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VA Technical Reference Model v 24.7

Dragon Medical Network Edition (DMNE)

General Information

Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. More information on the proper use of the TRM can be found on the TRM Proper Use Tab/Section.

Website:	Go to site
Description:	Dragon Medical Network Edition (DMNE) is a speech recognition software designed to work with an Electronic Health Record (EHR) in a clinical environment. This technology is intended to centralize user management and enhance dictation performance, while running an EHR in a client/server or virtualized environment. Dictation can be implemented when clinicians conduct reports and progress notes in an EHR. Voice profiles are accessible through any computer in a networked environment provided that each computer uses identical audio hardware and configuration. Additionally, the command input feature allows users to create and issue commands to control programs or functions not built into Dragon Medical. This technology is hosted on VA premises and stores sensitive data in a Microsoft Structured Query Language (SQL) Server database. This technology also offers Nuance Management Server (NMS) in the Cloud (instead of an on-premise NMS), which stores data objects on the cloud server in the Nuance data center. This allows organizations that have more than one Nuance product to share data across multiple Nuance applications. Please note that Dragon Medical (360) refers to a number of different client-side products from Nuance. In this case, the Dragon client installed on VA workstations is called Dragon Medical Network Edition (DMNE). The TRM decisions in this entry only apply to technologies and versions owned, operated, managed, patched, and version-controlled by VA. This includes technologies deployed as software installations on VMs within VA-controlled cloud environments (e.g. VA Enterprise Cloud (VAEC)). Cloud services provided by the VAEC, which are listed in the VAEC Service Catalog, and those controlled and managed by an external Cloud Service Provider (i.e. SaaS) are not in the purview of the TRM. For more information on the use of cloud services and cloud-based products within VA, including VA private clouds, please see the Enterprise Cloud Solutions Office (ECSO) Portal at: https://dvagov.sharepoint.com/sites/OITECSO
Technology/Standard Usage Requirements:	Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.
Section 508 Information:	This technology has not been assessed by the Section 508 Office. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov.
Decision:	View Decisions

Decision Source:	TRM Mgmt Group
Decision Process:	One-VA TRM v23.10
Decision Date:	10/12/2023 at 19:34:50 UTC
Aliases:	Dragon Medical 360
Introduced By:	TRM Request
Vendor Name:	Nuance

Vendor Release Information

The Vendor Release table provides the known releases for the TRM Technology, obtained from the vendor (or from the release source).

Version	Release Date	Vendor End of Life Date	Vendor Desupport Date
10.1	02/16/2010	12/31/2023	12/31/2023
11.0		12/31/2023	12/31/2023
12.0/2.0		12/31/2023	12/31/2023
12.5/2.1		12/31/2023	12/31/2023
2.2	04/01/2014	12/31/2023	12/31/2023
2.3	09/30/2014	12/31/2023	12/31/2023
2.4.x	02/11/2016	12/31/2023	12/31/2023
2.5.x	06/02/2016	12/31/2023	12/31/2023
12.51.216/2.6.x	01/20/2017	12/31/2023	12/31/2023
12.51.217/2.7.x	09/19/2017	12/31/2023	12/31/2023

Current Decision Matrix (10/11/2023)

Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.

The VA Decision Matrix displays the current and future VA IT position regarding different releases of a TRM entry. These decisions are based upon the best information available as of the most current date. The consumer of this information has the responsibility to consult the organizations responsible for the desktop, testing, and/or production environments to ensure that the target version of the technology will be supported. Any major.minor version that is not listed in the VA Decision Matrix is considered unapproved for use.

Legend:

White	Approved: The technology/standard has been approved for use.
Yellow	Approved w/Constraints: The technology/standard can be used within the specified constraints located below the decision matrix in the footnote[1] and on the General tab.
Gray	Unapproved: This technology or standard can be used only if a POA&M review is conducted and signed by the Authorizing Official Designated Representative (AODR) as designated by the Authorizing Official (AO) or designee and based upon a recommendation from the POA&M Compliance Enforcement, has been granted to the project team or organization that wishes to use the technology.
Orange	Divest: VA has decided to divest itself on the use of the technology/standard. As a result, all projects currently utilizing the technology/standard must plan to eliminate their use of the technology/standard. Additional information on when the entry is projected to become unapproved may be found on the Decision tab for the specific entry.
Black	Prohibited: The technology/standard is not (currently) permitted to be used under any circumstances.
Blue	Planning/Evaluation Constraint:The period of time this technology is currently being evaluated, reviewed, and tested in controlled environments. Use of this technology is strictly controlled and not available for use within the general population. If a customer would like to use this technology, please work with your local or Regional OI&T office and contact the appropriate evaluation office displayed in the notes below the decision matrix. The Local or Regional OI&T office should submit an inquiry to the TRM if they require further assistance or if the evaluating office is not listed in the notes below.

