Need IT help. Internet slow at work.

[MossRoad]

Nothing. Management says they are going to double our speed through the ISP but no one has actually done anything. Lots of messages between IT folks but not one single thing has been done and now my daily speeds are down around 12 Mbps. But, these are the same IT people who are replacing my current laptop because of a software problem in Dragon that they can't figure out. This level of slackness and incompetence is a new experience for me. Never seen anything like it.

Did you ever find out if all of your traffic is heading back to your corporate office through a private network (VPN or similar), and that would make your corporate IT your ISP. As I mentioned before, I'd wager THEY are the bottleneck, and not the company that is providing the physical connection. They can give you a gigabit pipeline and you'll still be mud because they're throttling you to a low speed at corporate to save on data costs.

At my old employer, we OWNED an entire fiber between us and our corporate offices. We were moving data between us and them at gigabit speeds and we had 100mb to the internet. When corp took over all IT ops, they flipped the connections so now we had to go THROUGH them to get to the internet. They signed a contract with the ISP for limited data and then decided to throttle us to 10mb speeds for internet traffic. Good grief! Several hundred people in a news gathering organization limited to 10mb speeds! Just 2-3 people watching live news feeds would choke the entire operation.

I doubt you'll ever get a straight answer from them, but ask if you can how things are set up.

 

[N80]

I know who the ISP is (IT and management confirmed this). It is a private regional phone/communications company. They are literally the only game in town.

 

[MossRoad]

I know who the ISP is (IT and management confirmed this). It is a private regional phone/communications company. They are literally the only game in town.

Right. But even though they are the "ISP", that doesn't mean your corporate office isn't the ones controlling your bandwidth and acting as your ISP. Here's my lame analogy....

- It's like your county provides the road in front of your house (your internet company). Their speed limit is 30MPH.

- Your corporate office gives you a car to use on county roads, but limits its speed to 15MPH.

- Each and every time you need to drive somewhere, they make you drive all the way over to the corporate offices first, through their gate, do a security check on the entire contents of your car, then out another gate before you can begin your journey, all at 15MPH.

- And if they are doing packet shaping, and if your car contains soup(medical records), you can drive 15MPH. But if your car contains soup(medical records) and nuts(youtube squirrel videos), the soup can travel at 15, but the nuts are limited to 5. Even though the speed limit on the county road is 30.

Does that make sense?

 

[zmountaineer]

I manage the EMR for one hospital in the nations largest hospital system. I'm also a Dragon Medical Administrator. I can tell you that dragon over the Internet/Citrix is NOT worth trying. Yeah, it will work wherever your cursor is, but if it isn't installed on the same system as the EMR then it is going to run SLOW. Our EMR can be customized immensely. I make templates for just about all the providers. EWSR (dragon) works extremely well here and providers say they cannot live without it.

 

[JimRB]

Are you using the Dragon dictation box which does processing on the workstation and then does a bulk transfer of whatever you dictated? The practice I work for is gastroenterology where they make decent money and can afford to do scribes. A few doctors do not use scribes. We even have one younger doctor typing all his notes. One doctor talks to Dragon at a 100 word per minute or faster. I have not paid enough attention to see what his accuracy rate is. I cannot say that I have seen anyone but the guy that retired saying the statement "Correct that" in Dragon. Almost all the PAs are using Dragon without any odd speaking patterns.

 

[zmountaineer]

I teach all my providers to make commands that lets them do notes really fast. The exception would be ENT. They have no real standard that they go by and just rattle off a SOAP note. Most dictate directly into the note. Oncology is he only one that I know of that uses the dictation box. I have his set up at about 50% transparency and he flips around the chart with the box open while dictating.

 

[N80]

I do not think Dragon is running over Citrix now but apparently it is over the internet because I have to log onto Dragon and it seems that my Dragon profile resides somewhere other than my computer.

Dragon is fairly fast, but slower lately. I do talk fast and I do articulate (unnaturally) to improve accuracy.

