vsync Best Practice Guide

Dragon Medical Enterprise Network Edition Service Pack 2 and Hotfix 7 vsync Best Practice Guide

Contents Reasons to upgrade to DMENE Service Pack 2 or Hotfix 7 5 Benefits of upgrading to Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7 5 Supported upgrade paths for DMENE and DMENE components 5 Upgrading Dragon to Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7 6 Verifying Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7 are installed 6 Overview of vsync and Full Text Control 7 Overview of vsync 7 Overview of Full Text Control 7 Availability of Full Text Control 8 Applications with Basic Text Control support through vsync 8 Support for Dragon and vsync with Citrix clients and servers 9 Support for Dragon with vsync and Citrix 9 Support for Citrix Xenapp clients and Windows operating systems 11 Install vsync on a Citrix server 12 Viewing Dragon set up log files to verify the vsync installation 13 View the Dragon set-up log file from the Start Menu or Windows Explorer 13 Enabling vsync in the Nuance Management Console 14 Recognizing a Full Text Control or vsync issue 15 Recognizing a Full Text Control issue 15 Recognizing a vsync issue 15 Using log files to troubleshoot issues 15 What to do if someone reports a Full Text Control or vsync issue 17 Checklist: Troubleshooting a Full Text Control or vsync issue 17 Restoring vsync support after updating a Citrix client 19 Pre-requisites for installing the DMENE vsync Restoration Patch 19 Steps for installing the DMENE vsync Restoration Patch on a workstation 20 Troubleshooting vsync on a workstation 21 Verify the vsync plug-in is installed on the Citrix server 21 Verify that the vddgncompatibility.dll is installed correctly 21 Verify the vsync process on the workstation 22 Verify the vsync registry entries on the workstation 22 Verify Dragon users see a warning message about the vsync connection 22 Verify Dragon users have disabled vsync for the current or all user sessions 23 Verify Dragon users set Dragon to auto-disable vsync 23 Verify the color of the Full Text Control indicator during dictation 26 Troubleshooting vsync on a Citrix server 28

Contents Understand the vsync components that are on the Citrix Server 28 Configure the MiniDragon watcher 28 View Dragon log files from the Nuance Management Console 30 View the Dragon log file from the Nuance Management Console 30 View the Dragon log file from the Start Menu or Windows Explorer 31 What to look for in the dragon.log file when a user reports an issue with vsync 31 Viewing vsync log files for Dragon user activity with Citrix published applications 32 Important note about the size of vsync log files 32 To enable vsync logging for all Dragon users that work with Citrix published applications 32 Viewing notifications about vsync connectivity issues 33 Obtaining the vsync timeout notification tool 33 Support for edit controls 34 4

Reasons to upgrade to DMENE Service Pack 2 or Hotfix 7 Benefits of upgrading to Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7 Hotfix 7 includes many updates for Dragon users that use Dragon and vsync with applications that are published from a Citrix server. Dragon Medical Enterprise Network Edition (DMENE), Service Pack 2, is the newest version of the product. Service Pack 2 includes many of the same vsync and Dragon updates from Hotfix 7. You should upgrade to DMENE Service Pack 2 or Hotfix 7 as soon as possible. Supported upgrade paths for DMENE and DMENE components This section contains information about supported compatibility between different versions of Dragon, vsync, and the Nuance Management Server (NMS). Use this information to plan your next upgrade of DMENE. The Dragon client in Service Pack 2 is compatible with the following versions of the NMS: RTM Service Pack 1 Service Pack 2 The Dragon client in Service Pack 2 is compatible with the following versions of the vsync plugin on a Citrix server: RTM Service Pack 1 Service Pack 2 For best results, you should upgrade the vsync plug-in to Service Pack 2 before you upgrade the Dragon client to Service Pack 2. The vsync plug-in in Service Pack 2 is compatible with the following versions of the Dragon client: RTM Service Pack 1 Service Pack 2 For best results, you should upgrade the Dragon client to Service Pack 2 as soon as possible. The Nuance Management Server in Service Pack 2 is compatible with the following versions of the Dragon client: 5

L-3422 DMENE vsync Best Practice Guide RTM Service Pack 1 Service Pack 2 Upgrading Dragon to Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7 To upgrade to the latest Dragon Medical Network Edition Client Version or to install Hotfix 7, login to isupport.nuance.com and search for solution: Solution 14274: What's New in Dragon Medical Software and Can I download the current version? Verifying Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7 are installed 1. From the Dragon Bar menu, click Help. 2. Click About Dragon 3. The version number, as shown below, should be Version 10.50.650.118 6

