Home Forums Discussions General Discussion large group using ac

Any groups of 4 and larger using ac? We are currently 4 but will likely grow to 8 in the next few years. Any specific challenges? Will this system work for us?

No and Yes.

If you plan for more than one office location, take AC off your list right now. Although some of us are stretching AC to accommodate off-site access with VPNs, Hamachi & LogMeIn, there is no support for this and it may break with a future upgrade.

I am happy with the responsiveness of AC in my 2 MD, 7 computer office. But with all users in AC, plus other apps running on the network, we all see slowdowns. I think you will be disaapointed with AC with 8 MDs and their staff, possibly also with 4 users.

Just my thoughts. Maybe email AC sales and get a comment.

I understand where John is coming from. But, I do think AC could support 8 users. It would be borderline SQL Express, but if you had a 64-bit server and upgraded to SQL Server Work Edition or Express, it would be able to use a lot more memory. I don't see what is inherent about AC as far as amount of users.

I think those with a lot of users who complain about issues with speed on here are those who concentrate 100% on SQL and do not have a sound 1GB, Cat5e or Cat6 network that is configured perfectly to begin with.

Most of the work with AC is going to be with queries of the SQL database. I think SQL should be able to handled multiple queries if it is in the 8 or 12 range. If you hire someone to set up your network (properly) and talk with a SQL guru from the start who can set it up properly and configure your page file on the server, etc. I think you will be fine.

Bert's the man as far as SQL stuff. So I defer.

But 8 MDs in an office? I suspect more than one site, and not presently possible with AC.

Thanks John. Of course, now I have to defer to JamesNT.

I will say that two offices could work except everyone is stuck on VPN and LogMeIn, etc. Again, you would need a professional, preferably Microsoft MVP in networking and use a server at either end with Terminal Services. Then it would be like the satellite office is using the same database in real time.

I think that many of these issues arise, because users face difficult issues but don't hire IT people who can solve difficult problems. Yes, the price goes up in the beginning, but it likely costs very little or nothing to have a professional networking guy come out and say, "Sure, that can be done or oh my god, are you kidding me?"

Users come on here all the time and ask about Imported Items and scanning and ePrescribe, and they will like get a fast and valid answer most of the time. But, they also come on here and ask how to network two or more offices together and expect 1) for us to have the knowledge to do it, 2) for us to be able to communicate that knowledge over a website, and 3) for us to understand their complete setup and what they want for an end result as well as what hardware they are using.

Sorry John, I don't mean to keep saying the opposite. I am not talking about tceg's group, I am referring to users who want to do something fairly complicated but don't want to pay for it up front.

I'm not disputing your example of the framework that could be used to run AC in multiple offices, Bert. Just wondering why tceg's group would want to go with a basic, simple EMR like AC, if they had to upgrade SQL, servers, terminal services, etc.

The attraction for me is that I can handle AC myself much of the time. When I had Medical Manager, my office needed to call every time we went down, or needed an upgrade, or a report done. The tech reps had an average turnaround of 24-48 hrs. I have the same issues now with my POL software that runs the CBC machine & analyzers. Being all paperless, I can't be down for that long. So I feel comfortable with AC on a workgroup network. That's just my level of computer smarts. I can't be calling an IT person for issues. That tceg posted on this board says to me he/she's interested in AC for the same reason. Just trying to be straight with him/her (hey tceg -- its tough when you don't have a real name).

I have two offices and use remote access sometimes. I think it is too slow to be very useful for office hours. We have considered a VPN but don't really need to do this yet as I am only one provider so I take AC with me for office hours and remote access for the second office when I'm not there. Remote access is fine....except for seeing patients/encounters....at least out here in the boondocks.

There are a couple of larger groups running AC. I am not sure how many docs are working simultaneously.

We have 2+ (myself and my NP) along with residents, NP students and staff. It is not uncommon for about 5 people to be on the system in either office simultaneously.

Each office has a separate database. I have set up a logmein shortcut to allow them to go to a computer just for remote access.

There are a lot of misconceptions here. First, we aren't talking what St. Lawrence said (no offense). Remote access (LogMeIn, RDP, GTMPC, etc.) is far different than running two, three, maybe more offices off one database. People keep thinking that VPN is a solution when it's not. It's a security solution between two routers such as RDP, etc. They are talking and many have talked about actual connections to a database like you are in the same building. This requires servers and terminal services and IT to set up.

