If you’ve been reading EMR and HIPAA for a while, back in 2006 I came across a really cool company called Sensible Vision that does facial recognition software. You can read about my first experience setting up the facial recognition software and my love affair with facial recognition as the best biometric solution.

I admit that I still have a love affair with my facial recognition software. I use it every day when I sit down at my computer. I can’t imagine not having it. In fact, it’s almost time to replace my computer and I’ll be very sad if I can’t find a way to transfer the software to my new computer. It has its quirks, but I just love the added security that it gives me. I’m far too lazy to lock my computer screen myself and then log back in, but the facial recognition software does that for me. Not to mention the single sign on capabilities.

I was on a support call yesterday with my EMR vendor and when I opened the application my facial recognition single sign on kicked in and took care of the username and password typing for me. The EMR vendor told me that he was amazed at how fast I typed. I do type fast, but not that fast.

I should mention that we haven’t been able to implement this in our clinical environment. A mix of process issues and budget issues has prevented us from doing so. However, I think there are a number of places where facial recognition software could be great for security of your desktops.

I decided to go check on what’s happening with Sensible Vision since I hadn’t spoken to them in a while. Looks like they have a million devices installed and a deal with Dell to offer facial recognition with their computers. Very cool stuff. However, what I found most interesting was Sensible Vision’s reply to the Black Hat presentation about hacking facial recognition. It’s an interesting read for those looking at biometric authentication in health care. Now I just need to find the black hat presentation they’re talking about.

We’ve discussed before the voice recognition software Dragon NaturallySpeaking (Medical and Preferred) and the microphone options and even announced when Dragon NaturallySpeaking Medical first came available. It’s enough to say that we’re big fans of voice recognition software and Dragon NaturallySpeaking in particular. It’s a great companion to an EMR or EHR implementation.

Today, I came across the Sony Digital Voice Recorder with Dragon NaturallySpeaking Software and I wondered if any of my readers have used this before. It seems like it could be an interesting way to replace a transcriptionist.

Basically, the doctor would record his notes on this device and then the Dragon NaturallySpeaking software would convert it to text and could be easily placed in the EMR. For $150, that seems like a bargain.

Really, the only question is how good Dragon NaturallySpeaking is at converting the recorded voice into text. I imagine it’s at least as good as doing it in real time. Does anyone have experience with it? If I hear some good reviews, then I’ll add it to my list of EMR technologies. This seems like it could be a really good solution for that doctor that doesn’t want to give up his/her transcribing ways.

I’ve always been a little bit skeptical about paying the $1000+ for the medical version of Dragon Naturally Speaking. $1000 just seems like a lot of money to be paying for what seems to amount to some medical dictionaries. However, someone who is very familiar with nuance and Dragon Naturally Speaking told me that doctors should really purchase the DNS Medical or they’ll end up dissatisfied.

Well, today I was reading the forum on Amazon for Dragon Naturally Speaking which asks if the medical version is worth it for doctors. The responses generally weren’t worth while, but someone who calls themselves “Pain Doc” suggested the following:

I have used DNS for about 7 years. I started with version 6 as I recall. I had my transcriptionist email me the text files from all my dictations for several years and then I “fed” those to DNS to learn the vocabulary. I then had a very serviceable medical DNS for my practice and an unemployed transcriptionist.

What a genius idea for anyone that’s currently doing transcription. A great way to save about $1000 on software.

Check out the following prices for the various versions of DNS on Amazon:
Dragon NaturallySpeaking 10 Preferred – Currently $151.49 with $50 rebate ($101.49 after rebate)
Dragon NaturallySpeaking 9 Preferred – Currently $92.97
I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

Interestingly, this same person quote above also said, “I also upgraded to DNS 10.0 which is a total POS. I am back to 9.0 and wouldn’t recommend 10.0 to anyone.” I’d love to hear more people’s comments on this subject.

In a recent comment by Tom Hamilton, he gave a nice review of a wireless microphone that can be used with Dragon Naturally Speaking Medical. I figured I’d been covering enough EMR politics and implementation lately that it was about time to mingle a little bit of technical content in the middle.

I’ve been told a number of times that if you want to use Dragon Naturally Speaking medical, then finding a high quality microphone is absolutely essential to a quality voice recognition experience. Check out Tom’s review of the Samson Stage 5 Wireless microphone. Wireless is definitely the future.