Overview of vsync and Full Text Control Overview of vsync Dragon Medical Enterprise Network Edition includes a feature called vsync that allows Dragon users to use Full Text Control functionality with an application that is published from a Citrix server. vsync uses a connection with the Dragon client to tell Dragon about events in the Citrix server window that corresponds to the generic window for the application on a client computer. This allows Dragon users to utilize Full Text Control features with the published application. To enable vsync for your Dragon user, you must perform the following tasks: 1. Install the vsync plug-in on the Citrix server 2. Enabling vsync in the Nuance Management Console For details about support and system requirements for Dragon, Citrix, and vsync, see Support for Dragon with vsync and Citrix. Overview of vsync Mirroring vsync mirroring of edit controls in Citrix published applications for information about cursor movements, utterances, and window location and focus. The mirroring application accesses this information by communicating through the Citrix Virtual Channel to a tracking application that runs on the Citrix server. Applications published from a Citrix server appear as a Transparent Windows Client on a client workstation. vsync starts when a Dragon user accesses a published Citrix application. Overview of Full Text Control Full Text Control (formerly Select-And-Say) provides Dragon users with the full set of dictation, editing, correction, menu, and dialog box features that are available in the Dragon client. The commands that quote text from the screen (select <xyz>, correct <xyz>, insert after <xyz> ) work thanks to Full Text Control. For more information about commands that are fully enabled by Full Text Control, see the Dragon Help. Full Text Control feature list Full Text Control provides many capabilities and commands to Dragon users, including: Select and deselect text by voice and display the Correction menu (select <words>, select <words> through <words>) Select from a list of alternative spellings and words (choose 1, etc.) Display the Spell dialog box (spell that) Play back dictation (play that back, play back paragraph, etc.) 7

L-3422 DMENE vsync Best Practice Guide Capitalize selected text (cap that) Open the Correction menu. (correct <words>) Move the insertion point to a specific location (insert before <words>, insert after <words>) Overwrite the selected text with new dictation If Full Text Control is not available, Dragon defaults to Basic Text Control which does not include the capabilities mentioned in the Full Text Control features list. Availability of Full Text Control For Full Text Control to be available to a Dragon user: 1. A Dragon user must use Dragon in applications with supported edit controls. See Support for edit controls. 2. A Dragon user must use Dragon: with an application; and both Dragon and the application are installed and running on the same client computer or both Dragon and the application are installed and running on the same server. See Support for Dragon with vsync and Citrix. with Dragon installed and running on a client computer, an application published from a Citrix server, and vsync enabled on both the Dragon client and the Citrix server. In this configuration, vsync issues will occur if you: Install Dragon and then upgrade the XenApp client Install Dragon and then uninstall and reinstall the XenApp client Install the XenApp client after installing Dragon If any of the above are true, perform one of the following actions: Run the patch installer See Restore vsync after updating a Citrix client on a workstation. From the Dragon installation DVD, run the Modify option to reinstall the vsync for EHRs feature on the Dragon client and restore Full Text Control functionality. Applications with Basic Text Control support through vsync While vsync supports Full Text Control with certain applications published from Citrix, there are some applications where only Basic Text Control support is available from the Dragon client. If you use Dragon with these published applications over a vsync connection, features such as using voice to correct text and move the cursor may not work as expected. The Dragon user may need to use the DictationBox to make corrections and move the cursor. The following is a non-exhaustive list of common applications where only Basic Dictation Control is available over a Citrix connection. If you are using Dragon from a client computer and these 8

applications are published from a Citrix server, you can only use Basic Dictation Control with these applications. Microsoft Word Microsoft Outlook (with Microsoft Word as the editor) Microsoft Excel Microsoft Internet Explorer Notes: You can use Full Text Control with these applications if Dragon is on the Citrix server that the applications publish from. Nuance will publish a Technical Note on this subject as soon as possible. Support for Dragon and vsync with Citrix clients and servers Support for Dragon with vsync and Citrix This section lists the supported versions of the Citrix Xenapp client that you can use with the Dragon client in Dragon Medical Enterprise Network Edition (DMENE). You can use this information as you plan and set up your DMENE network. In DMENE, vsync supports Full Text Control with certain applications published from Citrix. The Citrix XenApp client session options must use "seamless" mode for publishing and connecting to a published application. Citrix XenApp client version 10 Citrix XenApp client type: Web Client: Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit Program Neighborhood: Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit Program Neighborhood Agent Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit 9

L-3422 DMENE vsync Best Practice Guide Citrix XenApp client version 11 Citrix XenApp client type: Web Client: Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit XenApp 6 on Windows Server 2008 64 bit R2 Program Neighborhood: Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit Program Neighborhood Agent Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2008 32 bit, and Windows Server 2008 64 bit XenApp 6 on Windows Server 2008 64 bit R2 Citrix XenApp client version 12 Citrix XenApp client type: Web Client: Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit XenApp 6 on Windows Server 2008 64 bit R2 Program Neighborhood Agent Metaframe Presentation Server 4.5 on Windows Server 2003 32/64 bit XenApp 5 on Windows Server 2003 32/64 bit, Windows Server 2008 32 bit, and Windows Server 2008 64 bit XenApp 6 on Windows Server 2008 64 bit R2 10

