Fluency Direct 10.0 User Manual

Transitioning from a previous version of FD?  Check out Transition to 10.0 to see what's new.

For assistance with the Fluency Direct application, please contact Fluency Direct Support at 1.888.290.2001.

For the most updated content, please visit our new site!

CDI Engage & Engage One: CDI Engage User's Guide 

HCC Engage: HCC Engage User's Guide 


Getting Started

Congratulations! With the Fluency Direct application installed and ready to go, you can begin your Fluency Direct experience.  

After logging in for the first time, you will be prompted to perform the Initial Experience.  By performing the Initial Experience, you are completing a series of steps that customize Fluency Direct not only for your personal use, but to begin building your voice profile.  Using key phrases during this process, Fluency Direct builds your voice profile which optimizes recognition and produces results. 

 

 

 

Opening Fluency Direct

 

Once you have successfully installed Fluency Direct, you can open Fluency Direct by going to Windows Start > MModal > Fluency Direct. The Fluency Direct application will open; you will see the Splash screen appear while the application loads.  

Signing In

NOTE: If your organization has Single Sign On methods (such as Imprivata), you may be able to skip this step.

If you are signing in for the first time or if you have signed out, the Control Bar will be available for you to sign in.  Enter your Login Name and Password and click the Sign In button to access Fluency Direct.  

TIP: Username and Password are case sensitive!

 

NOTE: When logging in for the first time, or if you have requested a password change, you may receive the following notification and the application will prompt you to change your password.  This does not apply to all users and is dependent on your configuration.  

 

The Control Bar will notify users of the application status.  Error Messages will appear above or below the Control Bar, depending upon the position of the Control Bar on the desktop.  Error messages will be displayed for a short time before fading away.  

 

Forgot Username or Password

Clicking this link will open a pop-up asking for the user's email address.  Once entered, they can click the Send account Details button and they will receive an email shortly that includes their Username, Account, and User Type along with a link which will allow them to reset their password. 

Note: Change Password links only work for one hour after being sent. In addition, some facilities disable the Change Password Option.  You may not have the option to change your password based on your company policy.

 

 

Benefits

  • Ready to use in minutes
  • Physicians can speak in conversational tones
  • Instant conversion of dictation into medical reports
  • Coverage across all specialties
  • Continuous Learning for Continuous improvement
  • Can be used with third-party software, such as MS Outlook, Word and EMR's
  • Ability to define voice enabled commands to automate frequent tasks and normal text
  • Ability to add new/custom vocabulary

 

 

 

Requirements

  • Microsoft® Windows® 7 SP1 or higher Windows OS (7, 8, 8.1 and 10)
  • Processor: Intel Core 2 CPU, 2.0 GHz, 2GB recommended for Local Recognition
  • Processor: Intel Core 2 CPU, 2.0 GHz, 1GB recommended for Remote Recognition
  • Disk Space: 4 GB for local Recognition, 1 GB for Remote Recognition
  • Microsoft® Internet Explorer Version 8 or higher
  • .Net Framework 4.61
  • US: Access to fluencydirect.mmodal.com:443, fd-atl.mmodal.com:443, audiorelayserver.mmodal.com:8077. fluencyupdate.mmodal.com:443 and catalyst-apps.mmodal.com:443
  • UK non-N3 customers: Access to *.mmodal.co.uk:443, audiorelayserver.mmodal.co.uk:8077, *.mmodal.com:443
  • UK N3 customers: Access to *.mmodal.thirdparty.nhs.uk:443, audiorelayserver.mmodal.thirdparty.nhs.uk:8077, *.mmodal.com:443
  • For dictation support into Java based applications JRE 1.7 u6 (32 bit) or higher needs to be installed on the computer before Fluency Direct is installed.
  • For Citrix XenApp support with the Fluency Connector, you must have already installed the Citrix Client 10, 11, 12 or the Citrix Receiver in advance of installing Fluency Direct as well as have the Connector configured on the Citrix Server.
  • Must provide Open Port 443 for HTTPS/SSL traffic to allow fluencydirect.mmodal.com through customer firewall, as well as amazonaws.com (for the vpa server). Will also need to accommodate the TTS server we provide.

 

100 Kbits/sec of bandwidth is required for each concurrent/active user. Therefore, a 1 MBits/sec connection can support 8 – 12 concurrent users. Please keep in mind that users are not dictating non-step, so the number of concurrent users is typically 50 % or less of the total number of users at any given time. Most of the bandwidth its consumed by data upload at the time audio is being streamed to the data center for training purposes. Significantly less data is passed between the client software and the remote Citrix session or Remote Recognition servers. Download traffic from the data center is minimal compared to the upload.

CPU Benchmarks

While the above CPU guidelines serve as a good general rule for system requirements. It is often helpful to assess particular computers in your organization against an ideal CPU speed. Websites like www.cpubenchmark.net offer objective scores to individual processors. By going to a site such as www.cpubenchmark.net you can get a benchmark score for your processor(s) and compare it to the minimum value of 3000. Any computer with a benchmark score lower than 3000 should consider a remote recognition configuration to assure maximum and consistent performance during speech recognition.  If using a PACS or other resource intensive systems will also be in use, we suggest a minimum of 5000 and recommended of benchmark of 8000 or higher.

Browser Extensions

The browser extension is a plug-in that extends the functionality of a web browser. The following extensions have been developed for Fluency Direct to ensure the best dictation experience possible when using web based applications.

NOTE: Available only for Versions 10.0.400 and above.

FireFox

Click here for the FireFox Fluency direct Web Extension.  Once the page opens, click the blue Install Extension button and follow the prompts.

Chrome

Click here for the Chrome Fluency direct Web Extension.  Once the page opens, click the Install button and follow the prompts.

Open Source Attribution

Information on Open Source Components utilized by Fluency Direct is available.

 

 

Basic Functions

This section covers the following basic functions of Fluency Direct.

  • Changing your Password
  • Sign into Fluency Direct
  • Sign out of Fluency Direct
  • Quit Fluency Direct

Changing Password

To change your password, open Account Settings from the Control Bar dropdown menu.  The Change Password button will allow users to change their password, as desired.  Enter your current password, then the new password. You will need to confirm the new password as well.  Once the new password has been confirmed and the length is between the required 4 - 20 characters, the green checkmarks will appear and the Apply button will be highlighted.  

Signing In

If you are signing in for the first time or if you have signed out, the Control Bar will be available for you to sign in.  Enter your Login Name and Password and click the Sign In button to access Fluency Direct.  The Control Bar will notify users of the application status.  Error Messages will appear above or below the Control Bar, depending upon the position of the Control Bar on the desktop.  Error messages will be displayed for a short time before fading away.

Signing Out  

Sign out from the Fluency Direct application using this option; this option will not exit the application, it will remain running on your desktop. 

Quit 

To exit the application completely (the Control bar will no longer be available on your desktop), select Quit from the Control Bar menu. 

  

 

Settings

Select Settings from the Control Bar dropdown menu.

 

 

Version 10.0.500  10.0.400 and below 

 

 

The Manage Settings window allows you to manage important information in regards to your account.  

Security Question

The security question is used to identify your account if you forget your password.  You can select one of the pre-populated questions from the drop down menu or select Custom to create your own unique question.

List: Select from the available questions or select Custom

Custom: select this and the drop down menu will become a text box. Type your unique question in the Security Question text box.

Answer to Security Question

Type in your answer to the security question selected in the text box.  The field is not case sensitive so you will not need to remember that.  For example, "What is your mother's maiden name?" could be Johnson or johnson and the system will still recognize your account.

Email address

Enter your email address that is associated with your account (primary work email is the most common email address used here).  Your email address is used for internal purposes only to update and protect your account.  It is not shared or sold in any way.  

Password

NOTE: Some facilities disable the Change Password Option.  You may not have the option to change your password based on your company policy.

The Change Password button will allow users to change their password, as desired.  Enter your current password, then the new password. You will need to confirm the new password as well.  Once the new password has been confirmed and the length is between the required 4 - 20 characters, the green checkmarks will appear and the Apply button will be highlighted.  

NOTE: Fluency for Transcription (FFT) Customers must reach out to their administrator to facilitate any password changes.

Control Bar and Window Layout Memory

Previously, Windows and control bar positioning was stored per Windows User on a given workstation. This meant that all users using the given Window account would have the same position memory. This has been expanded to allow memory across computers and for individual Fluency Direct Users (not Windows Users). Whether you would like to remember position across computers is now configurable via Settings.

 

 

Fluency Direct Control Bar

After opening the Fluency Direct application, the Control Bar will appear on the desktop.  

You can drag the Control Bar to any location on the screen or you can dock it on any edge of the screen that you prefer.  To dock the Control Bar, click and drag to a screen edge (the screen edge will become highlighted when you near it).  Drop it where you want the Control Bar to be docked.  Fluency Direct will remember the location of the Control Bar and will open in the same position each time you log in.

 

 

Version 10.0.500  10.0.400 and below 

 

From the Control Bar’s drop down menu, you can access the Fluency Direct personalization settings and tools.  You can also access the Help Menu for User Guides and Video Tutorials, open the Editor, Change your Password, Sign Out, or Quit Fluency Direct.  Follow the links below to learn more about each option.

Your microphone is setup during your Initial Experience, but can be changed at any time.  When installing a new microphone, the setup will need to be performed again.

Allows you to customize your Dictionary, add Abbreviations, create Commands, define Formatting, select your Device Buttons, and define Medical Specialty.  In addition, you can perform Profile Training at any time from here.

The Speech Box is an integrated application that allows you to dictate into and then transfer the text to any application.    The benefit of Speech Box over the standard text/note pad is that Speech Box will respond to a pre-defined set of voice commands.

Access the online help, Perform System Check, Submit Feedback, and view the About information.

The Account Settings option will allow you to update your security question and answer, update your email, and change your password.

Sign out from the Fluency Direct application or exit the application completely 

 

 

Microphone Setup

Microphone setup should be performed during the Initial Experience. But a microphone can be setup at any time for any reason. If you are changing microphones, you will need to perform the Microphone Setup again.   

 

Select Microphone Setup from the Control Bar Menu.  

 

 

Version 10.0.500  10.0.400 and below 

 

The Microphone Setup window will appear.  

Microphone

If you have not installed a microphone at this time, you can connect it now. If you have a microphone installed, you can select it from the drop down menu. 

Note: It is strongly recommended to select an M*Modal supported microphone from the Suggested Microphone List.  We do not recommend using your internal laptop microphone. 

Linking with the Mobile Microphone

You can use your iPhone or iPad as a microphone source for M*Modal Fluency Direct. See Mobile Microphone App for additional details.

Record Button

Select the microphone button or keyboard key that you wish to use to start and stop recording. Click the X to remove the selection. 

Calibration

The calibration process is a single screen that will calibrate your microphone to your specific voice and surroundings. You will be prompted to read a paragraph to complete this process. 

Microphone calibration will control the volume level of the input source which has a direct effect on recognition quality.  This is not the same as the volume slider, which controls the volume level of speakers. 

Microphone calibration will stay with your profile, regardless of what computer you are using as long as you are using the same type of microphone. New microphones will require a new calibration. 

