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#71739 - 09/29/17 02:00 PM Feedback on AC Cloud
sbc Offline
Member

Registered: 06/09/10
Posts: 23
I did not see any information on AC Cloud (after a search) on the board. I am considering moving from an in-house AC Server to the AC Cloud version. I wanted to get advice if this is a good move - and any issues I need to be aware if I move to the cloud version.

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#71740 - 09/29/17 06:30 PM Re: Feedback on AC Cloud [Re: sbc]
jimmie Offline
Member

Registered: 10/16/11
Posts: 1404
Loc: Montana
sbc,

I have done both in house and cloud AC, currently using cloud based since April 2015. I don't ever see going back to in-house server AC. I am very satisfied with the move to the cloud over 2 years ago. We have very little internet downtime and have designated licensed 30/30 microwave internet, so speed is not an issue. but for the cloud to be an option internet downtime and speed ( I would check with AC IT regarding specifics recommended) very important.

I think the best result of this move to the cloud has been the upgrades go smoothly behind the scenes and no or very minimal downtime usually done some evening and I have to have to be signed out of AC on my two computers I use at the office. The next day the upgrades go through with very little or no issues most of the time, currently on 9.4.2.

I really have not noticed much of a difference with the in-house AC, other than less worry for me about backups and upgrades.

Probably the biggest negative and it does not occur very often, is that occasionally if you click too quickly and keep clicking the server will need to be reset because a big black box will show up on the AC image. Usually you can get Guardian Angel help within minutes, so minimal down time again. As time goes on, both my nurse and I have learned not to click too quickly to avoid this.

I figure the monthly cost may be equivalent to upgrading a new server every 5 or so years so the cost may be cheaper over time, who knows, probably not a big difference.

Good luck on whatever decision you make, I think you will be fine either way.
_________________________
jimmie
internal medicine
https://twitter.com/jimmie_vanagon

https://jimmievanagon.wordpress.com/about/






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#71744 - 10/01/17 02:33 PM Re: Feedback on AC Cloud [Re: jimmie]
sbc Offline
Member

Registered: 06/09/10
Posts: 23
Thanks for your feedback Jimmie. Much appreciated.

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#71745 - 10/01/17 06:46 PM Re: Feedback on AC Cloud [Re: sbc]
jimmie Offline
Member

Registered: 10/16/11
Posts: 1404
Loc: Montana
You bet sbc. One other minor difference I have noticed between the server in-house AC versus the cloud AC is this. We had an electrical outage at the office on a weekend and being in the Cloud AC I was able to keep working with no issue, but one of my partners could not remote in to the local AC server at the office he uses. So if you are away from the office without being able to have someone restart the computers/servers in the event of an electrical outage, this difference may be important. Thanks again, sbc.
_________________________
jimmie
internal medicine
https://twitter.com/jimmie_vanagon

https://jimmievanagon.wordpress.com/about/






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#71807 - 10/14/17 03:23 PM Re: Feedback on AC Cloud [Re: sbc]
JayA Offline
Member

Registered: 06/26/08
Posts: 78
Loc: Winter Park, FL
I'm glad to hear that some using the cloud are very happy. We too had very high hopes for moving to the cloud for all of the reported advantages. However, it has not been good for us.
We have a 2 Doc and 2 mid-level in the practice. Probably 13 users overall with 16 different workstations. Have been on AC since about 2007 with a dedicated server, use most of the AC services like backup, Updox, guardian angle, etc. Have midmark vitals, spirometry, ekg, script writer, HL7 with Quest labs/Labcorp, Radiology, and FL shots registry. Use MTBC for our billing. Converted to cloud almost 2 months ago and now we are converting back to an in-house server.

Problems include:
1. We have hard wired computers in every room. When moving to the next patient you have to log off and log on to the next computer every time. In our previous in-house server setup we had all of our client computers connected to the server and my AC profile was open in every exam room. This allowed me to just move to the next room and open the next chart without any delay. You pay for each user to have a connection to the hosted server, so when the user moves to the next computer he logs off and logs back on. One of our docs has converted to carrying a laptop from room to room, connected on Wifi which seems to work better because it eliminates this issue all together.

2. RDP will freeze intermittently. Sometimes will correct itself. Other times will require AC support to restart the hosted computer in the cloud. Prior to going to the cloud, AC had us do connectivity tests throughout the day for a couple of weeks and the tests came back as adequate. If you need help on the weekend, you cannot get guardian angle to restart the hosted computer for you.

