I work in healthcare software and recently did a spike building a voice assistant for the EMR. We compared Google, AWS, Azure and Nuance's voice and intent recognition and Nuance blew all the others out of the water. When it comes to understanding medical terminology Nuance is way ahead of anything other providers have.

Dragon has been around for 23 years and has been THE product for VR in the medical field for at least the last 10 years (from my experience).

Dragon's actually been around since 1982 (39 years). Sad story about the founders, Janet and Jim Baker, though.

https://www.nytimes.com/2012/07/15/business/goldman-sachs-an...

The Bakers sued Goldman Sachs for negligence, intentional misrepresentation and breach of fiduciary duty, which in January 2013 led to a 23-day trial in Boston. The jury cleared Goldman Sachs of all charges.

https://www.nytimes.com/2013/01/24/business/goldman-sachs-cl...

Very sad story. Two pioneers of voice tech had literally nothing for their hard work.

I think in a lot of cases that is because they tried. You can tell 90% of Google's focus is ad consumers when they develop new services, whereas Nuance has sold medical-focused dictation tools for over a decade.

Wow, did not know EMR voice assistant was a thing. Can’t wait till our team works on something like this

Every medical practitioner has been begging for voice EMR for like 10 years. EHR systems are a nightmare to update; a doctor basically needs an intern with an iPad to wander behind them and translate their dictation into EHR. Whoever controls this space will have a close relationship with every doctor and nurse (and any EMRs that don't will seriously falter)

I worked years ago at a major cell phone mfg company, and we were comparing vendors (circa 2013-2014) for the voice recognition/transcription software. I remember two of the leading options were SoundHound (dba then as "Hound", which has since gone to market as a voice solution[0]) and Nuance which was a company not many of us had ever heard of.

At the time, Hound actually was very very good at language recognition and impressed everyone quite a bit. Compared to Nuance, the experience of conversing with Hound was better as I remember. However, Nuance had the edge in language support... while Hound was great for Western dialects of English, and some others, Nuance supported Mandarin. End of the day it was no contest which product we had to go with.

I'm not surprised that Nuance had continued to be an industry leader all these years.

...

0. https://www.soundhound.com/hound

I'm pretty sure Nuance also does the Comcast Xfinity voice remotes. They are actually really well done. And it's a humongous customer to have your claws in.

I have this and it really is quite remarkable. The entire voice integration in the x1 set top box is really polished. Other than the occasional "wow, this is pretty good for comcast!" I hadn't given it much thought until now.

Can you remove the ads from the EPG?

It’s literally better than Siri. I don’t know how, but it is. I’d say it’s even better than Alexa in terms of its ability to recognize things I say.

I think they've been at it for a pretty long time with old products like Dragon. A friend used to work there some years back and said they pretty much perfected speech detection up to some very reasonable error rate. I imagine they've just continued to cover all the dark corner cases and irregularities and accents etc.

No, the real challenge now is how do you minimize the amount of processing power needed, or bandwidth needed, and how do you do all this while minimizing translation time to under 0.5 seconds.

Obviously accents and irregularities are also areas I'm sure they are focusing on, but I imagine that optimizing for real time, mobile and low CPU power devices is a huge focus for them.

They ran dragon on contemporary computers, and that was very good at least 10 years ago, probably more. So they have voice recognition working well on what would now be considered very constrained hardware.

I had an early version of Dragon on Tandy running Windows 3.1. And it was pretty usable. Not just dictation it could imitate mouse clicks when you said stuff like "maximize window".

The biggest leg up they have is that their product works in a very controlled domain. Siri is out there trying to be a complete interactive AI human and failing miserably. The Xfinity remote just controls your TV and does it smashingly. I found the Alexa-driven voice control on my FireTV to also be a pleasant experience compared to regular Alexa.

Ironically, Siri (as a virtual assistant) came from SRI's Darpa program "CALO" back in the 2000's. SRI also has a speech recognition platform called EduSpeak, and that is the codebase that was licensed to Nuance for their product.

