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Thinking about getting speech recognition for your small practice?

There are some pretty impressive stats about the amount of time physicians spend documenting.  According to a study on, 43% of doctors spend their workday on data entry and click an average of 4,000 times per day during documentation. Working as a physician should not be a desk job, but these statistics demonstrate how it can be. As for now, there isn’t a way to avoid the 7.2 million words a doctor will document within the year. However, there is a way to lessen the burden: speech recognition.

If you’ve been researching speech recognition software for your small physician practice you’ve probably heard about the top solutions from M*Modal and Nuance. M*Modal’s Fluency Direct is a previous Best in KLAS recipient for Speech Recognition: Front End EMR. Still, Nuance’s Dragon Medical Practice Edition is one of the most popular solutions and achieves 99% accuracy right out of the box without voice training. Dragon Medical One is the newest speech recognition option from Nuance. Dragon Medical One is cloud-based and can be used on a wide range of Windows® devices.

At a glance, each speech recognition solution has great pros. Who wouldn’t want award-winning or highly accurate speech recognition. So, we dove a little deeper and compared the three popular options in small practice speech recognition. Let’s start with Fluency:

M*Modal’s Fluency Direct for Practice

Key Features:

  • Create, edit and sign clinical notes directly within EHR templates
  • Natural Language Understanding technology for contextual understanding of the physician narrative to improve accuracy
  • Designed for practices with 10 users or less
  • Covers sub-specialty medical terminology and supports all regional accents
  • Includes a microphone
  • Easy, click-once installation from a web address and minimal software training requirements
  • Auto-updates and upgrades
  • Single cloud-hosted voice profile
  • Customized macros can be used to enter often-dictated text
  • Minimal training
  • Machine learning based on the collective voice profiles of over 200,000 clinicians
  • Patient information is immediately available in the EHR
  • Adjusts on-the-fly to differences in cadence, accent, dialect and medical terminology
  • Edited through voice commands followed by finalization and electronic signature
  • HIPAA Compliant

Online review:

“Fluency Direct has been an awesome addition to my work flow. As a primary care physician, dictation, transcription, or voice recognition has always seemed like something out of reach. Having embedded M*Modal in my work flow has transformed the way I approach my patients, process my documentation, and rapidly and efficiently close my encounters. I cannot speak any more quickly in any noisier environment than some of my work spaces, speaking quietly yet accurately having my thoughts transcribed into my documentation. I spend much more time face-to-face with my patients using only cryptic notes to key me into a more complete documentation of my encounter once I leave the room. With my microphone as my navigator, I can move about my chart using voice commands to move to different sections, voice activated macros to fill common dialogue, and have been able to “pre-round” on my patients saving vital information to easily post after intake is complete. I do not type well, but you cannot type this fast!”

Management, Pediatric Medicine
Clinic size: 9

Dragon Medical Practice Edition 4

Key Features

  • Achieves 99% accuracy out of the box without voice profile training
  • Available for independent practices of 24 or fewer physicians
  • Combines 90 medical specialty and sub-specialty vocabularies with acoustic models based on audio, syntax, style and structure
  • Regional accent support
    • Advanced adaptation techniques and accent-specific acoustic models
  • Advanced Deep Learning technology constantly learns and adapts to voice and environmental variations – even during dictation – to refine performance
  • Dictate for real-time speech to text or transcribe audio recordings
  • Movable DragonBar provides easy access to popular features and collapses when not in use
  • Hybrid touch and keyboard interaction work for controlling the DragonBar
  • Customized macros for frequently dictated text can be created with a voice command
  • Compatible with Windows 10 touchscreen devices
  • Dictate within applications and EHR textbox fields, or use the Dragon dictation box to compose content
    • insert auto-texts
    • navigate template fields
    • dictate and edit – and transfer text with a simple voice command
  • supports HIPAA requirements
  • easy access to popular help searches and topics
  • Includes a full library of AutoTexts for standard notes and “medical normals” by body system
  • Automatically detects hardware resources and determines the best use of infrastructure
  • No internet connection required. Locally-installed speech recognition ensures uninterrupted access
  • Automatically detects poor audio input and alerts the user with advice to remedy the situation and ensure high-accuracy results.


“With Dragon Medical Practice Edition and the EHR, we can generate the code that truly reflects the work we do for complex patients. Our Level 4 encounters increased from 3% to 14% over a six-month period.”