The calibration process will adjust automatically as you read the paragraph included on the wizard.  It will require a minimum of 20 seconds of audio to adjust the gain properly.

Once you have finished calibrating the microphone, you can click OK to close this window. 

Advanced Options

Additional options are available by clicking the Advanced Options link. These options allow you to assign a device button for recording Commands and Text. 

Device Button 

Click the ADD field to bring up the Add a Device Button screen.  From here you can add a Device Button by clicking in the Device Button field and pressing any microphone button.

Recording Mode

Standard Recording This option recognizes the difference between dictation and commands and accepts both options.
Text Only Recording

Selecting this option sets the device button to be used for recording text only. When using this button, you will only be able to dictate. Commands will not be recognized as commands, only as text. 

Command Only Recording Selecting this option sets the device button to be used for commands only. When using this button, you will only be able to speak commands. Dictating non-command terms when using this button will not result in dictation.

 

Recording Behavior

Hold to Talk Use this option when you will be using the microphone sporadically and you wish to use the push button to activate the microphone.  With this mode, you will hold the record button during the entire dictation and release the button when finished.
Toggle to Talk This option allows you to select a microphone button or key press, which will begin your recording session. When finished recording, pressing the button or key press will end the recording session.  This method is commonly used with headsets.

 

 


Suggested Microphone Habits

The best speech recognition quality comes from optimally recorded audio.  Follow the habits below in order to achieve a better experience.  The General Dictation Habits section is applicable to every microphone type.

General Dictation Habits

  • Check the microphone settings to verify the microphone you intend to use is selected and the record buttons are appropriately set.
  • Gather your thoughts and assemble any pertinent information prior to dictating.
  • Dictate in a quiet area, with minimal background noise. Calibrate microphone if environment changes.
  • Speak in full thoughts or sentences, consistently and evenly, avoiding fragmented dictations.
  • Use correct verbiage and grammar – including punctuation. 
  • Speak clearly, at a regular pace – articulate properly without over enunciating or speaking too slowly.
  • Enunciate words that can be misunderstood: abduction vs. adduction and hyper vs. hypo
  • Avoid using slang, acronyms, and/or coined terms.
  • Be sure to wait until recording has begun before beginning to dictate and only releasing the record button (if using Hold to Talk) or recording is turned off (if using Toggle to Talk) after dictation is complete. This prevents words from being “clipped” from the start or tail end of the dictation.
  • Stop recording when taking a pause from dictation. This is to prevent capturing other conversations or background noises.
  • Avoid heavy breathing or coughing into the microphone while recording.
  • Never allow another person to dictate under your login. This will negatively affect your recognition quality.
  • It is best to mention any issues to your in-house Help Desk as it may or may not be related to the hardware.

Handheld Microphones

  • “Hold to Talk” is the recommended setting for when using a handheld microphone. This option allows you to press down a microphone button, key press, or foot pedal which will begin and sustain your recording session. When finished recording, release the button to end the recording session.  
  • Release the record button when pausing so as not to record typing, ambient noise, or conversations.
  • When dictating, hold the device approximately 4-6 inches off to the side of your mouth.  When turning your head, please remember to keep the microphone at a constant distance near your mouth.
  • Place the handheld device in the palm of your hand with the thumb able to reach the record button.  Your index finger will rest near the trigger button on the bottom side of the device.  Be careful not to squeeze tightly so as not to accidentally press the trigger button.

Headsets

  • “Hold to Talk” is the recommended setting for when using a headset microphone. This option allows you to press down a microphone button, key press, or foot pedal which will begin and sustain your recording session. When finished recording, release the button to end the recording session.
  • “Toggle to Talk” is an alternate recording mode. This option allows you to select a microphone button, key press, or foot pedal which will begin your recording session. When finished recording, pressing the button again will end the recording session.  This mode is less desirable because it is easily left on during pauses between dictations which allows for typing noises, conversations, or long periods of silence.  This could insert undesired text or degrade one's voice profile over time.
  • Release the record button when pausing so as not to record typing, ambient noise, or conversations.  If using Toggle to Talk mode, be sure to turn the microphone off when pausing.
  • Headsets should be worn on the head with the microphone positioned off to the side of the mouth. 

Gooseneck Microphones

  • “Hold to Talk” is the recommended setting for when using a gooseneck microphone. This option allows you to press down a microphone button, key press, or foot pedal which will begin and sustain your recording session. When finished recording, release the button to end the recording session.
  • “Toggle to Talk” is an alternate recording mode . This option allows you to select a microphone button, key press, or foot pedal which will begin your recording session. When finished recording, pressing the button again will end the recording session.  This mode is less desirable because it is easily left on during pauses between dictations which allows for typing noises, conversations, or long periods of silence.  This could insert undesired text or degrade one's voice profile over time.
  • Release the record button when pausing so as not to record typing, ambient noise, or conversations.  If using Toggle to Talk mode, be sure to turn the microphone off when pausing.
  • Gooseneck microphones are best utilized with a foot pedal for complete hands-free dictation.
  • They should only be used in quiet environments such as a personal office.
  • It is recommended to stay at a constant distance from the top of the microphone.  It is optimal to be 8 inches away, however, it is more important to maintain a constant distance facing the microphone, even if that distance is more or less than 8 inches away.
  • Moving away and back to the microphone while dictating is not recommended.

Mobile Devices

  • “Toggle to Talk” is the default recording mode when using a mobile microphone. This option allows you to use the button within the app as well as select a key press or foot pedal which will begin your recording session. When finished recording, pressing the button again will end the recording session.  

  • Toggle the microphone off when pausing between dictations to prevent typing noises, conversations, or long periods of silence from being recorded.  This could insert undesired text or degrade one's voice profile over time.

  • Moving away and back to the microphone while dictating is not recommended.  When turning your head, please remember to keep the microphone at a constant distance near your mouth.

  • It is recommended to stay at a constant distance from the microphone.  It is optimal to hold or position the device 6-12 inches, however, it is more important to maintain a constant distance facing the microphone, even if that distance is closer than 6 inches.

  • If using a handheld mobile device such as an iPhone, it is optimal to hold the phone in the palm so that fingers are not in contact with the screen.  Dictation should be directed towards the bottom of the device.

 

  • If using a mobile tablet such as an iPad, it is optimal to prop the device on a stand so as not to block the microphone on the backside of the device.  Dictation should be directed towards the top of the device.

 

  • The M*Modal Mobile Microphone app also offers an optional “Hold to Ear” recording mode which allows the user to turn the microphone on when holding it to his or her ear.  Taking the phone down from one’s ear will then turn the microphone off.  This setting is only available within the app.

  • Like with any microphone, it is recommended to turn off the recording in between dictation, during long pauses, and when setting it down/moving onto the next task such as typing.  Extraneous, non-dictation noises could be recorded and misinterpreted as text.

Switching Microphones Disclaimer

  • It is strongly recommended that users do not frequently switch between microphones types.
  • If you must switch microphones, it is important that you run the calibration process for the new microphone.
  • In addition, the system will require time to train for the new microphone audio to achieve optimal quality and performance.

 

 

Microphone Status

The Control Bar will display a variety of colors based on the status of the microphone and/or the connector; as well as your configuration.  This is a quick visual cue for the user to know when to begin speaking or if there is an issue with the microphone.  

Mic icon colors

 Dictation & Connection

Gray

Normal, not dictating; sleeping

Green

Normal, dictating. 

Once you begin recording, you will see the microphone on the Control Bar light up GREEN.  A green bar will show around the bottom of the Control Bar, moving left to right, to display an indication of the microphone volume.

Blue

Server Connector not found, which could be normal in a virtualized application. 

Connector is not running on the Citrix XenApp or Terminal Services Server

Yellow

Local (workstation) Connector is not working properly. 

Install may be incorrect on the client workstation. Either the Citrix Receiver or Remote Desktop Client do not have the correct virtual drivers installed as part of FD. This could happen if the Citrix Receiver isn't restarted after install or if a new install of the Citrix Receiver was done and a Fluency Direct self-heal was not possible.

Red

The Microphone Status will display RED when the user cannot dictate.  This will occur when the user is not logged in, is signing in, or if a microphone is not detected.

Severe problem typically related to microphone or remote recognition server. Red is unrelated to the Connector state. Red could mean either no microphone can be found by Fluency Direct or if doing Remote Recognition all servers are at maximum capacity in terms of connections



CAPD Ribbon

Empty gray  No CAPD communication

This state occurs in the following situations:

  • CAPD is unsupported in the current context
  • CAPD servers are unavailable 

Hovering over the ribbon will show a tooltip with the same message as in the banner once you open the drawer with the exception of the "Why?" link.

Gray with checkmark No CAPD messages Occurs when CAPD is supported in the current context, functioning properly and there are no messages.  Hovering over the ribbon will show a tooltip with the same message as at the top of the drawer.
Red with number  CAPD messages  Occurs when there are CAPD messages in the current context.  Hovering over the ribbon will show a tooltip "You have 1 message" or "You have <#> messages".
Blue with number  Educational messages such as Precyse

If we have a combination of educational content (e.g. Precyse) and standard CAPD content, the ribbon will be red and the number will reflect how many cards are present (e.g. 2 would mean that you have one standard CAPD card and one Precyse card).

 

 

 

Suggested Microphone List

Wired Handheld Microphones

Accuracy 1 Usability 2 Microphone Brand and Model
 *****  ***** Olympus RM-4000 RecMic II 
 *****  ***** Olympus RM-4010 RecMic II
 *****  ***** Olympus RM-4015 RecMic II
 *****  ***** Olympus DR-1200 RecMic 
 *****  ***** Olympus DR-1200 DirectRec 
 *****  ***** Philips SPM3700 SpeechMike Premium Touch 
 *****  ***** Philips LFH3600 SpeechMike Premium - Barcode Scanner
 *****  ***** Philips LFH3500 SpeechMike Premium
 *****  ***** Philips LFH3205 SpeechMike III
 *****  ***** Philips LFH3200 SpeechMike III
 *****  ***** Philips LFH3300 SpeechMike - Barcode Scanner
 *****  ***** Philips 7276 SpeechMike Pro Plus - (No longer manufactured)
 *****  ***** Philips 7274 SpeechMike Pro - (No longer manufactured)
 *****  ***** Philips 5276 SpeechMike Pro Plus - (No longer manufactured)
 *****  ***** Philips 5274 SpeechMike Pro - (No longer manufactured)
 *****  ***** Philips 5284 SpeechMike Pro - Barcode Scanner - (No longer manufactured)

Wireless Handheld Microphones

Accuracy Usability 2 Microphone Brand and Model
 *****  ***** Philips SMP4000 SpeechMike Premium Air
 *****  ***** Phillips LFH3000 SpeechMike Air
 *****  ***** Phillips LFH3005 SpeechMike Air

