Home Forums Discussions Problems Intermittent slowing

Hi all, 5 year AC user, started way back with AC v2, looked at these boards several times but never posted. But....

We switched to AC v5 just short of 1 year ago. Since then I have been much less happy with AC. Perhaps because I feel much more tired. It feels like AC is more time and labor intensive, and slower (more on this below). I am located in semi-rural western Maryland, old, sick, and poor population with lots of chronic meds. Updating meds to v5 remains time consuming. Order writing is much slower. Still cannot find some of the old vaccines. About the only plus is eRxing, even there between mail order plans and controlled meds still print out a lot of rxs.

Specifically, AC v5 is slower. At times it will "hang" for 5 to 20 seconds, which gets quite annoying. This typically will occur when several users all working at once. If this were improved, the rest of the complaints would be more bearable. The "hanging" came since v5 update. I am wondering whether it is due to network, or "main" computer being underpowered.

1 physician 1 PA practice.
8 desktops XP pro 32 bit
3 laptops XP pro 32 bit

Desktops Dell Optiplex GX620, about 3 gig processor, 2-3 gig RAM, "main" c 4 gig RAM, recognizes 3.5 gig RAM, "dedicated" to AC and lab interfaces

Laptops Dell Latitude D510, 1.6 gig processor, 2 gig RAM

Main switch Linksys EF4124

Linksys n wireless router WRT300N

Amazing Utility speed test

"Main" 0.74
desktops 0.8 typical
Laptops 3.5 typical

**"Hanging" will occur on desktop as well as laptop

My guess is the next move would be a new switch. Any other thoughts? Any recommendations for a new switch?

Sorry this is so long. Any thoughts appreciated. Thanks and God bless. Gene Nallin

is your main computer running other tasks? does a utility hog like - say - internet explorer ever get run on that machine. Is it running a virus scanning program?

Thanks for the quick response, the "main" computer is dedicated to AC, no other programs and no antivirus. Thanks. Gene

Your network times are reasonably quick so it probably is not network related.

I agree, you should run task manager and see what programs are hogging memory. Be aware, V5 added Cassini Web system and another program that escapes me at the moment (and I do not see on my task manager currently) that take up a lot of memory.

V5 is much more of a memory hog than any prior version. You have machines with enough memory that should not be an issue.

I prefer the Rx system and eprescribing and abhor the order system. The rest is not that different. It may scant less quick that V4 and below but not by a lot.

At this very moment, on "main" computer,

"Physical memory

total 3,659,844
available 2,474,400
cache 270,204"

I do not think this is a memory problem. When I am in office by myself, just about never a problem. Slowing occurs with multiple users, so I am wondering whether "things back up" at the switch.

Thanks. Gene

Gene,

If the lags come with greater usage, then it is potentially the limits of peak network through-put; if you will, the diameter/size of the pipe.

Based on a quick peek, it appears you are running a 10/100 switch. A layer 2 (or 3) switch should give you better peak/burst performance, but that is constrained by how many machines already have Gigabit (1000) network adapters to take advantage of the potential greater through-put.

For a practice of 20 machines, we recently installed http://www.amazon.com/gp/product/B00358MP02, Netgear GS724T-300.

One of the things that you can also consider is adding a second Gig network adapter, and 'balance' the traffic over both adapters, or take the second adapter and plug it directly into the wireless router.

Are you using Updox?

Indy, I was thinking along these lines. Will look into this. Thanks!

Jon, not using Updox, actually using PaperPort on another PC

Thanks Gene

Indy, currently using motherboard network ports, which I'm guessing are 100 at most. You are suggesting 1000 ports, any specific recommendations on which ones?

For your 2 switch suggestion, would it help to put 2 1000 network cards in "main" computer?

Thanks Gene

A clue! (Perhaps) After a day of using all my OCD and frequently checking Amazing utility speeds, all in range listed in first post, my laptop slowed considerably. At that time speeds from this laptop were 16 to 19 seconds. I tried from a second laptop, speeds 10 to 14. At this time desktops still fast, 0.8 or so. After several minutes, speeds came down to 5 sec or less on laptops.