Samson Stage 5 Wireless Microphone With Dragon NaturallySpeaking Review:<iframe src=”http://rcm.amazon.com/e/cm?t=crashutah-20&o=1&p=8&l=as1&asins=B0002ORQ56&md=10FE9736YVPPT7A0FBG2&fc1=000000&IS2=1&lt1=_blank&m=amazon&lc1=0000FF&bc1=000000&bg1=FFFFFF&f=ifr” style=”width:120px;height:240px;” scrolling=”no” marginwidth=”0″ marginheight=”0″ frameborder=”0″></iframe> 

We’ve just completed Phase 3 testing of the new Samson Stage 5 wireless microphone [$99 on Amazon] and you can read our complete review by clicking Samson Stage 5 Review but the short version is that the new Samson Stage 5 wireless VHF microphone combo includes both a lapel microphone and a headset microphone, costs $99-$105 and is as accurate as our best (starting at $115) theBoom “O” [$149.99 on Amazon] and $145 Sennheiser ME3 wired microphones [$135.83 on Amazon] which cost more and are not wireless. The Stage 5 even includes a three-year warranty. With the exception of end users who require extreme portability, we can’t imagine why anyone would want to pay extra for a wired microphone with a one or two-year warranty. Now everyone can afford to cut the cord!

KnowBrainer, Inc. Support Staff – Tom Hamilton
A Nuance Gold Certified Endorsed Vendor
ALWAYS Ask If Your Speech Recognition Vendor Is Nuance Certified

Thanks Tom for the review.

Check out the following prices for the various versions of DNS on Amazon:


I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

Choosing a microphone is one of the most important decisions you can make when implementing a speech recognition software like Dragon Naturally Speaking Medical 10. Thanks to Eric over at Speech Recognition I’ve gotten some interesting information about a microphone called the PowerMic II. Looks like it’s a microphone on steroids. Definitely one other microphone to consider when selecting a microphone to use with voice recognition software. Here’s an overview of the PowerMic II utilized with Dragon Medical 10 thanks to 1450, Inc. with commentary by Jay Goodfellow.

OVERVIEW:
The PowerMic II is a speech recognition microphone designed to be used with Dragon Medical 10.

However, the PowerMic II is much more than a hand held microphone. It is a powerful tool that enhances a physician’s control of dictation and navigation through documents, templates, electronic medical records and other applications. It has been designed specifically to be utilized with Dragon Medical 10, and the extraordinarily tight integration shows that to be true.

Not only does the PowerMic II have full mouse functionality, but there are 10 function keys that are programmable to provide practically any operation that a physician might want to do on his/her computer.

Yes, you can already use Dragon Medial 10 to do almost anything you want to on your computer by voice. However, using the PowerMic II and Dragon Medical, you substantially enhance your ability to do essentially anything you’d like on your computer, using the more convenient method at that moment: voice or function button.

The PowerMic II is designed to be fully functional with Dragon Medical 10 only. Dragon Preferred 10, Professional 10, and Legal 10 are not capable of using all of the programmable PowerMic II features.

Check out the following prices for the various versions of DNS on Amazon:


I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

Lately, I’ve been getting a ton of traffic with people looking for Dragon Naturally Speaking 10 Medical (DNS 10 Medical). Well, in honor of the launch of DNS 10 Medical, here’s this video that all doctors should appreciate if they’ve used Dragon Naturally speaking in the clinical environment before (even if the final “doctor” does a bad job acting and feels like he’s trying to sell the software).

If anyone else wants to do a review of Dragon Naturally Speaking 10 medical, please let me know and I’d love to have you do a guest post on it. Especially in the context of Dragon Naturally Speaking 10 medical being used in an EMR.

Thanks Eric for pointing me to the movie.

Check out the following prices for the various versions of DNS on Amazon:
Dragon NaturallySpeaking 10 Preferred – Currently $151.49 with $50 rebate ($101.49 after rebate)
Dragon NaturallySpeaking 9 Preferred – Currently $92.97
I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

NaturallySpeaking (Medical) Version 10 is now available. Have any of the EMR and HIPAA readers used DNS 10? I’d be interested to know people’s reviews of DNS 10 as compared to 9. Luckily the upgrade is relatively inexpensive to go from one version to the next, but I’d be interested to hear people’s experience with DNS 10.

One of my blog readers already did their KnowBrainer 7 page pictorial preliminary review of DNS 10. Too bad the pictorial review is a pdf file. Also, that review is pretty technical, so if you’ve never used DNS before, then I wouldn’t suggest reading that review.

Check out the following prices for the various versions of DNS on Amazon:
Dragon NaturallySpeaking 10 Preferred – Currently $151.49 with $50 rebate ($101.49 after rebate)
Dragon NaturallySpeaking 9 Preferred – Currently $92.97
I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

My guess is that many of you are using an HL7 interface between your EMR and your lab. How does your EMR handle the signing of lab results?

We worked for an entire year testing, making requests, testing, more requests and more testing before we were able to launch an interface between our lab and EMR, but it’s been one of the best things we’ve done. The reason it took so long is the topic of another post, but it was for good reason.

One of the best advantages to a lab interface with your EMR is that you don’t have to worry about what to do with all those paper labs that you’ve signed. Inevitably all those signed paper labs will have to be scanned and attached to a patient in your EMR.