3. Print issues: AC support has been unable to correctly configure the script printer.

Those are the big problems I have have been struggling with.

Jay

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#71808 - 10/14/17 03:39 PM Re: Feedback on AC Cloud [Re: sbc]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11221
Loc: Brewer, Maine
I am sorry you are having that experience. I hope this doesn't come across mean, but didn't you know about paying for each connection prior to changing over to the cloud?

Also on #3, what do you consider "the script printer." The Star Printer? TPS?
_________________________
Bert
Pediatrics
Brewer, ME

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#71809 - 10/14/17 03:57 PM Re: Feedback on AC Cloud [Re: sbc]
JayA Offline
Member

Registered: 06/26/08
Posts: 78
Loc: Winter Park, FL
Of course I knew about the $39 per connection, that was the very first thing discussed during contracting, but the log on and log off process is time consuming and a change in our workflow. Longer than expected adding precious minutes of delay over the course of the entire day. We did consider the purchase of additional connections so we can have multiple computers open for us. But we really don't want to spend $78 or $117 per doctor/provider per month. If we were to continue in the cloud, we would only be able to to do this with a Laptop with Wifi. We have 2 TSP printers. Script print size could not be configured properly by AC support.

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#71810 - 10/14/17 05:27 PM Re: Feedback on AC Cloud [Re: sbc]
jimmie Offline
Member

Registered: 10/16/11
Posts: 1404
Loc: Montana
JayA,

Your posts bring up several very important points I didn't mention before. I have a partner that did not like the Cloud AC, and switched back to in house server AC, so switching back I think is fairly easy to do. I am not sure why she switched back, but next time I see her I can ask her and if she doesn't mind me discussing it on the user board, will let you know.
The other issue about the delay logging on and off with each hard wired computer in each exam room brings up another interesting point. I keep my AC open on my dual monitored office desktop and with VNC viewer made for the Chrome, Enterprise version use my Chromebook to simulate my dual monitored office desktop. So when I interface with the patient in the exam room I bring in my Chromebook and access both my AC and Updox which I keep open, or click out of VNC viewer and can then google stuff or whatever I need to do on the chromebook. So I don't open and close AC multiple times throughout the day as you do, so this is good to know about the delay you describe.
I don't work much on the weekends, but you likely saw my frustration on Columbus Day about having the RDP freeze up on my nurses computer and unable to get Guardian Support on the holiday to get the problem corrected on a busy workday (I chose to work that day). So your point about not being able to get Guardian support on a weekend if this happens could be very problematic. It would be nice if AC would have a direct easy fix after hours/on weekends, especially for the Cloud Users, to get this simple problem rectified if it should happen.
Thanks,
_________________________
jimmie
internal medicine
https://twitter.com/jimmie_vanagon

https://jimmievanagon.wordpress.com/about/






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#71811 - 10/14/17 08:09 PM Re: Feedback on AC Cloud [Re: sbc]
JBS Offline
Member

Registered: 09/20/09
Posts: 2489
Loc: Baltimore, MD
Jay,
I no little about AC's cloud set-up or using RDP, so I may be totally off base... but if I hear you correctly, an issue is that one user, lets call him/her "Doc A" is moving from office to exam room and must log off and on to AC at each computer. That process is time consuming, and of course you do not want to have to pay for that one user twice, once on each of those two machines, hence the need to log on and log off.

But what if when Doc A moves, say from the office to the exam room, they stay logged into AC in the office but in the second room somehow remotes-in to the initial computer?
_________________________
Jon
GI
Baltimore

Reduce needless clicks!

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#71812 - 10/14/17 08:47 PM Re: Feedback on AC Cloud [Re: sbc]
jimmie Offline
Member

Registered: 10/16/11
Posts: 1404
Loc: Montana
Jon,
Remember the Laramie trip from a few years ago when Indy talked about the Chromebook? Well shortly thereafter I got one as a Christmas gift, but in my opinion using this device at the point of care has been very cost effective and practically useful.
But to answer your question above, even though addressed to Jay, as I understand RDP, internet and intranet. My office desktop RDP's to AC in the Cloud via the internet. I access via the intranet (behind the firewall at the office) my office desktop with wifi, by chromebook with 256 encryption the purchased Enterprise version of VNC viewer made for chrome.
I bet there would be an easily affordable way for Jay to do a similar intranet connection via wifi to reduce the delay time as you are describing.
I know this isn't part of the topic but the chromebook is very affordable and easy to replace so as the point of care device really nice, and then no maintenance or changing/upgrading windows every few years.
Nice thing about the cloud, less hardwired computers to maintain by using the chromebook in the exam room as point of care device, plus with the hdmi cord can share all you are doing to turn the EHR into a teaching tool for a very low cost large screen tv if you wanted.
_________________________
jimmie
internal medicine
https://twitter.com/jimmie_vanagon