So at that time hardwired network was normally fast, wireless very slow. Any ideas?

Looks like I'll be lookings for switch, network cards, wireless router, and laptop network cards. Any suggestions for the latter 3?

Thanks again. Gene

Gene,

First, I doubt you need a ton of new network cards and switches, etc. Sure, it is always good to have Gb everything which means NICs and switches, etc. But, you aren't sending a lot of packets around that requires 1,000Mbs speeds all the time. You already said it yourself. I always think of two things. And, people give me a hard time for it.

First, get rid of the wireless for security issues and speed. Secondly, while it may not make a difference, XP Pro computers were meant to run programs, e.g. AC while servers and server OS were meant to run background services. Again, peer-to-peer is fine, but you will never get the performance you will from a server and domain.

Servers specialize in file sharing and as stated, background services. They tweak drive reading, processor use and RAM.

One experiment you may wish to try to make your main machine more like a server is to change it from being optimized to run programs to being optimized to run background services.

My computer | properties | advanced | performance ? settings | advanced | change from ?programs? to ?Background Services?. On the tab next to that ?visual effects, if it doesn?t automatically change, set it to ?adjust for best performance?.

If your main computer that you are using ONLY for AC (which is great) has nice blue borders and nifty sliding menus, then you are using up valuable resources. Make it look like WIN 98.

Hi Bert, thanks for the reply. I am not going to seriously challenge someone with 5072 posts, but I have a few thoughts.

1) Wireless worked very well for 4 years. It works well now about 95% of the time. If the wireless network is passworded, I do not see a security concern. I would rather fix it than scrap it.

2) I have gathered from numerous posts from you and others that a server is advantageous. No arguement. BUT if the network (esp switch) is slowing things down, would switching to a server circumvent this? My thought is to optimize what we have, then if not adequate consider a server.

Thanks again. Gene

Gene,

Good points. I just think that while upgrading to a Gb can't hurt, I am not sure it will solve your problem. A new switch (managed if possible) can be helpful. One weak link can cause issues. For instance, a NIC that is not set to autonegotiate can be a problem. Nice thing about a managed switch is that you can look and make sure everything is at 1,000.

Wireless is fine. I just know it is always slower so I brought that up and you had mentioned it in your previous post.

This could be a simple issue or it may be many things. I would try that change on your main computer to background services. That was recommended by a very high up and knowledgeable IT network person.

I still think that the most bang for your buck would be hiring a network IT (preferably a Microsoft MVP) to spend a day (probably at $75 per hour) and watch what is going on at certain times of the day. What appears to be a Gb setup may be only 10 if you aren't set up correctly. Rob, my IT friend, said he went into a large telephone company and found tons of issues that were slowing it down.

When it does start to slow down see how much RAM SQL is using. Look at the error and log files (I can't think of the right word) on the main computer.

Good luck. Troubleshoot one thing at a time. Think about this. You started with issues around a year ago. All this time you were frustrated when a super sharp IT person may have fixed things right up.

I can't say a server would make a huge difference. And, it is expensive. But, a domain is a hell of a lot more fun than a P2P, trust me.

Oh yeah, my post count has little to do with my computer knowledge, although I do have a little. I admire that you are working through this as much as you can on your own.

Gene,
I have exactly the same problem. We are running a server with Servor 2008 (I think, anyway the version after 2003) and a switch and network that is both hardwired and wireless. We upgraded the Router to whole new device and replaced the wireless with a new Cisco system because we have the same problem you are having. Late in the morning or afternoon, with a lot of users it slows WAYYY DOWNNNN. The laptops on wireless are the worst, but the desktops are also a problem hence the money spent on the new router.
We can fix it by having everyone log out and log back in. This week I hit upon the theory that I can recreate the problem myself by just forwarding a lot of charts to myself over and over, (This occurs when I have more than one Resident seeing patients with me). I will play with it this weekend and see if this is really the cause.
I would be curious if you can temporarily fix yours by having everyone log out, then in again.
Martin

Unfortunately, some thoughts and ideas are not easy to implement easily and inexpensively. But, the following is another possible answer.

this may be because of the limitations of SQL Server Express in combination with Windows XP OS machines. Since OS is not good enough to handle network connections and Express versions has limitations on the amount of memory they can use and CPU to operate. If a particular doctor is doing transacting heavily, it might impact others..

