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#22134 06/27/2010 8:18 PM
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Having problems with amount of RAM and AC. 1 month ago starting getting memory warnings from the server. Added another 500mb of Ram 2 GB total now - didn't fix the problem What happened is that the AC SQL instance just took all the rest of the "new" RAM. Called support 1st person didn't know what to do and nobody else got back to me. Looked at Task manager SQL using up to 1 GB with the AC instance and another 200 - 300 for the other instances. Is that the amount of RAM overhead everbody else is at? Running version 4 SBS small business server R2. With this setup am running under SQL for workgroups. When I run the database utilties AC starts at about 250MB but rapidly climbs within 1 day to almost 1 GB although that varies somewhat. Worried about going to V5 because I know it takes even more RAM. Haven't run a virus scan for the server but no other problems AC4 running fine. Ideas???


Cary Herl
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Cary #22138 06/28/2010 12:07 AM
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Cary,

Part of the issue here is that, in my opinion, and completely understandably, those in tech support will be very good with AC but not necessarily with SQL. SQL is a rather complex database. Given I attended their lecture this morning I should have asked them and Jon if any of them are SQL experts and/or does he plan on hiring one.

Looking at your situation, it is a common one, and I am surprised it does not come up on the boards more often.

In your situation, it shouldn't matter whether you move to v5 or not, and I wouldn't let this change that. Basically, SQL is just doing what it is supposed to do. SQL is designed to use memory dynamically, taking what it needs and giving back what it doesn't. Unfortunately, it tends to forget about the latter. It is important to understand that SQL itself is a 32-bit program requiring memory. But, it also acquires memory due to two reasons. One, every time it reads a page from disk, it allocates that page to cache so it doesn't need to obtain it from disk next time. Second, it piles up memory in its procedure cash. Every time there is a query, SQL comes with execution plans as to how best handle that query. It then chooses the most efficient and dumps the others and attaches it to that particular query. Computational queries are very "computer intensive." When SQL reaches its maximum amount of memory allowed it gives back some of this memory by deleting the pages and plans that have not been used lately. Unfortunately, from my understanding the maximum memory allowed is a mere 2.1 million GB.

Fortunately, it is rather easy to change the minimum and maximum settings. I could easily do this for you or recommend how, but given there are possible implications on the maximum, I should get more info from you, AND, I would want to ask my SQL expert.

Ironically, it sounds like you are a victim of NOT using SQL Express as it is limited to 1GB of RAM. AC doesn't need a lot of RAM for it to run well, and there are probably many, many stored pages and procedures that you don't need.

What SBS are you using. Are you using 32-bit or 64-bit. How many users and clients. Are you using SQL Server 2005 Workstation or Work groups.

It is not a virus. smile If only it were that easy.


Bert
Pediatrics
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Bert #22163 06/28/2010 2:14 PM
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Using 32 bit and 2005 workgroups. 28 user/clients don't plan on anymore expansion.


Cary Herl
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Cary #22165 06/28/2010 3:28 PM
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Is this SBS 2003? I am not familiar with that SQL version being on there?

Right there you have work groups with a limit of 3GBs. Again, the irony of Expresses limit. We will definitely need to change your settings.


Bert
Pediatrics
Brewer, Maine

Bert #22291 07/01/2010 3:24 PM
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It would be interesting to note where you are with this.


Bert
Pediatrics
Brewer, Maine

Bert #22300 07/01/2010 8:10 PM
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Sorry been busy. Yes its basiclly 2003 server but with release 2 it was upgraded to workgroups 2005. You're right it is REALLY ironic because I set this up this way instead of going with straight 2003 server because it was eligible for 2005 workgroup which now is the problem. Planning on upgrading to V5 this weekend and will talk to my IT guys about setting the limits but would like to hear from u to compare. Ure explanation makes perfect sense


Cary Herl
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Cary #22351 07/03/2010 1:48 AM
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Busy? In medicine? LOL. smile

I need to make sure of one thing. The current version of SQL in that category is SQL Server 2005 Workgroup Edition. Just want to make sure we are talking apples and apples.

We would basically want to determine what all of the other services and the OS are using and subtract from the total amount of physical RAM and set this as the maximum for SQL.

This would be quite easy to do.

Also what is the size of your page file, and where is it located?


Bert
Pediatrics
Brewer, Maine

Bert #22362 07/03/2010 3:32 PM
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Coming to the party late, but just saw the thread.

Part of what you are experiencing is SQLServer will move more and more information into it's specific memory as it operates to improve performance. At the same time you have to have sufficient memory for the server to perform it's other tasks independent of SQLServer.

As was pointed out earlier, each connection also consumes additional memory within SQLServer.