Wired Headset

Accuracy Usability 3 Microphone Brand and Model
 *****  *** Andrea Electronics NC-181VM USB
 *****  *** Andrea Electronics NC-185VM USB
 *****  *** Andrea Electronics NC-250V
 ****  *** Plantronics Audio 310 + USB Adaptor
 *****  *** Plantronics Audio DSP 300 USB - (No longer manufactured)
 *****  *** Plantronics Audio DSP 400 USB
 *****  *** Plantronics Audio DSP 500 USB
 *****  *** Plantronics Audio 678 USB
 *****  *** Plantronics Audio 655 USB
 *****  *** Plantronics Audio 648 USB
 *****  *** Plantronics Audio DSP 626 USB
 *****  *** Plantronics Audio 628 USB
 *****  *** Plantronics Audio DSP 626 USB - (No longer manufactured)
 *****  *** Plantronics Audio 610 + USB Adaptor
 *****  *** Plantronics Blackwire C710 via USB
 *****  *** Plantronics Blackwire C710-M via USB
 *****  *** Plantronics Blackwire C720 via USB
 *****  *** Plantronics Blackwire C720-M via USB
 *****  *** Plantronics Blackwire 725

Wireless Headset

Accuracy 4 Usability 3 Microphone Brand and Model
 **  *** Andrea Electronics BT-201
 **  *** Jawbone ERA
 ****  *** Plantronics Voyager Legend UC 
 ***  *** Plantronics M50
 ****  *** Plantronics Savi W410-M
 ****  *** Plantronics Savi W420-M
 ****  *** Plantronics Savi W430-M
 ****  *** Plantronics Savi W440-M
 ****  *** Plantronics Savi W445-M

 

Gooseneck Microphones

Accuracy Usability 5 Microphone Brand and Model
 ****  *** Buddy GooseneckMic 7G USB
 ****  **** Buddy GooseneckMic 7G USB + Footpedal
 ****  *** Buddy GooseneckMic 3.5mm Analog
 ****  **** Buddy GooseneckMic 3.5mm Analog + Footpedal
 ****  *** SoundTech GN-USB Professional Gooseneck Microphone
 ****  **** SoundTech GN-USB Professional Gooseneck Microphone + Footpedal

 

Mobile Devices

You can obtain the M*Modal Mobile Microphone application from the iTunes App Store or Google Play.

Supported Operating System Device Recommendations
Android OS Unlike its competitor, there are many, many devices in the market offered by a variety of manufacturers.  There will be variability of microphone quality across the different devices.  Phones and tablets, especially newer devices, will generally have better quality microphones which will lead to better quality speech recognition.  See below for Android devices with known audio issues.
Apple iOS Phones and tablets, especially newer devices, will generally have better quality microphones which will lead to better quality speech recognition.  For example, an iPod Touch would not be recommended.

Unsupported Mobile Devices 

The following devices should be avoided with M*Modal products.  They are unsupported due to core issues with Samsung's issue with 11 kHz audio recording.  There may be other devices with similar issues, however, this list shows devices that definitively have this issue.

Brand

Model

Model Number

Samsung J3 (2018) SM-J337V
Samsung S8 (HK, Australia)  
Samsung A30 SM-A305F
Samsung A10 SM-A105M
Samsung J7S  
Samsung A8 (2018) SM-A530W
Samsung  A20  SM-A205U
Samsung S20 SM-S205DL

Related Hardware 

Function Brand and Model
3 Position Foot Pedal Olympus RS-27H Footswitch
4 Position Foot Pedal Olympus RS-31H Footswitch
3 Position Foot Pedal Philips ACC2320 USB Foot Control
3 Position Waterproof Foot Pedal

DAC FP-7000-3D/W

4 Position Waterproof Foot Pedal DAC FP-7000-4D/W
Hand Control Olympus RS-RS-32 Hand Controller



Switching Microphones Disclaimer

  • It is strongly recommended that users do not frequently switch between microphones types.
  • If you must switch microphones, it is important that you run the calibration process for the new microphone.
  • In addition, the system will require time to train for the new microphone audio to achieve optimal quality and performance.

 

Microphone Notes

1 - Accuracy is dictated by a combination of audio quality, noise cancelation technology and the likelihood of consistent microphone placement relative to the speaker's mouth. 

2 -For Handheld Microphones usability is typically impacted by how recording is started and finalized. Microphones with record switches instead of record buttons tend to have higher rates of user error during the recording process. It is not uncommon for users of switch activated microphones to accidently leave them on after dictation is complete. This causes otherwise unintended noise and speech to be recognized by M*Modal Fluency Direct. 

3- When comparing headset microphones with handheld microphones, users typically notice two shortcomings to headsets.  A headset microphone's usability can be impacted by how recording is started and finalized. Typically the keyboard or the M*Modal Fluency Direct control bar is used to start and end the recording process. It is not uncommon for users of headsets to accidently leave them on after dictation is complete. This causes otherwise unintended noise and speech to be recognized by M*Modal Fluency Direct. An additional concern is that an array of handheld programmable buttons that would otherwise be accessible via a handheld microphone are unavailable to headset users. This can prevent quick access to some M*Modal Fluency Direct functionality.

4 -Wireless communication between a microphone and a computer can occur via Bluetooth or other proprietary communication protocols. The Bluetooth communication protocol uses lossy compression which limits the audio quality available to M*Modal Fluency Direct. Some proprietary communication protocols do a better job of transporting audio without loss of audio quality. Higher audio quality typically means better accuracy for M*Modal Fluency Direct. This applies to Bluetooth headsets that may be used with the Mobile Microphone app.

5 - When comparing gooseneck microphones with handhelds and headsets, users typically notice three shortcomings. A gooseneck microphone's usability can be impacted by how recording is started and finalized. Typically the keyboard or the M*Modal Fluency Direct control bar is used to start and end the recording process. It is not uncommon for users of gooseneck microphones to accidently leave them on after dictation is complete. This causes otherwise unintended noise and speech to be recognized by M*Modal Fluency Direct. This type of common error can be limited by the use of a footpedal in conjunction with a gooseneck microphone. The use of a gooseneck microphone also introduces increased variability in the distance between the user and microphone. With a headset or a handheld, a user is much more likely to keep the microphone a consistent distance and positioned correctly relative to the mouth. Consistency in microphone placement has an impact on recognition accuracy. An additional concern is that an array of handheld programmable buttons that would otherwise be accessible via a handheld microphone are unavailable to the user. This can prevent quick access to some M*Modal Fluency Direct functionality.

 

 

 

Personalization

Fluency Direct offers a variety of tools to help you personalize your experience and daily use.  

Dictionary: Create a custom dictionary of Names, Locations, Medications, Procedures, Diagnoses, and Excluded Words

Abbreviations: Create a collection of abbreviations. This is a list of words or phrases that you use repeatedly but abbreviate when speaking.  

Commands: Create commands to which can be used to insert snippets of text, perform keyboard shortcuts, and more. 

Formatting: Define specific options related to the display and rendering of the dictation and draft text including dates, times, measurements, and spacing. 

Medical Specialty: Fluency Direct focuses on the physician's medical specialty, select your specialty here to ensure improved recognition. 

Profile Training: Training your voice profile, or enrollment, is a simple process.  Once you login as a new user, you have the option to complete the enrollment process after you have selected and calibrated your microphone.  This is recommended for best recognition results, but is not required to run the program.  

 

 

 

Dictionary

The Fluency Direct Dictionary allows you to create a custom dictionary of Names, Locations, Medications, Procedures, Diagnoses, and Excluded Words that you use often to ensure recognition each time.     

The Dictionary should only be used to add words which would not be in the baseline dictionary.  It is not necessary to add general terms such as “purulent” or “atelectasis”.  These types of terms already exist in the M*Modal dictionary.

NOTE: Adding basic words impedes the recognition effectiveness of other clinical words and locations that have been added.  Avoid entering small words to the dictionary, such as “a”, “ the”, “one”, “then.”  

To open the Dictionary, open Dictionary in the Control Bar drop-down menu. The Dictionary window will appear.    

 

 

Version 10.0.500  10.0.400 and below 

First Time Use

The first time you open the Dictionary dialog, you will see one of the two screens below. To begin using the dictionary, you will click the +Add button. 

Published Dictionary

Published Dictionary terms are those words or terms that have been published by an administrator for use across a company or facility.  

These items will be available in the Dictionary dialog but will contain a lock symbol to the right of them. 

Published Dictionary terms can be recorded for Pronunciation or you can adjust the Spoken Form. You can change the pronunciation and spoken form as you would one of your normal terms. The Name field and the Category buttons will be disabled for editing. 

When a dictionary term, word, etc. has been published, it is locked from both editing and deleting. Only an administrator can remove published items.

Note:  For some published items such as Dictionary Items, Device Button mappings, and Data Set Items it is possible to modify them to a certain degree, For example, you can give your own pronunciation to a dictionary item. In some cases, you might want to revert that modification to the previous, published state. You can now do this via the “Revert to Published Version” context menu item available via right click. 

Managing your Dictionary

After you have populated your dictionary, when you open it, it will open to the screen below. From here you can select your category and add or edit your dictionary as needed.

Adding a Dictionary Entry

To add a dictionary entry, you can select the category and click the Add button in the top right. Note that the tooltip will change depending on the type of entry you are adding (Name, Medication, etc).  

Note: Adding Categories to all dictionary entries is an important step!  Each item will default to “other”, changing it to the appropriate category of Medication, Name, or Location will significantly improve your recognition results of that term. 

 

The Add a New word window will appear.

Type in the word to be added to the dictionary.  Below, you will see a phonetic pronunciation generated.

NOTE:  The Written Form pronunciation is often very accurate, so it is recommended to check it before deciding to Change the pronunciation.    

You can change the pronunciation by clicking the blue Change link.

The Pronunciation dialog will then appear.  From here, you can view the Written Form and choose to change the Spoken Form or Record a Pronunciation by selecting the different tabs.

The Spoken Form is a way to change the pronunciation through typed text.  For example, a name might be spelled Nguyen is pronounced "win" so typing win into the Spoken Form will generate the appropriate pronuncation.  

After changing your pronunciation, you will be returned to the Add a Word dialog.  From here you can select the category for the dictionary entry.  If you want to assign it to a different category, select the category here.  Click Save to finish. 

Adding While Dictating

You can add a dictionary entry during the dictation process using the dictation command, "Add to Dictionary".  The Add a Word window will appear, as described above.  Just like adding the word from the Dictionary window, you can review the word and choose to record the pronunciation again, if needed.

Adding While Correcting

You can also add a dictionary entry using the dictation command, "Correct That". When the correction dialog appears, if the word is not a common word, the Add to Dictionary checkbox will be available.  Once you check the box, click Save and follow the steps above.

  

 

Excluded Words

 

The excluded words will not appear in the categories for Adding a New Word. Excluded Words are words that have been specified to never appear in the dictation, for a variety of reasons. 

To add an excluded word, you MUST select the Excluded Words category and then click the Add button.

Enter the word that you wish to exclude and click Save.  

Edit Dictionary Entry

Dictionary entries can be edited by clicking on the item to open it. Make your changes and click OK to save and close the dialog. 

Move Dictionary Entry

If you have created a dictionary entry and discovered that it is in the wrong category, you can click the dictionary entry and change it to the correct category. 

Delete Dictionary Entry

To delete a dictionary entry, select the word and click the Delete icon to the far right. 

Bulk Review

By Accessing the Manage Dictionary Dialog via Shift+Click users can now review pronunciations in bulk. New Context Menu items also exist to make it easier to re-categorize dictionary entries.