Citrix XenApp client Support for Citrix Xenapp clients and Windows operating systems Citrix XenApp client type Metaframe Presentation Server 4.5 XenApp 5 XenApp 6 Windows Server 2003 32/64 bit Windows Server 2008 32 bit v10 Web Client Program Neighborhood Program Neighborhood Agent Windows Server 2008 64 bit v11 Web Client Program Neighborhood Program Neighborhood Agent v12 Web Client Program Neighborhood Agent Windows Server 2008 64 bit R2 11

L-3422 DMENE vsync Best Practice Guide Install vsync on a Citrix server The vsync plug-in communicates with Dragon Medical Enterprise Network Edition 10.1 Client in a Citrix environment. You install the vsync plug-in on a Citrix server to allow Dragon users to use Full Text Control functionality with published applications that are on the server. 1. On the Citrix server that hosts the published applications, place the Dragon Medical Client 10.1 disc in to the DVD drive. 2. On the disc, perform one of the following actions: To install vsync on a 32-bit Citrix server, in the root directory of the DVD, find and double-click the MiniTracker.exe file. To install vsync on a 64-bit Citrix server, in the root directory of the DVD, find and double-click the MiniTracker_x64.exe file. 3. When the InstallShield Wizard appears, install the Visual C++ 9.0 runtime for Dragon by clicking Install. You must install the C++ runtime before you install vsync. 4. On the Welcome screen, click Next. 5. On the Destination screen, to select a folder for the installation, click Change. Click Next to install in the folder. 6. On the Ready to Install Program screen, click Install to start the installation process. 7. When the installation process is complete, on the 'InstallShield Wizard Completed' screen, click Finish. 12

Viewing Dragon set up log files to verify the vsync installation When you install the DMENE Dragon client on a workstation, vsync is also installed if the XenApp client is already installed. When vsync installs on the Dragon client, you can view the dgnsetup.log file to verify that the vsync installation was successful. You can view the dragon set up log file from the Start Menu or Windows Explorer. If vsync did not or is not installed on the workstation, the dgnsetup.log file contains the following text: Script Info: <timestamp>: Not-Installed or Not-Supported Feature: vsync View the Dragon set-up log file from the Start Menu or Windows Explorer There are several ways to locate the Dragon setup log file: In the Start Menu, select All Programs > Dragon Medical 10.1 > Show Setup Log In Windows Explorer, on Windows Server 2008, look here: C:\Users\Administrator\AppData\Local\Temp\dgnsetup.log In Windows Explorer, on Windows XP, look here: C:\Documents and Settings\<user_account_login>\Local Settings\Temp\dgnsetup.log 13

L-3422 DMENE vsync Best Practice Guide Enabling vsync in the Nuance Management Console To enable vsync support for Dragon users, you must enable the vsync: Full Text Control option in the Nuance Management Console (NMC). After you enable the option, the vsync Full Text Control Support option starts when a Dragon user opens an application published from a Citrix server where vsync is installed. The vsync Full Text Control support starts communicating with vsync when the user logs into the Dragon Medical Client 10.1, Dragon receives options data from the NMC that indicates the vsync Full Text Control support option is enabled. To enable vsync in the Nuance Management Console 1. Launch the Nuance Management Console from an Internet browser. 2. Click Manage Organizations. 3. Click Site and select Organization Details. 4. Click the Dragon Settings tab and select Miscellaneous. 5. Select vsync: Full Text Control. 14

Recognizing a Full Text Control or vsync issue Recognizing a Full Text Control issue Symptoms that indicate Full Text Control is not working correctly include: A Dragon User complains that some commands are not working, especially the select <words> command. Dragon User complains that Dragon does not capitalize the first word they dictate into a text field. A Dragon User complains that Dragon is not always putting spaces between words. A Dragon User complains that Dragon is typing text slowly into the text field. A Dragon User complains of reduced accuracy in a certain text field. The user may actually mean that Dragon is having trouble recognizing commands such as select <words>. You may have to observe the user to verify that this is the case. The Full Text Control indicator is grey instead of green. The yellow message area of the DragonBar says Dictating to a non-standard window instead of Normal mode after the user has dictated at least one phrase. Recognizing a vsync issue In addition to the above symptoms, symptoms that are specific to vsync include: Dragon displays a warning icon in the system tray area. A Dragon User reports seeing this message: "On <date> <time> a vsync connection issue was detected verify dictation. Click to dismiss." Using log files to troubleshoot issues You can enable and view many different log files to troubleshoot issues that may be related to vsync or Full Text Control. You can also email the log files to Nuance Technical Support to help us trouble shoot the issue. You can view the following log files to help trouble shoot issues with vsync: Dragon log file on the Dragon workstation: To troubleshoot possible vsync connectivity issues, view the dragon.log file. See Viewing Dragon log files to troubleshoot vsync connectivity issues. Dragon set up log file on the Dragon workstation: To verify that vsync was successfully installed on a Dragon workstation, view the dgnsetup.log file. See Viewing Dragon set up log files to verify the vsync installation. 15

