Nuance Citrix Client Audio Extension Download

[Ashlie Mealey]

Whenever a Citrix client is upgraded, repaired or reinstalled, the Dragon client side Citrix extensions provided by Nuance (Dragon Medical One extensions or DMNE vSync) must be reinstalled. See the product-specific procedures below.

For Dragon Medical One, the procedure to reinstall the Nuance Citrix extensions is documented below and also in the Deployment and Configuration for Citrix Environments guide provided with the most recent extension download, located here (NuanceCitrixConfig_EN.pdf).

IMPORTANT: If you upgrade, repair or reinstall the Citrix client, you must reinstall the Nuance Citrix Client Audio Extension. Re-installation

nuance citrix client audio extension download

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When you run the vSync Restoration Patch, both success and error messages are logged to the DgnSetup log as well as the version numbers of the currently installed Citrix support components and the components in the patch. Support can access this resource if needed.To learn more and keep current with any changes to this topic, please review this information within Article 8441 - Dragon client side extensions (including vSync) require reinstalling anytime Citrix client is upgraded, repaired or reinstalled.

On local machine we have Nuance Citrix client extension and PowerMic Citrix client extension installed, along with Philips speech drivers and associated registry keys are also added . Everything works perfect locally, pressing buttons on the foot pedal, starts recording on dragon.

If Audio over UDP Real-time Transport is not required for adaptive audio, Citrix recommends configuring the policy setting to Disabled. This helps avoid Citrix Workspace app clients requesting open UDP connections or triggering unwanted Citrix Workspace app client firewall configuration dialog windows to appear.

As audio USB devices plugged into USB 3.0 ports on Linux clients can lead to malfunction, USB 3.0 ports are not supported on clients where Linux based operating systems are running. Please use USB 2.0 ports for your dictation devices.

When using Nuance software integrating Philips Hardware SDK version 4.4.441 or 4.5.450.13 (e.g. Dragon Medical One 2021.4) in a remote environment, Philips client extensions (if used) must be version 4.4.441 or later. Otherwise, button events from Philips dictation devices are not received by the Nuance software. This issue can also be resolved by upgrading Philips SDK and target extensions to version 4.6 or later.

Upgrading the VMware Horizon Client or Citrix Workspace app on Windows does usually not break Philips Speech Extensions, unless the upgrade is done by uninstalling the old VMware or Citrix client first. In this case, after installing the new VMware or Citrix client, Philips client extension drivers need to be installed again (run \2_Windows_clients\philips_client_extension_setup.exe from the Philips Speech Extensions package)

2 Table of contents Overview 3 System configurations 4 Single-hop virtualization 4 Double-hop virtualization 4 Available solutions 6 PowerMic Mobile 6 PowerMic Virtual Adapter 6 Nuance virtual extensions 7 USB redirection 8 Recommendations 9 Zero clients 9 Single-hop configuration (thin or thick clients) 9 Double-hop configuration (thin or thick clients) 9 References

3 Overview For accurate speech recognition, Dragon Medical One must capture clear audio from the user's device. To achieve this in a virtualized environment requires the following considerations: The client workstation, where the user is dictating, is not running a locally-installed instance of Dragon Medical One or the EMR. The applications are running on a virtualization server or virtual desktop. The workstation displays a bitmap representation of the applications or virtual desktop via a receiver application. Dragon Medical One must be installed on the same server or virtual desktop as the EMR to be able to access the EMR's text fields. Button controls and high-quality audio must be routed from the workstation where the PowerMic is connected to the virtualization layer where Dragon Medical One and the EMR are running. Here we summarize the types of virtualized environment at customer sites and the Nuance solutions available. This helps Nuance customer-facing personnel to recommend the best solution for each customer's configuration. Note: Many sites install Dragon Medical One locally in addition to a virtual configuration; local installations are not the primary focus of this document