However, after Siri was sold to Apple, I don't think that they retained the EduSpeak portion for speech-to-text. (I honestly don't know - but it seems to me it did not; I don't think Apple wanted to pay that license fee to SRI).

The TV remote only has to understand TV-related things, like inputs, channels, volume, and program names. Siri and Alexa have to understand everything.

Not true.

"Xfinity Home, dim the bathroom lights to 40%"

"Youtube Yuri Gagarin"

Are both things it knows how to execute.

I use Siri every day. Former radio guy. Siri is horrible even for me

They do. The amount of magic involved to make it work is amazing from an engineering perspective.

Microsoft already has relationships with Comcast [0] and nearly every major telecommunication around the world.

[0] https://cloudsolutions.comcast.com/apps/64168/office-365#!ov...

And 100% agreed, the voice is great on the Xfinity remote. Was very impressed.

Universal remote control makes all Comcast remotes.

Forum crowds will look to the tech but this is bang on, CEOs are ultimately coin operated and any company would salivate to get their hands on a vendor that is so deeply burrowed into the operations of the healthcare industry.

Yes / No

>>“free healthcare for all”

There never has been and will never be 'free healthcare for all' - its not free, it's only free for some people if some other people pay for it.

I'm curious who you think is actually out there laboring under the assumption that healthcare becomes absolutely, and literally, free?

Given the venue of these remarks, and the otherwise reductio ad absurdum of the alternatives, we can surmise this is referring to free as in speech, not free as in beer, and they mean santé libre, to distinguish it from proprietary licensed healthcare.

Some examples would be useful. Yes, many that don't pay tax benefit from the government, and yes, you can view that as a working class paying for the unemployed.

Imagine, if you will, a 50-year-old woman on the dole (she's paid a monthly sum by the government). In Germany, for instance, this is only paid if she can prove that she applied, and continues to apply for work/seek employment.

It's a bit of a mad circle - she doesn't want work, because she has a comfortable, if meagre life. Of course she dutifully applies for employment every month, and occasionally lands an interview.

She's been out of work for so long though, that's she's no longer employable. She's too old for manual labour, cannot type, doesn't do Internet. And so no one will have her.

It's not ideal for someone expecting to get out what they put into the system, but it's a social safety net that's better than forcing people out onto the street. Will all the problems that brings.

And yes, the 50-year-old gets "free" healthcare. Which I contribute to, from my hard work. And I think this system among the best on the planet.

> And yes, the 50-year-old gets "free" healthcare. Which I contribute to, from my hard work. And I think this system among the best on the planet.

I wish more people had that attitude.

Instead, in the US, we have people actively making their own lives worse because they don't want to give others things they don't believe they "deserve".

If taking more out of my paycheck would get all the homeless people off the streets, I would happily do that. I personally believe that everyone has a right to housing, but even if I didn't care about people, I'd be ok with it because getting homeless people off the streets makes my life better too.

Ensuring that people aren't insecure about housing and food translates to lower crime rates and safer neighborhoods.

It makes me genuinely angry that anti-welfare people don't get this, and actively lobby against their own interest. I'm sure there are some people who just believe that welfare programs don't work, and are against them on those grounds, but most of the rhetoric I hear seems to be around not giving people things they haven't worked for and don't deserve.

Your last paragraph is the bit that resonates with me.

Paying taxes to treat people humanely and with dignity is a good option because when people are desperate, riots and violence are not far away.

And if your thoughts are to push people to that extreme so you can be violent against them, then it is you who are the lesser person.

we americans seem to prefer paying for bombs more than paying to have our own citizens treated decently

i think you are referring to the american government.

now, we are suckers for people giving us promises that they cant seem to keep. That's a different story.

As someone who was born under the NHS in Scotland, grew up in Australia under its Medicare system (and the introduction of partial privatiz(s)ation), and has lived in the US since 2006, no-one is laboring under that misapprehension. Medicare tax is indeed a line item on Australian taxation paperwork.

