I have been using a work around partially found in the forum here. I made a free text form like the speech dictation box labelled for chief complaint and HPI. I use the report function to make a printable copy of the history and problem lists that I copy and paste into the speech dictation box. I made a simplified review of system form with the layout based form system and then use the physical exam form for the exam. By the way, I corrected the spelling of organomegally in the physical form. My MA fills out the vitals form and updates med lists and such to streamline the process. It is kind of convoluted but makes a pretty complete note and goes pretty quickly once you get used to it. It also gets you to update problem and med lists but copy a current list into your note for when the patient was seen. For more simplified problem based visits, I just use dragon to dictate a note into the speech dictation box. I think it would be nice to have a single form that pulled all of these things together perhaps with a button to import values once you update problem and med lists etc., but I personally don’t know how to do that yet.
Thank you, cverk, for your insight. What do you do for prescription. I installed 4.0 and it doesn’t look like it has prescription (like e-prescribe or whatever it is call) and no icd9 as it states it has functionality of.
There was somewhere someone mentioned i have to buy icd 9 plug in as well.
Lab data is missing as well (another plug in?)
I am pretty sure that there are many people who deveoped the H&P type of note that medicare accepts for reimbursible note.
I wonder where i can get that. If there is none (which i have hard time to believe) may be several physicians who might be interested in developing one share the cost to have programmer to develope one. Since it is simple rejoining of menu systems, i don’t think it will take long (a few days to a week?) so shouldn’t cost too much.
Just like one said above, hiring someone to restructure the note would be more cost effective (if not able to find somwthing already made and available)
There are several versions of Dragon Speak: from home edition ($42) to medical edition (small practice =$1149) and more for the "medical practice edition, 10.1 " ($1599). Anyone with specific information? For use w oemr, what are the differences other than price? What sort of microphone works best?
We tried almost 2 years to use speach recognization softwares. Wastes lot of time. Such softwares are good for people who can’t use templates - like writers, journalists, research etc.
My suggestion - use templates, and hire a translator. Your (physician) work will be done in less than 2 minutes per dictation.
Answer to your question - Altec Lansing or Logitech are good and reasonable priced microphones.
I agree with tsvas that speech recognition software is really waste of time and money. I used four different versions of Dragon speech over yhe years (all only briefly). I purchased the latest software about month and half ago to test the latest one, hoping it can do some good. The Dragon came long way and recognition software is amazingly acurate, however, not 100%. The software can be trained but still makes fairly significant mistakes. So, you basically have to proof read again.
For busy physician, this is definatelywaste of time and money probably well spent contracting out to transcriber company.
The best option i believe is using template and instead of telling story on HPI, you try to be as short as possible.
I still use Dragon time to time becausei only see a few people a day and i have not installed EMR yet.
For your question: yes, Dragon works in Oemr. You just speak into any blank line and it will transcribe. I tested that yesterday. But again, my suggest is probabaly much more beneficial to develop template to use.
Ahoy,
The topic of speech recognition software was tossed around on the AAFP EHR listserv for a while last year. The take home was: Dragon 10 basic has been crippled so that it does poorly with medical terms forcing one to buy the more expensive medical versions. Some recommended using Dragon V 9, if you can find it, as the basic version is medical terminology trainable. Some folks say the long time spent in training it was worthwhile in the end. I have not personally used it.
Jack Cahn MD jc@oemr.org
I am using allscripts basic free version mostly for complex patients on multiple meds and electronic refills. You do have to document them back into openemr via the prescriptions area at the bottom of the problem lists. Apparently there is coming a more direct interface with version 4.1 but the programmer guys seem to be pretty opaque about the cost involved which kind of worries me since allscripts is free and I have developed a pretty good size database with allscripts at this point. 4.1 also is supposed to have a lab interface, but again seems to lead you to a select group of developers. This kind of stuff is a real turnoff for providers like myself who do not wish to be under some type of corporate control. It is my guess that I am pretty representative of the audience that would be interested in an open source project in the first place. I think an open discussion of options and costs for these outside services would be useful and allow input from some of the various involved players.
I was using dragon 9 premium now updated to dragon 10. I trained it under dragon 9 using old dictation files and it seems to work fine for me. You just have to watch and read as it types to correct any stuff that is wrong.
I am also using officeally for a clearinghouse which has been great and also free. I have slowly turned my big payers over into electronic remittance with them which has worked pretty well. They have hosted EMR and e-prescribing and are very clear about costs, but I prefer having flexibility and holding onto my data. I don’t do a lot of medicare so I am not in a huge hurry for the meaningful use stuff, so I am just adding these aspects into my workflow incrementally to keep up with the changes in medicine that are pretty obviously coming. If this leads me into meaningful use and some increased income from my medicare patients, then great, but mostly I am trying not to use so much paper and toner in my office and to reclaim some storage space which I have run out of. I also think it may be organizationally helpful for me as I get older and don’t easily multitask 4-5 thinks at a time like I did 25 years ago.
I am very newbie here, so my advanced apology if i an stating something it is already available.
I want to use openemr (which i am still havenot finalized my decision) because of freedom to customize and change.
I am certain that is so many physicians are already using it, there should be so many API and customized version to fit US doctors. I just cannot believe there was no one who customized the progress note to standard H&P to be able to adequatly bill medicare.
If there was none (which is unbelivable), number of physicians should gather around and share the cost to develop this. Since many programmers developed oemr without compensation, i think there are good number of programmers who will be willing to share its cost by lowering the cost of programming as well.
Or am i just being naive?
If i was inpractice for years and making handsome money as most of non-medical people think about millionaire doctors in Hollywood, i would pay a company to build one for myself. But at this time, i have to work for entire day to pay programmer’s one or two hour fee.
About 95% of my patients are medicare and medicare only pay 40-60 dollars for 45-60 minutes of my patient visit, and somehow, people think i can make half million dollar with that.
Kevin Yeh,
It seems you know quite good amount on nephrology at at least had spent time to investigate about it.
I would greatly appreciate if you can drop me an email. Yes, i am very interested in getting professional help.
My email address is chokidney @@@ gmail
If anybody who may have interest in providing professional help with fee, please feel free to contact me as well.
So far, i have installed ubuntu server and installed for oemr 4.0 version to test around and see how it is.
Will need help on setting up from beginning for production server desktop, with H&P type of note, lab integration, icd9, e-prescribing, faxing to pcp or other consultant funcion.
Thank you
Thank you.