Chuck Stillwaggon
Practice Administrator, Orthopedics Northwest, PLLC, Yakima, WA

“I use the EHR for a lot of point-and-click, but for the subjective information, as well as my conclusions and impressions, that’s where Dragon Medical Practice Edition shines…I would never go back to life pre-Dragon Medical.”

Andrew Fireman
MD, Cardiologist, AMS Cardiology, Abington, Pennsylvania

Dragon Medical One

Key Features

  • provides secure, accurate, and portable, cloud-based clinical speech recognition across a wide range of Windows® devices
  • Nuance® Healthcare ID puts power in the clinician’s hand with the ability to personalize their experience and gain access to new features, products, and services as they emerge
  • access their personal voice profile in a growing catalog of mobile productivity apps. Including:
    • secure communication
    • care coordination
    • clinical reference tele-medicine
    • population health
  • comes with a secure online analytics portal to track clinician efficiency, productivity and workflows
    • Use it to help determine what is working and pinpoint areas of improvement for informed decision making
  • no per-device limits so clinicians can stay productive anywhere
  • complete their patient notes at any available workstation, with or without a hard-wired microphone, as soon as they meet with each patient
  • PowerMic Mobile is a smartphone compatible app available via the App Store and Google Play Store to simplify the documentation process

Check out these case studies by Nuance:

The difference between Dragon Medical Practice Edition vs. Dragon Medical One (DMO)

If you’re torn between two great speech recognition solutions from Nuance and want to know the difference, we’ll make it simple for you: the payments and device access. Practice Edition is installed on one local device and DMO is stored in the cloud. This means DMO can run on any computer that has access to your medical voice recognition profile.

DMO is also paid through a monthly subscription of $99.00. The monthly payments enable automatic backup of your profile and access to new update that enhance accuracy and language modeling.

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Fluency Direct – Adding a Mobile Mic (iPhone)


If you have downloaded the mobile dictation app for Fluency, then you are ready to connect your Fluency Direct. If you are still in need of downloading the app to your phone, please click one of the links below:




iPhone Installation

After installing the app on your iPhone, you will see the welcome screen upon the first launch.  Click Get Started to connect the phone to the app.  This will bring us to a screen where we must use the computer.  


  *On your computer:

Open Fluency Direct, log in and click Microphone setup.  


    In the Microphone drop-down menu, select Link a mobile device…  



  Enter the 4-digit code that is generated from Fluency as seen in the image below.  Every time you connect a device, the 4-digit pin will change:  



*On your phone:  



After inserting your code, you will be prompted to choose a location.  



    Your phone is now connected.  You will now be able to push the microphone button on the app and begin to dictate.  


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Fluency Direct – Using Commands


Fluency Direct allows you to create commands to make your speech recognition and dictation smoother and easier to use.


To create a new command, click on the Fluency Bar and select Commands.



The Command Center window will appear.  Click on Add to open the command console.  




Below are just a few examples of commands you will see.


  1. Name Field – This is what you will verbalize when you use the command. If you notice an orange warning triangle, this means you already have a command named ‘Signature.’


  1. Key – These are the hotkeys you can set for commands. For example, you could name the command ‘Open New Document’ to open a new document press a keyboard shortcut for the command.


  1. Mouse – This is used to move the mouse to a specific location on the screen. You can use a Mouse command to close a word document, for example.


  1. Script – You will also be able to insert your own custom scripts into the software. If you have a previously created script, copy and paste it into the text field.





Another powerful tool you can do with Fluency is to link multiple commands.  If you want a command that can do more than just inserting a signature, you can have multiple aspects to one command.  For example, you can create an efficient command to insert your ‘Signature’ and then have the mouse close out of a window.



Making use of these commands is a great way to reduce your dictation and transcription time.  If you would like to know more about the other command sets in the software, please feel free to reach out to us!

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Fluency Direct – Using Abbreviations


Fluency Direct has a nice feature to help your efficiency.   You can say an abbreviation of a word and Fluency will insert that word into your dictations.  To add abbreviations to your profile, click on the drop-down menu and click on Abbreviations.


  After you click on Abbreviations, select Manage Abbreviations.  Click on the Add button to add a new abbreviation.  

  You will be prompted to add the new abbreviation and the word.  Click Save and your new abbreviation is now ready for use.