Man shooting at target and missing

Looking at Recognition Accuracy

We feel your pain. Working with as many clients as we do, we certainly find that every so often, a healthcare provider will complain that their speech recognition accuracy when using Dragon® Medical Practice Edition 2 is poor.

There are several possible contributing causes here. What we want to do is to look at the presenting issues and talk about what we’ve found works well to address them. In this article, we’ll be breaking things down into three cases: bad formatting, bad recognition, and gibberish.

In this analysis, we’re looking specifically at Dragon Medical Practice Edition 2, Build 12.52.350.048—but many of these principles can also be used for Dragon Medical 10 and Dragon Medical Practice Edition 1.


Case 1


Your transcribed text is in all caps or has no spaces—or both.


This usually happens during background voice recognition, when a dictation is made on a digital voice recorder and then processed through Dragon Medical—either directly or using third-party dictation/transcription software.

This can happen when dictating “live,” known as front-end speech recognition, but it’s much less common.


There are three common reasons why this can happen, and they’re fairly cut-and-dried:

  1. In your dictation, Dragon Medical heard one of the command phrases that turns off spacing or turns capitalization on.
  2. Your profile is corrupt.
  3. Your computer does not meet the system requirements for Dragon Medical Practice Edition 2, as specified by the Admin Guide, or was using too many system resources while speech recognition was taking place.


Follow these procedures one at a time—starting with A, then B, then C. And before you go from one fix to another, test to see if you’re still getting spacing or capitalization issues.

  1. Open the Vocabulary Editor and search in the “Spoken form” field for “caps.” Find the forms “all caps” and “all caps on” and delete them. Do the same thing for “space,” and then delete “no space” and “no space on.”
  2. Restore your profile, or create a new one.
  3. Try shutting down as many applications as possible, and then running your file(s) through again. If that works, you’ll either need to do that whenever you use background speech recognition, or you’ll need to upgrade your machine. Be sure to consult your IT department for the latter.



Case 2


My overall accuracy is poor.


Because there could be multiple issues/causes at play here, it’s important to be able to inspect the dictation environment—including the physical space, the dictation habits of the healthcare provider, the computer hardware and software, and the application where dictation is taking place.

Because we’re not there to do all of this for you, we’re going to suggest several of the most common ways to address accuracy in Dragon Medical. Of course, if you’d like our help, we’d be happy to schedule a remote session with you.

Causes & Fixes:

More comprehensive information is provided at the end of this article, so be sure to reference those sections to learn more.

  • Your profile could be in the beginning stages of corruption. Consider a restore or a new profile.
  • You might’ve selected the wrong accent model during profile creation. Create a new profile and choose the correct accent.
  • You might not have the correct source selected. See here and here.
  • You could have a unique accent that requires some additional reading — especially if your accent is not covered in the default accent profiles.
  • You might not be making corrections.
  • You might not be running Accuracy Tuning at all.
  • Your computer might not meet the minimum requirements for Dragon Medical Practice Edition 2, which include 4 GB of RAM and a 2.4 GHz processor.
  • You may have the wrong vocabulary
  • You might be dictating into an unsupported environment.


Case 3


Dragon Medical is producing results that don’t reflect my speech at all, or that look like gibberish.


We’re now back to more of a clear-cut issue. If you’re getting total nonsense from Dragon Medical, your profile is probably corrupt. That’s not the only explanation, but it’s the best one. Restore your profile or create a new one. You can do this in about four minutes (or less). There are definitely other possibilities, but we recommend trying this one first.

Additionally, some of the fixes that were suggested for poor accuracy might also address this problem, but these below are the most likely. For the bigger picture, make sure to review the information at the end of this article.

Causes & Fixes:

  • You might be using an unsupported microphone; by that, we mean a microphone that is not qualified to deliver audio for speech recognition. The most likely culprit would be a built-in microphone on your laptop. See here to find Nuance-approved mics.
  • Dragon Medical itself might need to be repaired or reinstalled.
  • You might be dictating into a field where Dragon Medical does not have full-text control.
  • You might just need to do an audio check because your levels are too high or low. Click on Audio > Check microphonefrom the DragonBar.

And now, we’re going to proceed into more general best practices and concepts when working with Dragon Medical.  You should find that these significantly inform the issues we have already been looking into above.



Making Corrections

Correcting misrecognitions using the Select-and-Say method is highly recommended whenever possible. The procedure is pretty simple: say “select” or “correct” and the word or phrase that’s wrong. When the Correction Menu pops up, choose the right item. You can either click your choice, or say “choose” and the number of the word you want. To see how this works, go to Help > Interactive Tutorial and follow the prompts.

While there is certainly more complexity involved in making corrections, we want to focus on how those corrections get processed and improve your profile.

In order for corrections to have their full effect, you should be saving your profile and running Accuracy Tuning. Saving happens automatically, when you close your Dragon Medical profile (unless you’ve changed the default setting under Options > Miscellaneous). If you need your changes reflected instantly, from the DragonBar, click Profile > Save User Profile.

As for Accuracy Tuning, it’s a scheduled process that optimizes your acoustic and language models and improves Dragon Medical’s recognition as well. If you aren’t doing this, your profile isn’t improving as much as it could be.

If you’ve never run Accuracy Tuning before, or aren’t sure what it is, here’s more information.

Reading the Training Text

You might have a strong accent, or speak in a way that is particularly difficult for Dragon Medical to understand. If so, reading some of the included stories may help boost the application’s understanding of your voice.

From the DragonBar, go to Audio > Read text to improve accuracy to get started. And remember—just like making corrections, this process requires that you run Accuracy Tuning afterwards.



Accent Model

During profile creation, you were prompted to select an accent from a list. By no means is the list comprehensive, so it may not cover your particular accent.

If you’re sure that you have a specific accent that is listed in profile creation, by all means, choose it. But, if you aren’t sure, or if you don’t see your accent, pick “Standard.” When you perform Accuracy Tuning, Dragon Medical may decide you have an accent that falls into one of its existing models, or it may not.

But, it’s vital to your accuracy that you don’t pick the wrong accent. Otherwise, Dragon Medical might produce very poor recognition results.


There are a number of ways that a Dragon Medical user profile can become corrupt, but the most likely culprits are:

  • You left the microphone on when not dictating.
  • You let other people speak into your profile.
  • You shut off the computer without shutting down Dragon Medical first. This could also be attributed to power outages.
  • You closed Dragon Medical improperly. The application should be shut down by clicking either the green flame icon or the “Profile” menu and choosing “Exit Dragon.”

Once corruption occurs, your accuracy goes down the tubes, so you’ll need to take action. You can restore your profile, or create a new one.


Text Control

If you want to know if Dragon Medical has full text control in a text field, place your cursor in that field and look at the DragonBar. If you see the green check mark, you’re good to go. Basically, full text control means that Dragon Medical is 100% compatible with the field and can do everything it is designed to do.

When you don’t have full text control in a field, there could be any number of reasons behind it. But when it occurs in an EHR, we have found that it’s often a symptom of:

  • An improperly configured or unsupported virtual environment
  • An EHR\EMR that doesn’t currently meet all of Dragon Medical’s specifications

For the stubborn electronic health record, whether it’s one field or the entire application, there are a few tricks that you can try. Refer to the section called EMR Issues.

For information on supported virtual environments and configurations, we highly recommend consulting the Dragon Medical Practice Edition 2 Admin Guide. Don’t be afraid to get your IT administrator involved.