When AC used Access it had many limitations. SQL and Oracle are POWERFUL databases that scale from minimal to maximal. The reason Jon went with Express was it is free and can be packaged in an install package. Can you imagine 3500 users being told you now have to go out and spend $2,000 to $3,000 on full fledged SQL databases with licenses. When Microsoft had to fill the void between Access and SQL Server 2005, they came out with a SQL Server MSDE verion which, while powerful, was rather dumb downed. SQL Express replaced it, and it is much more like the full versions.

AC has nothing to do with the ability to work with large groups to some extent. What you aren't taking into consideration is that with a "large group" they would need to purchase the servers anyway.

Let's look at the following servers they may need:

Microsoft Windows Server 2008 Premium Edition:

This will come with Exchange and with SQL Server 2008 Enterprise Edition

Microsoft Windows Server SBS 2008 Premium Edition:

Comes with Exchange Server plus SQL Server Standard Edition
IT ALSO COMES WITH A COPY of Windows Server 2008 Standard Edition which could be used exclusively for Terminal Services.

When one chooses Small Business Server, they are thinking about a group of 75 users. When they choose the non-SBS version, they are thinking Google, Verizon, etc. with unlimited users.

So, the addition of other hardware is due to the fact that a "small group" and eight is small wants to have several offices.

I do not know all of the licensing, some comes with it such as Exchange with SBS.

As an example, we are implementing VoIP which will be hosted. I have run 10 more Cat6 cables and purchased a $1,000 PoE Switch. But, we have met with the company four times now and will meet with them again three more times. This is all up front for free. The lesson is, while I could probably do it, I would never install VoIP by myself. And, if I wanted to set up an eight person office with 24 staff, eight of which will be on the database for seconds at anyone time, I would hire an IT person, I wouldn't decide from our userboard. Getting advice as to whether it can be done yes.

I use IT people for networking, SQL, Exchange, etc., two of which do all for free. All of my SQL decisions are done from a Micrisofot SQL Server MVP from Pakistan remotely. As an FYI, I have offered the services of this SQL person over and over on here and only two groups have come through at of eight original interests. Both groups had their issues resolved in days.

I find it would be interesting if Jon created a high tech IT group which could help groups like these. The more it took off, the more that could do it. I know that Indy does some of this and JamesNT could help. But, ultimately, it needs to be done in house. I don't think it will come to fruition because Jon wants AC to stay small, but then in the beginning, he didn't want PM or Obamacare.

This is a very interesting discussion. Bert brings out some great points. I think this subject could be a great breakout session at the next user meeting.

Amazing charts moves a whole lot of data across the pipes and I suspect a little VPN connection would not work well.

If Amazing charts wanted to support multiple offices on one database they would need to create a group within the company to support this and price it higher. The competition is fierce and might distract from Amazing Charts core users.

Bert,

If you ever need me to help out in a conversation, please email me. I'll have my email to you in a PM.

And that goes for everyone else, too. If you need my email, PM me. I'm happy to answer questions and help out when I can.

Now, let's see what we got here. First, we start with Bert.

Your heart is in the right place and you have the right facts, but your wording is just a little bit off.


Access is a fine database, however, you are quite correct in that it has its limitations. For example, an Access database cannot be more than 2GB in size and that's even with the 2010 version.

You can also package SQL Server 2005 Standard and Enterprise with your application - this isn't limited to the Express Edition.

MSDE is the "SQL Express" version of SQL Server 2000, not 2005. SQL Server 2005 Express replaces MSDE.


For the most part, I agree. And when I say for the most part, I mean like 90% agree. However, we are assuming that the database designers of AC tuned the database appropriately in that they:

1. Used indexes appropriately
2. Designed the database in accordance with the 4 normal forms of database design.

No one gets number 2 completely right but as long as they get number 1 at least mostly right they can often get away with number 2 for the most part.


Bert, something tells me you were distracted when you wrote all this. I know you know this stuff. So I correct you in all this with the utmost respect for you.