If you have max'ed the memory in your server, Bert will be able to help you set the memory for SQLServer and the server os. One work-around if upgrading your hardware isn't viable is to install a 64/128 GB Solid State Drive(SSD), and create two partitions on it. use a 6-20GIG partition for your paging file (virtual memory), then install version 5 on the otehr partition, with your automated backup going to regular disk/RAID/NAS. The goal is to improve the virtual memory that you can allocate while also increasing performance.


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Bert #22363 07/03/2010 3:32 PM
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Coming to the party late, but just saw the thread.

Part of what you are experiencing is SQLServer will move more and more information into it's specific memory as it operates to improve performance. At the same time you have to have sufficient memory for the server to perform it's other tasks independent of SQLServer.

As was pointed out earlier, each connection also consumes additional memory within SQLServer.

If you have max'ed the memory in your server, Bert will be able to help you set the memory for SQLServer and the server os. One work-around if upgrading your hardware isn't viable is to install a 64/128 GB Solid State Drive(SSD), and create two partitions on it. use a 6-20GIG partition for your paging file (virtual memory), then install version 5 on the otehr partition, with your automated backup going to regular disk/RAID/NAS. The goal is to improve the virtual memory that you can allocate while also increasing performance.


Indy
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Indy #22384 07/05/2010 12:10 AM
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Bert- Yes it is 2005 workgroups. It has a 3 GB RAM limit. Ran a check on the PID's and found it wasn't AC but SBS monitor that was sucking up all the RAM. Set mem max for the monitor to 150MB and now have 1 GB physical mem available. BUT now the VM has exploded. Is set to max of 4GB and is on C drive - Problem - C drive is 12GB max. Have other partitions that have plenty of room. - set it up so that only the OS is on C drive and now I'm getting out of HD space warnings probably from shadow copy and other issues. Planning on moving the page file to another drive as INDY alluded to or the other solution is to increase RAM to 4GB leaving 1 GB for the rest of the server. How big should I make the page file? Also from what I read moving the page file to a different drive helps with performance. So- should I buy more Ram or move the page file? - Lastly ure right about Jon needing a SQL person. This really isn't an AC problem but a SQL SBS server issue. Hopefully he will be looking at this thread.


Cary Herl
Candlewood Medical Group
Family Practice
Cary #22385 07/05/2010 3:29 AM
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Yes, increasing or changing your virtual memory will have. And, as Indy alluded to moving it to a separate drive, not just a different partition is useful.

The rule of thumb is always 1.5 times the physical RAM, so you would change it in My Computer properties. Virtual memory will allow the Windows to free up some physical RAM by paging or "swapping" the memory. Anytime this happens you will be experiencing system degradation.

I would suggest setting the initial virtual memory the same as the maximum. Also, some will tell you to leave a small amount of VM on the C: drive such as 4Mb to 10Mbs.

I am not sure that 4GB is exploding. You would set it to 3GB anyway. In your case maybe less such as 2GBs. Make SURE that on the window where you set your VM, that you select best performance for background services.

Setting a maximum for SBS monitoring, given that SQL as a whole is managing its own memory, it will just start storing pages and procedures from AC. Of course, you are right that with more physical memory, even if you let Workgroup do its own thing, you would still have the 1GB. The problem is SQL will take its 3GB and you will be left with 300Mbs given the limit of a 32-bit OS.

Still, I would add 2GB of RAM tomorrow. By 7 am smile This would be the single best thing you can do to improve performance. You stated you have 28 clients. Everything will run better with more RAM.

Not being a SQL expert, I am not sure if 150MBs will be sufficient. I am not sure.

How much space did you set up the C: drive to begin with. You can always increase its size with a partition manager for servers, but I would back up everything first.

I am guessing you set your mins and maxs using SSMS? You would likely need to set ACs as well.

How feasible is it for you to move to SBS 2008 or Windows Server 2008? Of course, you could still install a 64-bit 2003 OS, but if you were going to change, then you may as well upgrade to 2008. It's a sweet OS. Then, of course, you are only limited by the hardware up to the 64GB limit. Dell gave me some RAM, so I installed 20GBs, which is overkill, but 8 to 12 GBs of RAM would definitely solve your problem.

If you need a SQL guru, let me know.

You can probably clear off some of that space on the C: drive. Temp files and Windows Updates restore files take up mega room. Do a search for .tmp and see what shows up. Also, Google a free program called TreeSize Free. This program will show you exactly what is taking up what space on your PC. Finally, do you empty your Recycle Bin? Sometimes, I forget after I delete large files from the bin, and it is still taking up space.

HTH. Let me know.

Indy's suggestion on the SSD is a good one, but I am not very familiar with that one.