Release/Version Information:

VA decisions for specific versions may include a ‘.x’ wildcard, which denotes a decision that pertains to a range of multiple versions.

For example, a technology approved with a decision for 7.x would cover any version of 7.(Anything) - 7.(Anything). However, a 7.4.x decision would cover any version of 7.4.(Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM.

VA decisions for specific versions may include ‘+’ symbols; which denotes that the decision for the version specified also includes versions greater than what is specified but is not to exceed or affect previous decimal places.

For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not.

<Past

CY2021

CY2022

CY2023

Future>

Release

12.5/2.1

Unapproved

2.2

Unapproved

2.3

Unapproved

2.4.x

Unapproved

2.5.x

Divest
[6, 12, 13, 14, 15]

Unapproved

12.51.216/2.6.x

Approved w/Constraints
[6, 12, 13, 14, 15]

Approved w/Constraints
[6, 12, 13, 14, 16]

Approved w/Constraints
[6, 12, 13, 14, 17]

Approved w/Constraints
[6, 12, 17, 18, 19]

Divest
[6, 17, 18, 19, 20, 21]

Divest
[6, 17, 19, 22, 23]

12.51.217/2.7.x

Approved w/Constraints
[6, 12, 13, 14, 15]

Approved w/Constraints
[6, 12, 13, 14, 16]

Approved w/Constraints
[6, 12, 13, 14, 17]

Approved w/Constraints
[6, 12, 17, 18, 19]

Divest
[6, 17, 18, 19, 20, 21]

Divest
[6, 17, 19, 22, 23]

Decision Constraints


[1]	This Technology is currently being evaluated, reviewed, and tested in controlled environments. Use of this technology is strictly controlled and not available for use within the general population.

[2]	Projects using this technology must meet Veterans Affairs (VA) Directive 6500 and implement Federal Information Processing Standards (FIPS 199) for all laptop devices and National Institute of Standards and Technology Special Publication 800-53 for all desktop devices when VA sensitive information is involved, or additional mitigating controls must be documented in an approved System Security Plan (SSP) to prevent potential disclosure of PII/PHI data. Additionally, projects which interface with external VA partners must have a Memorandum of Understanding and Interconnection Security Agreements (MOU/ISA), which detail the security requirements for users and systems that share information and resources outside of the VA production network.

[3]	Versions of Dragon Medical prior to 2.3 have been identified by NIST as having a dependency on MSXML4, which is an unsupported Microsoft XML parser identified on their high vulnerability list. Version 2.3 of Dragon moves the dependency to MSXML6. Previous versions of Dragon Medical must be deprecated to eliminate the risk of vulnerabilities.

[4]	Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with VA Handbook 6500.

[5]	Due to National Institute of Standards and Technology (NIST) identified security vulnerabilities, extra vigilance should be applied to ensure the versions remain properly patched to mitigate known and future vulnerabilities. The local ISO can provide assistance in reviewing the NIST vulnerabilities.

[6]	Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities.

[7]	Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. Appropriate access enforcement and physical security control must also be implemented. All instances of deployment using this technology should be reviewed to ensure compliance with VA Handbook 6500 and National Institute of Standards and Technology (NIST) standards. It is the responsibility of the system owner to work with the local CIO (or designee) and Information Security Officer (ISO) to ensure that a compliant DBMS technology is selected and that if needed, mitigating controls are in place and documented in a System Security Plan (SSP).

[8]	Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. Appropriate access enforcement and physical security control must also be implemented. All instances of deployment using this technology should be reviewed to ensure compliance with VA Handbook 6500 and National Institute of Standards and Technology (NIST) standards. It is the responsibility of the system owner to work with the local CIO (or designee) and Information Security Officer (ISO) to ensure that a compliant DBMS technology is selected and that if needed, mitigating controls are in place and documented in a System Security Plan (SSP).

[9]	Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with VA Handbook 6500.

[10]	Due to potential information security risks, cloud based technologies may not be used without the approval of the Enterprise Cloud Solution Office (ECSO). This body is in part responsible for ensuring organizational information, Personally Identifiable Information (PII), Protected Health Information (PHI), and VA sensitive data are not compromised. (Ref: VA Directive 6004, VA Directive 6517, VA Directive 6513 and VA Directive 6102).