* Windows Server 2008 R2 Standard Edition
Can use up to 4 processor sockets. In other words, the number of cores in each processor doesn't count.
Can use up to 32G of RAM
Can have one Virtual Machine guest for free.
Unlimited users or workstations as long as you purchase CALS.

* Windows Server 2008 R2 Enterprise Edition
Can use up to 2TB of RAM
Can use up to 8 processor sockets. Again, number of cores doesn't count.
Can have up to four Virtual Machine guests for free.
Unlimited users or workstations as long as you purchase CALS.

* Windows Small Business Server 2011
Includes Standard edition of Windows Server 2008 R2
Includes Exchange 2010
Includes Sharepoint Foundation 2010
Has a limit of 75 users/workstations regardless of CALS purchased.

* Windows Small Business Server 2011 with Premium Technologies
Includes licenses for second server to run SQL Server 2008 - you could run Terminal Services instead but not along with.

For most small offices, Windows Server 2008 R2 Standard or SBS 2011 Standard would be a great choice. It all depends on if you want Exchange. If you dig the idea of your employees using their personal email addresses to correspond with each other, you, vendors, and patients, then Windows Server 2008 R2 is sufficient. If you want to have a company email that you control, go with SBS 2011 Standard. That way if you fire someone you don't have to worry about how much company information was in their private Hotmail account that you have no right to.

I don't recommend SBS 2011 with Premium Tech unless you have some serious SQL Server experience or have AC's blessing to upgrade their SQL 2005 Express install.

You can find out more information about the different editions of Windows from the following:

http://www.microsoft.com/sbs/en/us/compare-features.aspx

http://www.microsoft.com/windowsserver2008/en/us/r2-compare-specs.aspx

SBS would also be a great choice if you needed additional Fax technology such as GFI Faxmaker (www.gfi.com) since GFI requires Exchange.

About SQL Server:

SQL Server 2005 Express has the following limits:

--Can use only 1G of RAM
--Each database can only be 4G in size (10G for 2008 R2 version)
--Very little Business Intelligence abilities

SQL Server 2005 Standard
--64G of RAM supported
--524PB database size supported
--Comes with BI tools (Integration Services, Reporting Services, Analysis Services)

You can read more about the edition differences here:
http://www.microsoft.com/sqlserver/en/us/product-info/compare.aspx

SBS 2011 with Premium Tech comes with SQL Server 2008 R2 Standard. If you know the BI stuff and can convince AC to give you the password to their database, then this is a worthwhile purchase for you. You could run SQL 2008 Standard instead of SQL 2005 Express as your AC database engine.


Bert brings up an very important point. I see way too many posts on this forum from people who know nothing about IT looking for free help instead of just getting an IT person. If you truly want to learn IT and have no problem reading a 1200 page book on Windows Server, you have my blessing. But if you truly believe you can come to a forum such as this one and do the whole "20 question" thing thinking you can learn "just enough" to be your own IT you are sadly mistaken. I can promise you that you'll just end up taking way more time than you need to and there is a good chance you may get the wrong advice because you're not able to fully describe the situation to the expert.


Quite correct. Good IT starts in-house regardless of what anyone says. Even if you put everything in the cloud, you have to have good enough IT support to get to the cloud.


The following is a server I recommend that should handle up to to 20 users on AC: server recommendation

Notice that this server has:

1. 4GB of RAM
2. Comes with Windows Server 2008 R2
3. Has two 15,000rpm SAS drives in a RAID 1 array (146G storage capacity)

I assume this server would also be your Domain Controller, DHCP and DNS server, your anti-virus server (I recommend Trend Micro), would backup using Backupassist (www.backupassist.com) as your backup software, and would run Windows Server Update Services (www.microsoft.com/wsus). This server should pull the load. I assume no other software installed on this machine.

Notice that this server:
1. Has another socket for another processor. You can add another proc without reinstalling Server 2008 R2.
2. Can support up to 32G of RAM.
3. You can add hard drives on the fly up to four.

If you need remote access, a second server like this one set up as a Terminal Server should handle up to 20 remote users with 8GB of RAM. I cannot attest to this as I have never used AC in a Terminal Server environment. I may need to download the 90 day trial and try it out.