L-3422 DMENE vsync Best Practice Guide vsync log files on a Citrix server: To view data about the activities of Dragon users that dictate into applications published from a Citrix server, view vsync log files. You must enable vsync logging it is disabled by default. See Viewing vsync log files for Dragon user activity with Citrix published applications. 16

What to do if someone reports a Full Text Control or vsync issue Checklist: Troubleshooting a Full Text Control or vsync issue If a vsync issue is reported, you can perform the following actions: Action View online resources for DMENE Verify that you or another administrator has installed, upgraded, or re-installed the XenApp client after installing Dragon. Verify the Dragon client and vsync configuration Verify that the Dragon user is dictating into published applications that have Full Text Control support through vsync Verify that the Dragon client and vsync are updated to DMENE Service Pack 2 or Hotfix 7 Verify that Sync warning messages are displaying to the Dragon user Verify that certain vsync options are enabled in Dragon Details To obtain technical support information, visit http://isupport.nuance.com Perform the following action if the answer to any of these items is : From the Dragon installation DVD, run the Modify option to reinstall the vsync for EHRs feature on the Dragon client and restore Full Text Control functionality. Full Text Control with published applications is only available in certain configurations of Dragon and vsync. See Availability of Full Text Control. vsync does not support Full Text Control with certain published applications. See Applications with only Basic Text Control through vsync. See Benefits of upgrading to Service Pack 2 (Build 10.50.650.118 SP2) or Hotfix 7. Dragon displays a warning icon when there is a communication issue between vsync and the Dragon client. See Verify Dragon users see a warning message about the vsync connection. Users can manually disable vsync for the current session, all of their sessions, and set Dragon to auto-disable vsync. See the following topics: Verify Dragon users have disabled vsync for the current or all user sessions Verify Dragon users set Dragon to auto-disable vsync Verify the color of the Full Text Indicator in Dragon The DragonBar includes a Full Text Control indicator that indicates if Full Text Control or Basic Text Control is available to the user. See Verify the color of the Full Text Control indicator during dictation. Verify the vsync plug-in is installed on the Citrix server that hosts the published application The vsync plug-in must be installed on the server the Dragon is connecting to. See Install vsync on a Citrix server. 17

L-3422 DMENE vsync Best Practice Guide Action Verify that vsync is enabled on the Dragon workstation Verify that the Citrix ICA Client and Dragon were installed properly and in the correct order. Verify the current and active vsync processes Verify the vsync registry settings Verify how often the vsync plug-in looks for the Dragon custom virtual channel View the Dragon set up log file and the Dragon log file for information Details See Enabling vsync in the Nuance Management Console. See the DMENE 10 1 Dragon in a Citrix Environment Administrator Guide.pdf in http://isupport.nuance.com by searching for solution: 14111 "Dragon Medical Enterprise. See Verify the vsync processes on the workstation. See Verify the vsync registry entries on the workstation.. See Configure the MiniDragon watcher. See the following topics: Viewing Dragon log files to troubleshoot vsync connectivity issues Viewing Dragon set up log files to verify the vsync installation Enable vsync logging Enable notifications for vsync issues Restore vsync after an upgrade of the Citrix ICA Client Ensure the Dragon user is dictating into a supported edit control Verify that the System Requirements are met You can set vsync to create log files that contain data about errors, warnings, or all activities for all vsync users on the server. See Viewing vsync log files for Dragon user activity with Citrix published applications. You can configure the NMS to send a notification if the vsync connection experiences a time out. See Viewing notifications about vsync connectivity issues. Updating or reinstalling a Citrix ICA client deletes the Dragon vsync components; disabling vsync support. See Restoring vsync support after updating a Citrix client. Dragon users can use Full Text Control in specific edit controls in applications (local or published). See Support for edit controls. See Support for Dragon and vsync with Citrix clients and servers. 18