Bert
Pediatrics
Brewer, Maine

Bert #22386 07/05/2010 3:37 AM
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To expound a bit - a SSD is a drive that is actually made up of memory chips; it runs effectively at the computer bus speed, far faster than a standard drive.

It is a less radical modification that several other choices.


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Cary #22921 07/20/2010 11:43 PM
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Interesting- cranked down SBS sharepoint, monitor, sql task monitor to a max of 200MB ram total but as Bert pointed out AC sql instance took the rest of the RAM Now at 1.5GB Tried to limit the AC sql instance BUT SBS won't let me because I don't have permission to edit it. Must be something with AC. Indy- looked at the SSD drives to move the page file but my MB has SATA-2 burst rd/wr at 300MB and all the SSD drives seem to be slower than that. Better off to get a SATA2 drive for the page file? Another thought am running dual drives RAId for the server/AC which does degrade my SATA2 to about 90MB read write/sec- Ran diagnostics before I set up the RAID and burst rates ran at 170. I can put a dedicated drive for the page file not on RAID which should run faster. The board was rated at 4GB mmax but due to chipset BIOS taking RAM or whatever all I can get is 2.6

Last edited by Cary; 07/20/2010 11:49 PM.

Cary Herl
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Cary #22922 07/21/2010 12:07 AM
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Cary - sounds like you are making progress on freeing memory, and that should help.

The benefit of the SSD drive is reduction of latency (in theory one clock cycle to access desired file/sector - the Input/Output (I/O) latency of drives are bounded by three factors - 1)the RPM speed of the drive [faster is better] controls the speed of the drive head positioning 2)and the raw read-through speed, and 3)the memory buffer on-board the hard-drive.

That said, it is the I/O performance of your drive that will typically be the limit, not the bus speed of the MB.

Pointing to another drive partition on the RAID may be faster.

I just thought of another low-cost option, add a card-reader, and mount a 4G or 8G SD card, and use that as the accelerator for the page file.


Indy
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Indy #22923 07/21/2010 12:56 AM
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Ideally, you would want your page file on a separate and fast hard drive as Indy says. In the end, I don't know. In your situation, it may seem hugely important, but if you are having to swap memory between physical memory and virtual memory, you are already degrading performance.

Why can't you set a max on AC? It isn't going to be SBS. It would be the username and password on the AC instance. That shouldn't be hard.

With a mirror your write times should be slower, but your read times should be as fast as one drive.

We can easily get you down to say 800MBs on SQL AC.

All in all, though, with 28 users, not sure why you're not going with 64-bit SBS 2008 Premium with SQL Server Standard 2008. Then, RAM won't be as issue.


Bert
Pediatrics
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Bert #22976 07/21/2010 7:07 PM
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Actually have 28 computers but only 14 users rooms hardwired My board max is 4 gb so to upgrade would have to get new MB as well. Am using the command line to edit sql when I go in and try to edit the AC instance I get User does not have permission message when I edit the others with the max memory command no problem. I have tried it with AC running with me logged in and with it not but that souldn't make any difference since I'm working in SQL I can't find a management console for sql is there a snap in u can run


Cary Herl
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Cary #22980 07/21/2010 7:55 PM
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Did you make sure all of the workstation components and dev tools are selected?


Bert
Pediatrics
Brewer, Maine

Cary #22981 07/21/2010 8:26 PM
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Well, then I guess I should say maybe it's time to purchase that new Dell server with enough room for 64GBs of RAM if necessary, although you certainly won't need that much.

All SQL Server 2005 editions and higher (except Express) should come with SSMS. Have you installed everything from the install package?


Bert
Pediatrics
Brewer, Maine

Cary #22986 07/21/2010 10:59 PM
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I'll see if SSMS is around or on the install disk Thanks

Last edited by Cary; 07/21/2010 11:00 PM.

Cary Herl
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Cary #22988 07/21/2010 11:06 PM
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Good. If you can find it, we will be all set. If you can't, let me know, and I will email Raja. My guess is he could come up with it. smile


Bert
Pediatrics
Brewer, Maine

Bert #23030 07/22/2010 3:39 AM
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I read in one post that it was time to purchase that "new server" with more memory. Could anyone tell me what the ideal server should have to be able to run AC with 18-20 users and not saturate the memory. Right now we can only have four users directly on the server on AC because it seems to consume a fourth of the memory with each user. I do not understand SQL but dearly want to solve this porblem even if it means new hardware as long as the new hardware works with our clients and does not stall.

Lois #23035 07/22/2010 3:58 AM
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I don't think you can do better than these. Keep in mind that the 2900 PowerEdges have been discontinued. These are the replacement models.