In all this time, I don't know that anyone has posted the results of deep packet inspection on a network running AC. For a client that is implementing VOIP along their existing AC operations, I think that we will be running MRTG in their network to suss out some more detailed info about network traffic.

The project list backlog is pretty extensive atm, but if I find anything of immediate import, I will update this thread.

At some point, I will formulate the nuggets (and charts/images) into a blog post that I'll drop a link to here.

If there is interest in an AC-focused MRTG implementation How-To, please drop a comment here, or send me a PM.

Our VoIP takes up so few packets it's crazy. Nothing against Gene or anyone else, and I ran peer to peer for three years. But, it kills me that we pay over $200,000 for medical school, and then trust our practice to a $500 Dell and XP Pro.

When Microsoft offers Microsoft Foundation Server dirt cheap, I don't see any other way to go.

http://www.microsoft.com/windowsserver2008/en/us/foundation.aspx

"But, it kills me that we pay over $200,000 for medical school, and then trust our practice to a $500 Dell and XP Pro."

......Perhaps because the return on investment of our $200,000 education is pretty crummy

Seriously, Bert, no question you are right. IF COST WERE NO OBJECT, the server would be a total no brainer. BUT I have essentially no IT costs now, and I can troubleshoot just about anything that happens, PC or networkwise. I am not going to try to set up a server, so we would have hardware and IT costs. And we would be dependent on a tech for problems.

In our area, it is hard to make a buck in Family Medicine. Several local practices have left the area over the last few years. Our health insurance costs have had 35-40% increases both of the last 2 years. I am really wondering if we have more than a year or so in solo practice. Not to mention 1 kid in college and 2 in high school....

So I am not just being cheap on general principle. Finances are REALLY tight.

I will try Berts suggestion for "server emulation" next, and then either replace the wireless router or switch.

Thanks again for all the thoughtful comments. Gene

Martin, sounds extremely similar. Sometimes just waiting will improve things, usually we reboot the main computer.

Thanks. Gene

Gene,

I am certainly not trying to talk you into a server. I have plenty of other threads for that.

I am simply giving you options for what may be your issue.

If you read my posts carefully, I have never said, "Wow, a server would fix all of this." My server comments have only come out of or led to what could be a possibility.

A server being designed for application and database sharing may fix the problem. Since a server is set up for background services, maybe do the same to your XP Pro machine. Given the issue could be SQL, SQL Server runs better on a server. I am not sure if going from 100Mbs per second to 1000Mbs will make a huge difference. Maybe in a hub but not a switch. If you are using the PC alone, then everything is going through Port 1 to you and back. None of the packets go to Port 2. So all of the packets would still get 100Mbs.

Sure, I may be a little more knowledgeable with troubleshooting a domain, but you don't necessarily need to pay for IT.

Where paying for IT would be helpful would be now.

Gene try just closing AC on the computer you are using, and any other users, (not your main computer) and re-open AC and see if it isn't fast again for several hours.

One of the things I learned recently from AC support that isn't listed anywhere is to periodically use the AC utilities to re-sequence your imported items. we scan about a 6 inch stack weekly so we need to do it weekly and it definitely speeds it up and we can tell by the end of the week the system is slower.

It would be nice if these good to do things were listed somewhere under a PM or ongoing maintaince log or folder we could reivew.

What command is used to resequence the imported items?

Are you referring to the databases or the import items?

The database to speed up access please

I believe he is referring to the Amazing Utilities.

Of course, I start with a full backup of the AC database as well as the Imported Items.

Yes it is under the amazing utilites advanced utilities and reindex databases.

