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Using CRIS with Integrated Dragon Medical 11 Voice RecognitionBy using Dragon Voice Recognition software the reporting clinician can directly enter report text, and verify the report at the time of reviewing images. The report will then be immediately available to referring clinicians external to the radiology department.

STARTING CRIS AND DRAGON

Log in to the CRIS application as normal. Dragon software will load automatically (you SHOULD NOT open Dragon Naturally Speaking software) and present you with a list of user profiles.

Select your voice profile – Dragon will remember your profile from this point on.

When Dragon is available in CRIS the microphone button will be visible and active

IInactive, waiting to be activated

Asleep, waiting for clinician to wake the VR system up

Active, whilst this icon is displayed, whatever is dictated will be displayed via the Reporting Screen.

To use voice recognition in CRIS it is recommended that you are in Reporting Mode. To switch to reporting mode, click the Options Menu in CRIS, go to MODE and select Reporting from the list.

VOICE TRAINING

Dragon Voice Recognition is an excellent way to improve report turnaround times, however to get the most out of the software the user must train any words that the system cannot recognise. There are some tools built into Dragon to allow this.

SPELL – If the user dictates a word and it appears as a different/incorrect word, it is very important that the incorrect word is trained by the system. To do this simply say select (word) followed by ‘SPELL’, a prompt box will appear on the screen with possible selections. The Choose 1, 2, 3 etc. selection is not supported via CRIS and you should therefore select the word using the mouse or arrow keys. Having selected the correct word, or alternatively having typed in the correct word if it is not already displayed you must train dragon so it can tell the difference ‘phonetically’ between the word that was displayed originally and the correct word that has been selected. To do this click [Train], and the system will prompt you to say the correct word, in some cases you will also be presented with other phonetically similar words to improve future recognition.

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GUIDANCE AND SUPPORTING DOCUMENTATION

When a clinician is reporting using Voice Recognition the accuracy will depend on a number of factors - the amount of training performed background noise etc. Any clinical report should be carefully checked by the responsible clinician before being finally verified and issued. This can be done as part of the reporting workflow, or alternatively the reports can be saved and reviewed later using the ‘Batch Verify’ feature. The following documentation is designed to provide additional information for anyone using Dragon Voice Recognition within the CRIS Application.

These are all available via the CRIS Documents Portal at www.hssnet.com or by selecting Help > Contents via the CRIS system on any web enabled PC.

CRIS_CM_CRIB284_Report_Info_List CRIS_CM_CRIB276_Clinical_Reporting

REPORT INFO LIST

To aid workflow for the reporting clinician users can personalise their CRIS reporting worklists by ticking any of the following choices via the ‘Options’ menu in Report Info List. The ‘Auto Select Next Event’ option is specifically designed for use in conjunction with Voice Recognition as it will automatically load the next patient’s report screen. This negates the need to return to the Report Info List, and manually select the next patient and therefore facilitates continuous reporting.

CRIS REPORT INFO LIST - STANDARD COMMANDS FOR MOVING AROUNDCOMMAND ACTION PERFORMEDMove Down This will highlight the next patient downMove Up This will highlight the patient aboveGo to top This will move to the patient at the top of the listGo to Bottom This will highlight the last patient in the list

CRIS REPORT EDITOR - STANDARD DRAGON COMMANDS FOR MOVING AROUND YOUR REPORTCOMMAND ACTION PERFORMEDMove left three words Moves the Cursor left 3 wordsMove down three lines Moves the Cursor down 3 linesGo to end of line Takes the cursor to the end of the current lineInsert before <word> or Insert after <word> Places the cursor before the specified textGo to Bottom Places the cursor at the end of the documentGo to top Places the cursor at the top of the document

Next Window These commands allow you to move to from the PACS screen

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to CRIS Report Editor via voice when using Personal Commands (i.e. MyCommands) rather than using the mouse to manually navigate back and forth from PACS to CRIS.

Previous Window

EMBEDDED CRIS COMMANDS WITHIN THE CRIS REPORT EDITORCOMMAND ACTION PERFORMEDSave report Saves the report without verifyingFinish report Presses the finish button to go to the finish pageVerify report Saves the report as verifiedClear patient Clears the patient without saving the report (F5 key)Insert title Inserts Exam name in the same way as using [ALT + E]Start report Inserts Exam name with carriage return.Insert All Titles New Command for 2.09.10p8 and above- Inserts the title for

Clinical History and All Exams, followed by a carriage return for each. The cursor is placed in the first relevant section – i.e. 1) Clinical History [Alt + A].

Insert Exam Titles New Command for 2.09.10p8 and above - Inserts the title for All Exams but not the Clinical History, followed by a carriage return for each. The cursor is placed in the first relevant section – i.e. 1) Exam 1.

Next exam Moves to next exam section on screenPrevious exam Moves to previous exam section on screenInsert phrase Presses [Alt + P] to show coded phrase dialog

CRIS > PACS COMMANDSLoad image Sends PACS message to load images for this examPACS off Turns off PACS auto image loadingPACS on Turns on PACS auto image loading

DOCUMENT SCANNINGShow request card Toggle to show request card in report optionHide request card Toggle to show request card in report option

FORMATTING COMMANDSBold on or Select <word> Bold That Turn on bold textBold off Turn off bold textUnderline on or Select <word> Underline That Turn on underlineUnderline off Turn off underlineItalic on or Select <word> Italicize That Turn on italicsItalic off Turn off italics



STANDARD DRAGON COMMANDS

Dragon Naturally Speaking includes a comprehensive set of standard commands, below is a list of commonly used commands that can be used within CRIS. You can view a complete list of all Dragon commands via the Command Browser.