[11]	Due to potential information security risks for cloud-based technologies, users should coordinate closely with their facility ISSO for guidance and assistance on cloud products. If further guidance is needed contact the Enterprise Cloud Solution Office (ECSO), which is the body responsible for new software development in and migration of existing systems to the VA Enterprise Cloud (VAEC) and ensuring organizational information, Personally Identifiable Information (PII), Protected Health Information (PHI), and VA sensitive data are not compromised within the VAEC. For information about Software as a Service (SaaS) products or to submit a SaaS product request with the Project Special Forces (SPF) team, please use their online form. (Ref: VA Directive 6004, VA Directive 6517, VA Directive 6513 and VA Directive 6102).

[12]	Users must ensure that Microsoft .NET Framework, Microsoft Internet Explorer (IE), Microsoft Internet Information Services (IIS), and Microsoft Structured Query Language (SQL) Server are implemented within VA-approved baselines.

[13]	Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with VA Handbook 6500.

[14]	Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. Appropriate access enforcement and physical security control must also be implemented. All instances of deployment using this technology should be reviewed to ensure compliance with VA Handbook 6500 and National Institute of Standards and Technology (NIST) standards. It is the responsibility of the system owner to work with the local CIO (or designee) and Information Security Officer (ISO) to ensure that a compliant DBMS technology is selected and that if needed, mitigating controls are in place and documented in a System Security Plan (SSP).

[15]	Due to potential information security risks for cloud-based technologies, users should coordinate closely with their facility ISSO for guidance and assistance on cloud products. If further guidance is needed contact the Enterprise Cloud Solution Office (ECSO), which is the body responsible for new software development in and migration of existing systems to the VA Enterprise Cloud (VAEC) and ensuring organizational information, Personally Identifiable Information (PII), Protected Health Information (PHI), and VA sensitive data are not compromised within the VAEC. For information about Software as a Service (SaaS) products or to submit a SaaS product request with the Project Special Forces (SPF) team, please use their online form. (Ref: VA Directive 6004, VA Directive 6517, VA Directive 6513 and VA Directive 6102).

[16]	Due to potential information security risks for cloud-based technologies, users should coordinate closely with their facility ISSO for guidance and assistance on cloud products. If further guidance is needed contact the Enterprise Cloud Solution Office (ECSO), which is the body responsible for new software development in and migration of existing systems to the VA Enterprise Cloud (VAEC) and ensuring organizational information, Personally Identifiable Information (PII), Protected Health Information (PHI), and VA sensitive data are not compromised within the VAEC. For information about Software as a Service (SaaS) products or to submit a SaaS product request with the Project Special Forces (PSF) team, please use their online form. (Ref: VA Directive 6004, VA Directive 6517, VA Directive 6513 and VA Directive 6102).

[17]	Due to potential information security risks for cloud-based technologies, users should coordinate closely with their facility ISSO for guidance and assistance on cloud products. If further guidance is needed contact the Enterprise Cloud Solution Office (ECSO), which is the body responsible for new software development in and migration of existing systems to the VA Enterprise Cloud (VAEC) and ensuring organizational information, Personally Identifiable Information (PII), Protected Health Information (PHI), and VA sensitive data are not compromised within the VAEC. For information about Software as a Service (SaaS) products or to submit a SaaS product request with the VA OIT Product Engineering team, please use their online form. (Ref: VA Directive 6004, VA Directive 6517, VA Directive 6513 and VA Directive 6102).

[18]	Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. All instances of deployment using this technology should be reviewed by the local ISSO (Information System Security Officer) to ensure compliance with VA Handbook 6500.

[19]	Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. Appropriate access enforcement and physical security control must also be implemented. All instances of deployment using this technology should be reviewed to ensure compliance with VA Handbook 6500 and National Institute of Standards and Technology (NIST) standards. It is the responsibility of the system owner to work with the local CIO (or designee) and Information System Security Officer (ISSO) to ensure that a compliant DBMS technology is selected and that if needed, mitigating controls are in place and documented in a System Security Plan (SSP).

[20]	Users must ensure that Microsoft Internet Information Services (IIS), and Microsoft Structured Query Language (SQL) Server are implemented within VA-approved baselines. Users must utilize approved internet browsers, as Microsoft Internet Explorer has reached End of Life status. See Category Tab for details.

[21]	The Federal Information Processing standards (FIPS) 140-2 certification status of this technology was not able to be verified. This technology will require a 3rd party FIPS 140-2 or 140-3 certified solution for any data containing PHI/PII or VA sensitive information, where applicable. More information regarding the Cryptographic Module Validation Program (CMVP) can be found on the NIST website.

[22]	Users must ensure that Microsoft Internet Information Services (IIS) and Microsoft Structured Query Language (SQL) Server are implemented within VA-approved baselines. Users must utilize approved internet browsers, as Microsoft Internet Explorer has reached End of Life status. See Category Tab for details. Users must not utilize this technology as it will reach End of Life status on 12/31/2023.