I don't know where you get the impression that I'm criticizing the NHS or a nationalized Healthcare service. I'm all for a nationalized healthcare service. My issue is with people who pay nil significant taxes in Europe gloating ignorantly about how European Healthcare is free, and won't stop shitting on American Healthcare. Yeah, your healthcare is cheaper than the US but it isn't free. There is a whole bunch of middle class folks and upper class folks paying for it.

Bruh.

You have deep issues. No thinking thinks anything is free. Its free as in I can walk in get treated and walk out without having a cent or anyone asking about my credit details. The difference is in the quality of care as gov run hospitals have much tighter budget constraints and can't treat patients with as much delicacy as private medical institutions.

> You have deep issues

Thanks for the personal attacks. Highly appreciated /s

> The difference is in the quality of care as gov run hospitals have much tighter budget constraints and can't treat patients with as much delicacy as private medical institutions.

Yet somehow places such as Singapore, Thailand and Japan manage to provide top notch healthcare even in government institutions, healthcare that is much better than most private European hospitals.

And yes, my point was exactly about how a not insignificant number of people in Europe seem to think that their healthcare comes for free (because they don't pay tax for a variety of reasons).

No; everyone knows that goods and services, including those supplied by government, come at an economic cost.

This slur of outright idiocy via economic illiteracy is fiction, and applying slurs to people from a specific region on the basis of their economic circumstances is bigotry 101, so the personal admonishment above is hardly surprising.

Sure. Personal attacks are uncalled for and I retract that part of my statement.

But the rest of my points still stand.

Just a thought, "paying nil significant taxes" would mean lower or nil income...? we could also include refugees, prisoners in that group I guess.... these people, may also be providing a huge extra to society in the form of being low paid, having future potential or not adding to externalisation costs such as increased infrastructure needs higher income earners do... also I think the main criticisms of the US health system is that insurance is in most cases part of the job contract and that there are huge (cost) inefficiencies due to insurers battling over coverage costs with health providers... as an aside I live in Romania and as a low income earner I forgoe insurance because it's a lot cheaper to get care when I need it

> insurance is in most cases part of the job contract and that there are huge (cost) inefficiencies due to insurers battling over coverage costs with health providers.

To say nothing of how maddening it is to have to change doctors every time we change jobs, or to lose coverage for certain conditions when we change jobs, or to have to perfectly time certain life events such as childbirth or pregnancy to either before or after we change jobs, or to make sure we don't get sick during the probationary period while we're changing jobs, and so on.

Even if there is a large group of people who believe that, why do you care so much? How do their beliefs, as foolish as they may be, actually negatively impact you?

Uhm, I guess that you have some inner frustrations, as I have yet to meet someone who thinks that healtcare is literally free.

If you're talking about people who for some reason don't understand European tax laws (which is a lot of people in the mainland and in the US), yeah I'm quite frustrated.

My issue is with people who pay nil significant taxes in Europe gloating ignorantly about how European Healthcare is free, and won't stop shitting on American Healthcare. Yeah, your healthcare is cheaper than the US but it isn't free. There is a whole bunch of middle class folks and upper class folks paying for it. And I'm not even supporting the American model.

That is not reality, that is what American right thinks about European people. We of course know that we are paying for healthcare with our taxes, but we also know that in the end what we pay is lower than what we would pay without a government healthcare system. So we chose this healthcare system consciously.

Do we though?

What % of the general population do you think can actually come close to estimate the real cost of their complete annual health care premium cost (let alone actual procedures or services like emergencies)?

And what subset of that do you think would be incredibly shocked at the actual price ?

> the situation in Europe is unsustainable with all the youth and elders voting for "free healthcare" (it's so hard to make them understand it's free for them but oh so expensive for many others)

I think you might misunderstand how the systems work. First of all, there is no such thing as European healthcare. Every country has their own system. In Germany for instance, 14.6% of your post tax income go towards healthcare (capped at a post tax income of EUR 58.050). No one thinks it's free and it isn't free for anybody except for those who really cannot afford it which have never heard anyone critizise.