Restoring vsync support after updating a Citrix client Dragon uses vsync support to provide Dragon users with Full Text Control when they work with applications published from a Citrix server. An administrator updates or reinstalls one or more Citrix ICA clients on a workstation with Dragon. Updating or reinstalling a Citrix ICA client deletes the Dragon vsync components; disabling vsync support. The vsync Restoration Patch provides a quick and simple way to reinstall vsync support after updating or re-installing a Citrix ICA client. After updating or reinstalling a Citrix ICA client on a workstation, run the patch on the workstation or push the patch install to the workstation. In DMENE Service Pack 3, only use the vsync Restoration Patch to repair damaged vsync client components or to install the vsync client components for the first time. To upgrade vsync client components. use the the patch installer. Do not use the vsync Restoration Patch to upgrade these components. Note: You must upgrade vsync on your Citrix servers before you upgrade vsync on Dragon client computers. The patch can be run on a 32-bit or 64-bit workstation where all, some, or none of the vsync components are installed. The patch installer can also be run in 'silent' mode. When you run the patch installer, it successfully patches and re-registers the relevant dll and component files. The installer also displays messages about installation success or errors. You can run or push the vsync Restoration Patch using any version of the DMENE Dragon client Service Pack 1 (Build 10.50.650.033) or higher. If you do not have Service Pack 1, you must install it before you can install the patch. Pre-requisites for installing the DMENE vsync Restoration Patch Ensure the following items are met before you run the patch. Otherwise, the patch installation will fail and log error messages to the DgnSetup log file. The Dragon client must be installed on the workstation Dragon must not be running on the workstation A Citrix ICA client must be installed on the workstation Citrix ICA Client Engine process (wfica32.exe) must not be running on the workstation You can install the patch even if the vsync components in the patch are the same version as the vsync components currently installed on the workstation. 19

L-3422 DMENE vsync Best Practice Guide Steps for installing the DMENE vsync Restoration Patch on a workstation Perform the following steps after updating or reinstalling a Citrix ICA client on a workstation. 1. Ensure all the installation pre-requisites are met. See Pre-requisites for installing the DMENE vsync Restoration Patch for details. 2. On the DVD, in the VsyncRestorationPatch folder, find and run the vsyncrestorer.exe file on the Dragon client workstation. Alternately, you can push the patch install to the workstation. DMENE vsync Restoration Patch Logging When you run the vsync Restoration Patch, it logs success and error messages to the DgnSetup log. It also logs the version numbers of the currently installed Citrix support components and the components in the patch. 20

Troubleshooting vsync on a workstation Verify the vsync plug-in is installed on the Citrix server You must install the vsync plug-in (minitracker.exe) on the Citrix servers that host the published applications that Dragon users work with. See Install vsync on a Citrix server. Verify that the vddgncompatibility.dll is installed correctly The vddgncompatibility.dll runs on the computer where the Citrix ICA client is installed. The vddgncompatibility.dll: starts when the Citrix channel opens to access an application. The vddgncompatibility.dll is overwritten if you install or upgrade a Citrix ICA Client after you install Dragon. If this occurs, you will need to fix the vddgncompatibility.dll in the Citrix directory. The location of the Citrix directory depends on the Operating system on the Citrix server machine: C:\Program Files (x86)\citrix\ica Client\ C:\ProgramFiles\Citrix\ICA Client\ To verify the correct order to install the required workstation components, see the DMENE 10 1 Dragon in a Citrix Environment Administrator Guide.pdf (available in isupport by searching for solution: 14111 "Dragon Medical Enterprise Network Edition User's Guides"). To fix the vddgncompatibility.dll, perform one of the following actions: Redo the installation process in the correct order Use the new vsync patch available on isupport. The version of the patch you use depends on the Hotfix level currently installed in your environment. See Restoring vsync support after updating a Citrix client. For more information, on isupport, search for solution 14274: "What's new in Dragon Medical Software and can I Download the Current Version?" 21

L-3422 DMENE vsync Best Practice Guide Verify the vsync process on the workstation You can view the vsync process that runs on the workstation when the Citrix Virtual Channel starts. In the Task Manager, verify the citrixwindowmgr.exe: process is running. Verify the vsync registry entries on the workstation When the vsync processes register with the Citrix Virtual Channel, you should see the following registry keys in the Windows Registry: [HMLM\SOF- TWARE\Citrix\ICAClient\Engine\Configuration\Advanced\Modules\DNSMED] "DriverName"="Unsupported "DriverNameWin16"="Unsupported" "DriverNameWin32"="vddgncompatibility.dll" [HKLM\SOFTWARE\Citrix\ICA Client\Engine\Configuration\Advanced\Modules\ICA 3.0] "VirtualDriverEx"="DNSMED" Verify Dragon users see a warning message about the vsync connection When a user dictates into an application published from Citrix, network issues may cause vsync connection between Dragon and the Citrix server to slow down. This may negatively impact dictation performance. Dragon displays the following graphic in the system tray area if the connection speed between itself and the Citrix server slows down: The graphic appears when the connection first times out. The graphic then appears when the connection times out for 4 out of 20 utterances. If a user places the mouse over the message, the following message appears: "On <date> <time> a vsync connection issue was detected verify dictation. Click to dismiss." This message indicates that the vsync connection between the Dragon workstation and the Citrix server experienced issues. The issues do not impact the overall network and vsync is still enabled. 22

