nuance or any other large corporation doesn't understand PR -- they have no problem flacking a new product or update. But this step came out under the table without any warning. Of course its dumb to do it that way, regardless of the advisibility of doing it.
So why not announce the change? Maybe because consumer outrage would lead to a flood of protests that any reasonable manager would find cogent. Still, I have trouble respecting any agent that tries to hide from public reaction to its actions -- all the more so because there is no safe way out. If a person acted like that, we'd shun him. In this case, we'll all choke down our anger to feed our memories.
Bruce
10 times more expensive?!
10 times more expensive?! No it's not - maybe 20% or so more, but not 10 times....
DNS 10 and EMR
I was surprised to see that Nuance disabled this functionality without announcing this in the intoductory E mails that were sent to DNS 9 users. I think it is unethical to disable a standard feature without infroming the users.
Dragon Medical 10 and the EMR
Previous versions of Dragon NaturallySpeaking did work with various Electronic Medical Record (EMR) programs (allowing physicians to dictate directly into the system). The decision to make EMR capabilities available in Dragon Medical only is threefold:
1). Our customers: While 70,000 caregivers use Dragon Medical speech recognition software to drive clinical documentation, there is a substantial clinical user population who use consumer versions of Dragon NaturallySpeaking in medical settings and simply do not achieve the accuracy, quality, profitably or usability that would be achieved with Dragon Medical. We have received negative feedback from clinicians about the performance of the consumer versions of Dragon in medical settings via KLAS (a research firm specializing in monitoring and reporting the performance of healthcare vendors) and from customers themselves.
2). What goes into Dragon Medical: Nuance has made a significant investment in building, tuning and distributing Dragon Medical for exclusive use by the healthcare industry. The integration and engineering required to deliver the ease-of-use of Dragon Medical with all major EMR vendors, including Allscripts™, Epic, Misys®, GE® Healthcare, NextGen®, Siemens, eClinicalWorks, Meditech, McKesson®, Cerner and Eclipsys®, requires a Herculean effort, comprising thousands of man hours in developing and testing. As one would expect, there is a premium associated with the delivery of this capability and the resources devoted to further hone and evolve the product to meet the specific needs of the medical end user.
3). The difference in solutions and cost: It is common practice in the software industry to set a price structure equal to the value of functionality that a solution offers and is consistent with other enterprise/professional vs. consumer software offerings (Microsoft’s Office Home = $100 vs. Microsoft Office Professional = $500). Dragon Medical 10 is the only Dragon solution that offers medical specific vocabularies and language models, optimizes accuracy for medical dictation and provides integrated EMR voice activated commands and documentation. The decision has been made to associate these specific medical features, along with other new version 10 functionality in Dragon Medical only.
We believe there is a sound and equitable business judgment underlying our decisions, yet we understand the frustration from some customers who have been using non-medial Dragon versions in medical settings. We are committed to extending the value and user base of all Dragon versions and will work with our customers to do so.
What is the likelihood
What is the likelihood of the microphone being shut off on a non-medical user due to a false positive on Dragon's part? What triggers the detection of an EMR being used I guess is another way to put it.
(In case anyone is interested, the post above IS from a Nuance account)
I read elsewhere that they
I read elsewhere that they code a list of "banned" EMR softwares into the product -- if DNS can identify such a software is running, the mike fails to turn on. But that's just hearsay, so I could be wrong. In any case, a false positive seems unlikely.
BTW, the Nuance post's airy preamble suggests that I'm not the only flatulent poster hereabouts. I think they have an excellent case, but rather than present it, they prefer to shoot themselves in all three of their feet at once
Bruce
BruceCyr wrote: BTW, the
BTW, the Nuance post's airy preamble suggests that I'm not the only flatulent poster hereabouts. I think they have an excellent case, but rather than present it, they prefer to shoot themselves in all three of their feet at once
Bruce
I agree with you to a degree, but why do you say that the Nuance poster has shot themselves in the foot, I can also see a side of their argument (a little bit).
dragonuser, 1. They
dragonuser,
1. They institute a major marketing change for the affected audience without any forewarning or rationalization. There are PR firms specializing in disaster management who would have averted that act of stupidity.
2. The posted notice lamely claims this change is for the good of the user, which is a blatant lie that the affected parties know and clearly resent. Nuance apparently hired a consulting firm to tell them what they wanted to hear -- which is typical of political regimes that have already decided on a policy that is detrimental to the affected parties. Why not let the affected parties sort it out themselves by making their own cost/benefit calculations? This notice demeans the competence of physicians by implicitly asserting they are are too stupid to determine their own best interests. Second act of stupidity.
This is clearly management incompetence not commensurate with the quality of the software.
Bruce
Solutions
We refer to this tactic as “White House Spin” but perhaps the following
will help:
If you are using an EMR application like eClinicalWorks with DNS Standard/Preferred/Professional/Legal
. To further rub salt into the wound, if someone sends you an
10, your microphone WILL turn itself off (no ifs, ands or buts) and dictation
will not be permitted until you physically move your cursor into another
application. You won't even be able to write macro to cut and paste text from
the Dictation Box or even Notepad into eClinicalWorks because the Nuance
developers saw that one coming and prevented it. This is just one of the ways they
are helping us
e-mail with the word “soap” in the subject line, you will probably not be able
to respond to them because NaturallySpeaking will likely mistake the word soap for
S.O.A.P. Notes. If you name a document (in any application) “NextGen” you won't
be able to dictate into it and if you visit the Amazing Charts website you may be able
to keep your microphone on for a short while but NaturallySpeaking will
eventually figure it out and you won't even be allowed to dictate onto the
Amazing Charts forum. This probably wasn't Nuance's intent but it's a problem
nevertheless.
Problem Defined: The problem is twofold. DNS looks for the name of the
application and the Window.
Solution: Our customers will not have to worry about this problem because it is
simple to implement non-EULA violating modifications to all EMR programs (not
NaturallySpeaking) to eliminate this problem. You will find additional information
on limiting EMR functionality on KnowBrainer
Speech Recognition Forums where the subject has been discussed in great
detail.
Lunis
Orcutt - Developer of KnowBrainer
&
Host of the
http://www.TheMicrophoneStore.com
Does Nuance only disable DNS10 preferred in EMR they optimized?
I would like to know if Nuance only disables DNS 10 preferred/pro in the EMRs where they have actually done "The integration and engineering required to deliver the ease-of-use of Dragon Medical...requires a Herculean effort, comprising thousands of man hours in developing and testing. As one would expect, there is a premium associated with the delivery of this capability and the resources devoted to further hone and evolve the product to meet the specific needs of the medical end user."
Or does Nuance disable DNS 10 preferred in EMRs which do not seamlessly support Dragon's advanced features?
I have just ordered the upgrade to Dragon Medical 10. I agree with Nuance's argument about value provided when it is being used by a physician to do dictation. (My template EMR does not integrate with DNS. If I click anywhere in the text box, I loose voice editing capability.) However, if I have an assistant who is doing tasks which are not primarily medical dictation, will Nuance let DNS 10 preferred work on her/his computer in non EMR applications if the EMR is also running on the computer in background?
If DNS preferred works, if they switch into the EMR to look up information, what will they have to do to reactivate the microphone when they switch back to the word processor? If Nuance truly understands our frustration and "are committed to extending the value", will they make it so the microphone only goes to sleep so we can use voice to reactivate it in the nonEMR application?