Another big issue I see is workstations. If your idea of a workstation are the $399 deals at Best Buy, then you are probably inviting trouble. Here is my officially recommended workstation: workstation

Notice the following:
1. This is a small form factor machine designed to save space.
2. Comes with a 17inch monitor.
3. Comes with 4G of RAM
4. Comes with Windows 7 Professional
5. Comes with Office 2010 Home and Small Business Edition

You can easily affect the price by changing whether or not the machine comes with Office if you don't need it.

Altough I have strayed, regardless, time to get off Bert and on to someone else.

ryanjo:


You've answered your own question. The attraction for you to AC is that you can do all the IT yourself. But for a larger group such as TCEG they will have their own IT group or at least I think they will (and I assume they can negotiate AC for the database password for upgrade purposes to SQL Standard or something).

Furthermore, I realize everyone loves to HATE, HATE, HATE on Windows. But I say to you now for all eternity: The vast majority of problems with Windows has to do with hardware or drivers and how Windows is set up. If you buy a Dell or HP server and have competent IT, you should have nowhere near the problems you mentioned unless the software you bought is that flawed. If you have to call your IT person all the time for issues, then it's time for a new IT person.

I had to start scheduling quarterly visits with my IT clients just to get face time with them so they would pay my invoice. Otherwise, their attitude was, "things are so quiet and I haven't seen James in months or had to call him so why am I paying this???" And that's the way it should be.

JamesNT

Wow. It's amazing how a post sounds to the person who wrote the next day. Maybe I should just not respond to posts at 1am when I'm tired and have lost three games of Starcraft in a row.

I'll go up there and clean some of that up.

JamesNT

Too late, I already read it, lol. I think if you took out the Nectar of the gods comment, that was wise, lol.

You are write about MSDE being 2000. I was just trying to bring up the fact that SQL 2005 Express was Microsoft's first attempt at not bringing out a completely stripped down version of SQL.

I have every version of SQL (well version-wise) and 20GB on my server, but I have chosen to stay with Express, because I don't think I will get that much better performance, plus I don't want the hassle of worrying with every new update.

I know Microsoft can bundled the full version of SQL 2005, but that wouldn't be free to Jon or license-free to the recipient, would it?

As to the servers and what come with them, I definitely would research that if someone is going that direction. But SBS 2008 Premium definitely comes with Windows Stardard 2008 edition to either run SQL 2005 or 2008 and/or Exchange.

http://blogs.msdn.com/blogfiles/mss...rverSBS2008Premiumgoing_7639/image_2.png

There is a workaround for changing SQL Express to a full SQL.

James, I would be glad to email you, but you would get a lot of emails. I am thinking that if I say something like, "I think this, but James would be the guy," I don't think I need to email you. If I quote you or say what I think you would say, I would email you, fair enough?

So, let me ask about IT in general. I am in the same position here as a medical layperson who has a medical problem that is incompletely resolved. I have every reason to think my providers know what they are doing, and maybe this is as good as it gets, but I have friends and blog sites saying " you need to go to the Mayo clinic; those local guys never get it right."

Almost no one on this forum reports a totally stable system. By stable, I mean by comparison to my other 4 Mac based databases running 4D SQL server, and which have run 24/7/365 for in some cases over 10 years without a single crash. So, is this really an issue that someone with " god like" powers should get down cold, and if so, why does it not seem to be happening?

I am not sure I completely understand your question, but you know me...

1. My system is a Totally Stable System in as much as Microsoft can be.
2. You must have caught the "god like powers, lol), but I would cut some slack as it was removed. (I think -- long post). But, yes, someone with a great deal of IT experience could come a lot closer to getting things right.
3. I find it interesting (not bragging) that if I have an issue (I know that contradicts number 1 above, the first thing I do is troubleshoot my network, my clients, my server, AC, etc. I don't immediately assume it is AC and SQL Server
4. The larger the practice, the greater the chance is that there will be issues.
5. If one is using a regular computer for a server and if there are other programs on that computer, SQL Server Express will take up 1GB of RAM. That is the first thing to look at.
6. I was lucky to be able to set up my network from scratch with perfect cable runs by professionals, perfect terminals at the end of the cables (makes a big difference), perfect patch cables, a very nice switch, a Cisco PIX router firewall, Roadrunner cable with incredible speed and on and on. I was also there when it was put together and designed.