I could not live with out Dragon either but still consider it the best of 3 poor options (type, check boxes or Dragon). Human transcription is by far and away the best, but most expensive, option.

Again, accuracy is pretty amazing but it simply is not up to the standard that a medical note should be. It has a hard time with medicine names. It has a hard time with prescriptions because they are a string of numbers and if you don't say something just right it will get the Rx wrong. In other words, I might say "change dose to 100mcg" and it will transcribe as "change dose 200mcg". Dragon gets "he" and "she" wrong all the time. I dictate "He is on lipitor which he takes daily" and it will transcribe "He is on lipitor which she takes daily". It has a hard time with numbers despite the various formatting options. I've been using Dragon for about 4 years now and these types of errors remain common.

Like many physicians who use Dragon my note template includes a header that says "This not was dictated using voice recognition software that is prone to transcription errors. Call me with any questions."

BUT......I'm used to all that. My problem now is that in our EHR (Athena) there are many dialog/selection boxes for medications, labs, tests, diagnoses. They work really well and populate with options as you type (like a search engine) which is awesome. But with the latest patch or whatever IT applied when I dictate into these boxes using Dragon, the EHR does not recognize that anything is there unless I then hit the space bar. While that is not the end of the world, it did not do this before and this is something I do many times with every patient so it is a slow down. Would love it if you guys could suggest a solution. Our IT efforts have failed.....including starting me over with a new laptop. Athena has user forums, I will try there soon.

In regard to using the Dragon dictation box, I do not find it to be any more accurate or fast and it is just another inefficient layer (extra steps) that I should not have to deal with.

Maybe I need to research having Dragon on solely on my computer and not via internet........but I don't really know what that means or who to talk to about it.

Thanks guys for being interested and trying to help me out. I know some of this sounds trivial but inefficiencies have been greatly magnified by ALL EHR systems and patient visits have gone down accordingly. I'm trying to get back up to 26-27 patients per day (on time and still finish in time for lunch and quitting time) so every second/ mouse click counts. And this isn't just about income.........remember patient volume = patient access. I'm stuck at about 20 patients per day and my patients are frustrated by lack of available appointments.

 

[zmountaineer]

I do not think Dragon is running over Citrix now but apparently it is over the internet because I have to log onto Dragon and it seems that my Dragon profile resides somewhere other than my computer.

Dragon is fairly fast, but slower lately. I do talk fast and I do articulate (unnaturally) to improve accuracy.

I could not live with out Dragon either but still consider it the best of 3 poor options (type, check boxes or Dragon). Human transcription is by far and away the best, but most expensive, option.

Again, accuracy is pretty amazing but it simply is not up to the standard that a medical note should be. It has a hard time with medicine names. It has a hard time with prescriptions because they are a string of numbers and if you don't say something just right it will get the Rx wrong. In other words, I might say "change dose to 100mcg" and it will transcribe as "change dose 200mcg". Dragon gets "he" and "she" wrong all the time. I dictate "He is on lipitor which he takes daily" and it will transcribe "He is on lipitor which she takes daily". It has a hard time with numbers despite the various formatting options. I've been using Dragon for about 4 years now and these types of errors remain common.

Like many physicians who use Dragon my note template includes a header that says "This not was dictated using voice recognition software that is prone to transcription errors. Call me with any questions."

BUT......I'm used to all that. My problem now is that in our EHR (Athena) there are many dialog/selection boxes for medications, labs, tests, diagnoses. They work really well and populate with options as you type (like a search engine) which is awesome. But with the latest patch or whatever IT applied when I dictate into these boxes using Dragon, the EHR does not recognize that anything is there unless I then hit the space bar. While that is not the end of the world, it did not do this before and this is something I do many times with every patient so it is a slow down. Would love it if you guys could suggest a solution. Our IT efforts have failed.....including starting me over with a new laptop. Athena has user forums, I will try there soon.

In regard to using the Dragon dictation box, I do not find it to be any more accurate or fast and it is just another inefficient layer (extra steps) that I should not have to deal with.