Verify Dragon users have disabled vsync for the current or all user sessions Verify Dragon users have disabled vsync for the current user session On sites that support the vsync feature, Dragon users can disable vsync just for their current user session by pressing Ctrl+F9. If they perform this action, they cannot use Full Text Control with applications published from a Citrix server unless they re-enable it by pressing Ctrl+ F9 again. Verify Dragon users have disabled vsync across all of their user sessions On sites that support the vsync feature, Dragon users can enable or disable the vsync feature across all of their user sessions. A Dragon user may wish to disable vsync if they are experiencing network latency and connectivity issues with vsync. Users can set the Enable vsync Full Text Support option in the Options > Miscellaneous tab or use the hot key combination Ctrl+Shift+F9 to enable or disable vsync. This feature applies to individual workstations. If a user moves from one workstation to another workstation, the setting is not applied to the new workstation. If a user performs the above actions, they cannot use Full Text Control with applications published from a Citrix server. This option persists for all of their user sessions until the setting is reversed. Notes: Once users turn vsync on or off, the setting persists across all future user sessions. Users can turn vsync off without having to restart Dragon or reload a user profile. After a user turns vsync off, they must log out and log back into Dragon before they can turn vsync on This feature applies to individual workstations. If a user moves from one workstation to another workstation, the setting is not applied on the new workstation. Verify Dragon users set Dragon to auto-disable vsync On sites that support the vsync feature, Dragon users can enable the Automatically switch to Basic Dictation Control option to have Dragon automatically switch them to basic dictation mode if the connection between Dragon and vsync fails. The option is located in the Options > Miscellaneous tab in Dragon. If users enable this option, they cannot use Full Text Control with a Citrix published application for the current Dragon session. Before they can enable vsync, they must close and re-start Dragon. Notes: 23

L-3422 DMENE vsync Best Practice Guide Once users turn vsync on or off, the setting persists across all future user sessions. Users can turn vsync off without having to restart Dragon or reload a user profile. After a user turns vsync off, they must log out and back into Dragon before they can turn vsync on. This feature applies to individual workstations. If a user moves from one workstation to another, the setting is not applied to the new workstation. We recommend that users do not enable the Automatically switch to Basic Dictation Control option unless the Dragon user is having network latency or connection issue with vsync. If this option is enabled and a user is disconnected from vsync, the user loses Full Text Support for the rest of the current user session. Please consult with the Dragon Support Team before you enable this feature. 24

Furthermore, users can use Hotkey combinations to enable or disable these settings: 25

L-3422 DMENE vsync Best Practice Guide Verify the color of the Full Text Control indicator during dictation A Dragon user can determine if Full Text Control support is available in the current application they are working with. In the Dragon client, the DragonBar includes a Full Text Control indicator. The indicator turns green when Full Text Control is available. The indicator turns grey when only Basic Text Control is available. 26

If a Dragon user reports an issue that is impacting Full Text Control availability or may be related to vsync, ask the user about the color and behavior of the Full Text Control indicator when the user experienced the issue. Full Text Control colors and behavior during dictation When a Dragon user uses Dragon with an application published from a Citrix server, the Full Text Control indicator exhibits the following behavior: When the Dragon user first turns on the microphone, the Full Text Control indicator is gray until the Dragon user starts dictation. When the Dragon user begins dictation, the Full Text Control indicator turns green if they have Full Text Control and vsync is functioning If a Dragon user is dictating into a non-standard window (a window in which Full Text Control is not supported) and changes the focus to a standard window or loses vsync connectivity, the Full Text Control indicator remains gray. If vsync stops working, Dragon users may experience issues responding to correction commands and may notice inconsistencies when they use certain commands, including capitalization, formatting, select <xyz>, correct <xyz>, and insert after <xyz> ) commands. For more information about commands that are fully enabled by Full Text Control, see the Dragon Help. 27

L-3422 DMENE vsync Best Practice Guide Troubleshooting vsync on a Citrix server Understand the vsync components that are on the Citrix Server A vsync installation on a Citrix server includes several components. The vsync plug-in (MiniTracker) installs on the Citrix XenApp server and sends UI information to a UI Mirror that allows the Dragon Medical client to integrate with a published Citrix application. vsync acts as a proxy between the Citrix Server and the Dragon Medical client. The installation files for the vsync plug-in are: MiniTracker.exe for 32 bit Operating systems MiniTracker_x64.exe for 64 bit Operating systems Both installers are on the Dragon Medical Network Edition Client media disk. MiniDragon is an executable that is installed on the Citrix Server and starts when a Dragon user access a published Citrix application. Minidragon.exe and a process called Minidragonwatcher.exe alternate until either the Dragon Citrix Virtual Channel closes or Minidragon can open the custom virtual channel. Minidragon.exe can use approximately 10 MB of memory per user session. A process called dgnuiasvr_x64.exe allows minidragon to provide Full Text Control support with 64-bit applications, for example, the 64-bit version of Notepad). The dgnuiasvr_x64.exe process can use approximately 20 MB of memory per user session. Configure the MiniDragon watcher You can configure the MiniDragon Watcher process by setting the EHRForceLogOff registry value. With vsync installed on a Citrix Server, when a user starts a published application on the server, vsync starts. If vsync cannot find the Dragon custom virtual channel, Minidragon.exe and Mindragonwatcher.exe take turns starting each other. The number of times this occurs is based on registry settings. By default, after attempting to start Minidragonwatcher two times, Minidragon.exe turns off and does not try to restart Minidragonwatcher.exe a third time. When you install Minidragon.exe (vsync) on the Citrix Server, the registry key HKEY_LOCAL_ MACHINE\Software\Nuance EHRForceLogOff (REG_DWORD) is set to 3. You can set the registry key to a value between 0 and 99: EHRForceLogOff=0 The feature is turned off. Minidragon and Minidragonwatcher take turns starting each other until Minidragon can find and open the Dragon Citrix Virtual Channel. EHRForceLogOff=1 Minidragon exits after a single unsuccessful attempt to open the Dragon Citrix Virtual Channel. 28