I wouldn't go lower than the 610. But, it would fulfill your needs.

http://www.dell.com/us/en/business/...erver-poweredge-t610&s=bsd&cs=04

The 710 will allow up to 16 hard drives, which is crazy, allows more memory (but you would never need that much memory). But, it isn't that much more expensive.

http://www.dell.com/us/en/business/...erver-poweredge-t610&s=bsd&cs=04

You can get your IT person to look at them. He probably already knows. You simply can't beat Dell (for servers). You can get a great lease, and you can talk them down on the price. The service is phenomenal in my opinion. Make sure you get a 3 year 24/5 warranty, if not better.


Bert
Pediatrics
Brewer, Maine

Bert #23036 07/22/2010 4:00 AM
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And, of course, it was I who talked about getting a new server. I love spending other people's money. smile

I am so confident you will like those servers, I would tell you to buy one tomorrow. I will personally back it up.

But, I would at least wait until Friday <WINK!>


Bert
Pediatrics
Brewer, Maine

Bert #23040 07/22/2010 4:32 AM
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Towards that end, I have a mid-market sales team that sells directly to several clients I support - I have no commercial interest in potential transactions, I just like getting the volume price to people.

If you want to go IBM or HP, there is someone esle I would connect you to for that.

Just PM me if you want contact info.

I'm with Bert - you can almost never but too much memory in this business, or too fast a hard-drive.


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Bert #23110 07/23/2010 11:23 PM
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It has been an interesting road - Looked on the net- loading sql 2005 when u had a previous version of sql on the server the tools don't fully load even though sql 2005 says it does - fixed that but with the SSMS running still would not connect to the AC instance- called Claire at support today 1st time through!! and set up a net meeting she knew exactly what to do. The AC instance needs a login and password that only support has. She logged me in and I was able to set AC5 at 1GB max. Now have 300 to 400MB free and the page file did not increase. Maybe these guys know something about sql/AC - Anyway food for thought

Last edited by Cary; 07/23/2010 11:26 PM.

Cary Herl
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Cary #23116 07/24/2010 2:10 AM
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Cary,

I am glad you got it fixed.

But, I do have to ask, "Do you check your Private Messages?" I was taking care of that back on July 4.

AARRGGHH!! Oh well, you got it fixed.


Bert
Pediatrics
Brewer, Maine

Bert #23125 07/25/2010 2:46 AM
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Bert, Indy, Cary:

i would like to change to client server - I did not start on that platform b/c of price and percieved need for intense IT support. It seems prices have dropped and Dell is marketing beginer servers to non IT people like myself.

The above discussion, although fascinating is potentially discouraging. I would not want to go through what Cary just described. It would drive me to entertain the SAAS EMR options. I appreciate "the voodoo that you doo soo well..." but I do not have the passion for another learning curve and dedicated IT support I suspect would be expensive. Please tell me all that tech voodoo was necessary b/c you were trying to get a vintage system to perform at today's performance expectations.

I would like to demonstate to my collegue that AC5 on a server is cost effective, more secure, robust and feature rich than some of the "free" SAAS based offerings. He and I are discussing PracticeFusion.

I hope to show that windows 7 on thin clients, a Dell T310, 410 or 610 running SBS -is a cost effective alternative. This may be difficult. BTW, broad band delivery is improving nationwide - do you think AC or some enterprising intermediary will ever provide AC as SAAS? I think in a yr or two most of the limitations making broadband unattractive will be solved - different post.

Indy, I would be very interested in working with you to get volume pricing - Dell's web site seems higher than what was quoted on another post. I am thinking 3 thin clients - windows7 and the Dell T310 (410 if price right) + the other network "stuff."

Bert, the T310 has swapping HDs which is my essential requirement - it has a very nice price. Was your recommendation to Cary of T610 based on his users? - T410 comes with SQL and a heafty price hike over T310. I thought AC4 and AC5 included a working version of SQL - At peak use i would expect at most 6 people accessing AC -

gentlemen, it is late.

GIno

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Originally Posted by gino
The above discussion, although fascinating is potentially discouraging. I would not want to go through what Cary just described. It would drive me to entertain the SAAS EMR options. I appreciate "the voodoo that you doo soo well..." but I do not have the passion for another learning curve and dedicated IT support I suspect would be expensive. Please tell me all that tech voodoo was necessary b/c you were trying to get a vintage system to perform at today's performance expectations.

I would like to demonstate to my collegue that AC5 on a server is cost effective, more secure, robust and feature rich than some of the "free" SAAS based offerings. He and I are discussing PracticeFusion.

You should read Jon Bertman's response to the question of SaaS-based EMRs, posted recently here. It's the third from last question.


John
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Gino - would be glad to help.

