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#71457 - 07/25/17 11:34 PM AC incredibly slow (intermittently) for past week
Dr_AJ Offline
Member

Registered: 05/05/11
Posts: 126
Loc: SE Michigan
Ok, so I have not made any changes to our network or wifi or to the main computer. Neither have I updated AC version recently. However, for the past week, all users (wired and wireless) are having AC run so slow that it times out and crashes. Especially seems to occur while prescribing. I need to fix this fast because its going to become in-usable soon. Every 2nd or third chart is slow--not all of them! The only thing I recall happening is a windows update on some of the machines in the office last week.
Anyone have any ideas?
_________________________
a.j. godbole
pediatrics

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#71459 - 07/26/17 02:23 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
First you may want to give LAN Speed Test a try to make sure your speeds to the server are decent. You can use \\servername\Amazing Charts and use 2000 packets. Another trick is if the speed seems slow, from the same computer you could try \\ajgodbolepc\users\ and see what its speed is. If it is much faster, could be something on the server.

Are you using a lot of the checking stuff on the script writers? I know if you were, it was still probably much faster. But, that's one of the few things that is Internet dependent. I don't do any of them. Try turning them off.

Of course, there is the wireless issue, although the wired does the same.

Maybe it is I, but I tend to immediately think these things are my network issue. One good test is to run one computer directly to the server. And, you can remove the update.
_________________________
Bert
Pediatrics
Brewer, ME

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#71460 - 07/26/17 02:25 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Indy Offline
Member

Registered: 06/23/09
Posts: 1705
Loc: Western US
I have heard that a recent Windows patch is producing some AC problems.
Recommend you check with AC support to see if they have a fix.
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Indy
"Boss"

Indy's Blog

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#71461 - 07/26/17 02:30 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
KrisM Online   content
Member

Registered: 07/28/15
Posts: 14
Loc: The Villages, FL
We have had this slowness issue as well for a few weeks. It has also carried over to ACPM which we use. It is actually worse in ACPM at times than the EHR side. Prescribing has caused mini crashes and multiple resends for my providers. Support usually defaults to the "bug" in the newest version response so we have just dealt with it, but it is causing frustration for myself and my providers.
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--Kris

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#71462 - 07/26/17 06:33 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Nick@AC Offline
Member

Registered: 01/12/16
Posts: 12
Hello Dr.Godbole and Kris,

There are a few things that can cause performance issues in Amazing Charts and ACPM. It would be best to have one of our technicians log in and troubleshoot the issue to determine the cause, and find a resolution.

I have made tickets for each of your practices to have a technician reach out and address the problem. You should be contacted shortly.

Thank you,

Nick@AC

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#71463 - 07/26/17 06:35 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Dr_AJ Offline
Member

Registered: 05/05/11
Posts: 126
Loc: SE Michigan
Thanks for helpful replies, Bert and Indy.
I tested the speeds with Lan Speed test. They are MUCH faster on the same computer than to the server and back (as mentioned by Bert). To the server and back they are 5.3 and 6.9 (milliseconds??) whereas within the same machine they are 0.07

So, it could be the server?? The server is SSD hard drive PC with 8 GB RAM. The server PC (and therefore the processor) is over 5 yrs old though....
Bert: can you elaborate what you mean by "turning off the script checking stuff."
Thank you.
_________________________
a.j. godbole
pediatrics

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#71464 - 07/27/17 12:35 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
First, let's talk a little more about the speed test. I guess we are at apples and oranges right now. I think you said on the same computer. You wouldn't want to test on from one location to another on the same computer as that will be blazing fast as it does not have to go over the network.

You want to run four tests.