https://jimmievanagon.wordpress.com/about/






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#71813 - 10/14/17 10:21 PM Re: Feedback on AC Cloud [Re: JayA]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11221
Loc: Brewer, Maine
Originally Posted By: JayA
Of course I knew about the $39 per connection, that was the very first thing discussed during contracting, but the log on and log off process is time consuming and a change in our workflow. Longer than expected adding precious minutes of delay over the course of the entire day. We did consider the purchase of additional connections so we can have multiple computers open for us. But we really don't want to spend $78 or $117 per doctor/provider per month. If we were to continue in the cloud, we would only be able to to do this with a Laptop with Wifi. We have 2 TSP printers. Script print size could not be configured properly by AC support.


This is why I was very careful about stating how you took my answer. Before I could give feedback I needed to know that one piece of information.

There are probably several different ways to go about this and Jimmie and Jon have hit on one theme. Using one connection and using RDP (probably the best way) or other means of connecting over the network. This would likely be more fair if it were per user and not per connection. That is the way many companies such as Lexi-Comp and our hospital does it.

The variation on the above theme would be to use RDC with RDS what used to be TS. Then all apps would be on one Terminal Server. I am not completely sure of how it would divvy up the Internet. Wouldn't want it do one for all. There would also be the possibility of each doctor having a proxy server with one Internet connection. Some of the solutions may have to be discussed with AC. The way I look at it, logging off each time is just not doable. I don't know enough about routers, but I will throw this out anyway. Computer A is sending out packets. I am not sure how that is differentiated from B. But, when the packets come back, the router remembers who sent them and sends the info to Computer A.

As to the TSP clinic, you are in luck. First, there is no way support is going to know much about the Star Printer. In fact, give HP, considered the printing gurus, there developments and support team likely couldn't set one up. I am an expert, and I am still terrible. Basically, the Star Printer and its drivers is the most difficult printer to set up. Period. If you could give a little more info. Is it happening at the AC admin level or is it the printer that isn't set up properly. Once set up properly, it will work with no issues pretty much forever. Also, keep in mind that if you get it to work on ANY machine, you can share it out. It is a temporary solution, but it will work permanently, biggest problem being when that computer is shut down.

Back to the Internet connections. Depending on your hard drive (SSD vs HDD -- SSD being much faster to reboot or log on), using log off and log on is very time consuming, not the least which is how long it takes for AC to start up. Logging off is your way of disconnecting the Internet. I don't know, because I don't use it. But, if that is what you are trying to accomplish, there is a much faster way.

Go to Network and Sharing Centers => Change adapter settings. Right-click on the adapter and make a shortcut. It will tell you it can only go to the desktop, which is exactly where you want it. Now, when you go to another computer, you can right click on it and choose Disable. This will disable your Internet. You can then lock the computer. When you come back, simply right-click the same icon and select enable. The whole process back and forth is about four to six seconds. You could even use my script for locking the computer and put that icon directly below the local area connection icon. In one quick movement: Right-click | Disable | double click on the script icon -- the computer locks. Go to the other computer and repeat. Come back to this computer, unlock and right-click on the Local Area Connection icon and choose enable. Total time 6 to 10 seconds.
_________________________
Bert
Pediatrics
Brewer, ME

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#71814 - 10/14/17 10:25 PM Re: Feedback on AC Cloud [Re: sbc]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11221
Loc: Brewer, Maine
It is also your lucky day. We have used two Star printers for 12 years. You have to use the correct paper for each state, so that may be an issue. We would go through a case maybe in 2 1/2 years, if that. We write A LOT of ADHD scripts, plus you cannot print an AC paper script to a patient with Medicaid. They have been proven to change amoxicillin scripts to Augmentin scripts with the addition of clavulinic acid and have been known to change Melatonin from 3 mg to 5 mg. Very serious stuff.