DRAGON COMMAND ACTION PERFORMEDCONTROLLING THE MICROPHONE:

Go to sleep Stops listening

Wake up Start listening

Microphone off Turns the Microphone off

SELECTING AND CORRECTING:

Select <word> Selects specific word

Select again Selects the specific word again but in a different place

Select the next five characters Selects 5 characters following the cursor

Select previous paragraph Selects the whole previous paragraph

Spell that Displays the spell dialog box for the user to S.P.E.L.L the word.

Train that Displays the train dialog box for the user to train the specific word.

Correct <word> Displays the correct menu for the specific word

Unselect that Unselects the highlighted text

INSERTING LINES AND SPACES:

Space Bar Presses the Space Bar

New line Moves the cursor down one line

New paragraph Starts a new paragraph

Press Enter Enters a return character

Tab Key Presses the Tab Key

CAPITALIZING:



Capitalize that or Cap <word> Capitalizes the first letter of the selected words

All caps on or All caps <word> All words/letters in CAPITALS

No caps off Turns off capitals

UNDOING AND DELETING:

Scratch that Deletes most recent text

Delete that Deletes selected text

Undo that Un-does the last action/command

SETTING UP USER SPECIFIC STANDARD TEXTS COMMANDS

Dragon Naturally speaking software allows users to set up their own commands. By setting up Text and Graphic commands a user can quickly and easily create standard reports.

To create a new command you should go to the TOOLS menu and choose VR Command Browser which will launch the Dragon Command Browser.



To add a new command go to the MyCommands menu and choose [New] to display the following information into the MyCommands Editor Dialogue box:



MyCommand Name This is the ‘Command’ you will say whilst reporting and you should therefore aim to use words which would not occur in everyday reporting.

Description A description of the reporting template.

Group Set as ‘User-Defined’.

[Train] Click the [Train] button to train the Command Name and follow the on screen instructions. This step is essential for Dragon to accurately recognise your commands.

Availability This should be ‘Global’ to ensure it can be used in CRIS.

Command Type Text and Graphics will allow you to enter a block of text for this command.

Content Type the text you want this command to enter into CRIS.

Once you have saved the new command it can be used immediately within the CRIS application.

TRAINING OR ADDING AN UNRECOGNISED / UNKNOWN WORD

This is an example of how to ‘TRAIN’ OR ADD AN UNRECOGNISED / UNKNOWN WORD FUTURE USE. Training Dragon via CRIS is very accurate but does not take effect until the next time CRIS is accessed since the Dragon profile is only saved upon exiting the CRIS client. Consequently if you intend to use the same word or phrase more than once during the same reporting session it is advisable to use the Dragon Vocabulary Editor.

1. Right click the Dragon Menu and select the VOCABULARY MENU followed by OPEN VOCABULARY EDITOR.

2. TYPE THE UNRECOGNISED / UNKNOWN WORD INTO THE [WRITTEN FORM] FIELD – i.e. supercalafragalisticexpialadoshus or Savage-Mady in these examples. If the word is already in the dictionary it will appear in box below and you will simply need to CLICK [TRAIN] to continue



3. Alternatively if the word is not in the dictionary already you should also TYPE A [SPOKEN FORM] AND CLICK [ADD] and acknowledge and additional messages (i.e. Guess Pronunciation). You should then CLICK [TRAIN] as normal.

Please note: Any personalised Vocabulary can be identified by a RED +

4. Finally CLICK [CLOSE] and right click the Dragon Menu choosing the PROFILE MENU followed by SAVE USER PROFILE. Adding or Training words via the Dragon Vocabulary editor enables them to be used immediately via the CRIS reporting module.

***IMPORTANT PLEASE NOTE***

To ensure CRIS and Dragon integration works correctly you should not load the Dragon Software independently.

The CRIS application will launch Dragon Software automatically, to ensure that CRIS is able to fully control Dragon functionality and facilitate full integration.

You should be aware that this does mean the Dragon Bar will not, and should not be displayed. However all required Dragon Tools are still accessible by right-clicking the Dragon Bar Icon in the Windows System Tray. Right-clicking once will display a restricted Dragon menu, whilst right-clicking twice will display the full dragon menu.

Failure to allow the CRIS System to launch Dragon will result in a reduction in the quality of integration, or in some cases disable the features altogether. This is due to the fact that Dragon will attempt to work independently and ignore commands sent by CRIS and leading to inconsistent results when reporting.© Healthcare Software Solutions 2014 All Rights Reserved

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Document Control

Title Using CRIS with Integrated Dragon Medical 11 Voice RecognitionAuthor HSS Training Manager Date Created 20/03/2012File Ref. document.docCRIS Version 2.09.10pChange HistoryIssue Date Author / Editor Details of Change1.0 20/03/2012 David Costin First Issue2.0 29/08/2013 Emma Savage-Mady Updates to include amended Command Browser now

embedded into the CRIS system, and removal of now defunct commands since Dragon can only be used via the Report Editor.

3.0 09/09/2013 Emma Savage-Mady Amendments to include use of the Vocabulary Editor as a useful tool for Radiologists.

3.1 03/07/2014 Emma Savage-Mady Amendments to format change based on company name change, and to include [Next Window] and [Previous Window] as a method of navigating via voice from PACS to CRIS and vice versa.

Review Date 03/07/2015