I hate slowness on computers - here's what I found to help, some of which I am still working on:
- run the amazing utilities optimizer weekly
- put in cheap gigabit NICs in the client computers
- make sure you have a gigabit switch
- don't bother putting in extra NICs on the main computer or server, mostly it can't use them, especially if the clients don't have two NICs. Make sure it does have a gigabit NIC.
- if using a server, run a MS Best Practices Analyzer - it will find out if your system is using TCP offloading algorithms that will slow down a network that is not using SAN disks and fibre channel
- buy a nice managed switch
- maximize your servers disk access speed with 5-disk RAID 5, or SSD drives
- finally, go virtual with thin clients
- check if some computer is doing heavy internet access at the slow times, as I found that sometimes really slows everyone down. Run SpeedCheck when you're slow - I'm not sure how slow internet access slows down the whole network, but it does.

We hit the internet interaction today as well. Internet was down for two hours, and AC was painfully slow. The moment the internet got fixed, AC popped right back to normal.

I have debated setting up a server, mostly after listening to Bert but have been running fine with Dell Optiplex for the most part. I really appreciate Bert's suggestion about switching to a higher performance, less graphics intensive mode. I'm planning to do this when I isolate my 'server' machine and get my CMA off it. (Have to buy another computer). If I went with a server, would have to have IT run it as I'm inexperienced with that realm.



Have you ever considered coming to Alaska? Reimbursement is great and we make a nice living for lowly primary care.


I have debated setting up a server, mostly after listening to Bert but have been running fine with Dell Optiplex for the most part. I really appreciate Bert's suggestion about switching to a higher performance, less graphics intensive mode. I'm planning to do this when I isolate my 'server' machine and get my CMA off it. (Have to buy another computer). If I went with a server, would have to have IT run it as I'm inexperienced with that realm.



I use Mac's at home and I've had really good performance from the Airport Express router/switch. My laptop times to the server are almost as good as hard wired.

Well I finally made the plunge and treated my self to a new server. Dell power edge T310
8GB 1333MHz ranked RDIMM
Z3440 Xeon 2.53 GHz with 8 M cache, Turbo, HT
Dual Gigabit network adapter
Small Business server 2008SP2, standard version
And a few extra 500 GB 7.2K rpm Hot Plug Hard Drive

This baby smokes. i used to have to reboot my old server during the day, 1-2 times. It was an old server with limited ram.
I also wired all of the exam rooms and up graded my switches.

This was long overdue, wished I had done it earlier. IT guys are nice to have, but most of us are going to have fairly simple setups. I've always seemed comfortable with the see one, read alot, try one, mess it up, try again, mess it up, call Bert!

Tom!

That is awesome. I am so happy for you. And, you went with SBS. Can't wait until you set up RWW and stop having to worry about LogMeIn, RDP and all of the others. It is tempting to use RDP as it's faster, but they do have a new way of setting it up securely so Port3389 isn't open. I like the standard version.

You also have to tell me how you do with Exchange. Just get a domain name and you're good to go. It's best to go SMTP and not use POP3 Connector at all.

And, then there is Sharepoint. I will make a deal with you. I'm available for all SBS calls including setting Exchange Server with SMTP (so you get emails instantly and not 15 minutes later), if you sing the virtues of Sharepoint after you use it a bit.

Anyway, that is so cool. Let us know how your speed goes? PM me or email if you need any help. And, www.trainsignal.com can be invaluable: Train Signal. The DVD for SBS 2008. Much less boring than reading a book.

Since Bert knows so much about setting up a SBS, maybe he should write a tutorial for us! Still debating whether this would give me much improvement for just doing AC, over my Optiplex, late model.

As Tom will soon tell you after using Sharepoint and Exchange along with RWW, etc., you will see it isn't just about AC.

When users talk about backups, they always talk about it like AC is the only thing they need to back up. When they talk about computers, they talk about AC only.

Tom won't just have AC run more efficiently, he will have a more efficient office with a lot more fun.