When I left Australia, which is now 14 years ago, so grain of salt: you paid 1% income tax for Medicare, unless you were above a certain income level, in which it became 1.5%. If you opted out of the system, you could purchase private insurance, and would not be subject to this tax. There was a floor, where below or near "minimum income" levels, you were also not required to pay this tax.

> For instance, you can use taxpayers money to give birth if you want, but you don't choose the date, you don't get a room for long and no way you get a C-Section unless you risk dying.

This makes absolutely no sense. Short of induction agents, which have varying degrees of efficacy, if you're not getting a C-section, the healthcare industry, hospital, don't decide when you give birth, you/your baby do.

(Australian here)

Note that the 1% (or 1.5%) Medicare levy doesn't fully fund the health system here.

The Medicare levy has never actually covered the cost of our public health system. It's theoretically a hypothecated tax that goes to health care, but the system is funded, like everything else, out of general revenue.

The system in Australia is:

* All Australian permanent residents (and some travellers) are able to access Medicare services. The services are funded by a combination of Federal and State governments.

* GPs/Surgeons/Specialists get set amounts from Medicare for different services delivered to patients. The amounts are set by the Federal health department and is the subject to ongoing arguments between the service providers and the government about the amount paid.

* For GP and out patient services, if the provider is willing to deliver the service at the set amount, then they "bulk bill" and the service is delivered "free at the point of delivery" to the paitent. If the provider charges more, then there is a "gap" that must be paid by the patient and cannot (by law and regulation) be covered by private insurance.

* For in-patient services, patients are either "private" or "public". Publicly funded hospitals accept patients of both types, private hospitals only accept "private" patients.

* Private patient services still receive the same reimbursement at a set value from the government. However, if the provider charges over that rate, private insurance is allowed to cover that "gap". Insurance companies can offer differing plans with different levels of cover for that "gap", as well as offering things like single patient wards, choice of physician/specialist etc.

* Public patients in a public hospital receive exactly the same services as private patients, but they: a) don't get to choose their doctor, b) are subject to waiting lists based on capacity, degree of urgency, etc.

* A public patient at a public hospital receives all services "free at the point of delivery". Private patients receive the same reimbursement, then their private insurance will reimburse according to their plan, then any remaining "gap" is payable by the patient.

* The "Medicare levy" is a theoretical additional tax that is added to a person's marginal tax, but it has never really covered the cost.

* As an incentive to get private insurance, the government subsidizes it at 30% and there are sticks and carrots (increased Medicare levy, age related reduction in subsidy if insurance is not continually held etc).

* Private insurance price increases are government regulated and require approval of the minister each year.

Subsidies for prescription medicines is a completely different system (the "PBS").

I opened my last paycheck, the tax is 10% (Eastern Europe).

There is some undeniable truth in this discussion: people with higher income pay for the people with lower income. 10% of 100,000€ is a lot more than 10% of 20,000€.

And so what? That's how a functioning society should work. I would much rather have 90k€ after health care taxes than 18k€; the higher earner is still coming out far ahead.

It's not like the private insurance system is "equitable" either. I am very healthy and hardly ever need to see a doctor, but my insurance comes in at around $650/mo (mostly paid by my employer, but the money still has to come from somewhere). I definitely do not incur anywhere near $650/mo in health care costs of my own; I'm paying for care for people much sicker than I am, who incur health care costs higher than what they pay into insurance.

Because 20K is a smaller number than 100K.

Taxes work with the basic assumption that people need some money to live, there is a humanitarian aspect to it if you see the govt positively or you can say, people in govt dont like thier head too far away from their bodies..

Considering disposable income; 10% of 100,000€ is alot less, taxes are not noticable for me as a high income earner.

I don't know why you want to draw comparisons to the Australian system here. We're comparing European to American, and the vast amount of ignorant thought in Europe about how healthcare is free.

Because the comment I replied to mentioned nothing to do with Europe?

> There never has been and will never be 'free healthcare for all' - its not free, it's only free for some people if some other people pay for it.

That's what I replied to. I also mentioned living with one European system, and a similar Australian system that are both largely considered "effectively free (or at least, out of pocket)", and how no-one living under either system that I've been a part of, thinks that their healthcare is "literally free".