Dictionary.10.0.400

Search

The search option is available for you to search through your dictionary terms (including categories). As you type in the search term, the dictionary will automatically filter out the terms that don't match.  

As the filter is applied, if your search term is not available in a category, that category is also filtered out. 

     

How to Enter Multiple Word Phrases in the Dictionary

Multiple word phrases that are dictated together should be added to the dictionary as one phrase.  If the individual words are uncommon to the general vocabulary, and will potentially be dictated separately, the individual word should also be entered. 

Example, Name with multiple words, Hospital Facility name

  • University of Wichita Medical Center would be added as a Phrase, and Wichita would be entered separately also

Example, Physician Name, first and last name, common

  • John Smyth would have two entries       
  • Enter “Smyth”, John would be a common name that would be recognized, so there is no need to enter it into the dictionary
  • Also Enter “John Smyth” 

Example, Physician Name, first and last, non-common

  • Arvil Constence would have two entries considering a typical physician practices
  • Full name dictation – Arvil Constence
  • Dr. followed by the last name only – adding only Constence

Do NOT include commands or command words in the dictionary

 

 

Abbreviations

Fluency Direct also allows users to create a collection of abbreviations. This is a list of words or phrases that you use repeatedly but abbreviate when speaking.      

First Time Use

The first time you open the Abbreviations dialog, the screen will appear like the one below. To begin using the Abbreviations, you will click the +Add button that the arrow is pointing at. This window will only appear the first time that you use the Abbreviations.  

Managing your Abbreviations

After you have populated your library, when you open it, it will open to the screen below. From here you can add or edit your Abbreviations as needed. 

  • When adding abbreviations, use caution and be sure to not expect the original word to be dictated elsewhere in the system; it will always provide the replacement word.
  • When adding common medical abbreviations such as "b.i.d.", it is recommended to dictate it into the Original field in order to achieve the best result. 
  • When adding an acronym like “UMC” for “University Medical Center”, be sure to capitalize “UMC.”  Also, "UMC" may need to be added to the Dictionary as a location.

Adding an Abbreviation

To add an abbreviation click on the ADD button towards the top right. 

 

The following screen will appear, enter the Original (dictated abbreviation) and the Replacement (full text to appear in the report). Click Save to save the abbreviation.  To add additional abbreviations, just click the Add Button again.

 Edit Abbreviation

Abbreviation entries can be edited by clicking on the item to open it. Make your changes and click OK to save and close the dialog. 

Delete Abbreviation

To delete an abbreviation entry, select the word and click the Delete icon to the far right.  

Published Abbreviations

Published Abbreviations are those abbreviations that have been published by an administrator for use across a company or facility.  These items will be available in the Abbreviations dialog but will contain a lock symbol to the right of them.  If you are an admin, then the tool tip will display ‘Published via <group name>’.  Non-admin FD Users will see a tool tip stating ‘Published by a Published Abbreviations administrator’’.

When an abbreviation has been published, it is locked from both editing and deleting. Only an administrator can remove published items. 

Search

The search option is available for you to search through your abbreviations. As you type in the search term, the abbreviations will automatically filter out the terms that don't match.  

 

 

Commands

Fluency Direct offers the ability to create commands which can be used to insert snippets of text, perform keyboard shortcuts, mouse clicks, and more.  Commands are organized by Groups which can help you organize EMR specific commands and adjust the availability of where those commands will work (such as specific EMRs or applications).  With the different availability of commands, the same Command Name can perform different functions in different applications. 

From the Control Bar, click on Commands to bring up the Commands screen (10.0.400 and below select Personalization > Commands).

 

 

Version 10.0.500  10.0.400 and below 

First Time Use

The first time you open the commands dialog, the screen will appear like the one below. To begin using the commands, you will click the +Add button where the arrow is pointing. This window will appear when the Command Group is empty. 

All users will have a default group available to them when they open the Commands dialog. This group will be called "User Name" Commands and can be populated with your custom commands.

Manage Commands

After you have created your commands, when you open the Manage Commands Window, it will open to the screen below. From here you can select your group and add or edit your commands as needed.

Click the Add Button to Add a new Command Group or Command or click a Command Group or Command to edit.  See below for more information.

Groups

As mentioned above, Groups are used to help you organize EMR specific commands and adjust the availability of where those commands will work (such as specific EMRs or applications).  With the different availability of commands, the same Command Name can perform different functions in different applications. 

New Group

Click the Add button arrow to create a new Command Group.  

 

The Add a Group dialog window will appear. 

  • Enter the Group Name. Ex: "ED Commands"

  • Select Availability - Click one of the three options below.

    • Available Everywhere - This option means this group of commands will be available in any application that you use to dictate.
    • Available only in windows with certain titles - Enter the window title(s) to limit the availability to an active title window containing that title in its title bar.  
    • Available only in certain applications - This option allows you to specify one or more applications (programs) that would recognize this command. 
    • Also Available on Mobile - Check this box to make this group and its commands available on Fluency Direct Mobile.
  • Click Save

Delete Group

To delete an existing group, select the group you want to delete.  Next, click the Delete Group icon to the far right. 

The message below will appear.  Click the Delete button to complete the action.  The Group will be deleted.

 

Commands

New Command

To add a new command, click on the +Add button in the top right corner.

 

The Add Commands window will appear. 

Name your command. The Command Name is an important step because this is the speech command that will activate the command details (inserted text, key presses, mouse clicks, wait time, or scripts). Do not choose a name that is complicated to pronounce or too long to be recognized easily.  In addition, try to follow these best practices: 

  • Spell out numbers rather than using the numerals (i.e.  "Four Two Five" instead of "425").
  • Use an Action Verb at the beginning of each command name (i.e. "Insert", "Print", etc.).
  • Dictating your command name - if you decide to spell out your command name, be sure that it is spelled accurately for recognition.
  • Keep your names simple and relative to the Command Action/Result. (i.e. "Physical Exam", "Patient Report", etc).
  • Make sure the command is more than one word by combining your Action Verb and Command Action/Result. (i.e. “Insert Physical Exam”, "Print Patient Report", etc)

Select the Group. From the Command Group dropdown, choose the group that you want the command to appear in. The Group will default to your custom commands group or to the selected group. 

Add Actions. Using the buttons, add text, keystroke, wait time, mouse clicks, or a script to the command. See Actions below for more information. 

Availability: Fluency Direct allows multiple custom commands with the same name with different availability. This allows for the creation of commands with the same name to run different actions based on context defined via Availability. For example, this could be used to have different behavior for “next field” in different EHRs. Previously command availability could only be defined at the group level. With the new approach, commands can inherit the availability defined by the group or deviate with its own availablity. This allows for a single group to better cover all portions of the EHR with a single command group.

Save the Command.  Click OK to save the command; clicking Apply will save the command and keep the Command Details window open.

Common Action Verbs 

Insert

GoTo

Click
Open Order Add
Close Navigate To  Enter

 

Apply Actions

TEXT

The Text option allows you to create text snippets (also referred to as Normals or Macros) and Templates that offer field support.  

The Rich Text feature is not currently supported in Fluency Direct for macOS.

Text Snippet

A text snippet is a piece of text that you insert into your document during dictation on a regular basis (Ex: "Insert Normal Exam).  Using the text snippet option can save time during dictation by creating a simple "Insert Text" command.  There are two methods to creating a text snippet; from the Commands window or by dictation.

To add a text snippet from the Commands window, select the Text action.  In the text box provided, enter the desired text that you wish to use.  Be sure to name the command something simple using the "Insert" command first.

 

Text Snippet from Selection

If you have a selection of text available, you can use the command, “Save this Text” or "Create Text Snippet" to create a new command.  

The Command window will appear with your selected text.  You will then enter the Command Name (by following the best practices for command names), assign it to a Command Group and (if desired) add additional actions to the command.  Click OK to save. 

NOTE: When inserting a text snippet, they are inserted using the current font attributes of the target text area. You cannot retain formatting from the original document used to create the Text Snippet with plain text.  If you want to retain formatting, use the Rich Text Formatting, available with Version 10.0.500 and up.

 

Template Fields

Creating a command using template fields allows you to create a reusable template which can be inserted and quickly completed by navigating through the fields. 

When creating a template, you can insert brackets [ ] to denote a field. Fields can be useful placeholders throughout the text. They can be blank, contain text to remind you what to add (such as [patient's age] ), or contain canned text that can be left alone or changed as needed.

If the field's content is not changed, saying the voice command "remove all fields" will strip away the brackets and leave the text behind.

Using the Next Field / Previous Field commands you can move through the bracketed [ ] fields in the template, dictating as you go along.  The Next/Previous field commands will wrap around to beginning/end of your text when the current cursor is beyond the last or first field in the text. For example, if you are at the end of the document, you can dictate "Next Field" to go to the first field in the document. 

 

KEY 

This option will capture your keystrokes and record them as the command. You can enter a single key press or a string of key presses, depicted below.  It is recommended when entering multiple key presses that you add a wait time in between the key presses, to ensure there is no overlap.

 

Key Press, Single or String

  

To clear a keystroke, click the X icon at the end of the field.  Once clear, you can enter a new key press. 

NOTE: Pressing additional keys, including Delete or Backspace, will add those key presses to the end of the field.  If you need to add a keystroke to the beginning or middle of the string, you will need to CLEAR the entire field first by clicking the X icon.  

When inserting key presses, it is recommended that you insert a WAIT in between the key presses, if they are not part of a string.  Example is depicted here.

WAIT

This option will cause the system to wait for a specified amount of time before proceeding to the next action.  

Sometimes it's better to wait for a window to appear before moving to the next step instead of setting a specific wait time.; adding the window title to this step will have the action wait until it sees that window appear or set a maximum time limit as an alternate option.

MOUSE

The Mouse action allows you to designate specific mouse clicks or movements that are then run as a voice command.  For example; you could create a "New Message" command using mouse clicks in Outlook that would create a new message to send.  

TIP! We recommend using Mouse actions when keyboard shortcuts are not available. If a keyboard shortcut is available, that is the more reliable method to use.

To begin, select the type of click that you want to use.  Left, Right, Double, or Move Pointer.  

Relative To Position

Then select the Relative To position, which is your anchoring point.  This position is based on the application window (NOT the screen). The drop down menu allows you to select the relative position.  For example, the Top Left Corner would be the top left corner of the window you have selected. At this point, the X and Y coordinates are set to 0.  

Selecting the anchoring point is an important step because it will determine where your X and Y coordinates meet up.  These coordinates can change based on your window size and screen resolution so it's important to set the correct anchoring points.

Examples:

When selecting a mouse click for a Save button located in the bottom right corner of the window, you will want to use a Relative To position of Bottom Right Corner.  This will allow the coordinates to retain their relative position when the window is resized.

When using the New Email button in Outlook which is located towards the upper left of the window.  In this case, you'll want to use the Relative To position of Top Left Corner.

NOTE: The Relative To position provides for an accurate X Y coordinate IF the exact screen size and resolution is the same.  If a user has different content in their browser window (additional menu bars, etc) the coordinates may not work exactly as expected.  This can sometimes be achieved by maximizing your window.