Bert:

I can feel your excitment through the post! The trainsignal training dvd is even on sale! I didn't know sharepoint 2010 was available yet. Bert, I'm nowhere near to your level of playin on the network, but, I'll be reading! My staff is afraid! Thanks for your encouragement.

Now, far it be from me to rain on the SBS parade, so instead I will offer you some additional resources should you be so inclined; setting up an Ubuntu server (aka Ubu) offers a variety tools that in many cases are unique to the *nix platform.

You can take one of your worn-out old machines, and give it a new life as a handy utility server. For some folks, the whole subject would be an exercise in technical esoterica, so I don't belabor such subjects.

So once you have your new Shiney up and operational, give me a shout if you want some help tinkering.

SBS is easily one of the best things MS has ever created. It allows small businesses to have all the Enterprise stuff without the Enterprise price. It is also easy to set up and maintain making it highly cost effective.

Tom,
One of your first ventures into Sharepoint should be, I recommend, using the vacation calendar. I know that sounds trivial, but it has helped our office tremendously and is a good starting point. Also, as Bert said, go to Godaddy and get yourself a domain and cheap SSL cert and you're good to go with having your own Exchange environment.

SBS is also easy to extend. Since you have Exchange and assuming your office does tons of faxing, you can look into Faxmaker by GFI (www.gfi.com). We use Faxmaker to route faxes to the appropriate employee via caller ID. Very handy.

Resources:

The Official SBS blog:
http://blogs.technet.com/b/sbs/

The SBS "Diva":
http://msmvps.com/blogs/bradley/default.aspx

JamesNT

James is SPOT ON! We did look at GFI and went with another company.

The SBS Diva Blog is incredible. Susan Bradley knows more about SBS than Bill Gates or anyone in Microsoft. If she talks, Microsoft listens.

I remember troubleshooting a problem on my server and I called Microsoft. This tech told me what I did was not supported by Microsoft and could ruin the "core" of the OS. She stated I could lose my warranty.

I emailed her supervisor and told him I had gotten the fix from her site. That was all he needed to hear. They fixed it and apologized profusely.

Okay! I must of hexed my system. It worked great for 2 months. For the last two weeks, (AC) it has not opened predictably on the work stations. It sits and spins when I try and open a patient, write orders or scripts, or even close a note. The workstation will come up with a statement about AC having 12 errors in the last few seconds and needs to shut down. A couple of workstations say something about a problem with the "matrix."
server is Well I finally made the plunge and treated my self to a new server. Dell power edge T310
8GB 1333MHz ranked RDIMM
Z3440 Xeon 2.53 GHz with 8 M cache, Turbo, HT
Dual Gigabit network adapter
Small Business server 2008SP2, standard version
And a few extra 500 GB 7.2K rpm Hot Plug Hard Drive

Workstations are VOSTRO'S with 4 gb ram, running through gb switch on a wired network.

I have rebooted the whole network many times. There are a few moments when it seems AC is working okay and the remaining 90+ percent when it doesn't work at all.

Glad I didn't throw away by pens and paper. Thanks for the chance to rant.


I've notified AC tech support.

1. Do other apps work fine? Word, etc.?
2. What are the OS on the clients?
3. What are the speeds (using the amazing utilities -- advnaced)
4. How is your DNS set up? e.g.:

If server is:

192.168.1.2 IP address
255.255.255.0 Subnet mask
192.168.1.1 Default gateway (IP address private side of router)
192.168.1.2 WINS Server
192.168.1.2 DNS Servers
All of this info obtained by ipconfig /all at a command prompt

The client should be:

192.168.1.x IP address, where x = 3 through 254
255.255.255.0 Subnet mask
192.168.1.1 Default gateway
192.168.1.2 DHCP Server (address of server)
192.168.1.2 DNS Servers (points to server)

WHILE YOU CAN USE STATIC, BEST PRACTICES = DHCP SUPPLIED BY SERVER AND NOT ROUTER OR SWITCH.

IP address of your ISP should be in the forwarders of your DNS on server.