You use the word "thin client" which can have a specific meaning in the IT world, but I am guessing you mean "inexpensive desktop PC" for connection to the server.

In that vein [desktop PC to talk to a server], a recent 'Dell Deal' that would seem to fit the bill is OptiPlex 380 MT (http://configure.us.dell.com/dellstore/config.aspx?oc=ftopt38&c=us&l=en&s=bsd&cs=04)
Win7 Pro/3yr basic service/Core2 Duo E7500/2Gigs memory

I would recommend 4Gigs RAM, but the base price of $539 is pretty compelling. Similar pricing from HP & Lenovo.

For a small office, that 3 years warranty and service can be an important feature.

Last edited by Indy; 07/25/2010 10:35 PM. Reason: clarified the specs were for a desktop (client) PC

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Indy #23155 07/25/2010 8:57 PM
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Originally Posted by .
I would like to change to client server - I did not start on that platform b/c of price and perceived need for intense IT support. It seems prices have dropped and Dell is marketing beginner servers to non IT people like me.


Everyone started as a non-IT person. A client/server model is no different than peer-to-peer until you get into a domain. The server OS can be a little more daunting than WIN7, but the 2008 OS look and feel much like the WIN7. You can start at the beginner server, but then you are right back to where you are now; wanting to upgrade later. I would at least move up a couple models. Also, as said over and over, if you go with Small Business Server instead of simply Windows Server 2008, you will find it much easier to set up.

Originally Posted by .
The above discussion, although fascinating is potentially discouraging. I would not want to go through what Cary just described. It would drive me to entertain the SAAS EMR options. I appreciate "the voodoo that you doo so well..." but I do not have the passion for another learning curve and dedicated IT support I suspect would be expensive. Please tell me all that tech voodoo was necessary b/c you were trying to get a vintage system to perform at today's performance expectations.

I would forget the above discussion. It is an unusual case with hardware and software that really more than the system had. When you have 28 users/clients using a 32-bit OS with 1.5 GBs of RAM and SQL Server 2005 Workgroup Edition that can use up to 3GBs of RAM (or wants it). The biggest problem there was not having enough RAM to start with. Not saying they could see that ahead of time, but the saying “You can’t have enough RAM,” is never truer than in her situation. I suspect that AC support is trying very hard to get up to speed with dealing with SQL issues especially when the SQL server being used is not what comes with the product. While Jon can decide what market he is after, currently he has said over and over that AC is meant for the one to five physician practice. If you bought a server and ran a 64-bit OS and bought 8 to 12GBs of RAM, you would never be hurting. In fact, if you went with 32-bit and 4GB and used SQL Express, you would be fine. It all depends on whatever else you are running on the server, which everyone forgets or overlooks. This situation also looks worse because of the nature of typing posts back and forth. Remoting in or one phone call may have saved quite a bit of time.

Originally Posted by .
I would like to demonstrate to my colleague that AC5 on a server is cost effective, more secure, robust and feature rich than some of the "free" SAAS based offerings. He and I are discussing Practice Fusion.

You have to decide if you wish to go with an ASP model or a program on your network. This has been discussed over and over. If you want your data in the cloud (online), then go with ASP model. If you want your data and everything on your own computers, then go with AC. It is extremely cost effective. It is practically free. If you look at the number of EMRs that are actual programs vs those that are ASP, it isn’t even close.

Originally Posted by .
I hope to show that windows 7 on thin clients, a Dell T310, 410 or 610 running SBS -is a cost effective alternative. This may be difficult. BTW, broad band delivery is improving nationwide - do you think AC or some enterprising intermediary will ever provide AC as SAAS? I think in a year or two most of the limitations making broadband unattractive will be solved - different post.

What limitations are you talking about for broadband? Broadband is pretty fast right now and can handle ASP EMRs. Granted speeds that are allowed when fiberoptics rule the Internet, will make each click almost instantaneous. Jon doesn’t appear to want to sell AC, and he is not going to change it to an ASP model. I doubt anyone will provide AC as SAAS. I think if you want that model, then you should concentrate on those models. If you want a networked application, then look at those. I think it would be a big mistake to purchase AC in the hopes that someone will make it an ASP model.

Originally Posted by .
Indy, I would be very interested in working with you to get volume pricing - Dell's web site seems higher than what was quoted on another post. I am thinking 3 thin clients - windows7 and the Dell T310 (410 if price right) + the other network "stuff."

