David (et. al) - you are right and we really do appreciate all the constructive criticism. The unconstructive criticism is a bummer, but is deserved given our lack of any reasonable response to all the concerns being voiced here.

Over the past number of months since V6 was released, we?ve become aware of performance issues affecting a sizable minority of our practices (i.e., about 10%). If you are one of the practices that has been affected, we sincerely apologize for the frustration, inconvenience, and stress these issues likely are causing you, your staff, and perhaps even your patients. We also apologize for not posting this information sooner.

Below is a summary of the most pressing issues that are being reported to our support team, and which we also understand from the board:

Prescription Writer
A number of practices are finding that the prescription writing process has slowed dramatically in V6.0. The effect is most often manifested with the medication window appearing to get stuck while opening. By far the most significant slowdown is when the medication window is opened for the first time after starting the program, taking up to 10 seconds for many ? and even longer for some. After the first time the window is opened, subsequent openings are better (in the 1-5 second range), but even a second or two for a window to open adds up over the course of the day and is definitely not what we would consider as "usable."

There are a number of workarounds which can increase the prescription window opening speed (including turning off Interaction checking, increasing the computer?s RAM, upgrading servers, turning off hardware acceleration where possible, or even purchasing better computers). Of course many of these options simple aren?t feasible. And although this can make the problem tolerable for the users affected with slow window openings, it does not address the underlying issue that we believe are related to the way our program handles all the ?stuff? it has to do to write a prescription ? nowadays -that conforms to the rules, regulations, and laws now required by Surescripts, CCHIT, and the DEA. (FYI - we hate adding all this extra stuff too, Leslie, but it is required for us to remain an ongoing concern.)

We are currently obtaining additional objective data (e.g., window opening speeds on different databases) to determine exactly where and how the slowdowns are occurring (though it is most likely multifactorial and related to the way we do Interaction checking).

Restarting Amazing Charts
Although quitting or shutting down the Amazing Charts program appears to happen quickly, it actually takes about 30 ? 60 seconds during which time if a user tries to restart the program they get a message that Amazing Charts is ??in the process of starting up or shutting down.? There are no workarounds for this issue as even using the Windows task manager (ctrl-alt-delete) doesn?t speed things up -it still takes a many seconds and the user is forced to wait before restarting.

Imported Items
The Imported Items module has a number of problems, some of which have been around in prior versions and were not adequately addressed for V6. These include an issue when clients sign-off their Imported Items faster than Amazing Charts can process the changes. In this situation, the program is still processing a prior command but allows another command to be entered causing the program to unexpectedly crash with a runtime 91 error (or a message that the item can?t be found). Another issue occurs when trying to delete an imported item that has been accidentally saved to the wrong chart by somebody in the practice. In this quirky issue, a non-specific ?no-permission? error can appear, requiring the user to click elsewhere on the screen and try again.
But the biggest frustration with Imported Items occurs when trying to open patient charts that have quite a few imported items (e.g., in the twenty neighborhood) ? which, of course, happens the longer a practice uses an EHR. While faster computers and wired internal networks make this tolerable for most, the real solution is a complete overhaul of the Imported Items module. In the meantime, we are looking at where we can get the best improvements with simple changes that can be incorporated sooner.

Orders
As discussed extensively on the board and at ACUC 2011, we know the Orders module still has a lot of room for improvement. Adding to the mediocre design of this module in past versions, we?ve now added the ability to reconcile and track orders as part of the Meaningful Use Wizard ? which can slow the orders process dramatically, resulting in the program appearing to hang for upwards of 20 to 30 seconds when opening the Orders window. Making this even more frustrating, since it appears that Amazing Charts has frozen, users commonly try to quit and restart the program leading to the frustrations described in the Restarting Amazing Charts issue above.

Once the orders window does open, the process to reconcile an order with a result is also slower in V6. If one tries to reconcile or close multiple orders at the same time, some users are even experiencing a runtime error 91, after which Amazing Charts simply shuts downs (aka: it crashes).

This is not related to how many orders remain outstanding or have not been completed and those clients experiencing this problem find it will occur not only on local computers, but also on the main (server) computer (although it is worse on the local computes). There is no adequate workaround, other than the hardware improvements of faster computers, wired networks, and more RAM.

Messaging
Moving from the Amazing Charts message Inbox to a group box can be quite slow and can even cause the program to crash in some cases and for some users. This appears to be related to a mailbox becoming too full ? which happens more now since we no longer automatically delete, deleted messages, after many users complained they were inadvertently losing charts attached to messages. Unfortunately, if the deleted message box gets too full, it can slow down messaging in general. The workaround is to turn back on the automatic deletion of deleted messages that is under the Edit | User Preferences menu on the main Amazing Charts Desktop screen.

Automatic Backup
For some clients, the Amazing Charts Automator, which controls automatic backup of Amazing Charts, may inexplicable stop functioning. Automatic backups will run at the set time for awhile, but may fail to update the ?next run time,? resulting in no automatic backup being completed. Other than manually performing backups using the Backup Utility, there is no workaround ? and we?ve yet to determine why this is happening to those it affects.

Star Micronics TSP printer
This worked in V5, but stopped in V6. We are still investigating the cause and possible solutions, although I see some workarounds have been posted on the board already.

Admin Services Not Running Error
We are hearing that a significant number of clients are receiving a message on their local computers that "admin services is not running" on the main computer. We are still investigating.


Take Home Message:

  • We understood some of these issues existed, but were not aware to what extent they were causing misery. Based on the total number of support contacts we receive, we estimate that one or more of the issues above affects about 10% of our clients.

  • We are currently analyzing what can be done programmatically to improve these performance issues STAT.

  • We are confident that we can find one or more solutions that will have a positive impact, and therefore are now planning to add a rapid-release build to get these solutions released ASAP (i.e., within a month).

  • This will likely impact our ability to release the Practice Management module in Q1 2012 (which is the reason we have delayed addressing the known issues that have been described on the board and at ACUC).

  • We will find a better way to acknowledge and communicate the status of significant (or possibly significant) issues like these in the future.


Again, please accept my sincere apology for not better communicating these issues, and have confidence that we are working hard not only to get a working solution to those affected as soon as possible ? but also keep you informed of what?s going on at Amazing Charts.

Jonathan Bertman, MD, FAAFP
President
Amazing Charts