EHRForceLogOff=1/99 Minidragon exits after the defined number of attempts to open the Dragon Citrix Virtual Channel. 29

L-3422 DMENE vsync Best Practice Guide View Dragon log files from the Nuance Management Console You can view the dragon.log file to obtain troubleshooting information for vsync connectivity issues. You can view the dragon.log file from the NMC, the Start menu, or in Windows Explorer. To help you diagnose specific problems, the Dragon Medical client creates a file named Dragon.log for each healthcare Dragon user. You can view this file in the NMC Console. In this file Dragon Medical records all of its actions that occur during each user dictation session. If you contact Nuance Technical Support, you may be asked to supply this file. The Dragon log file is not uploaded to the NMS server if there is a communication issue between Dragon and the server. The Dragon log file can also be found on the Dragon client workstation. To place the Dragon Medical Client place the log files in a location where they are accessible for viewing on the NMC Console, you must enable the option Copy Dragon log to network on the Site > Dragon Settings tab. View the Dragon log file from the Nuance Management Console 1. On the User Accounts screen, search for the Dragon user whose log files you want to view. To refresh the data on the User Accounts screen, press Refresh at the bottom right of the screen. 30

1. Select the Dragon user in the list and click the Dragon Client Logs icon on the ribbon. 2. The Dragon Client Logs tab opens and displays a list of log files. 3. Double click on the log file you want to view. The log file opens and displays user activity information. View the Dragon log file from the Start Menu or Windows Explorer There are several ways to locate the Dragon log file: In the Start Menu, select All Programs > Dragon Medical 10.1 > Show Dragon Log. For this to work, you must be logged in to Windows under the Dragon user s account. In Windows Explorer, on Windows Vista, Windows 7, or Windows Server 2008, look here: C:\Users\Administrator\AppData\Roaming\Nuance\ NaturallySpeaking10\Dragon.log In Windows Explorer, on Windows XP, look here: C:\Documents and Settings\<user_account_login>\Application Data\Nuance\ NaturallySpeaking10\Dragon.log What to look for in the dragon.log file when a user reports an issue with vsync The following information was placed into a dragon.log file during a 2,000 millisecond Citrix timeout: CtxWinMgr: PrepTarget - Local window is different. Asking for server window info. CtxWinMgr: GetServerWindowInfo - Asking server to send window info for local window 0x002c0340. vddgncompatibility<7496>: DriverPoll - 11 order received Speech starting to edit control 0x002c0340 0x002c0340 "Transparent Windows Client" key "" CtxWinMgr: GetServerWindowInfo - Window info request failed (result, elapsed time, timeout) = (258, 2015,2000) CtxWinMgr: PrepTarget - Failed to retrieve server window info CtxWinMgr: EnableGlobalDictation - Dictation into window 0x002c0340 will be handled by global dictation. If you see the following text in a dragon.log file, it means that vsync is disabled. [NAS] Info: vsync module is disabled. 31

L-3422 DMENE vsync Best Practice Guide Viewing vsync log files for Dragon user activity with Citrix published applications After you install vsync on a Citrix server, you can set vsync to create log files that contain data about errors, warnings, or all activities for all vsync users on the server. Once you enable logging, vsync produces a minitracker.log file for every vsync session. By default, vsync logging is not enabled. vsync creates logs files in the following directory on a Citrix server: C:\Documents and Settings\<username>\Application Data\Nuance\NaturallySpeaking10 Important note about the size of vsync log files Only enable vsync logging if you need to provide log files to Nuance Technical Support for troubleshooting. Each log file uses up disk space on the Citrix server. If you enable vsync logging, vsync can create many, very large log files. The logs files can use up a lot of disk space on the Citrix server and increase memory usage on the server. Note: vsync log file settings are set when vsync starts. Follow these guidelines for vsync logging: Only enable vsync logging to track and troubleshoot specific issues Enable vsync logging during a time when network usage is at a minimum. When you no longer require the log files, quickly disable the logging feature. To enable vsync logging for all Dragon users that work with Citrix published applications In the Windows registry, perform one of the following actions. Action Disable vsync logging for all users Enable vsync logging of errors for all users Enable vsync logging of errors and warnings for all users Enable vsync logging of all data for all users Steps Set the HKLM\Software\Nuance\LogLevel (DWORD) key to 0. Set the HKLM\Software\Nuance\LogLevel (DWORD) key to 1. Set the HKLM\Software\Nuance\LogLevel (DWORD) key to 2. Set the HKLM\Software\Nuance\LogLevel (DWORD) key to 3. 32