1. From a problem computer to the server (a folder on the server) may as well make it Amazing Charts.
2. From the best performing computer to the same folder on the server.
3. From the same problem computer to another computer on the network. \\computername\Users\
4. From the best performing computer to another computer on the network \\computername\Users\ to the same computer

The best way to test or at least the best way for some of us to interpret the data is to use 2,000 packet length and use the measure Mbps. Not sure which version you are using. I like the older versions such as 1.3.2. Time to complete isn't that helpful. In 1.3.2 Mbps is in bold. Think about it. Your entire wired network is configured at 1Gbps speed. Cat5e or Cat6, your switch, hopefully your NIC cards, etc. So, theoretically, you should be getting 1000Mbps, but you will almost never attain that on your network. Read speed will almost always best faster that writes. It will determine how fast AC opens up, how fast your chart opens, how fast medication data loads into the script writer, etc. So, for some examples:

My computer to the server:

Let's see what we can learn here. This is a decent connection, but less than half the 1Gb speed it should be getting. And, writes are faster than reads. Here, I will have fairly normal AC speeds. It will open OK. And, I probably won't notice, because I don't have a ton of computers going faster.



My computer to reception (two clients)

When the same computer (my computer) reads and writes to another computer on the network, I get much better speeds. I would get nearly double the performance at these speeds. Still not near the 1Gb.




Checkout to server

Here is a computer to server issue I have had and was troubleshooting for a while. Changed NIC cards and settings. Changed Ethernet. Changed switch ports. But, you can see the speeds are horrible. Given the low read speeds, AC takes a minute to load as it has to load all the demographics and other things over this slow connection. ePrescribe would be slow as far as loading a patient with a lot of meds, especially inactivated meds. Once brought over, I would be fine. Given this computer is not used much in production, I am waiting until my new server is brought online. You won't do much writing. Saving the chart would be one. Messages are small. I don't do a lot of II, so I can't talk to that much.

So, office to server was decent. Checkout horrible. Office to reception was pretty good, so the server must have an issue, but Checkout must be a problematic computer, right?



Checkout to reception (two clients - to the same computer)

So we would expect checkout to reception to be better than to server but not as good as Office to Reception. But, not the case. Blazing speeds and read speeds approaching the theoretical limit. So, we can't really say its Checkout.




We can only surmise that:

Office to server not bad
Checkout to server rather slow
Office to reception much faster
Checkout to reception very fast

So that really tells me two things:

Checkout to server is not good. AC on checkout will not perform well. It should be slower. Keep in mind that AC preloads for speed. I can't tell you everything that is preloaded, but it is demographics for sure. Also, note if you click on the demographics tab or the MRE tab, any computer will take three to five seconds to load (lets say). Do it again and it's instantaneous.

But, it also tells me that it doesn't seem to be the Checkout computer. So, if AC were rather slow there, it probably isn't AC's fault.

It tells me that it isn't AC, it seems to be more likely my network. While the connections all seem good, and the Ethernet and Switch and NICs are all 1Gbps, something is causing a bottleneck. And, there seems to be a problem with Checkout to server. Why? I don't know. But, both are slower to the server. So, is there an issue there?

So just for fun, we run Checkout to a different folder. Same issue. So, we have issues with the server speeds, worse with Checkout. Checkout computer is fine, but has an issue when connecting to server. So, what is our biggest common denominator. When checkout had blazing speeds to reception, it went:

NIC -> Patch cable -> Wall jack -> Ethernet cable -> Switch -> Ethernet cable of reception -> Wall jack -> Patch cable -> NIC of reception

When checkout went to server, it followed the same path, but the cable from the switch to the server jack to the patch panel to NIC was different. So, we have ruled out nearly everything except cable from switch to wall jack to patch panel to NIC of server. So there are various things you can do trouble shoot. You can get rid of patch panel, wall jack and Ethernet cable to switch, by connecting the Checkout computer via long Ethernet cable directly to the NIC. If that is still slow, then you probably have an answer. Still there are more steps.