Now, with the requirement of Electronic Prescribing of Controlled Substances, it is rare we need to use them. But, we ran out, and I had to purchase an entire case just to have the two ready in the case of Spectrum cutting out or NC going down. We now have 23 rolls left. This will last us about 22 years. So we would be glad to send some rolls to you at a very, very low cost if anything.
_________________________
Bert
Pediatrics
Brewer, ME

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#71815 - 10/15/17 07:55 PM Re: Feedback on AC Cloud [Re: sbc]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11221
Loc: Brewer, Maine
I should correct myself. Disabling the NIC would d/c the connection from that computer to the cloud, but it likely wouldn't be seen by the cloud connection as off.

I do have a question as I am probably misunderstanding the question. I suppose it is because we NEVER log off AC, only lock the screen.

Are you referring to logging out of AC, and then logging back in? Not logging off Windows and logging back in. The latter would be unacceptable.
_________________________
Bert
Pediatrics
Brewer, ME

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#71818 - 10/16/17 03:06 PM Re: Feedback on AC Cloud [Re: JayA]
Indy Online   content
Member

Registered: 06/23/09
Posts: 1717
Loc: Western US
Originally Posted By: JayA
... but the log on and log off process is time consuming and a change in our workflow. Longer than expected adding precious minutes of delay over the course of the entire day.


This is a problem with the level of implementation insight and coaching that you received during the process. Many of our larger practices (4+ providers) move at full speed by employing different methods that fit their practice.

That is perhaps the slowest way I can imagine to do what should be far faster.

There is a reason myself or someone else on our team that has actually been in practices using AC walks through the logistics of implementation. We know from experience how it really works, and how to make it as seamless as possible.

I'm sorry to hear you had a bad experience.
_________________________
Indy
"Boss"

Indy's Blog

www.BestForYourPractice.com
Our Name is Our Creed

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#71819 - 10/16/17 03:11 PM Re: Feedback on AC Cloud [Re: jimmie]
Indy Online   content
Member

Registered: 06/23/09
Posts: 1717
Loc: Western US
Originally Posted By: jimmie
Jon,
Remember the Laramie trip from a few years ago when Indy talked about the Chromebook? Well shortly thereafter I got one as a Christmas gift, but in my opinion using this device at the point of care has been very cost effective and practically useful.


To this day, I always travel with a Chromebook, and that is often my go-to tool, as it is live in seconds - far, far faster that my laptop grinding through all of the crap in the M$ OS to just become responsive.

Now that Chromebooks have 1920x1080 displays, it is an even easier choice.

Chromebooks can go all day on one charge, and are we recommend over laptops, especially for rooming patients, vitals.
_________________________
Indy
"Boss"

Indy's Blog

www.BestForYourPractice.com
Our Name is Our Creed

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#71823 - 10/16/17 05:52 PM Re: Feedback on AC Cloud [Re: sbc]
JBS Offline
Member

Registered: 09/20/09
Posts: 2489
Loc: Baltimore, MD
Jim, Indy sold me on Chromebooks at that meeting, too. I use mine less than I have in the past, but my wife would not give hers up for anything. I call it my $300 MacBook-light (though my kids don't think that is funny).
Good to know about the higher res display, because the dim and somewhat fuzzy screen has been a major drawback IMHO.
_________________________
Jon
GI
Baltimore

Reduce needless clicks!

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#71824 - 10/16/17 06:13 PM Re: Feedback on AC Cloud [Re: sbc]
jimmie Offline
Member

Registered: 10/16/11
Posts: 1404
Loc: Montana
Jon,
I have upgraded several times since then, and currently have an ACER 14 inch 1080 FullHD, which I really like, the best one yet. But easy to change out the old ones and can be done in minutes. I powerwash the old ones and give to the kids/wife, even my old ones are still working well. The 1080 FullHD screen is better than the original ones for sure.
_________________________
jimmie
internal medicine
https://twitter.com/jimmie_vanagon

https://jimmievanagon.wordpress.com/about/






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#71848 - 10/19/17 01:49 PM Re: Feedback on AC Cloud [Re: sbc]
JayA Offline
Member

Registered: 06/26/08
Posts: 78
Loc: Winter Park, FL
Sorry, have been away from the web for a couple of days. Thank to everyone for your responses. This is very helpful to our situation.

Jimmy, JBS, Bert - Yes, the problem really is the logging on and off of the RDP connection when moving from room to room. AC stays open on the remote computer we are accessing. I really like what you guys are saying in regards to having just one RDP connection to the cloud and remoting in to the connected desktop from each and every room. This option was not mentioned by the AC implementation team. So, what program would be a reasonable option to use to connect the windows desktops (in patient rooms) to the desktop that is connected to the cloud by RDP.