As I have said numerous times, my IT friend (27 years of experience in nothing but building and fixing and monitoring networks) has gone to huge networks (banks, large companies and medium sized companies) and troubleshot many issues checking the network. I can use some basic tools to see how my network is running, he can use a $15,000 fluke-type meter to see that one cable is running at 700Mbs while another is 200 and yet another is less than 50Mbs. That is a powerful thing.

Using your analogy if I understood it correctly, a patient MAY get the best care at the Mayo clinic just as you may get the best IT help with Microsoft MVPs and MCTS with 20 years of experience, but a patient has a lot better chance coming to me than they do going on WebMD or reading a textbook.

OK, Bert... again, please clarify the phrase "stable... as much as Microsoft can be."

I don't know what the expected standard for AC on a Windows network is. I come from a world of Macs and Mac networks and this is my first Windows network (although the wiring and hubs are the same), and where totally stable meant you came to work in the morning, the system was running, you started entering data, it stayed running, you went home that night leaving it on, it kept running, you repeated this cycle over and over for years without EVER having to restart a computer because the program had crashed, and you had 3 or 4 workstations accessing the same database and entering data all day long. Again, I do not know what people using AC have come to think of as normal, except for the replies to a previous post which implied it is not what I was used to. If one or two of 6 users having to restart or fiddle with their computer every day is normal, then that's what we have and I need to live with it. I really just don't know.

Already read the post, huh? Well that's just wonderful. I feel stupid, now. Oh well, those who know me know I'm insane.

Quite correct. SQL Server Standard would not be free. Jon would have to justify the licensing costs which would mean going after the larger groups. That may not be his game plan.

Your email terms are more than fair. As I said, I'm here to help. I do believe I can trust your discretion.

JamesNT

James,

I wouldn't worry about anything you put in a post at 1am on the weekend. I would imagine that only two people read it, lol.

Thanks for the post.

This is an interesting conversation, and I wish I had more time to contribute to it atm.

A couple of questions that I have not been able to test/document that perhaps others would know.

<>what is the average/peak bandwidth consumption of a AC client machine while in active use? (e.g. opening a chart, updating an encounter, viewing an imported item)
<>what is the average/peak bandwidth consumption of a AC client machine while in active use running remotely? [e.g. LMI, remote desktop, terminal)
<>has anyone tested AC running in a cluster environment to determine stability/data integrity in that architecture? [lic costs aside]

The four primary factors to balance are performance, data concurrency, reliability, and price.

In answer to question David, one of the sites that we support as a manged installation has 4 practitioners, 22 client machines, ~ 7000 patients, and one tired server.

We have continued to groom the network, tweak the existing mish-mash of hardware, and phase in new Win7Pro boxes as funds allow. The office manager is proficient in restarting machines, logging into the server from clients, and they only require our assistance about once a month, and system-wide outages are now rare.

Most commonly, if we have to get involved, we do some quick checking, but generally just restart the server if it hasn't been otherwise restarted [because of maintenance, MS patches] in a couple of weeks. Piss-poor from my enterprise perspective, but 'fastest/bestest' way to resolve. For contrast, we also run Unix/Linux servers for other clients that have two years + of up-time, and we hate to restart them, but power maintenance/outages are usually the culprit. Otherwise the servers would be still up from 2005 when we installed them. Part of the MS environment/constraints.

And yes Ketan, I know you want me to add a sig, and I'll get A-Round-Toit. :P

Indy
[not a Dr]
[Technologist Emeritus]
[of a company that I don't plug here]

dgrauman,

First and foremost let me tell you that I feel your pain. I have seen practices that were overrun by IT morons and had thousands of dollars lost to the four winds. One practice I went to spent $80k on new servers and new workstations. Their servers were re-built HP's and their workstations were home-grown misfits - and all the software was pirated. You can imagine what happened when I walked in and explained all that to them. In short - I've seen it all.

Let's get down to the main issue you are talking about:


The first thing to do is find out why the system isn't stable. Most people, upon seeing their computer crash, just throw their hands up and say "STUPID MICROSOFT!!", reboot, then go back to work. Most IT guys are very quick (as in lightening) to blame MS as well when something goes wrong.