But, if you notice, while you can do one troubleshooting step after another, it is complicated given the different speeds even with different computers. So, do you blame AC, do you keep spending all night troubleshooting? Or do you do the sensible thing and write all this down, call a reputable computer networking shop who can come over with a fairly expensive fluke meter and test all your connections in seconds to minutes. Total cost for one hour of work: $185? Then you will know if you have an issue with your network, if so, where it is, what it is.
_________________________________________

As far the script writer, on the settings at top right, you can see how many things are turned on for allergy checking and interactions and insurance tier checking, etc. If you use MU, then some of these have to be on. These, I believe but I could be wrong, are going to be dependent somewhat on the Internet. I don't think the AC database can check BCBS copays and tiers, etc. But, it shouldn't need much speed to do that.
____________________________________

Finally, it's hard to know exactly, because most people say ePrescribe is slow, but I am not sure where it is slow. Opening, writing a med, preparing the script, prescribing it, etc. If it were with sending, you could use NC's screens and send in about 15 seconds. To prepare a script there takes longer. Any med that you prescribe there that is codified will be save in your current meds in AC.
_________________________
Bert
Pediatrics
Brewer, ME

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#71469 - 07/28/17 01:07 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Dr_AJ Offline
Member

Registered: 05/05/11
Posts: 126
Loc: SE Michigan
Thanks for that detailed answer Bert! I will have to search some more in our area to find a network shop who knows what a fluke meter is.

I still wonder if its the windows update because the commonest error I get when AC hangs is ".Net framework......"

In the meantime, I noticed that the NewCrop interface is showing as inactive in my list of interfaces in AC.
Does that mean anything to folks?
_________________________
a.j. godbole
pediatrics

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#71470 - 07/28/17 11:22 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
Doubt it is .Net framework. But, go to Control Panel -> Windows Updates -> Open -> Installed updates -> Remove all updates on the day it started. (These will show up again when you do a check, and you can install again.

NewCrop interface no big deal.

Try to do things you can control. Still think it is computer related and/or network related. You can't control AC or AC support.

But a Cat6 cable and connect from worst computer to server. Don't have server connected to anything. In the past, you had to use a bidirectional cable to do this. Now, cables are fine for this. If there is an issue with connection, get a cheap 1Gb switch and use it. If speeds are good, then it is network. Start troubleshooting at switch.

Google networking businesses in the area. If possible, look for those with MCITP techs (Microsoft) but maybe doesn't matter.
_________________________
Bert
Pediatrics
Brewer, ME

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#71489 - 07/31/17 06:28 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Dr_AJ Offline
Member

Registered: 05/05/11
Posts: 126
Loc: SE Michigan
An update: AC still very slow for us: intermittently: usually when trying to write scripts. I got a level 3 tech from AC to log in on Friday and he "watched" my main computer and a laptop for over 2 hours and tried various things to sort out whether it's the server or the network.....credit to him for trying but ultimate conclusion was: "upgrade server pc and/or network and see if it helps".

I still think it is an AC issue because my PM program (not AC) runs along the same pathway and network and its working fine!!

I did the LAN speed test and the pings and they all show good speeds.

My most pressing concern today is: is there a way to Ctrl-Alt-Del the prescription box when it gets stuck? What is that process or exe file called? I ask because currently, when the script box hangs, the only way I can remedy it is to close AC and then restart it: a process that takes over 2 min.
_________________________
a.j. godbole
pediatrics

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#71490 - 07/31/17 06:32 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Indy Offline
Member

Registered: 06/23/09
Posts: 1705
Loc: Western US
Originally Posted By: Dr_AJ
....
My most pressing concern today is: is there a way to Ctrl-Alt-Del the prescription box when it gets stuck? What is that process or exe file called? I ask because currently, when the script box hangs, the only way I can remedy it is to close AC and then restart it: a process that takes over 2 min.


NewCrop has bypassed some internal problems, so this should be better this afternoon - that is what I'm hearing from clients.
_________________________
Indy
"Boss"

Indy's Blog

www.BestForYourPractice.com
Our Name is Our Creed

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#71492 - 07/31/17 09:04 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
In the Run box, type "taskmgr" without the quotes. Kill eRx windows in applications. We all do it, but the best way to never find a problem is to decide what it is and not keep troubleshooting. I doubt the server needs to be upgraded. The fact that your PM program is OK doesn't necessarily mean that AC should. Take a patient with 15 active meds and 30 inactive meds and open the script writer. Then do it with a chart with none. Notice the difference. If there is a bottle neck, you will notice it with AC but not necessarily with your PM. It depends on how much data you are pulling over. If it is intermittent as you said (every 2nd or 3rd chart), are you logging how many meds are in each.