6 Available solutions PowerMic Mobile PowerMic Mobile is an ios and Android app that routes audio and button controls from a smartphone to Dragon Medical One via a secure internet connection. This works independently from the virtualization technology and bypasses the intermediate virtualization layer in a double-hop configuration. Because no additional software needs to be installed on the client workstation, this is the only Nuance solution that works with zero clients. To use PowerMic Mobile, the user logs in to the mobile app and Dragon Medical One with the same user name. The user name can be defined in the site's authentication infrastructure or in the Nuance Management Server (NMS), explicitly for use with PowerMic Mobile. A Nuance-hosted component, the PowerMic Mobile Server, pairs PowerMic Mobile with the Dragon Medical One instance based on the matching user name. Once the two applications are paired, the audio and button controls are delivered from PowerMic Mobile to Dragon Medical One via the PowerMic Mobile Server. PowerMic Mobile provides the following additional benefits: The site does not need to purchase and install hardware PowerMics. Users can bring their own mobile devices (BYOD) or the site can provide shared devices. PowerMic Mobile can be used on site and remotely, when a network connection is available. PowerMic Virtual Adapter PowerMic Virtual Adapter is a Windows application that uses the same infrastructure as PowerMic Mobile to pair with Dragon Medical One and route audio and button controls via the PowerMic Mobile Server. Instead of capturing audio and button controls from a mobile device, it captures the data from a PowerMic II/III connected to the workstation. To use PowerMic Virtual Adapter, the system must fulfill the following requirements: The workstation must be running Windows or Windows Embedded 32- or 64-bit. Microsoft.NET Framework 4.5 must be installed. PowerMic Virtual Adapter must have access to the USB device. Users must have their own Windows accounts (not shared accounts), and must have permission to access USB devices. Dragon Medical One 3.x and PowerMic Virtual Adapter beta versions cannot run on the same client. This is due to an architectural limitation which will be removed in Dragon Medical One 4.0 and PowerMic Virtual Adapter 1.0. Other considerations: PowerMic Virtual Adapter should not be used to dictate into Dragon Medical One installations in a singlehop configuration that uses a virtualization vendor that Nuance supports (Citrix or VMware). The PowerMic Virtual Adapter/PowerMic Mobile architecture routes audio from the endpoint to the PowerMic Mobile Server, to Dragon Medical One and then back to Dragon Medical Server; therefore, it is more efficient to use the Nuance virtual extensions for virtual deployments that do not involve double-hop configurations. To enforce this requirement, PowerMic Virtual Adapter will not install if the Nuance virtual extensions are already installed on the endpoint

7 PowerMic Virtual Adapter should not be used to dictate into local Dragon Medical One installations. Native Windows drivers will provide the best performance with a locally-connected PowerMic. We recommend that the Windows taskbar is available; this enables full interaction with the PowerMic Virtual Adapter application in the notification area (for example, logging in and viewing the pairing status). The following diagram illustrates the PowerMic Virtual Adapter/PowerMic Mobile architecture and workflow: Nuance virtual extensions The Nuance Citrix and VMware Audio Extensions and PowerMic Extensions provide custom audio and microphone button channels for the following products: Citrix XenApp and XenDesktop VMware Horizon View Microsoft Windows and Windows Embedded operating systems, versions 7, 8.1 and 10 Linux thin clients The following speech recognition applications: Dragon Medical One/Dragon Medical Direct Applications based on Dragon Medical SpeechKit (.NET and COM editions) Audio extensions The Nuance Citrix/VMware Audio Extensions reduce the bandwidth required to transfer audio data from the client workstation to the server/virtual desktop where Dragon Medical One is installed. Native audio channels can require up to 1.4 Mbps bandwidth between the client workstation and the hosted application. The Nuance audio extensions require 19.2 to 256 kbps, depending on the sound format. This enables Nuance to offer compatibility - 7 -

8 with the most common virtualization solutions while at the same time delivering industry-leading speech recognition accuracy. The Nuance audio extension is only installed on the client workstation. PowerMic extensions Microphone buttons, sliders and other controls must be routed to Dragon Medical One separately from audio. To enable this for the PowerMic II/III in a Citrix XenApp/XenDesktop or VMware system, the Nuance PowerMic extensions provide a custom channel for PowerMic button controls. The Nuance PowerMic Extension is installed on the client workstation and on the server/virtual desktop where Dragon Medical One is installed. USB redirection Citrix XenApp/XenDesktop 7.6+ and VMware View 5+ can redirect the USB device from the client workstation to the server/virtual desktop. PowerMic II/III bandwidth consumption via USB redirection is approximately 440 kbps. USB redirection provides good voice quality and low latency, but it is preferred to use the Nuance virtual extensions, which are optimized for audio data. Exceptions are as follows: When using a PowerMic II/III with a zero client or with a thin client not supported by the Nuance virtual extensions. When using a double-hop configuration. There can be limitations depending on the virtualization platform and version used by a site. For example, VMware Remote Desktop Services Host (RDSH) does not support USB redirection on the server side. RTAV VMware Horizon View also features a variant of USB redirection known as Real Time Audio and Video (RTAV). RTAV redirects audio and video data to the virtual desktop at a significantly lower bandwidth than regular USB redirection. To use RTAV, the Nuance VMware Client Audio Extension must be installed on the client workstation. The configuration is only fully supported on Windows clients

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