 

X & Y Coordinates

Next, you will select your X and Y coordinates by clicking on the Change link.  When you click Change, a blue dot will appear in the relative position over the application that you are in.  Hover your mouse over the application window that you wish to perform the mouse click in and it will become highlighted in blue.  Press the Spacebar to confirm the area and the X and Y coordinates will now change to numbers other than zero.  You can perform tasks involving multiple mouse clicks by adding additional Mouse actions in the Command.

NOTE: When performing this command, you MUST be in the application that the command was created in.  For example, if you register Mouse Clicks for creating a new document in Word, you must have Word open and active to use the command.

WINDOW

The Window action allows you to assign specific actions to an application window. The application must be open for these commands to work. 

NOTE: The Window Title should match exactly how the application title appears.

For Example, when using Notepad:

Would appear as:

Activate - This command will bring the application window to the forefront and give it focus.

Minimize - This command will minimize the window so that it is no longer visible.

Maximize - This command will maximize the window so that it uses the entire screen space.

Restore - This command will restore an application to its original size from a minimized state.

Close - This command will close the application completely.

COMMAND 

Built-in Commands are the pre-populated speech commands that M*Modal has built into Fluency Direct. 

You can use these speech commands within a Command string to perform the function you need.  

This action wouldn't be used by itself, but instead layered into a multi-step command where a built-in command would be useful, such as "go to beginning of document" after a text action step.

When you add the Command action, you can start typing the Speech Command that you would normally speak (Next Field) and select from the list that appears.  

The speech command will then be added to your Command steps. 

Example: 

 

SCRIPT

Scripting is for advamced users only!

Advanced scripting feature is not currently supported in Fluency Direct for macOS.

The script step in a command is for advanced functionality. it is possible to use a script as a command step in one of two ways. 

  1. Specify a JavaScript method name. When interacting with an EHR hosted in Internet Explorer, M*Modal Fluency Direct can use JavaScript injection to call a JavaScript method available on the currently displayed web page. This allows M*Modal Fluency Direct to call methods exposed by the application for UI interaction. The JavaScript method runs in the context of the web browser.

  2. It is possible to create scripts to do complex actions such as interact with low level APIs and manipulate data from other sources. A script can be written in the VBScript or JavaScript and runs in the context of M*Modal Fluency Direct.  Typically this type of scripting needs to be created by someone with knowledge of computer programming languages.

    FOR FD ADMIN USERS ONLY

    How to write a script in JavaScript: KB10124 - Command Scripting Using JavaScript

    How to write a script in VBScript: KB10176- Command Scripting Using VBScript

 

COMMENT

The Comment option will add a comment at any stage for clarity between steps. It does not take any action, it simply inserts a comment for reference. 

 

Move Actions

Actions can be reordered after they have been set. To reorder actions, simply click in the box and drag the action up or down to the correct order.

Delete Actions

To remove an action from the Commands Details, hover over the command action or select the command action and click on the x in the upper right corner to delete that action. 

Edit Command

To edit an existing command, click on the command to open the Edit The Command window.  You can make changes and click Save to save your changes. 

Copy Command

Fluency direct allows you to copy a command from one group and paste it into another group.  

Right click on the command you wish to copy and select Copy.

Select the Group that you wish to copy the command to and right click. Select Paste Into this Group.

From here, you will need to name the command.  It must be unique and cannot be the same name as the command you copied.  

Example,

Copy the command Cancel Note

Paste it into a new group and name it Cancel My Note.

In addition, you can open the Command Editor and edit the command if needed.

 

Delete Command

To delete an existing command, hover over the command you wish to delete and click the (x) delete icon on the far right.  

 

Import / Export

Fluency Direct offers you the ability to import and export Groups and commands.  

Import Commands

  • From the FD Control Bar, select Commands (10.0.400 and below select Personalization > Commands)
  • Select the Group that you want to import the Commands into or Create a new Group by clicking the ADD button.
  • Right-Click the Group and select the Import button
  • From the Import Commands window, select the Commands file (.fdc or .xml) and click OK.
  • Your imported commands will then be available in that group.

Export Commands from All Groups 

  • From the FD Control Bar, select Commands (10.0.400 and below select Personalization > Commands)
  • Right-Click any Group and select the Export Allbutton
  • From the Export Commands window, name the Commands file (.fdc) and click Save.

Export Commands from Selected Group

  • From the FD Control Bar, select Commands (10.0.400 and below select Personalization > Commands)
  • Select the Group that you want to export the Commands from.
  • Right Click the group and select Export Commands in this groupfrom the menu.
  • From the Export Commands window, name the Commands file (.fdc) and click Save.

Export Individual Command

  • From the FD Control Bar, select Commands (10.0.400 and below select Personalization > Commands)
  • Select the Command that you want to export in the Commands frame.
  • Right Click the command and select Export from the menu.
  • From the Export Commands window, name the Commands file (.fdc) and click Save.

Dragon Commands

For users transitioning from Dragon to Fluency Direct, you can export your Dragon Commands and Import them to Fluency Direct. Learn more here.

Published Groups and Commands

Published Groups and/or Commands are those groups or commands that have been published by an administrator for use across a company or facility.  These items will be available in the Commands dialog but will contain a lock symbol to the right of them.

When a Group or Command has been published, it is locked from both editing and deleting. Only an administrator can remove published items. 

Note:  For some published items such as Dictionary Items, Device Button mappings, and Data Set Items it is possible to modify them to a certain degree, For example, you can give your own pronunciation to a dictionary item. In some cases, you might want to revert that modification to the previous state published state. You can now do this via the “revert” context menu item available via right click. 

Search

The search option is available for you to search through your Commands As you type in the search term, the Commands will automatically filter out the terms that don't match.  As the filter is applied, if your search term is not available in a group, that group is also filtered out. 

 

 

 

Formatting

 

The Formatting option provides additional options related to the display and rendering of the dictation and draft text.  More options may be added in the future.   

  

Numbers starting a sentence

Choose numerical or spelled out.  

Numerical

3 days ago

Spelled Out

Three days ago

Numbers 1-9 mid-sentence

Choose numerical or spelled out.

Numerical

It started 3 days ago

Spelled Out

It started three days ago

Ordinal Format

Choose 1st, 2nd, 3rd or first, second, third.  Note if used at the beginning of a sentence, it will be spelled out and capitalized.

Abbreviated

1st, 2nd, 3rd

Spelled Out

First, Second, Third

Range

Select the display of numerical ranges: 1-10, 1 to 10, or one to ten

Dictated Phrase 

She drank eight to ten cups of coffee per day.

Symbolic

8-10

Written Spelled Out

eight to ten

Written Numeric

8 to 10 


Measurements

Select Abbreviated (cm) or Expanded (centimeters) for how measurement abbreviations should be displayed.

Dictated phrase 

8 millimeters 

Abbreviated 

8 mm 

Spelled out

8 millimeters

Temperature

Choose to display the degree symbol “”or the text “degree”

Dictated Phrase 

A: temperature is ninety-six 

B: temperature is ninety-six degrees 

Textual if dictated 

A: temperature is 96 

B: temperature is 96 degrees 

Symbolic if dictated

A: temperature is 96 

B: temperature is 96° 

Textual (word 'degrees')

A: temperature is 96 degrees

B: temperature is 96 degrees

Symbolic (degree symbol) Always 

A: temperature is 96°

B: temperature is 96° 

Percentages

Choose to display the percent symbol” %” or the text “percent”

Percentage Symbol 

30% 

Text Format

30 percent 


Date 

Select the format that you wish to see dates appear in your dictation

Dictated Phrase 

January second two thousand nine 

As Dictated 

January 2, 2009

Alphanumeric (Ordinal Day)

January, 2nd, 2009 

Alphanumeric (Long form, day comes before month) 

2 January, 2009

Alphanumeric (Ordinal Day, No comma)

January 2nd, 2009

Numeric (Separated by Slashes, 4-digit yrs)

01/02/2009

Numeric (Separated by Slashes, 2-digit yrs)

01/02/09

Alphanumeric (Short)

Jan 2, 2009

Alphanumeric (Long)

January 2, 2009

Alphanumeric (Short form, no comma)

Jan 2 2009

Alphanumeric (Long form, no comma)

January 2 2009

Time 

Select the format that you wish to see times appear in your dictation. You can choose 12hr or 24hr format.

As Dictated 

ANY FORMAT 

Numeric 12h 

HH:MM AM/PM (1:00 PM) 

Numeric 24h 

HH:MM (13:00) 

Military time 

HHMM hours (1300 hours)


Paragraph Spacing

Set the number of <Return>; key presses that will be inserted when you say “New paragraph.”   Single or Double (default).    

 

Number of spaces after a list item

Set the number of <Return>; key presses that will be inserted after each list item, one (1) or two (2).   

 

 

 

Medical Specialty

Users can select their Medical Specialty to optimize the vocabulary for the types of documents you will be dictating. Fluency Direct focuses on the physician's medical specialty which offers improved recognition. While only one specialty can be chosen at any given time this shouldn’t be thought of as limiting one’s vocabulary, but rather adjusting the statistical model around one’s specialty.

Select Medical Specialty

Select your specialty by scrolling through the options or searching in the search bar. Once selected, click OK to save and exit. 

 

Search

The search option is available for you to search through the available medical specialties. As you type in the search term, the list will automatically filter out the specialties that don't match.  

 

 

Device Buttons

Using the Device Buttons option allows you to assign specific actions to buttons on your recording device.  

 

Select Device button  from the Control Bar menu, to bring up the Manage Device Buttons screen.

 

Add New Action

To add a new device button action, click on the Add button in the top right corner.

 

The Add a Device Button Action window will appear

Click in the Device Button field and then press the device button (i.e. EOL button on your Phillips SpeechMike). 

Choose the Action Mode for that button.

  • Recording Mode allows you to select Standard Recording, Text Only Recording, or Command Only Recording.
  • Command Mode allows you to enter a Command that will be performed when that button is pressed.  To enter the Command, start typing the command name, the list will populate with all commands matching.  You can select from your complete list of Commands.
  • Keystroke Mode allows you to assign a specific keystroke to that button.  Ex. CTRL+P.

Edit Action

To edit an existing device button action, click on the action you wish to edit to open the Edit dialog.  From this window, you can change the Device Button or the Action assigned to the button. Click Save to exit with the new changes.  

Warning

You may be presented with a warning that the action cannot be modified.  This will happen if it is the only button assigned to a required action for that device.  For example, you cannot have a device that does not have a Record button assigned.

Locked Action

If an action is inherited and the lock icon is shown, the action can be opened and viewed, but will be disabled for editing, as seen below.

 

Delete Action

To delete a device button action, click on the X located at the end of the selected action.

 

Search

The search option is available for you to search through your device button actions. As you type in the search term, Fluency Direct will automatically filter out the actions that don't match.   

Olympus RS31 and RS32 Support

Fluency Direct allows you to set up device button actions for your Olympus RS31 and RS32 Footpedal and Hand Controller in the same way that you define the button actions for you microphone.

Once you have installed your foot pedal or hand controller, click the Add New Action button.  The Add a device button action window will appear. From here, click in the device button field and then select your footpedal (right, top, left) or hand controller (right, center, left). You'll notice that the device button field will display a hand or foot depending on the controller set.

