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TECH: Dragon NaturallySpeaking first review

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So I was so fed up with the common tunnel syndrome article from my last big project that I went out on board Dragon NaturallySpeaking 9. Now I am a hell of a challenge for any dictation system because as any of you have met me and spoke been no I mumble my words, and of course I have a funny British accent that doesn’t match the mutual trans-Atlantic term to Dragon NaturallySpeaking was trained in.The first two paragraphs here the first first two things I have written for the tutorial.  It’s a little disconcerting because learned you have to still speak slowly and much more clearly than you usually would and the mother trendy headset digs into my skills with it more than I would like.  In addition the words and I in a yellow box at the top of the screen and although I guess you can wait some time while you’re dictating a way for it to continue to think, it’s a little disconcerting to accumulate into it and saying nothing appearing on the screen.  In fact some 10 years ago we tried out an e-mail program that IFTF that was supposed to be the greatest new thing but when you typed on the screen nothing appeared for several seconds.  This is a little bit like that but as I continue to talk it does seem to be doing a little data, or maybe I am doing a little better for it.  Now I’m going to leave those two paragraphs, corporate and below and correct them

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While doing this I discovered that you cannot copy and paste a huge section 🙂 I’ve spent some time fixing the next section so you can see what it should have been.So I was so fed up with the carpal tunnel syndrome from my last big project that I went out and bought Dragon NaturallySpeaking 9. Now I am a hell of a challenge for any dictation system because as any of you who have met me or spoken to me know, I mumble my words, and of course I have a funny British accent that doesn’t match the neutral trans-Atlantic tone Dragon NaturallySpeaking was trained in.The first two paragraphs here the first first two things I have written after the tutorial.  It’s a little disconcerting because you have to still speak slowly and much more clearly than you usually would and the rather trendy headset digs into my skull  with more force than I would like.  In addition the words appear in a yellow box at the top of the screen and although I guess you can wait some time while you’re dictating away for it to continue to think, it’s a little disconcerting to dissemble into it and have nothing appear on the screen.  In fact some 10 years ago we tried out an e-mail program at IFTF that was supposed to be the greatest new thing but when you typed on the screen nothing appeared for several seconds.  This is a little bit like that but as I continue to talk it does seem to be doing a little better, or maybe I am doing a little better for it.  Now I’m going to leave those two paragraphs, copy them below and correct them

——Well, it look longer to correct what I just said that to say it in the first place.  On the other hand, I guess the words that it cannot get the first time are going to be the ones it is going to continue to have trouble getting when you try to correct it.  It’s a little difficult because the manual says that you when you try to use the voice command for "select", it will actually training the software to recognize your voice and you want to try to recognize the words it has the most problem understanding.  On the other hand is a damn sight quicker to just use the mouse to select those words.Anyway it’s still a gazillion miles away from the 95% accuracy that talks about in its publicity, but it’s pretty damn clever nonetheless.  Given that the reason I bought it, was because my wrists were hosting not because I type slowly, it’s probably a good thing that I start trying to use it, at least when I’m writing lengthy pieces that require a lot of correction — and even as I keep talking now, it seems to be getting better.

The weirdest thing off all, and I suspect many of you had the same thing going on, is that I don’t consciously verbalize what I write when I’m typing.  None of your wisecracks please about the fact that I may not read what I have typed after I have typed it, although that may be true from time to time.  In some ways it’s like the old joke about the English majors in college, we used to say that if you look very closely you can see their lips moving.  While I guess I’m one of them now.

INTL/POLICY/POLITICS: American governor crosses border for healthcare

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BredesenbloodIn the first public (non-academic) health care talk I ever gave to a Rotary club (in I think 1993) I was laying into the US health care system when some guy stood up and said “when he was sick the Prime Minister of Ontario came to the US for treatment.” Apparently that meant that the entire Canadian health care system was rubbish and the American one was a-ok. Given that the small business people in that room have spent the last two decades paying through the nose for their political representatives’ determination to keep the government out of health care (or something), you’d think that that meme would have less of an impact. And my Canadian friends (with help from Yankee Steve Katz) blew up that “Canadians coming south in droves” myth in their Phantoms in the Snow paper in Health Affairs a few years back.

But no matter, according to Cato et al, the Canadians are dying to become just like us. And really what’s not to love about dragging in the “market forces” which have served our system to become so cheap, consumer friendly and deliver such great outcomes for the money! (Especially if you’re a poor underpaid Canadian doctor).