Bert, he T310 has swapping HDs which is my essential requirement - it has a very nice price. Was your recommendation to Cary of T610 based on his users? - T410 comes with SQL and a hefty price hike over T310. I thought AC4 and AC5 included a working version of SQL - At peak use i would expect at most 6 people accessing AC

You have to look past the baseline price. You have to customize each one. For instance, the T310 comes with 1GB of RAM. If you want 4GB, it will run $124 more. 8GB (what I would recommend) is $341. It has onboard hard drive controller and can only take 4 hard drives. Being able to swap out is only good if you have RAID for the most part. You can get a RAID controller, but you will need at least two drives or four if you go RAID10. I would be hesitant to buy a server that is limited to four drives. It also comes with a Celeron processor. You probably don’t want a Celeron processor. So you have to pay more for a Xeon. Like $250 more. You could go with a Pentium, though. A Celeron and Pentium processor limits you to whether you use unregistered or registered RAM. The 410 comes with a Xeon processor. I just don’t feel like spending the time to compare Xeon to Xeon. The T610, I mentioned because Dell considers it the equal of the PE 2900, which has been there top selling server to SMB. As soon as you go to the T610, you allow yourself the flexibility of 8 hard drive bays. So, when you are comparing the prices, you have to compare apples to apples. Dell will give you that money back in a discount anyway. Why is swapping hard drives your essential requirement?

To be honest with six users, you don’t need much of a computer to run AC. A regular computer would suffice. I would put most of my money on RAM, RAID and backup equipment. I guess I just try to convey to people to not just look at it like it is only for AC, but for your entire office and what you can do with it.
Indy, as always, gives excellent advice. I am a Lenovo or build it myself guy. To put things in perspective to your question, the Dell Optiplex is a great computer. It is a desktop (workstation), though, not a server. It depends what you are referring to when you say Client/Server. If you are really talking about a server computer with a server OS, then you are going to want to buy a server. That isn’t to say you can’t run AC well on the Optiplex.


Bert
Pediatrics
Brewer, Maine

Bert #23189 07/27/2010 3:13 AM
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Thanks Ryanjo - Jon's article and tireless responses to field questions were very helpful.

Bert, thanks for your comments. I do plan on
- SBS (Small Business Server). I am assuming I will do just fine with the SQL Express that comes with AC so no need to purchase the full SQL version.
- My "server" vocabulary is still developing. "Swapping Hard Drives" to me is the capability to each night easily take off premises an *.ENC fully backed up drive - I don't know what else to call this feature.
- I'm now thinkng a T410 with 4 GB running a 32-bit OS is likely plenty good for a 1-2 doc practice seeking server capabilities.
- Broadband limitations? There are some - not saying the technology doesnt exist - just that there are factors limiting wide spread use of the offerings needed to run an EMR properly. Cost, infrastructure, availability...I could get all kinds of bandwidth if I were willing to pay a lot and if the hospital allowed me to run line... (tried 4G mobile broadband - terrible upload speeds).
- this year my internet service has been down no more frequently than my workstation has been down due to some OS, hardware or application hiccup. I believe AC is a superior EMR because it is simply a more effective medical charting tool with the least admin/business distractions (Practice Fusion may actually post advertisements ... ?!) - I believe AC is a better vendor because I believe Jon has my back as a physician. Now, If AC had a "SAASy" twin ... what a pair! I do recall some products offering both hosted and local platforms. I have NO idea how hard a programing task this is and Jon is obviously spread thin perfecting the old while forging ahead with the new.


Thanks
Gino

gino #23190 07/27/2010 5:11 AM
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Are you thinking of SBS 2008 Standard or SBS 2008 Premium? The Standard Edition does not come with SQL, so yes Express will be more than enough.

You would not want nor would it be feasible to take home swappable hard drives. Swappable hard drives are a function of the server in that it allows you to put hard drives in from the front and the drives which generally have special pins allowing them to connect and be grounded simultaneously. While they can be swapped out to bring different data to the computer, their main purpose is to replace a failed drive in a RAID. A truely hot swappable drive can replace a failed drive while the computer is still running.

A hot spare, which is probably better and can be combined with hot swappable drives, is a drive which is already in the machine, but is not being used. It automatically replaces the failed drive behind the scenes and the RAID is rebuilt giving one plenty of time to replace it.

Taking a drive home from the computer is not your best option. The drive would probably be a 250+ GB drive which you would be using for a 50MB backup. What you would probably want to do is have two portable external drives and alternate taking them home. Many would recommend simply purchasing one or two 4GB thumb drives, but make sure you encrypt the data first. The .enc file is obviously encrypted, hence the extension .enc.

If you aren't using RAID (which is one of the main advantages of having a server with many hard drives), then hot swappable drives and hot spares aren't very functional.

The T410 is a very good choice. If you go with SBS 2008 Premium, it comes with a second server and you can run both 32-bit and 64-bit. This is because Exchange can be run separately. The Premium version usually runs about $800 more than the standard version.