  

 

 

Profile Training

Training your voice profile, or enrollment, is a simple process that only needs to be completed one time.    Once you login as a new user, you have the option to complete the enrollment process after you have selected and calibrated your microphone, during the Initial Personalization Wizard.  This is recommended for best recognition results, but is not required to run the program. Training your profile should take only a few minutes to complete.

Once you are ready to train your profile, click the Begin button. The Profile Training screen will display a series of paragraphs for you to read. As you complete each paragraph, the system will move to the next one. You can also click OK to move on. 

Once complete, you will be notified that you have completed your profile training and you can click the Finish button to exit. 

 

 

 

Data Sets

Data Sets are collections of data that can be used for a variety of functions such as scripting, command variables, field values, and more. 

Data sets are identified by their name (first column) and usually consist of multiple values (displayed in the second column).

If all of your values do not appear, don’t worry!  The display will only show the values that fit in the window.  Clicking on the data set will display all values.

Opening Data Sets

Data Sets is considered an Advanced Function and can only be accessed using the Shift+Click on the Control Bar.  You can then select Data Sets form the Personalization menu. (10.0.400 and later will display in the main menu).

Add New Data Sets

To add a new Data Set, click on the Add button in the upper right corner.

  • Enter the Name of the Data Set.
  • Enter the Values of the Data Set.
  • Each value will be entered one at a time, then click the Add button.  Once added, the values will appear in the box below. You can add as many values to your data sets as you need.

Click Save to finish.  Cancel will exit without saving your Data Set.

Edit Data Sets

To edit an existing Data Set, click on the name.  The Edit Data Set dialog will open.  From here you can change the Name of the Data Set, Add new values or delete existing values.  You cannot edit an existing value.

Delete Values

To delete a value, hover over the value and an “x” will appear at the end of the value row. Click the “X” to delete the value.

Delete Data Set

To delete a data set, hover over the desired data set and an “x” will appear at the end of the row. Click the “X” to delete the data set.

Search

You can search Data Sets by the name or any value.  If a value is listed in multiple Data Sets, they will all be displayed for you to choose from.

 

 

Dictation

Fluency Direct's ease of use makes it the preferred tool for medical professionals.  The following features will help you utilize Fluency direct during your dictation.  

Dictation Target: Allows you to select the dictation target using specific voice commands.

Speech Box: An integrated application that allows you to dictate into and then transfer the text to any application.

Playback Dictation: Allows you to playback all the audio associated with the text box that currently has focus.

Spell Mode: Allows you to check and correct the spelling of a word from Speech Box, EHR’s, the Dictionary, or from the Correction dialog. 

Error CorrectionIn-Line Correction or Error Correction Pop-up; Fluency Direct allows simple and quick corrections during dictation that won't slow you down.

Send to Transcription: Allows users to choose to self-edit or send their recent dictation directly to the transcription pool.  In addition, the Record for Transcription feature allows users to record and send directly to the transcription pool.

Speech Commands:  Built-in Fluency Direct commands can be used within most text editors.

Best Practices: Fluency Direct Best Practices help users to get the most out of their experience using Fluency Direct.

 

 

 

Dictation Target

Fluency Direct allows you to select the dictation target using specific voice commands. Setting a dictation target allows you complete control over your screen. By utilizing this feature, you can keep your EMR, image viewer, etc. front and center, covering the actual report. This allows you to focus on detailed patient information without having to move the report on the screen.   

Speech Commands to Set Target

  • Set target window
  • Set target window here
  • Set this as a target window
  • Target this window

Speech Commands to Cancel Target

  • Cancel target 
  • Clear target 
  • Remove target 

 

Target windows include Notepad, WordPad, MS Word, EMR's, etc.  

 

Target Commands are not recognized for non-targetable windows like Chrome, Firefox, Notepad++, Citrix apps, etc.  

 

Once a target window has been set, it is displayed above the Control Bar.  Dictation will be inserted into the target application. After cancelling a Dictation Target, dictation will be inserted into the active window.

 

 

 

Speech Box 

The Speech Box is an integrated application that allows you to dictate into and then transfer the text to any application.  The Speech Box comes in handy when an EMR does not have full support for Fluency Direct navigation, editing, and formatting commands. Speech Box can also be used when a user wants to collect their dictated documentation in one place while browsing the EMR for past medical documents, lab results, etc. In this mode, users can target dictation regardless if it is the active window on the desktop.Speech Box provides a standard dictation environment with a pre-defined set of commands.

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WorkFlow

The Speech Box should be used anytime the user would like to enter a body of text into a text box within the EMR.  The user should start by mouse-clicking in the EMR text box where they would like the text to end up.  Invoke the Speech Box, then dictation can begin, text can be edited with voice commands, voice-activated templates can be brought in and fields can be filled out.  When the body of text is complete, the user can then transfer text into the EMR.  The process repeats with the next EMR text box.

Modes

There are two modes to the Speech Box; In-Line and Floating.  Depending on how you dictate will determine the best method for you. 

In-Line

In this mode, the Speech Box will capture dictated text and then transfer the dictated text into the application where the cursor was previously located. 

This mode prevents the user from moving the cursor focus to any other window including those from other applications. This ensures that dictated text in the Speech Box could safely be transferred into the text editor where it was launched from. 

Floating

For some users, the ability to be able to access other applications or launch different windows in the existing one while the Speech Box is open is important. This is when you would use the Floating Speech Box. When the user transfers the dictated text, it will transfer to the text editor that has focus AT THAT TIME.  This is important because if you are switching between multiple applications, you need to be sure you have focus on the correct application before transferring the text.

Floating Dictation Target

While the Speech Box is Floating and set as the dictation target a message is shown stating that all text will be inserted into it regardless of focus. The Fluency Direct Control Bar > Dictation Target will also shows "Speech Box" as the current target of dictation.  You can cancel the dictation target by clicking the 'X' on the control bar or clicking on the "cancel dictation target" link on the Speech Box. The dictation target will also be cleared after the Speech Box is closed and text has been transferred.

Speech Commands

Fluency Direct allows you to select the dictation target using specific voice commands. Setting a dictation target allows you complete control over your screen. By utilizing this feature, you can keep your EMR, image viewer, etc. front and center, covering the actual report. This allows you to focus on detailed patient information without having to move the report on the screen.   Once a target window has been set, it is displayed above the Control Bar. Dictation will be inserted into the target application. After cancelling a Dictation Target, dictation will be inserted into the active window.

Click here for Speech Commands

Opening the Speech Box

There are several ways to access the Speech Box.  These configurations can be used for defining how to open Speech Box in either mode as well.

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  • Menu
    The Speech Box replaces the built-in-editor found in the menu section. Click on your name on the FD control bar. By clicking on Speech Box, it brings up the floating Speech Box.

  • Config File
    You can define the Speech Box to auto launch when “record” is activated while the focus is on a defined text editor.  For example, you can define it to activate whenever a user attempts to dictate into NotePad. 

  • Speech mike Button
    You can map a specific button on your SpeechMike to open the Speech Box. The first button press will open Speech Box in In-Line Mode. Double pressing will convert it to Floating Mode.

    NOTE: If you open the Speech Box in the In-Line mode and dictate then press the Speech Box button again, the Floating mode will become active and the dictated text will still be available. 

  • Voice Command
    You can say “Show Speech Box” or "Open Speech Box" and the Speech Box will open.  This will most likely be used by headset users.  

Transfer Text

The Transfer Text command will transfer the dictated text captured by the Speech Box into the target editor.  When using In-Line Mode, the text is inserted in the last location of the cursor.  When using Floating Mode, the text is inserted at the location you have selected. The Speech Box will close automatically after the text has been transferred. 

Transfer Text:

  • Map a SpeechMike button to the command “Transfer Text”
  • Say “Transfer Text”
  • Click the Transfer Text button in the Speech Box

Recall Text

The Recall Text button is available only after you have used the Transfer Text command to transfer text from Speech box to another application.  This feature prevents you from losing your text by allowing you to recall the text back into the Speech box.

Transparency

Using the Transparency slider in the bottom left of the Speech Box, you can adjust the transparency level of the Speech Box.  this feature allows you to dictate into the Speech Box while having document(s) open behind the Speech Box, still visible.

 

 

 

Playback Dictation

The Playback Dictation command allows you to playback all the audio associated with the text box that currently has focus.  There is a slide that can be dragged throughout the audio's length in order to skip ahead or go back without starting from the beginning.  

Playback Dictation only supports what is dictated in the text box that currently has focus. You can to move around between multiple text boxes and playback audio in each.  Fluency Direct will retain audio for playback for 30 minutes.

 

 

 

Spell Mode

Spell Mode will allow you to check and correct the spelling of a word from Speech Box, EHR’s, the Dictionary, or from the Correction dialog. The Spell Mode dialog box will pop up and you can dictate or type in the correct spelling of the word. The Spell Mode works like the Correction Dialog but is limited to spelling only and does not present an option to save it to one’s dictionary.  This may be useful when needing to dictate a proper noun that is used infrequently.

Enable Spell Mode

Use any of the following speech commands

  • Spell
  • Spell Mode
  • Spell That

Speech Box or EHR

 

Dictionary Dialog

 Correction Dialog

 

 

 

 

Error Correction

There are two ways to perform error correction with Fluency Direct: In-Line Correction using the phrase “Select <text>” or using the phrase “Correct Selection” to open the Error Correction Window. 

In-Line Correction

In-line correction only makes a change to the text in the current documentation.  On occasion, Fluency Direct might misrecognize a spoken word or phrase.  This misrecognition is not necessarily because a word or phrase is missing from the underlying vocabulary domain or user dictionary, but could be because of other factors such as background noise or spoken tone.  To perform in-line error correction, you can select the text that you want to correct and then speak over the text with the desired phrase or correct using the keyboard and mouse.  

Example:

Dictate your text; see the error…

Speak “Select Fibroma” or use the keyboard and mouse to highlight text…

Speak “Fibromyalgia” and the text is replaced.
Alternately, you can delete the selected word and type in Fibromyalgia to complete the In Line Correction.

 

Error Correction Window

If you routinely notice the system making the same errors repeatedly, there might be a problem with the underlying vocabulary domain.  The misrecognized word or phrase might not be part of the domain or the domain has never seen the desired word or phrase before in the existing context, such as a physician's last name or a hospital name.  By using the error correction window, you can force Fluency Direct to learn new words and phrases to react properly every time the newly learned utterance appears in dictation. 

Example:

Dictate your text; see the error…  

Speak “Select Fibroma” or use the keyboard and mouse to highlight text…  

Speak “Correct Selection” to trigger the error correction dialog.  The Error Correction dialog will appear… 

Fluency Direct will display suggestions based on the word being corrected.  From here, you can select a replacement option suggested by saying “Choose 1,” “Choose 2,” “Choose 3,” and so on. 

The suggested replacements are derived from a list of words detected with a phonetic similarity and in a similar context.  Over time, information is gathered regarding the specific speech patterns of the dictator as well the context of words previously spoken.  In this way, the system learns not only from enunciations, but also learns from the historical context of words used by the document author. 

