One thing to add to this discussion is that out of the box, Dragon has basic functionality for dictating to fields on web pages which is somewhat limited. There are add-ons and extensions for the various browsers that allow more Dragon functionality, such as the ability to correct errant dictation.
Apparently, the extension for Firefox recently became obsolete (see http://www.nuance.com/products/help/dragon/dragon-for-pc/enx/professionalgroup/main/Content/Web/about_firefox.htm), though I don’t recall it making a big difference when I had originally added it. Chrome and Internet Explorer both have functioning extensions for Dragon, but I opted not to use them because I know that OpenEMR is optimized for use with Firefox.
If one is doing very basic dictation, such as SOAP notes with little to no formatting, Dragon will be fine for dictating directly onto the browser fields. But, for any more sophisticated formatting, such as multiple font sizes and styles, fixed and hanging indents, etc., which make a dictated note look professional and easy to review, it is necessary to dictate one’s notes into a Word document, then copy and paste it into OpenEMR from there. I created some Layout Based Forms which are just a single field with no size limits, and I paste the Word document contents into these. There is some tweaking I have to do after this, such as changing the Format settings in LBF from “Normal” to “Normal (DIV)” in order to maintain the formatting exactly as it was in Word.
All of this means numerous extra steps and mouse clicks, but I have created several AutoHotKey macros that perform all of those extra steps with the push of one button. This, to me, provides the best of both worlds: the ability to have fully functional dictation by using Word, and the macro which saves most of the time it takes to move the text from Word to OpenEMR.
I should add that I’m using Dragon Medical v.10, which is several years old, but has amazing accuracy. It is possible that the newer (and waaaay more costlier) versions of Dragon Medical have improved browser functionality, but they still require installation of the browser extensions. I doubt they’ll ever get the browsers to do half of what Word can do with Dragon.