SBS 2008 Standard must be 64-bit as it contains Exchange Server 2007 which must run on a 64-bit OS. Given the fact that the 64-bit OS has many advantages and everything is moving that direction, I see no reason not to use 64-bit. You will be glad in the future. 4GBs is a lot of RAM (in fact it is the minimum amount to run either), but with 32-bit, you are forever stuck with 4GBs. You may never need more, but you never know. And, with 64-bit, you can go as high as 32GBs, which is the limit for SBS 2008 Standard. As you mention, there is really no reason for a different SQL server, but it doesn't matter with only 4GB as Workgroup edition takes up to 3GBs and Standard and other editions are limitless.

Amazing Charts as you say, will run very well on the SBS. Of course, if that were the ONLY reason to get a server, then it would be overkill, but it will definitely do well on the server. The main thing is that no one will be using the server, and a server is designed to run many days without a reboot. They are very stable.

HTH. I am glad to help, and my experience has been pretty much with what you are looking at. I have only worked with Windows Server 2000, SBS 2003 and SBS 2008 and used both 32-bit and 64-bit OS. I am fairly familiar with SQL Express and Standard and have used Exchange for over four years. If you have never used SBS, you will love SharePoint and RWW.


Bert
Pediatrics
Brewer, Maine

Bert #23252 07/28/2010 11:24 PM
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Bert - Where is the private messages folder? - Other issues fixed the AC/sql instance but now AC exe which runs on the server use it so I don't have to add another user -goes up to 475MB eliminating my spare RAM-that is really an academic point since at this point I don't care if I'm getting low RAM issues- the real issue is AC is running slow ( up to 15 seconds on a screen refresh in the prescription writer when trying to print either to the fax on the server or to the printer for schedule 2 narcs)-Rest of the screens usually do fine Shut down AC exe on the server and freed up the RAM no difference - Looked at network traffic on the linksys switch SWR248G4 collisions net traffic etc. not overloaded- also the problem semms to jump between clients 1 will run fine 1 time next time slows down The server had a gigbit NIC so bandwidth to the server should be OK- Maybe this is a problem of so many users on the system - I hardwired rooms and it's not like 28 users are on at the same time we have 10 rooms 4 docs and their desks that's 14 users not running at the same time unless with the upgrade AC querys these users every few minutes- saw a problem on another thread about inbox messages being to large and slowing things down- not the problem- I think that if this is a AC problem-not sure of that it will have to be resolved The only way that AC will survive will be run in a 4 to 6 maybe 8 doc scenario. AC will never be a 10, 15 30 doc system and I don't want it to be BUT there is power in numbers There are big changes coming over the next few years and we need numbers so that Jon has the Big stick to do what he has to do. Would like to here from Jon on this point. My opinion.


Cary Herl
Candlewood Medical Group
Family Practice
Cary #23254 07/29/2010 12:41 AM
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Cary,

There is no private messages folder. When you get a private message, a little white envelope will flash on the top of your screen on the toolbar. I don't know how you would have missed it. Maybe it goes away after awhile. But, you also have your profile set up to notify you by email. You will get the same notification as you do when someone makes a post in a thread that you have selected to be notified about.

Now, after the fact, you can go to the top where it says, "My Stuff" and click on the down arrow. The first choice is Messages. This will take you to your messages page where messages you receive and those you send will appear in regular Windows folders.

First, I can't emphasize this enough. Never use your server as a workstation. Besides the fact that it takes precious resources, the chances of having to reboot it, registry clutter and errors and especially viruses are a problem. The server should just be the server, and you can purchase another computer for that user. I have to differ with you on the RAM. A program that is taking up almost a half GB of RAM is something you should avoid. I would also run every free antivirus and spyware program out there that is compatible with it including the ones which run from the web. Seriously, run five or six different scanners. You can get AVG for servers for a full trial if you need to.

I would venture to say that your issue is either SQL or your network. It is most likely not AC and if you were a small practice with disconnects, I would say not SQL Express. But, you have from what I recall, a large network comparatively with a different SQL version than anyone else. I would say, using the famous medical jargon, your top three issues are your network, your network, and, then your network. There are so many things that can affect it, and one thing can affect another.

The first thing I would do is open Amazing Utilities, go to the Advanced button at the top left, and check the speed from all of your clients' AC. This may narrow some tings down. Just for perspective, mine generally run around 0.7 seconds for a round trip ride.

Then I would go to every computer, go to properties in your NIC cards from device manager and make sure that all of your link speeds are set to either 1,000 or, even better, auto-negotiate. The fact that your server's NIC is a Gb (and check to see if it is set to 1,000 or auto-negotiate, doesn't mean the rest of your network is set up that way. Is your switch 1) managed or unmanaged -- if managed, you can check your speeds from one web browser and 2) is it Gb?