If none of the suggestions meet your needs you can type in the correction dialog using the keyboard. 

As you make changes to the word or phrase, and that word or phrase is not available in the current vocabulary domain, you will be given an option to check and edit the pronunciation, to improve recognition.  Selecting the category of the term will also improve future recognition. 

Say “Save” or click the Save button to finish.

 

Formatting Commands

For Versions 10.0.400 and higher, the Correction dialog has formatting commands available.  If the user is in an editor that supports formatting then these commands will be enabled as "blue" and a user can speak them while this dialog is displayed.

Correction.10.0.400

 

 

 

 

Send to Transcription

NOTE: This is an optional feature within Fluency Direct and is only available for customers also using Fluency for Transcription.

The Send to Transcription feature allows users to choose to self-edit or send their recent dictation directly to the transcription pool.  In addition, the Record for Transcription feature allows users to record and send directly to the transcription pool.

Finalized text is delivered back to the EHR in two different ways:

  1. Complete document delivery via HL7 interface
  2. Delivery via database update via text based marker (partial dictation workflow).

Send To Transcription

This feature checks which control you have your cursor on. If it is a text box that has had audio recorded into it, then it will load this audio into the Send To Trans window. You can then play it back as well as record new audio. All new audio is appended. The window will "point" at the associated text box. If you switch focus to a different window then the point is removed and will not return.

Record For Transcription

Brings up the window without loading any audio. No yellow banner on top.

  • There should be a watermark on the Patient MRN and Patient Name text boxes. it will go away when you type in the box.

  • You should be unable to click send until you have typed a name and an MRN

  • Clear Audio should delete all the recorded audio from the recording control. You can then record new audio if you want.

 

 

 

 

Fluency Direct Speech Commands

 

The following is the list of built-in Fluency Direct commands that can be used within most text editors.

Editing Commands

Selection

COMMON COMMAND

ALTERNATIVE COMMANDS

select <written word/text>

select all

select next word (sentence, paragraph)

select next <number> words 

select previous word (sentence, paragraph)

select previous <number> words 

select next

select next one
next one

select previous

select previous one
previous one

select <word> through <word>  

unselect that

unselect text
clear that
clear selection

Correction

COMMON COMMAND

ALTERNATIVE COMMANDS

correct (written word/text/last utterance if no text selected)

correct that
correct selection

correct <word> through <word>  

choose one (two, three, etc)

 choose option one (two, three, etc)
show spell mode spell mode
switch to spell mode
spelling mode

Deletion / Undo

COMMON COMMANDALTERNATIVE COMMAND

delete that

delete selection

delete next word
delete previous word

delete next <2-10> words
delete previous <2-10> words

delete sentence

delete current sentence
delete next sentence
delete previous sentence

delete paragraph

delete current paragraph
delete next paragraph
delete previous paragraph

undo that scratch that
undo command
undo last command

 

Cut / Copy / Paste

COMMON COMMAND

ALTERNATIVE COMMANDS

cut that

cut selection

copy that

copy selection

paste that

paste selection

 

Formatting Commands

Capitalization

COMMON COMMAND

ALTERNATIVE COMMANDS

lowercase that

lowercase selection

uppercase that

uppercase selection

capitalize that

cap that

capitalize selection

cap next <single word>  
all caps on (off) caps on (off)

 

Text Formatting

COMMON COMMANDALTERNATIVE COMMANDS

bold that

bold selection

italicize that

italicize selection

underline that

underline selection

Navigation Commands

Text Navigation

COMMON COMMAND

ALTERNATIVE COMMAND

scroll up

 

scroll down

 

scroll to cursor

 

scroll to selection  

insert before <text>

 

insert after <text>

 

new line next line
new paragraph next paragraph

go to the beginning of the sentence / paragraph / document

jump to...
move to...
place cursor at...

go to the end of the sentence / paragraph / document

jump to...
move to...
place cursor at...

 

Field Navigation

COMMON COMMAND

ALTERNATIVE COMMANDS

next / previous field

go to..
jump to...
move to...

next / previous empty field go to..
jump to...
move to...

first / last field

go to..
jump to...
move to...

first / last empty field go to..
jump to...
move to...

remove all fields

 

 

User Interface Commands

COMMON COMMAND

ALTERNATIVE COMMANDS

All Fluency Direct Dialogs

All Buttons and Links


Save, OK, Apply, Cancel, Search, Send, Next, Back, Help, Close, Exit, etc.

Open Dialogs Open <Dialog Name> 
Show <Dialog Name>

EX: Show Dictionary
Sign out of Fluency Direct Sign off of Fluency Direct

Quick Add Commands

add to dictionary 
add an abbreviation
add a command 
add...

These commands will open the add dialog for Dictionary, Abbreviations, and Commands, etc.  When text is selected, that text will be pre-filled.  If no text is selected, the dialog will be blank.

save this text Creates a Command populated with the selected text.

Dictation Target

set target
set dictation target
set target window

Target windows include Notepad, WordPad, MS Word, EMR's, etc.

Target Commands are not recognized for non-targetable windows like Chrome, Firefox, Notepad++, Citrix apps, etc.

clear target
cancel target
remove target 
stop using target

 

Send To Transcription

send to transcription

For more information, go to Send Transcription.

record for transcription  

playback dictation

 

Speech Box

open speech box

show speech box

open floating speech box

show floating speech box

open speech box on top

show speech box on top

open hidden speech box show hidden box

transfer text

 

 

Punctuation & Symbols

COMMON COMMAND

ALTERNATIVE COMMANDS

colon

 

semi colon

 

open parentheses

open paren
left paren
left parentheses

close parentheses

close paren 
right paren
right parentheses

open quotation

open quote 

close quotation

close quote

period

full stop

slash

 

question mark

 

exclamation mark

 

point

 
comma  

 

Recording Controls

COMMON COMMAND

ALTERNATIVE COMMANDS

go to sleep

stop recording

wake up

listen to me
start recording

 

Additional UK Commands (En-gb language)

COMMON COMMAND

 ADDITIONAL COMMANDS

open parentheses

Brackets

Open brackets

Open bracket 

Close parentheses

Brackets close

Close brackets

Close bracket


End of parenthesis

End parenthesis

End paren

Close parenthesis

parenthesis

Open quotation

Open quotation marks


Open inverted commas

Open speechmarks

Close quotation

Close inverted commas

Close speechmarks 


Close quotation marks

unquote

Slash Stroke 

 

 

Best Practices

Fluency Direct Best Practices help users to get the most out of their experience using Fluency Direct. Utilizing the following practices will ensure a favorable experience and avoid unwanted errors or outcomes.  

 

Best Practices & Critical Success Factors in the FAQ

Dictation Best Practices

 

 

 

 

 

Help

Online Help

Clicking the Online Help will open the Fluency Direct Help Site.  From here you can view the Help files specific to the version of Fluency Direct that you are running. Watch a video about Seeking Help.

System Check

The System Check option will perform a diagnostic of your current system and provide you with the Versions, Microphone, Authentication, and Workstation properties that you are running.

Submit Feedback

The Submit Feedback option will allow you to send an email to our Product Development Group offering specific feedback and comments regarding the applications features, functionalities, and overall use.  This option is not to be used for support or service.

About

This option will display the Fluency Direct SplashScreen, which provides information regarding the current installation, and version number, which is required for support tickets.

 

 

 

System Check

The Fluency Direct System check will perform a quick diagnostic, checks configuration and network resources of an FD installation to provide you with information about the Versions, Microphone, Authentication, and Workstation.  This can be especially useful for IT and troubleshooting.  To open the System Check, select Help > System Check from the Control Bar drop-down menu.

 

Versions

Fluency Direct

Current installed version of Fluency Direct

AMCC

Current installed version of AMCC

CAPD

Current installed version of CAPD, if installed

 

Microphone

 

Selected Microphone Displays currently installed microphone.
Firmware Version  Displays the firmware version of the selected microphone.
Saved Gain  Displays the saved gain of the selected microphone. 
Starting Gain  Displays the starting gain of the selected microphone at most recent start of recording.
Current Gain  Displays the input gain of the currently selected microphone. 
Restore Gain Setting Yes (Y) or No (N) to restore the microphone gain setting when not recording.
 Dynamic Gain Adjustment Option to automatically adjust microphone gain to optimum levels. 
 Audio Relay Server URL Displays the Audio Relay Server URL.
Audio Relay Server Connected True if connected, False if not connected.

 

Authentication

 

CDS Authentication  Will display if the CDS Authentication has been authenticated successfully or not. 
CDS URL  Defines the Base Endpoint URL for the Server Connection to the MModal Data Center.
CDS Account  Customer FD Endpoint within the provided MModal Data Center.
CDS Home

Defines the CDS Home URL for the Server Connection Server Connection to the MModal Data Center.

 

Recognizer

Active Recognizer  Displays the domain ID 
Downloading Recognizer  Displays the recognizer that is downloading, if applicable.
Connection State  Displays the connection state, local or remote
Session ID   Displays the Session ID Number
 Channel  Displays the channel number for the recognizer
Version   Displays the version number of the recognizer
Language  Displays the language being used. English "en-us" is default
Active Group   Displays the active group if applicable
Recognizer State  Displays the state of the recognizer
Safety Mode  Displays if Safety Mode is enabled (local recognizer) or disabled (remote recognizer)

Text Editors

This table will list all the text fields that user has ever dictated into.  For example:

EDITOR CONTROL HANDLER
Chrome_WidgetWin_1 ApplicationDefault 
Edit ApplicationTextField 

Virtualization

Connector Version  Displays the connection version if available
Last Used On   Displays the date the connector was last used on
 Citrix Version  Displays the Citrix version number
 Citrix Driver DLL Date  Displays the Citrix Driver DLL Date
 Citrix with Connector On Displays if Citrix with Connector is on 
Citrix without Connector  Displays if Citrix with Connector is on 
RDP Version  Displays RDP Version number
RDP Driver DLL Date  Displays RDP Driver DLL Date 
RDP with Connector On Displays if RDP with Connector is on
RDP without Connector Displays if RDP without Connector 

Workstation

Name Displays the computer name 
Terminal Server Session True (Enabled) or False (Disabled if the terminal server session is enabled 
Host Displays the host name 
Operating System Displays the operating system name
Operating System Word Size Displays the operating system word size.
Ex: {32-bit|64-bit}| |
|Process word size|{32-bit|64-bit}
Processor Displays the processor
Number of Processors Displays the number of processors present
Number of Physical Cores Displays the number of physical cores present
Number of Logical Cores  Displays the number of logical cores present
Total RAM Displays the total RAM
RAM in Use Displays the total RAM in use
RAM Remaining Displays the total RAM remaining
Free Disk Space Displays the free disk space
Storage Manager Displays the storage manager information
FD Benchmark Score Displays the Fluency Direct Benchmark CPU Score

 

CAPD

Enabled   Displays if CAPD is enabled
Installed and Loaded  Displays is CAPD is installed and loaded 
Endpoint Configured  Displays if CAPD endpoint has been configured, if not default settings will be used.
Run Silent  Displays if CAPD has been configured to run silently; if not configured, all messages will be displayed as they come in.
Windows Title List  Displays if you have a configuration for a whitelist or blacklist of window titles setup in CAPD.  If not, all window titles will be evaluated.
Windows Process List  Displays if you have a configuration for a whitelist or blacklist of window processes setup in CAPD.  If not, all window processes will be evaluated. 

