The full potential of a voice recognition program such as Dragon NaturallySpeaking is not realized until the user takes full advantage of the program's ability to create customized commands or marcros. While it is true that for most of us speaking is quicker than typing, when the requirements of our work or fun lead to the need for repetitive text or keyboard operations, the development of shortcuts for insertion of common text or repetitive keyboard actions can increase your efficiency dramatically.
[Note: the information contained on this page is also viewable on the author's commercial site dedicated to speech recognition microphones and resources, Speech Recognition Solutions. The commercial site tends to be updated a bit more often, so please visit!]
Consider these two examples:
1. Every time you evaluate a patient you inquire about tobacco use and exposure and when present you regularly counsel the patient about the negative health impact of this behavior and make suggestions about methods that may be used to quit. For medical-legal reasons you like to document your discussion in the clinical note. Further, perhaps you like to provide your smoking patients with a small brochure or printed sheet over viewing methods of smoking cessation. You might document your discussion from scratch each time, dictating something in the manner of:
"During this visit we talked about this patient's ongoing tobacco consumption and the negative health impacts of this ongoing exposure. Specifically we reviewed the potential for tobacco exposure to increase future risk of lung disease, heart disease and cancer. I strongly urged the patient to take steps to reduce and preferably discontinue all tobacco exposure. We discussed potential strategies and at the end of the discussion I provided a printed brochure which provides an overview of cessation techniques and state/community resources which may help in the process. I encouraged the patient to consider these options and contact me for help in initiating any of the recommended strategies."
OK, chances are you wouldn't take the time to dictate something so lengthy. But what if all it took were saying "Smoking counseling" and it triggered the virtually instant appearance of the entire above paragraph? And what if you knew it took only about 20 seconds to develop this command and that it would forever be available for you? The same principle could be used to trigger insertion of aspects of a physical exam, common discussions, procedure risk discussions, etc.
2. You have a habit of printing your note upon the end of each patient visit, but are so rushed that the time involved with working through the file and print menu are slowing you down. Further, depending upon your location, you may need to select one of several potential printers. Wouldn't it be nice if you could simply say "Print document home Epson" or "Print document Med-Surg" and all the navigating were done for you instantly? This is exactly what a command can easily be designed to do for you.
Building a Basic Command
Commands are constructed with DNS using the "MyCommands Editor". This is a program that runs with DNS and in which the name and content of any command are specified. The MyCommands Editor can be opened in one of three ways:
[Special note to DHMC VoiceOver users: if these commands are not available to you, you can access the MyCommands Editor by choosing Dragon Command Browser from the Tools menu, then Script, and then New]
1. Say "Add New Command" (Voice command to open MyCommands Editor"
2. Select "Add New Command" from the Dragon tools menu
3. Navigate through menus to Tools > Command Browser > Script > New
Through one of these means you will be greeted with the MyCommands Editor which looks like this:
The window has several important components:
1. MyCommand Name: this is where you fill in the name of the command which become the statement that you will speak in order to activate the command, i.e. Smoking Discussion or whatever you choose to name the command. These should be simple, unique, and something you'll remember.
2. Description: this is optional but is simply a place for you to remind yourself what the purpose of the command is. This is more important when the command is doing something more complex that simply inserting text.
3. Group: command are categorized and later displayed on the basis of the selected category. Most often it's best to keep the default "user-defined".
4. Availability: this describes the context in which the command is expected to work. For simple text insertion macros, it's best to keep the default "Global" which means it will be available for use in all programs, i.e. your email program, word processing programs, etc.
5. Command type: this is important but for most purposes, i.e. commands which insert text or graphics, the default "Text and Graphics" is where you'll want to leave it.
6. Content: This is the area where you will type or paste the material which is the true "meat" of the command. Keep in mind that while you can alter the font size and style, the window comes with a default style and if you type within the window, your text will take on the default font style. If you create the content elsewhere (using the font characteristics you desire) and paste it in the window, your text will maintain its orginal font style.
7. Plain text box: this is a key box to pay attention to. If you check it, it will, in effect strip any font size and style formatting from your text and when inserting the text during use of the command arrange that the text assumes the font size and style of the surrounding text into which it is being inserted. In most instances, this is very advantageous, so, in general, you should check this box. The only time you might want to leave this box unchecked is the rare occasion when you want to force a particular text font size an style, such as with a letterhead, template defining a note structure, etc.
Putting it all together, in order to creat the command for the "smoking counseling" macro discussed above, the command editor would look like this:
Once you click "Save", this command will be saved and be forever incorporated into your user file within Dragon and unless you change or delete the macro, any time you say "Smoking Counseling" (preceded and followed by a brief pause), your paragraph about smoking counseling will be inserted. It's that easy.
Inserting Graphics Into a Command:
Creating a command that will insert a graphic image, i.e. a signature line, photo, logo, etc. is done using the exact same method above, with the exception that a image, rather than text is pasted into the content area.
Some Hints on Creating Simple Macros:
1. Remember to take advantage of the "plain text" option in the MyCommands Editor to be sure that inserted text assumes the same font size and style of the contextual text.
2. Keep your command names simple and intuitive (and write them down somewhere)
3. Not all paragraph formatting information is retained when text is added to the "content" area of the MyCommand Editor. Left or right justification is retained. Tabs are not. You'll learn this by trial and error.
Modifying Commands:
The process of modifying commands makes it painfully obvious that the structure of the command browser, the key element that creates and organizes commands could be improved. That having been said, here how you reach a command in order to modify it.
[Special Note to DHMC VoiceOver users: the Command Browser is opened by choosing Dragon Command Browser from the VoiceOver Tools menu]
1. Open the command browser by saying "Open command browser" or by navigating from the Tools menu to Command Browser. The Command Browser is a large, somewhat complicated window with lots of options.
2. Select "Script" (one of three large buttons near top of command browser)
3. Be sure "Current Command Grammer" scroll down list indicates "Global Commands"
4. In the main portion of the command browser window, scroll down to your command and highlight it. From here you can do one of several things, either by right-clicking or choosing from the menu above: edit, delete or create new copy (create new copy opens an almost identical copy of your original command which is re-named and available for modifying).
5. Select Modify. This will open the original MyCommand Editor for your macro from which you can make any desired changes prior to selecting Save.
Additional Resources Related to Commands and Macros
Needless to say commands can be complex and the simple insertion of text or graphics only touches the surface of the command capabilities of Dragon NaturallySpeaking. Although there is a wealth of information about building commands on the Web, the overwhelming majority of this information pertains to older versions of Dragon, when commands were built using a different format. Here are some resources you may want to view or visit if you choose to learn advanced scripting techniques or want to dabble with creating commands using the old "dvc" scripting.
Larry Allen's Scripting for Dragon NaturallySpeaking 8: This is the "bible" for those wanting to go beyond the Dragon user's manual and program help topics. Larry's book is highly recommended and can be purchased directly from his site at Softnet.
Another source of information on medically-related commands is a semi-commercial spin-off of this site - Speech Recognition Solutions. This site contains information on building advanced commands and also some downloadable files with some ready-made commands.