In fact, most of the tropes about "It's not really free, you're paying for it with taxes!" come from Americans bemoaning the insidious evil that they consider "healthcare for all" systems to be. It's a straw man, built up by some to decry "socialism".

> before fleeing communism to move to China

Is there some level of humour here that I'm missing? (and yes I know all the subtleties around the Chinese system. But still - that's a heck of a sentence to throw out uncritically)

He makes a lot of valid points about the unsustainability of the European system, but yeah couldn't help a chuckle at that line.

The "valid points" about how socialism will surely drive all of Europe bankrupt within the next decade have been repeated for the last seventy years. I'm sure they're right this time, though.

Of course, the European model is extremely sustainable if you can ignore the not insignificant amount of cost cutting and lack of coverage of certain drugs for orphan diseases. You can literally just talk to any doctor or nurse in the NHS system and ask them about how quality of care has declined over the past decade, while their professionals' workload has only increased unsustainably. And we're talking about one of the best run healthcare systems in Europe here.

It's of course nothing like the American system which is a bastardization of Healthcare, but it's no utopia either. Costs of delivering healthcare have increased in Europe mostly due to wasteful spending.

I don't know if you bothered to read his points after the first line, but he clearly outlined the Asian model of healthcare, and clearly criticizes the American model.

> lack of coverage of certain drugs for orphan diseases

This is literally the case in the US too. It's not "right" in Europe, when it happens, nor is it in the US.

US pharma companies have, repeatedly, discontinued cheaper, and in some cases, the only effective, medications when they've deemed them not profitable enough.

> The European ones are vast communist machines that can't pay for themselves.

Do you have any proof of that?

A family member is an expert in this area working for the government in a high position for a long time and they update quarterly the estimations on when the system will fall, not if. The current calculation is less than 15 years and it is fairly constant for the past 10-15 years. In the discussions they have between countries the situation varies a lot, from countries that are going from default to default like Greece) or close (PIGS) to countries that are almost stable (Germany), but on average the situation is bad.

For example I was told 10 years ago never to expect to retire because there will be no money for the public pension system when I will have the age. It is on an accelerating fall and the politicians are messing it up even further, pensions were increased by law by 40% about a year ago: if there is no future, you can start ruining the present.

This is a bit of a misterpretation. Yes they make that calculation but to know how to adjust the age of retirement and because there are shunt laws that limit the expenditure to a given percentage of gdp.

Portugal(p in pigs) is such a country and this shunt law is a 2/3 law meaning if debt ceilings are overridden by government or parliament it will be struck down by the constitutional court. just recently there was such a law and it was promptly sent there. E

I don't get it, isn't China communist too. Has that become an in name only thing? But yah there's no silver bullets as someone likes to say, tradeoffs are something adults recognize and have to manage.

The more correct term for universal healthcare rather than free should be cheaper as everyone with such systems wind up spending much less on healthcare than the USA. We basically spend as much per capita on our public system than other countries do on healthcare overall, and then we also have a private system that is even more costly.

America spends the highest amount per capita & the most in total terms by a large margin and they aren't able to cover 100% of their citizens.

Nobody thinks that healthcare is magically free in the rest of the world, but at least in countries with socialised medicine people pay into a system that covers everyone in society.

You pay with your taxes. Is that this hard to understand?

In France when my boss give me 1 euros, he has to give 0.33 cents to a found that goes toward my healthcare. Then most things are « free ». From regular doc appointments to oncologists.

Here I pay 500$/month, and then some co-pay and then some more.

It’s not that different.

France doesn't have $20 aspirin pills.

I’ve never seen anyone argue that. Well, until now anyway.

Agreed

Yes, that makes sense

Oh wow. The Dragon headset is a very strange product space. It is used by non-tech savvy doctors to avoid having to type into the EMR.

It’s not just the non tech savvy. It’s substantially faster to dictate text than type it, especially if your hands are occupied with the computer doing something else (ie interpreting radiology exams, dictating a treatment course or visit note while simultaneously reviewing labs).

Only if no one reads the output.