* But has anyone checked the event log? Do you subscribe to websites that help you determine what events in the event log mean, such as www.eventid.net, and list possible solutions?

* Did anyone analyze that blue screen of death?

* Are you following best practices or are you one of those "people" who tries to something like install Terminal Services on a Domain Controller then goes nuts when the machine behaves poorly?

* Do your computers have ONLY the software your employees need to do their jobs installed on them?

* When is the last time you updated your computers with the latest patches from MS?

* Are your users logging in with Administrator rights?

* Has anyone run the best practices analyzer? http://technet.microsoft.com/en-us/library/dd759260.aspx

These are some first questions to answer to determine why your network has issues. Once you start narrowing it down, you may find the answers easier than expected.

JamesNT

dgrauman,

The uptime you had with your Macs is the same uptime you should expect from your Windows computers. Please see my previous post for things to look at. Especially look at what software is installed on the machines. Only what the employees need should be there. Nothing else. Period.

Also, what of hardware are you using?

JamesNT

I'm going to have to call a bit of a small foul on Indy. Again, if you have to restart your Windows boxen for reasons other than:

1. Installing patches/service packs
2. Adding hardware or updating drivers
3. Removing hardware
4. Adding or removing a new app

then something is wrong and needs to be investigated. Furthmore, in regards to those linux/unix boxes that have been up for years and years, the first question I would have is are they secure? When is the last time they were updated with a security patch? I know serveral big companies that use unix/linix for their "big stuff" becuause they don't want to ever reboot the machines - and for that very reason those are usually the first machines to get hacked.

Lastly, another very big reason unix/linux is able to achieve good uptime is because when a unix/linux admin first sets the machine up, they go over every setting with a fine-toothed comb and use only approved hardware. Whereas the Windows guys just put in a CD, click Next three times then finish without even looking at any of the settings to install the OS on any old hardware they find, then scream bloody murder when the thing fails.

JamesNT

James,

If you have an issue with the facts start a conversation about it privately or in the Tech section. Anyone who has dealt with MS in the enterprise [5000-10000+ users] will talk about the disparity between corporate IT run and departmental servers. Our commitment to our clients is to make the most of what they have with what they can afford.

Also I'll call BS on patching/hacking enterprise *nix servers. I auto update BSD/Ubuntu servers for years at a time without restarting. That is a constraint of the Windows OS architecture, not the hardware.

AC runs on Windows, so QED you make the most of what you have to deal with in a given set of constraints.
Indy
[not a Dr]
[Technologist Emeritus]
[of a company that I don't mention here]

I can't imagine that the packets of information could take up that much bandwidth.

David, sometimes James, notwithstanding, we have a computer crash now and then. I do all of the things James talks about.

James,

Given the knowledge the average user has about computers and networks, etc., would you expect a Mac setup to be more stable for them?

Indy,

Quite correct. We all work with what we have when it comes down to it. And in the small business arena, things can get interesting real fast when it comes to what the customer wants and what the budget really is.

As for patching linux/unix boxes, again you are quite correct in that on many occassions you can patch a *nix box without a reboot. I totally forgot about that (just goes to show how long its been since I've worked on a *nix box).

Gawd, this discussion brings back memories of the NT 4.0 days. Back then EVERYTHING you did to a Windows machine required a reboot. bleh!

Thanks for setting me straight, Indy. Apologies if I rubbed you the wrong way.

JamesNT

Bert,

Yes, I would expect the Mac setup to be more stable for the following reasons:

* On a Mac, you aren't running with Admin rights. With PC's, people think nothing of logging on as Administrator just to use Word. User Account Control went a long way toward solving that problem, but then IT types came along and just turned it off.

* On a Mac, Apple has full control of the hardware so that means fewer crashes because of hardware for the simple fact that the user does not have opportunity to purchase anything suspect. However, the trade-off is that you can't run all the myriad things on Mac that you can with a PC.

* There is a certain amount of psychology involved. People respect their Macs more than their PC's. The next time you are in a room with two other people - one with an iPad and one with a laptop - observe how one lays down the iPad on the table with the utmost care and the other tosses the laptop in its carrying case over to the nearest chair. Also, people are more careful what they click on with their Mac whereas they go to download.com and cram everything on their PC.