[23]	Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. All instances of deployment using this technology should be reviewed by the local ISSO (Information System Security Officer) to ensure compliance with both VA Handbook 6500 and VA Directive 6500.

Note:

At the time of writing, version 12.51.217.164 (version 2.7.5) is the most current version, released 09/19/2017.

The following reference(s) are associated with this entry:
Type	Name	Source	Description
There are no references identified for this entry.

Note: This list may not be complete. No component, listed or unlisted, may be used outside of the technology in which it is released. The usage decision for a component is found in the Decision and Decision Constraints.
Name	Description
Dragon Client	The Dragon Client receives and interprets user or healthcare user dictation, producing text corresponding to each user`s speech. The Dragon Client sends the text into a target application and also preserves text and audio in the speech profiles.
Dragon Medical Software Development Kit (SDK) Client	Dragon Medical SDK is designed for developers and integrators to add Dragon`s speech recognition capabilities to in-house, commercial, or workflow applications, using existing user interfaces or workflows.
Nuance Local Authenticator	The Nuance Local Authenticator (LA) is a service that provides Dragon Medical Network Edition (DMNE) and Dragon Medical One (DMO) clients with Active Directory single sign-on authentication. This technology validates Dragon client credentials when the clients attempt to connect to Nuance Management Console (NMC) server, and then passes the validated credential call to the cloud NMC server to create a session.
Nuance Management Center (NMC) Console	NMC allows Dragon administrators to manage all Dragon clients from a single central console. The NMC Console allows NMC administrators to manage licensing and passwords. The NMC Console does not have permanent data storage. However, it does use a file share for temporary data storage to support file uploads and downloads.
Nuance Management Center (NMC) Server	The NMC Server (also known as the Nuance Management Server (NMS)) is the main web service that drives DMNE and helps it interact with external clients and servers by carrying out several vital tasks involving allowing user access, determining settings on servers and clients, and storing information about user preferences and transcription formatting. In addition, it works with the Profile Optimizer Server to ensure utilization of information about a particular speaker`s voice and language models. The NMC Server also stores user identification and related administrative information centrally, keeping user profiles available at any site the user travels (`roams`) to within the hospital and its affiliate facilities, whether the machines are located in different offices of the same site or at other sites in distant cities. This component includes the NMC Server Full Suite Installer.
Profile Optimizer (PO) Database	The PO Database stores the schedules for the Acoustic Optimization (ACO) and Language Model Optimization (LMO) tasks.
Profile Optimizer (PO) Server	The PO Server manages the iterative learning and integration of each user`s unique speaking/pronunciation patterns by scheduling two processes, Acoustic Model Optimization (often referred to as simply Acoustic Optimization or ACO) and Language Model Optimization (LMO). The ACO process integrates information about how the individual dictating speaks and pronounces words while the LMO process integrates information about words and phrases most likely to occur in the context of the particular user`s speech/composition (writing) style and combines that information with known data about speakers of that user`s language with the user`s accent, if an accent is applicable.
Profile Optimizer (PO) Speech Nodes	The PO Speech Nodes are modules that carry out the Acoustic Optimization (ACO) and Language Model Optimization (LMO) for each dictating healthcare provider. Each PO Speech Node generates two log files for each ACO and LMO process it carries out. This includes the Dragon log file (Dragon Medical SDK Client writes this file) and the Speech Node service log file (PO services write these files).
Upgrade Installer/Service Pack	The Upgrade Installer installs product updates as a software patch. These updates do not include updates for language or acoustic models. The Upgrade Installer can be used to upgrade the entire Dragon client at one time, including the vSync components on the client machine. Users can also use the Upgrade Installer to upgrade many Dragon clients quickly and simultaneously.
vSync for Electronic Health Records (EHRs)	vSync for EHRs creates a virtual channel between the client personal computer and the virtualization platform, passing EHR text box information to DMNE for dictation purposes.


Health Care Administrative	Health Delivery Support

- The information contained on this page is accurate as of the Decision Date (10/12/2023 at 19:34:50 UTC).

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VA Technical Reference Model v 24.7

General Information

Vendor Release Information

Current Decision Matrix (10/11/2023)

Decision Constraints

References

Technology Components

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VA Technical Reference Model v 24.7

General Information

Vendor Release Information

Current Decision Matrix (10/11/2023)

Decision Constraints

References

Technology Components

VA Categories View the VA Categorization Framework

Operating Systems Supported by the Technology

Technologies/Standards Relationships

Runtime Dependencies:

Comparable Technologies:

Companion Technologies/Supported Standards:

General Analysis

Adoption Benefits

Adoption Risks

Architectural Benefits

Architectural Risks

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