Maybe I need to research having Dragon on solely on my computer and not via internet........but I don't really know what that means or who to talk to about it.

Thanks guys for being interested and trying to help me out. I know some of this sounds trivial but inefficiencies have been greatly magnified by ALL EHR systems and patient visits have gone down accordingly. I'm trying to get back up to 26-27 patients per day (on time and still finish in time for lunch and quitting time) so every second/ mouse click counts. And this isn't just about income.........remember patient volume = patient access. I'm stuck at about 20 patients per day and my patients are frustrated by lack of available appointments.

The dragon program should reside on your computer. Your profile should be stored on the server. If there is any lag it is usually in loading the profile. If Dragon is not on your computer but, rather, running off of a server, that would explain the lag. Whenever we have server problems we have the option of running in offline mode to speed up the recognition.

This all based on if you are using dragon medical network edition. I believe it is version 12.1.

The case of it it recognizing until you hitting a space, it is likely that you need an updated INI file installed onto your computer. While we do not use the same EMR that you do, we have to have an updated INI file installed with every install of dragon on a new computer. Your dragon administrator should know what you need. The administrator is the person who adds new users through the nuance management console.

The recognition of he and she is an EASY fix. You can train individual specific words to exactly how you say them. We find that we have to do this frequently with people who have trouble with off and of (mainly the Spanish accented providers as well as those from India).

Making a command (template) within dragon should speed up your notes. For example adding one for a normal/negative physical exam. No need to go through the systems individually, but rather add them all at the same time.

 

[N80]

The log in box shows an option for when using a slower connection. I might try that. But usually speed isn't the issue with Dragon.

I will mention the INI file to my IT guy but he usually defers Dragon questions to the "Dragon Guy" who is not local and I don't know who he is.

I use commands mostly for the general structure of note but not any specific information at all. One of the biggest problems with EHRs these days are notes made by template. Yes, they are fast but you can always spot one and you can be fairly certain that they do not represent the actual individual patient or his situation. I don't mean to be preachy but the technology is driving us towards depersonalization. The trend is to treat patients like members of a herd or numbers and not individuals. I love technology and I don't mean to imply that technology is responsible for this.....but it pushes us that way and makes it easy to go that way.

I'm certainly a dinosaur but every one of my notes is entirely unique and ever communication/letter to my patients is personalized. I think short of human transcription, Dragon makes this easy for me, I just have to proof read more carefully than I would human transcription.

I don't think the problem with he vs she can be overcome within Dragon. If I say "which he" of "which she" there is almost no way it can differentiate or cope with this internally. I either have to say it a different way or say it very slowly....which is both slower and not natural. Likewise with four, for and fore and two, to and too. I'm surprised how well it actually does but it still has a high percentage of errors.

Thanks again for the help. Sorry about the soap box.

 

[WM75Guy]

It is happening at most medical facilities due to the volume of data being moved over old slow network equipment in the IT closet. I imagine that everyone and everything in the office and maybe the building is using the same 16MB pipeline. Every staff member probably has at least one cell phone that connects to WiFi the minute they walk into the building and some may have two. If you have guest WiFi it is using that pipeline. All of the wireless medical equipment such as Spectralink or similar brand phones carried by staff, IV pumps, vital sign machines, glucometers, workstations on wheels, and laptops all use the same access points and pipeline to connect to the remote server. While our hospital is in Texas our hosted EMR server is in Pennsylvania so it takes a while for data to make the trip.

Also due to the vast increase in ransomware most of your security has been probably been tightened way done. Your email and any other data being transmitted is being virus scanned not only when it is being received but also when it is sent. It probably scans internal emails now as well, not just ones from outside the network. To avoid HIPAA issues if something comes up missing your hard drives are most likely encrypted so that slows things done as well. Any storage device that contains PHI should be encrypted. If you use Citrix then nothing is stored on the local drive so encryption is not such a big issue.

Add in the staff streaming music from Pandora or watching videos and it gets really slow.