What are you doing with your server? Are you just letting it run or are you restarting it daily?

What happens when you run AC on the server directly to the database? Have you run a computer directly to the server to see what happens? If it is AC, then it should be slow on the server. My advice would be to hire a networking IT to check your network.

Can you post some of your speeds in Mbps using 2,000 packets?

I remember asking a question on Experts Exchange which was very long. One of the more experienced experts came on and took me to task. At the time, I was pretty upset. Now I understand, lol. smile
_________________________
Bert
Pediatrics
Brewer, ME

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#71562 - 08/18/17 01:14 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Dr_AJ Offline
Member

Registered: 05/05/11
Posts: 126
Loc: SE Michigan
An update:
I changed my AC server to a brand new PC with all the latest specs, changed out my switch to a new one and that has fixed my AC problems. AC is humming along like new. The switch was changed first and that didn't do much...so I think it was my server that was the bottle-neck. Now I just have to figure how to get my PM to AC interface to work since the 2 programs are on different PCs.
Thanks to all for all the suggestions.
Figured I should post an update in case it helps others.
_________________________
a.j. godbole
pediatrics

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#71563 - 08/18/17 02:18 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
Thanks for getting back to us. It is very helpful and rewarding. It also is proof that it isn't always AC that is the problem.

Can you fill us in on how the install went on the new server? Or are you not on v9 yet. If you are, then support would have had to log in and do the install, and you would have needed the activation key.

Glad you got it working. I think when there is an issue with speed, it shows up mostly in ePrescribe.
_________________________
Bert
Pediatrics
Brewer, ME

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#71564 - 08/18/17 03:01 AM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Indy Offline
Member

Registered: 06/23/09
Posts: 1705
Loc: Western US
Originally Posted By: Dr_AJ
.... Now I just have to figure how to get my PM to AC interface to work since the 2 programs are on different PCs.
Thanks to all for all the suggestions.
Figured I should post an update in case it helps others.


Usually the interface works on dumping HL7 files into a directory. Often the problem can be resolved by sharing the appropriate directories, then mapping them on the other machine so that they reconnect each time the machine restarts.

Then point the PM file importer to those directories.
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Indy
"Boss"

Indy's Blog

www.BestForYourPractice.com
Our Name is Our Creed

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#71568 - 08/18/17 05:59 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Dr_AJ Offline
Member

Registered: 05/05/11
Posts: 126
Loc: SE Michigan
Bert: install with new server with AC logged in took almost 2 hours! Then it took about 15 min to 'point' all the clients to the new server. I am on version 9.1.0

Indy: The PM apparently cannot push out the HL7 files over the network. It can only put it into a folder on its PC. Can you tell me how to point the AC PM file importer to the PM directory? In other words, how do I configure the AC file importer? (once I know how to configure it, I should be able to point it to the correct folder)
_________________________
a.j. godbole
pediatrics

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#71577 - 08/21/17 02:01 PM Re: AC incredibly slow (intermittently) for past week [Re: Dr_AJ]
Indy Offline
Member

Registered: 06/23/09
Posts: 1705
Loc: Western US
Originally Posted By: Dr_AJ

Indy: The PM apparently cannot push out the HL7 files over the network. It can only put it into a folder on its PC. Can you tell me how to point the AC PM file importer to the PM directory? In other words, how do I configure the AC file importer? (once I know how to configure it, I should be able to point it to the correct folder)


AJ - I'm glad to help you with this, but it will be easier with a phone call. Drop me a PM and we will get this worked out this week
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Indy
"Boss"

Indy's Blog

www.BestForYourPractice.com
Our Name is Our Creed

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