Windows can achieve the same reliability as Macs, but you have to follow the same rules.

JamesNT

I think this thread has got as about as much use out of its tread as can.

The bottom line is not everyone is going to be computer and networking gurus and that is why AC can be simpler to work with. Before SQL, we had Access, and you could simply move the entire folder. I think SQL caught many off guard including support.

The the bottom line is also set things up yourself and expect some issues and get some professional help and you will have a lot less. If you hire a professional painter, your house will look good inside and out, but if you do it yourself, you will save money but have less to show for it.

Has anyone noticed the irony that tceg started this thread and didn't post again. This was three days and many posts ago.

So my vote is to let this thread lie.

I agree with Bert.

As a last bad pun on Bert's comment about getting professional help:

Notice how people when living in a house decorate it themselves but when they want to sell it they hire a professional.

JamesNT

But Bert, it has a life of its own. It does not want to simply lie there, it wants to deviate to all forms of techie discussion points.

Which is why I didn't close the thread, lol. Actually, I would never do that unless huge flame wars broke out. But, then those are kind of fun to watch.

As for James and I, we have talked privately and are united in our desire to be of service to the members of the board.

It will be interesting to heard back from the poster, but the bottom-line on large installs is that a systemic approach is key, and that there are a significant risks in a DIY approach.

JamesNT-I have been a technician for 26 yrs and it always been the case of: By management of course-its working fantastic so why do we need you!I have gotten so used to it that I expect this response instead of great job-lol.

Hi Joe,

Welcome to AC and the board. It will be great to have your expertise around. Be careful, some of us may find ourselves PMing you quite a bit.

Where are you from? Do you work with any doctors or mid-levels? What is your role? Any particular knowledge in any area over another such as SQL, etc.?

Well, welcome again.

Joe,

Welcome to the board. I look forward to posting with you.

Beware Bert. As you can tell by how fast he responded to your post, he lives on this forum. Some of us believe he is not a human being, but an intelligent forum bot - perhaps the first real AI.

I have lost contracts from clients because so much time passed between problems. Their attitude was, "You haven't removed a virus or done anything in 8 months! Why are we renewing your contract again?" Of course, you can imagine what happened when just a few short weeks later things starting going awry.

Again, welcome to the board.

JamesNT

About 10 postings back in this thread I was griping about the lack of stability in our system, and thinking that it was just going to be our cross to bear. I have to say that it seems most of the bugs have been ironed out, at least for now, thanks in considerable measure to James and others here. I do logout at the end of the day and either login and restart first thing in the morning, or else I seem to get an error of some type with the first patient, but other than that it really is reasonably stable, and i can get work done without always thinking about the interface. It has taken a great deal of tweaking and IT time, however, and I still resent that this is so when I look at my Mac network that just like the Energizer bunny keeps going and going...

So David, first I'm glad that things are coming together, it sounds like you have found several of the necessary tweaks. There has been some have help here in this thread.

Now about your Mac network, I'll resist the urge to point out that your Macs are Unix based, and how Unix systems up-time is measured in months and years. Just saying ...

Follow the following basic tenets and most of your problems should disappear:

1. Anytime you install any piece of software, you are assuming the following:
----The software is well written.
----The software plays well with others.
----The software is from a trustworthy source.

If the software in question violates any of the above three, you increase the likelyhood of having issues.

2. Any and all hardware you use should have drivers from the Windows Hardware Compatibility List. Any name brand machine such as Dell or HP will have such hardware.

3. Keep your machines patched and up-to-date. You can do so automatically using Windows Server Update Services (www.microsoft.com/wsus) if you have a server. Otherwise, be sure to set automatic updates for all your machines to download and install updates.

4. If you are having issues with slow response time, locking, freezing, or video issues check with the manufacturer's website to see if you have the lastest drivers for the machine's hardware. For Dell, you would go to support.dell.com and type in the machines's service tag number to see the driver list.

5. Any and all software installed on your machines should be there for a reason. If you can think of no BUSINESS CASE as to why that software is there, it gets uninstalled. Period.

JamesNT

I am a jack of all trades-Expert in none.Mostly my expertise exists in troubleshooting-hardware,software,and organizing. Give me a problem,whether I have knowledge of it or not and I will come up with a solution.