Really, that’s why a lab interface is so much better. The interface inserts the lab info right into your EMR so you don’t have to worry about:
1. Losing your lab results (before or after you sign it)
2. No need to scan your signed lab results into your EMR
3. You can run really cool reports on the data from those labs in your EMR (ie. blood sugar change over time)
4. Most EMR will notify you that there are lab results to read, so there’s no more waiting for the paper to somehow make it to you

In our EMR, a lab result gets easily signed off with the click of a check mark. Actually our labs our grouped into batches according to labs that were ordered at the same time. This makes it so all our lab results appear on one nice lab report as opposed to one lab report per lab. All doctors have to do is highlight all the labs and click “Mark as Read” and that whole batch of lab results are signed electronically in the EMR.

Of course, many of you will probably ask how we handle abnormal results. Well, I guess you’ll just have to wait to learn about that.

I’ve been pretty outspoken about my love for biometrics in healthcare. In particular I couldn’t imagine my computer without facial recognition, but I’ve also enjoyed playing around with biometric fingerprint readers and proximity readers too. Sorry, no retina scans yet. Anyone willing to send me one?

Today I came across a new biometric authentication method that recognizes a person’s typing behavior. Techcrunch described it as folows:

It’s a Flash-based interface that compares your typing style against a list of known styles and logs you in based on your individual typing fingerprint. To enroll you simply type a sentence nine times and then the system senses the pauses, mistakes, and speed of your hunting and pecking. Obviously, this doesn’t work if you have a broken hand or, presumably, you’re under duress so it’s fairly hard to crack a system using physical coercion. A cool way to add biometrics to web-based forms.

They have a test on their site, but the registration process seemed a bit onerous. Haven’t they realized the first key to a website is to let me test the product with no registration. Then, let me register when I like it? Maybe if I have some free time later I’ll register and try it out.

I wonder if something like this could merge with the OpenID movement and make this one other method of authenticating yourself to an open id enabled site. Could be pretty interesting I think.

It looks like my previous post about Digital Signatures in an EMR drew quite a bit of interest looking at the stats. Really this isn’t surprising. How long have we been signing things electronically at Walmart. Longer than I can remember honestly. Sure, Walmart is worth billions of dollars, but the technology isn’t that expensive. The real advantage that Walmart has is a great legal team.

Setting the legal items aside, the technology of a digital signature is not rocket science by any means. In fact, it’s the legal questions that are harder mostly because there just hasn’t been much case law that has dealt with it. Just as a thought, I would highly suggest that whoever reads about this talks with a good legal team before implementing it.

Of course, reading the comments from my previous post made me realize that what we’re doing is really quite innovative. I’m not just talking about digital signatures. For more than two years now we’ve been collecting patients health history form in our Health Center and intake questionnaire in our counseling center electronically. These forms don’t require the patient or client to leave a signature. It’s basically just capturing information. I think most people can see why it’s valuable to have a health history form captured electronically. In our case it makes all of the necessary clinical information available in one place without dealing with the time consuming and inaccurate scanning. Even more significant for us as a state institution was the ability to do aggregate reporting on the type of patients we were seeing. How many other people can find out things like 20% of your patients have a family history of heart disease (not our actual number)?

I know there are a number of EMR companies out there that have a whole patient portal where this kind of stuff is done, but I’ve never seen any that use a kiosk at the doctor’s office to collect this information. If you are an EMR vendor that has this feature, please leave a comment. I think we’d all love to know who else does it.

Looking at it now, capturing digital signatures for HIPAA privacy forms, consents, etc is just the next step in ridding ourselves of paper. In fact, this addition means that our patients can bypass the front desk completely. They check in on the computer, fill out their necessary forms and then are directed to have a seat. This notifies the nurse that they have arrived and they are ready to be seen. No face to face contact. Privacy at its best.

Well, I got a few questions and comments in my digital signature post that prompted this post. I’ll do my best to answer them here.

Chris Kozloski said, “I like the idea. A kiosk for registration that they could fill out the paperwork online and sign the blocks on the screen would be really neat.”

See my notes above. It’s not just an idea. We’ve been having them fill out the paperwork for two years now. We also have the technology to do the signatures. Just waiting for the other signature pads to arrive and we’ll be implementing it.

One thing I’m not sure most people think about is how the computer will know which forms need to be filled out by the patient. I think that’ll have to be the topic for my next post.

Craig Briars asked, “What software are you using to do this with?”

This is a good question. We are using Medicat EMR. It’s an EMR that is focused on the College Health community, but could be used in a general practice if needed. I’m not sure how it is in a general practice, but I know that they have a ton of features that make it a solid choice for College Health offices interested in EMR.

Medicat has integrated it’s software with topaz signature pads. Medicat uses the Topaz software to capture the signature. It’s actually quite neat how the signature is captured and stored in the database. We did find that the LCD signature pads with the back light were the best. The cheap $100 topaz signature pads just wouldn’t capture my signature if I did it quickly. Plus, if it isn’t LCD, then I don’t know which part of the signature it missed so that I can correct it.