Refresh

The refresh button will refresh the information in the window.

Copy Results

The Copy Results button will copy the properties for the category selected to your clipboard.  You can then paste the results into a text editor to be used as needed.  

Close

The close button will close the System Check window. 

 

 

 

Activity Log

This Activity Log window is meant to aid in debugging FD issues related to commands, replacement rules (abbreviations) and other real-time information.

 

To open the Activity Log, you will need to SHIFT+Click on the Control Bar. and go to Help > Activity Log.

Once opened, the Activity Log will immediately begin capturing information until it is closed or Fluency Direct is closed. 

To capture the Activity Log, you can click the Copy Results button.  This will copy your log information to your computer's clipboard, allowing you to paste it into a text editor or the Submit Feedback window.

The window will automatically scroll as information is logged.  All information will be logged in chronological order.

Note: you can control the transparency in the same way as the SpeechBox, allowing it to run in the background, unobtrusively.

 

 

Send Feedback

The Send Feedback option allows you to send a message to M*Modal, detailing an issue you are experiencing with Fluency Direct. The Feedback option is truly meant to report chronic recognition issues or offer suggestions to improve Fluency Direct. General questions and concerns should be directed toward your local Admins and trainers. Should you experience an issue where you are unable to dictate, please contact your local Admins or Support staff for immediate attention. They will followup with M*Modal Support to expedite the resolution process.  

To access the Send Feedback option, Select Help > Send Feedback from the Fluency Direct Control Bar with your name on it.

Fluency Direct tracks the last several words and commands you have said and allows you to select the utterance(s) causing a problem, if needed.

Occasionally, additional information may be needed to resolve your issue, if you select Yes, a support technician may contact you for additional details.  If you say no, additional information will be requested through your account manager.  Click Send to submit your feedback or Cancel to close without sending. 

 

Recognition Feedback

Select the Issue Type (Substitution, Deletion, Insertion, Command Execution, Other) then select the Issue Theme (Short words, Singular vs Plural, Tense, Homonyms, Compound Words, Medications or Medical Procedures, or Other). You can select your utterances by clicking on the checkbox. additional information can be provided in the Message box.

 

Formatting Feedback

Select the Issue Type (Spacing, Capitalization, Punctuation, or Other) that you are experiencing an issue with.  Select your utterances by clicking on the checkbox. additional information can be provided in the Message box. 

 

General Feedback

For general feedback that isn't Recognition or Formatting, you can provide details of your issue in the Message box. This is vital in helping M*Modal better understand your concern. Here, you can also ask questions about functionality and use.

 

Best Practices

  • Ensure you are reporting a chronic recognition issue.
  • Do not submit repetitive feedback tickets – i.e. only submit feedback once or twice, even is the issue happens 100 times.
  • Direct general questions and concerns toward your local administrators/trainers or your Fluency Direct Adoption Specialist.
  • Should you experience an issue where you are unable to dictate, please contact your local administrators/trainers or your Fluency Direct Adoption Specialist.
  • For word misrecognition, follow these steps prior to submitting feedback:
    • Add the misrecognized word to the Dictionary
    • If the misrecognized word is already in the Dictionary, modify the pronunciation by adding your own recorded pronunciation
    • Make in-line edits to the misrecognized word using the mouse and keyboard, or built-in FD edit commands (i.e. “select <text>” or “correct <text>”)
  • For command misrecognition, follow these steps prior to submitting feedback:
    • Dictate the command name, rather than typing the command name
    • Ensure the command name starts with an action word
    • Ensure the correct command name is being stated as it is named
  • For a formatting concern, follow these steps prior to submitting feedback:\
    • Ensure the microphone icon on the control bar is green rather than blue, yellow, or red
    • Determine if a replacement rule can be created
      • E. I dictate “anticoagulant,” but FD outputs “anti coagulant.”

  • Additional information may be needed to resolve your issue, please select “Yes” for a support technician to contact you for additional details, if applicable.
  • Describe your issue in the message block for the 3M|MModal team to have more details around the issue you’re experiencing
    • Ensure the microphone icon on the control bar is green rather than blue, yellow, or red
    • Determine is a replacement rule can be created
    • Fluency Direct tracks the last several words and commands, so select the utterance(s) causing a problem, if applicable

 

Contact Support

If you need help with the Fluency Direct application, please contact Fluency Direct Support.

24x7x365
1.888.290.2001

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Computer Assisted Physician Documentation (CAPD) 

Introduction

Completely integrated into Fluency Direct and the physician's documentation process, Computer Assisted Physician Documentation (CAPD) enables real time feedback based on content of notes created by any modality - templates, typing, text macros, copy/paste, or front-end speech recognition. Feedback is based on enabled Natural Language Understanding (NLU) applications, which are configured in M*Modal's cloud-based NLU platform, M*Modal CatalystTM

Workspace

Control Bar

After opening the Fluency Direct application, the Control Bar will appear on the desktop.

You can drag the Control Bar to any location on the screen, or you can dock it on any edge of the screen, whichever you prefer. To dock the Control Bar, click and drag to a screen edge (the screen edge will become highlighted when you near it). Drop it where you want the Control Bar to be docked. Fluency Direct will remember the location of the Control Bar and will open in the same position each time you log in.

Ribbon

The Ribbon on the Control Bar is where CAPD interactions will occur. The number indicates how many CAPD messages are available.  

New CAPD messages will accumulate in real time as they are triggered based on the physician's documentation. A status indicator will notify the user if messages are up to date or currently being processed. Messages can be viewed in two different ways, in the "Drawer" or "Sidebar."

Drawer

Click the Ribbon to open the CAPD Message Drawer. The drawer can be used with the Control Bar in floating, docked, or micro mode. The Drawer can be closed by clicking the ribbon or arrow at the bottom of the drawer.

Sidebar

The Sidebar is a CAPD interface which presents messages to a Fluency Direct user in an always viewable fashion. When activated, open windows will automatically resize so that content is not hidden behind the Sidebar. Sidebar can be activated by dragging the Pill to the upper left or upper right hand corner of the screen and releasing when you see the translucent blue indicator. The Sidebar can be deactivated by dragging the pill from its docked location.

Message Balloon

The drawer and the ribbon are designed to be more subtle than the sidebar while showing messages to the users. While the drawer is closed, a message balloon will appear next to the Pill to show a quick preview of a new message that will be added to the drawer. While the drawer can be opened to see the full message details, the message balloon will only show the title of the latest messages added to the drawer.

 

Example

One CAPD NLU Application, CDI Engage, focuses on the most common documentation deficiencies according to coding and billing requirements.  CDI Engage messages will communicate how to satisfy best practices.

If the following text is documented, 

“The patient is a 54-year-old woman with chronic kidney disease."

CAPD will trigger a CDI Engage message for underspecified Chronic Kidney Disease (CKD):

By fully specifying the condition, the message will be resolved and disappear from the Sidebar or the CAPD drawer. The text can be edited using Fluency Direct, or with your keyboard.

“The patient is a 54-year-old woman with a chronic kidney disease stage I.”

The text triggering the message can be edited as shown above, or you may fully specify later in the document, for example:

"The patient is a 54-year old-woman with chronic kidney disease.

...

Impression: Chronic Kidney Disease Stage I.  "

Please note that in order to resolve the message, you must specify the condition within the same document.

CAPD NLU Application - CDI Engage

Part of the M*Modal CDI One solution, CDI Engage is an NLU Application focused on automatically identifying the most common documentation deficiencies at time of documentation capture. By providing real-time feedback to physicians, CDI Engage aims to improve quality of clinical documentation and reduce the number of concurrent (CDI) and retrospective (coding) queries by educating physicians of the documentation requirements at the time of report creation. Feedback will be based on the content of the current document being created. Categories of such feedback includes,

  • Top CDI Conditions
  • Abnormal Lab Results
  • Joint Commissions Do Not Use Dangerous Abbreviations
  • Temporal Copy / Paste Identification 

 

Top CDI Conditions

CAPD messages for the following conditions will be geared towards documentation requirements for ICD-9 and ICD-10 coding and billing requirements.  By providing real-time feedback on best practices, physicians have the opportunity to correct and complete documentation while it is being created, preventing the need for downstream CDI or Coding queries. 

CARDIOLOGY

Acute Coronary Syndrome 

Atrial Fibrillation/Flutter 

Cardiomyopathy

Heart Failure 

Hypertension 

Cor Pulmonale 

RENAL

Acute Renal Failure 

Acute Tubular Necrosis 

Chronic Kidney Disease 

End Stage Renal Disease 

ENDOCRINE

Diabetes Mellitus 

RESPIRATORY 

Pneumonia 

Respiratory Failure 

SEPSIS 

Urosepsis 

Sepsis/Sirs 

Septic Shock

Sepsis Syndrome

Urinary Tract Infection 

NEUROLOGICAL 

Stroke

Level Of Unresponsiveness

Residual Hemiparesis 

Ataxia

Brain Hemorrhage

Hyrdocephalus/Vp Shunt 

Aphasia

Concussion 

NUTRITIONAL DISORDERS

Malnutrition

Obesity 

 ORTHODPEDICS

Fracture

Stress Fracture 

Pathological Fracture 

Spondylosis

SIGNS AND SYMPTOMS

Chest Pain 
Abdominal Pain 
Syncope

SURGICAL 

Debridement 

Transbronchial Biopsy

INTEGUMENTARY 

Pressure Ulcer 

Primary Ulcer

Skin Lesion 

LABORATORY 

Electrolyte Imbalances 

Acidosis/Alkalosis 

HEMATOLOGY

Anemia

Blood Loss Anemia

 

GASTROINTESTINAL 

Appendicitis 

Colonoscopy

 

  

Dangerous Abbreviations

The following pieces of content have been created to identify Dangerous Abbreviations that are part of the list of "Do Not Use" abbreviations created by the Joint Commission and the National Patient Safety goal that they approved. Joint Commission requires that all of its accredited facilities comply with this list and its National Patient Safety goal. These abbreviations are identified by our NLP and the rules that have been put in place. Some abbreviations have special rules in place around lab result and vital signs to ensure the accuracy of the engine. The following items are the dangerous abbreviations that we now identify.

CC

UG

QD

QOD

U

IU

MGSO4

MS

SC/SQ

Trailing Zero

Temporal Word Copy / Paste

The purpose of this content is to be used, in conjunction with our CAPD functionality, to identify possible inappropriate use of temporal words in copy and pasted text within the electronic medical record. The pasting of temporal words may be overseen and can have an impact on the care the patient receives. The following items are included in the temporal word identification content. These words may have synonyms associated with them that are not listed below. For example, ‘day number’ also would identify ‘day #’, ‘POD’, ‘post-operative day #’, etc.

Today

Tomorrow

Yesterday

This Morning

Last Night

Overnight

Day Number

Extended Time

Tonight

Day(s) Ago

This Afternoon

Currently

Last Weekday Number of Hours