Bert- in regards to the Star printer, Iím not knowledgeable enough to answer the question on what level the problem is occurring. I only know enough to get myself into trouble. We do use the FL specific paper and still print quit a bit for the controllers and for those who just want to bring in a paper script somewhere. The main problem with the configuration is that the print size comes out tiny. My staff was able to make some adjustment to approximate the normal print size, by guessing and changing some of the parameters with trial and error. The scripts still donít look right, but it is useable for now. Only one script can be printed at a time. AC from my perspective has just given up on trying to fix it.

Indy- thank you for your insight

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#71850 - 10/19/17 03:31 PM Re: Feedback on AC Cloud [Re: sbc]
Scott Offline
Member

Registered: 03/24/08
Posts: 206
The Star printer is awesome...when it works. Ours works great for a few days and then out of no where the print size changes, etc. I've given up playing with it, I just print and then make my corrections on the paper by hand.

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#71851 - 10/19/17 05:51 PM Re: Feedback on AC Cloud [Re: sbc]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11221
Loc: Brewer, Maine
Hi Jay,

I should be able to get back to you on the main topic later today. The Star Printer should NOT work like that. You are getting the famous "stamp" prescription. This can be fixed by changing some settings on the printer itself and the computer. What version AC are you using.

Also, you should be able to print one, two, three....whatever amount of scripts. We used to print three all the time. You can do that with one script for say, Metadate CD 20 mg. But, if you set up Metadate CD 20 mg in the ePrescribe window and then set up Adderall XR 30 mg and you try to print any amount, you will likely get a printout with both on the same paper. This can be cut, but with my OCD; I can't handle it.

Let me know a good time to go through this. I may need to remote in. I also need to reach back in my brain to recall the exact settings.
_________________________
Bert
Pediatrics
Brewer, ME

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#71852 - 10/19/17 11:48 PM Re: Feedback on AC Cloud [Re: sbc]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1997
Loc: Central Florida
These setup instructions for the Star TSP800 Rx printers are working for me. I can print multiple Rx's, no problems with font size, etc. Remember that there are two models, the original TSP800 & the TSP800II . Each has its own driver install program; located at this Star support site. Amazingly, the Win 7/Vista drivers for the TSP800 still work with Win 10 (HP certainly can't claim that for an over 10 year old printer).

Some of the loss of connectivity, difficulty printing multiple pages, micro font sizes and other problems mentioned could be wrong drivers or incorrect configuration.
_________________________
John
Internal Medicine

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#71854 - 10/20/17 01:26 AM Re: Feedback on AC Cloud [Re: sbc]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11221
Loc: Brewer, Maine
A couple of things. Excellent instructions. I have to say if you think it is confusing now, you should have tried to configure it 10 years ago. There can still be issues that allow the postage stamp to be printed. It is a crazy printer. But, finding the driver now, is MUCH easier than before.

One thing that MAY be helpful. Not sure. But, if you turn off the Star Printer, then hold the feed button down, turn it back on while still holding the feed button down and wait about four seconds. Paper will start printing from the Star. Maybe four to five inches. You can take your hand off the feed button, but do NOT do anything. After about 10 seconds, it will print out a lot more. This will be your entire printer configuration.

Just a plug for a print server on a server. You can install the print driver that is correct for the server. Set up the configuration. If it prints correctly, then you can add a network printer to any computer in seconds, and you know it will work. A shameless plug for servers. Yes, you can share a print driver from a client, but it's not quite the same.
_________________________
Bert
Pediatrics
Brewer, ME

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#71856 - 10/20/17 04:36 PM Re: Feedback on AC Cloud [Re: sbc]
jimmie Offline
Member

Registered: 10/16/11
Posts: 1404
Loc: Montana
JayA,

I have used the VNC viewer for Google Chrome (Enterprise Version) with good results

https://www.realvnc.com/en/connect/download/viewer/chrome/

or

https://manage.realvnc.com/en/pricing?_ga=2.34981287.704473137.1508516956-300412236.1508174893

There is a Chrome RDP but I liked having the 256 encryption with the Enterprise version for a minimal cost, thought the added security was a bonus.

Maybe Indy or someone else might be able to shed more light on this for you as I have not used a wired desktop in my exam rooms because of the small size of my exam rooms, have only used laptops or chromebooks, so I bet there is an RDP function that would work for you, but I just don't know enough to tell you correctly.
Thanks,


_________________________
jimmie
internal medicine
https://twitter.com/jimmie_vanagon

https://jimmievanagon.wordpress.com/about/






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