Viewing notifications about vsync connectivity issues When vsync starts, it keeps track of application windows that open and close. vsync does not take any action on any window until a dictation occurs. When a dictation occurs, vsync attempts to communicate with the Citrix server. vsync may timeout if it is unable to communicate with the server. If that occurs, Dragon users will be unable to use Full Text Control functionality with an application published from a Citrix server. You can now receive a notification when a Dragon client cannot establish a vsync connection to a Citrix server. You can use a vsync timeout notification tool, a stand-alone command line tool, to receive notifications when network issues cause vsync to time out. The notifications contain information about the number of users in a site that experienced vsync timeouts and the names of the users. The vsync timeout notification tool searches the Dragon log in the Master Profile Directory for a special log statement that the Dragon client Citrix components generate when a certain number of attempts to communicate with the Citrix server time out. The tool generates notifications (as a WMI event) about the network issues. You can write an MOF script to detect the event and perform an action when the event occurs. An example action could be to send an email or SMS message to an inbox, or to write an event to the NT Event Log. The generated WMI notifications contain information about the number of users that experienced vsync timeouts and a list of the users that experienced vsync timeouts. You can use the Windows Task Scheduler to configure the vsync timeout notification tool to run according to a schedule and to receive periodic notifications of vsync timeouts. Administrators should schedule the tool to run once a day. Obtaining the vsync timeout notification tool You can obtain the vsync timeout notification tool from Nuance through an ftp site. Contact Nuance Technical Support for details. You will receive a zip file that contains the vsync_notifier.exe, a readme.txt file and a sample MOF script called vsync_event_consumer_example.mof. The Readme.txt file and the sample contain information about the event properties that an MOF script must use to detect and react to vsync timeouts. The Readme.txt file contains prerequisites and requirements for the vsync timeout notification Tool and also contains instructions for installing, un-installing, and using the tool. 33

L-3422 DMENE vsync Best Practice Guide Support for edit controls Dragon Medical Enterprise Network Edition includes support for a wide variety of edit controls. You can use either Basic Text Control or Full Text Control with an edit control. To use Full Text Control with an application published from a Citrix server, the vsync feature must be enabled. Edit Control You can use Full Text Control (formerly Select-And-Say) with the following edit controls: Description DMENE Dragon support Edit (NotePad) A Microsoft edit control EmrTerClass A Ter edit control from GE EpicTer78Class An Epic edit control Excel A Microsoft edit control for Excel No INKTEXTBOX A Microsoft edit control INKEDIT A Microsoft edit control Meditor 2.6 and higher A Meditech edit control RichEdit20A A Microsoft rich edit control RichEdit20W A Microsoft rich edit control RichEdit50W (Word Pad) A Microsoft rich edit control RichEdit20WPT A Microsoft Outlook edit control RichTextWndClass TEdit A Microsoft RichTextBox edit control An edit control from Borland International ThunderRT5TextBox A Visual Basic edit control ThunderRT6TextBox A Visual Basic edit control TMemo TRichEdit Ter13 Class Ter14 Class Ter15 Class Ter16 Class Ter17 Class Ter32 Class TX10 / Txedit10 An edit control from Borland International An edit control from Borland International A TE edit control from Sub Systems, Inc. A TE edit control from Sub Systems, Inc. A TE edit control from Sub Systems, Inc. A TE edit control from Sub Systems, Inc. A TE edit control from Sub Systems, Inc. A TE edit control from Sub Systems, Inc. A TX text control from Text Control GmbH Dragon with vsync support 34

Edit Control TX11 / TXedit11 TX12 / TXedit12 TX13 /TXedit13 TX14 / TXedit14 TX15 / TXedit15 TX32 / TXedit32 Description A TX text control from Text Control GmbH A TX text control from Text Control GmbH A TX text control from Text Control GmbH A TX text control from Text Control GmbH A TX text control from Text Control GmbH A TX text control from Text Control GmbH DMENE Dragon support Windows edit A Microsoft Windows edit control Windows rich edit A Microsoft Windows rich edit control Word A Microsoft Word edit control No Dragon with vsync support 35