Nuance - Fatigued Fingers

Either their speech - recognition software

I wonder what version of Dragon - they are using

Biggest difference with Dragon Medical - Edit while they speak

The biggest difference that I can see is that they are actively editing while dictating.  So, as they dictate a sentence, if Dragon types something wrong, then they can (like their commercial's indicate for the regular, home-use program) say stuff like, "scratch that" or "delete that last sentence."

For the accounts I work on, about 75% of the stuff that comes in is relatively minor corrections.  Moving headings here and there, adding punctuation, removing sentences and words that the doctor dictated twice while correcting themselves, etc.  I'm not discounting the work we do because we also check for major things like medication dosage mis-match, wrong gender/patient, wrong leg being amputated, etc.  We still have a vital role in patient care, but with front-end speech, it's not something they dictate into a phone and don't see the results for a day/week/month when they get around to reviewing the files (if they ever actually do that, which I don't believe most of them do).  They're seeing it type as they speak, so it's easier to correct.  And really, all Dragon Medical is doing is taking some EMR that has individual boxes for the narrative sections and allowing them to dictate those parts.  The others like the physical exam and such get auto populated by what they click, what the nurse puts in for vitals, etc.  The medications, allergies, all that gets populated by what the front desk puts in from the patient's intake form, etc.  That's why these reports look like crap, contain mistakes, and whatnot. 

Bottom line, the EMR companies and legislation (which I hate to say, is really needed for us to move forward as a civilization... maybe not in its current iteration, but in some form) and Nuance are putting us out of business.