There seems to be a known problem with Dragon that when typing in an EMR through Citrix individual or groups of characters are skipped.  Examples: "The patientis a25 year ol."  Does anyone have a fix to this problem.  I just recently started experiencing it.

One of the challenges of using Dragon with an EMR that is implimented via Citrix is that Dragon is on the local computer and the actual document being prepared or edited is on the (distant) Citrix server.  Nuance has developed a strategy which places a small spy application called "Vsync" on the Citrix server and this small application serves the function of communicating between the Citrix server and local computer.  Full "select and say" or Text Control will only work while Vsync is operational.  Some of the indications that Vsync is not working properly are the following:

-Loss of normal spacing and capitalization
-Loss of ability to select or correct text by voice
-Loss of the green dot which signifies full text control (see image below)

Select and Say Green

I'm suspecting it is a loss of Vsync that's causing your problem.

One of complications of the system is that the Citrix application on your local machine may get updated periodically and when this happens, some key Dragon-related dll files are over-written and the Vsync connection becomes inoperable. 

Some common causes that restrict vSync from providing Full Text Control can include:

  • vSync being permanently disabled at the Dragon Medical client by hot key combination:{Ctrl+Shift+F9}.
  • vSync being disabled for their current session at the Dragon Medical client by hot key combination: {Ctrl+F9} (Basic Dictation Control invoked).
  • vSync setting being disabled (unchecked) at the Dragon Medical client (DragonBar>Tools>Options>Miscellaneous tab>Enable vSync Full Text Support).
  • Basic Dictation Control setting being enabled (checked) at the Dragon Medical client (DragonBar>Tools>Options>Miscellaneous tab>Automatically Switch to Basic Dictation Control).
  • vSync setting being disabled at the Nuance Management Console (NMC) Site.
  • Mismatched vSync versions between the Citrix server and Dragon Medical client.
  • vSync at the Dragon Medical client requiring reinstallation using the vSync Restoration patch. This can occur whenever the Citrix client software on the workstation is updated or reinstalled

In my own use of Dragon with Epic, I will occasionally see the Vsync connection die.  Usually this is only temporary, but depending upon the cause, it can require input from your IT folks. 

I would suggest the following:

1.  First, check to see if the "green dot" is visible, confirming Vsync functionality
2.  If not present, try the following:

-Log off of Dragon and try reconnecting; if this doesn't help
-Log off of your EMR and reconnect; if this doesn't help
-Restart your computer; if this doesn't work
-Talk to your IT department or Dragon administrator to find out if other users are experiencing the problem and if a Citrix update has happened on your local computer - if so, running the VsyncRestore application will get things working again

I hope this information is helpful.


Jon W. Wahrenberger, MD
Speech Recognition Solutions
Dragon 12 does not have the above setting options.  Interestingly, the green light is off.  My site does not specifically support Dragon thus I am on my own.  This is an interesting problem, copy/paste works just fine but slows work flow.  I am surprised dragon does not have a fix for this.  Any way to force dragon into a functional basic mode to permit simple dictation?  Any workarounds people have discovered?


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