I will send you another PM with a quote from a user about my SQL guru. This entire thing could be SQL and to let it slow you down IF it is a simple fix is just not a good idea. I can give you his email address or vice versa. He is very good. I can't tell you how much I recommend your letting him remote in and take a look.

Finally, after Raja looks at your SQL Server, hire a Windows SMB Certified tech to come to your office. Figure on just over $100 an hour and set aside two or three hours. My friend that I use via email, etc. has some fluke meters and other meters (I forget the names). He uses one that costs $1800. He has told me that many networks are running at 20% of capacity. So, if a tech support person came to your office and tested everything, and it was 100%, then you will know that.

I don't see why AC can't accommodate a lot of users. When it used Access for its database, that was different. Access just can't handled that many users and it has a 2GB limit, so with 14 users or so, you may fill up pretty fast. Plus, even at 1.4 to 1.6GBs, you may lose some functionality.

So, I will send you that quote. Hopefully, you will be notified twice.

The first PM asked if you needed the info that you got a week later from AC.


Bert
Pediatrics
Brewer, Maine

Bert #23371 08/03/2010 1:58 AM
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Bert,
Thanks. As always plenty to think about and plenty of good advice.

gino

gino #23375 08/03/2010 2:58 AM
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Let me know where you go with it.


Bert
Pediatrics
Brewer, Maine

Bert #23407 08/03/2010 9:38 PM
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Bert- Totally agree On the PM didn't set up the email so that's not the problem ure right will break out the server to be just the server -me bad and cheap- have a managed switch have looked at the network traffic But it is dynamic can refresh every 15 or 30 seconds but have to watch this under load on the network and I'm part of the load hard to observe when ure taking care of patients with ure nurse asking u things with a doc on the line. GREAT tip on the speed thing have run on some clients already pinging at 0.9 to 1.2. Am going to purchase antivirus and run it. On the RAM thing in reality the clients are taking up to 380MB RAM as well. The NIC cards are all auto and the switch has 4 1GB backbone ports the server is on auto plugged in to one of the GB ports Raja sounds great send me a PM - looking on the posts people are running AC with more overhead than what I got so I think AC is the last on the list as far as the problem goes- Ask Raja if he needs the server toolkit don't know if I have this installed but obviously will need it to diagnose what is the problem - Will keep u informed This stuff keeps me sane versus fill out this prior auth By the way wish I was up in Maine it's 105 here now


Cary Herl
Candlewood Medical Group
Family Practice
Cary #23416 08/03/2010 11:28 PM
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Doing way too much multitasking. Lost my post, so I will make this one brief and to the point.

-- I am sure you know, but the AV scanners I referred to were just to be run once manually and not all installed at the same time.

-- http://www.microsoft.com/downloads/...9BB-800F-352F3B6F2922&displaylang=en

Consider running SBS 2003 Best Practices Analyzer

-- Do you really having clients taking up RAM on the server? Where do you see that?

-- I will alert the SQL Service.


Bert
Pediatrics
Brewer, Maine

Bert #24031 08/25/2010 11:00 PM
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Bert- thanks for the link. had my IT finally get over here does not look like a problem with the network or server- AC is pulling 300mb RAM on the clients and when we ran task manager watching the real drag- prescription writer- some clients are at 100% CPU when this occurs server at 10-14 % at the same time no real bump on the server. looks like a A/C prob or SQL to be clear- my desktop client 3.0 GB CPU dual core 6MB L2 cache 4GB dual channel 1066 RAm will pull 50% load when this is dragging I got the hot box.takes 6+ seconds to go to the next window on my box SHouldn't pull that much. My other clients have less muscle but something isn't right I am going to hook up with A/C support and figure this out - there is an old thread that had the same problem Will keep u up to date and let u know the solution.

Last edited by Cary; 08/25/2010 11:03 PM.

Cary Herl
Candlewood Medical Group
Family Practice
Cary #24037 08/26/2010 2:25 AM
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Was there a problem talking with Raja? I am doubtful that support is going to be able to fix a networking/RAM/SQL issue. Nothing against them. I would highly recommend working with a SQL specialist until you can rule that out. But, it also sounds as if there are problems overall. There are also, as you know, better tools than task manager to troubleshoot with. AC on my computers use almost 200MB of RAM easily. Shouldn't do anything with CPU on server or RAM. The only thing taxed over there would be SQL.

If I am correct, you still have only 2GB on the server? If there is an issue either way with my friend, PM me.


Bert
Pediatrics
Brewer, Maine


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