So I began thinking that those of us on the other side of the spectrum need our own meme. And I think I’ve found it.

Before I tell you what it is, a little bit of background. In 1992 Ian Morrison at IFTF wrote a great piece comparing three Scandinavian health care systems. The three Scandinavian “countries” were Sweden, Denmark and Minnesota—which on all kind of ethnic and social measures, as well as in health care practice, looks far more like Scandinavia than it does the rest of the US. So in my view we can call Minnesota, in health care terms, a foreign country.

Here’s where it gets good. Tennessee has a Democratic Governor, Phil Bredesen, who is a multi-millionaire former HMO executive and the one who managed to basically throw a good chunk of his state’s population off Medicaid. So he’s representative of the prevailing wisdom about American health care. So when Phil got sick, what did he do?

He high-tailed it for Minnesota! American health care wasn’t good enough for him!

I think that’s it. American health care—not good enough for the best and brightest amongst us!

Feel free to add your own slogan

HEALTH PLANS/QUALITY: BC California on P4P

My erstwhile colleagues at FierceHealthcare have an interview up with Dr. Michael Belman, staff VP and Medical Director, Blue Cross of California. It’s a pretty good introduction, for those of you who don’t know much about it, to the P4P program in California.

On the other hand they never asked him what kind of wonderful results that Wellpoint got from dumping $40m worth of computers onto the doctors of America without any metrics or intent to actually make them integrate said computers into their workflow. (I suspect eBay got some sellers’ commissions out of it, though). Nor did they ask whether paying for performance includes paying bonuses to their underwriting staff to find ways to cancel members’ policies retroactively.

Oh well, perhaps that’ll be in the next interview!

TECH: JSK tries to sort out the “Chaos and Creation in the Health IT Market”

Jane Sarasohn Kahn tries to sort out chaos and creation in the Health IT Market.  JSK “remains hopeful” that the market will sort it all out. I’d say she was from the Planet Pluto, but it’s not one anymore. (Ho, Ho)  Seriously, she lays out a whole host of reasons why the government “push” for IT has perhaps been overstated by the analysts as a factor for market growth, and knowing JSK as I do, reading between her lines, she’s quietly crying bullshit. On the other hand, I do think that the automation of the smaller hospitals due to the labor shortage is a bigger factor than the mainstream analysts seem to think. So there will be some creation, but still lots and lots of chaos.

PHARMA: Jim Edwards is very smart

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Brandweek’s Jim Edwards is very smart and sees through the industry BS very well—almost at a Venessa Furhman level. He probably should be plying his trade on a bigger stage given the rubbish that the science/business reporters of certain national dailies have been writing about health care lately.

His latest is one called, Drug Companies Won’t Sell Sales Reps Short. Jim notices that despite all the pundits (me included) thinking that pharmacos will have to rationalize their sales forces, they haven’t actually done so yet, and don’t appear very keen to do so.

INTERNATIONAL: Maybe privatization in the UK will not be quite so swift

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Strike one for the little guy. A pensioner (that’s a “senior” to us Yanks) has won a court battle to stop a US healthcare giant from taking over a GP practice. The giant in question is United HealthGroup which apparently has also got a few other problems.

Perhaps doctors and hospitals in Arizona, St Louis and the outer boroughs of New York City should be flying in 67 year old Ms Pam Smith, 67, a former hosiery worker and Labour councillor from the huge metropolis of Langwith, Derbyshire, to advise them on how to “work” with United?

PHARMA/POLICY: New trial for Hurwitz

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Excellent news as there’ll be a new trial for William Hurwitz. I’m trying to find out if they’ve released him from jail already. I and my crusty old dad have both contributed to his defense fund, and it looks like it’s paying off. (More on the story here)

Of course in any just society, Hurwitz would be practicing medicine, with the forces of organized medicine at his side protecting him and his patients instead of just turning their backs, and the scumbag DAs and DEA arseholes who put him in jail would be rotting there in his place—and being denied the pain medication that they need.

How about a new trial for Richard Paey now?

PHYSICIANS/TECH: Technology won’t replace doctors — and it won’t cut costs, at least so says a doctor

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Kessler’s book on how doctors will get replaced by technology is dissed by a doctor who points out that he had to go to medical school and learn stuff that you could never teach a CT Scanner, dammit! And those bastard venture capitalists next door earn far more money! I suspect steel workers in the 1960s said the same thing. I’m not exactly sympathetic to Kessler’s argument, but with defenses of the status quo like this…..

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