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#45011
05/19/2012 2:33 PM
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We have a asd;lfkjsda;lkfjasd;lkjf;lsadkjf 32 bit server with only 4GB ram and SBS 2003. We can only run 6.09 pulling our hair out most of the time waiting for it to catch up. At times we can wait 3 min to get to the imported data screen or send a script-other times we;re not as lucky-the whole thing locks up and then shuts down. Since we don't have money to buy the kind of server we want or need, we are considering Practice Fusion or Next Gen on a separate host to bypass the server and double entry issues. We were hoping AC in cloud would be an answer, but he charge per seat issue makes it too costly. We really don't want to change. We love the user friendliness of AC and the great tech support. We are wondering if AC could be put an i7 Dell server to just run AC? We would keep our old server to run other things and have it connected (all this done by pros). Thanks in advance.
Vicki Roberts, MD Family Medicine of Southeast Missouri Sikeston, MO
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Hi Vicki,
The board is full of server vs peer-to-peer discussions, search and you will find way more info than you ever wanted.
We are running peer-to-peer, and have for 6+ years. I do not think the peer-to-peer ever caused problems. We ran on an old Dell single core Optiplex GX620 until June of last year. We then upgraded to a Dell Optiplex GX 690 i7, Win7Pro 64 bit, about $900 from NewEgg. It came with 4 gig RAM, I added 8 more.
Basically it has done fine, no speed issues.
Workstations now a mix of old single core Pentiums and newer i3/i5s, the single core Pentiums are slower but adequate.
My PA and I use wireless laptops, the old single core Latitudes got too slow, HP ProBook 4530s i5s do really well. About $650 if I recall.
I have toyed with the idea of a server, Bert and Sandeep certainly advocate these. But our practice does not have a lot of extra money, I have 2 kids in college and a third in high school, so I have tried to be as cheap as possible!
Hope this helps. Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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Vicki,
"Yes" to answer your specific question.
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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Doc Gene, thanks for the comments on your experience. Will look up the peer to peer items (I guess that is what I was talking about, but never knew it had a name).
Vicki Roberts, MD Family Medicine of Southeast Missouri Sikeston, MO
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Get Gigabit network switch. A hundred bucks or two. Best bang for Buck to improve network speed.
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Vicki,
To simplify, AC runs on a "main computer."
If the main computer runs Windows 7 (or Vista or XP), each computer is "equal", but one still holds all the data. This is a peer-to-peer system.
The advantages to this system:
It is cheap It is simple It is easy to add to.
If the main computer is a server, then it runs a server operating system. The hardware in a server may be better, the power supply may automatically protect against failures (redundant power supply), the server may have data duplicated to protect against hard drive failures (RAID), and so forth. The software gives better security, and can do other neat things that are over my head.
Disadvantages:
Cost Needs an IT person to set up/support. (Although Sandeep is trying to convince me otherwise.)
If cost were no object, and if I were assured of a good network IT person, a server would be the way to go.
But operating on limited funds, with myself being the IT person, peer-to-peer has been quite adequate.
Please don't let this cause you to give up on AC!
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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This User Board is one of the main reasons I don't want to change. Physicians are giving away their right to practice medicine as a doctor sees fit, rather than what a practice manager/corporation wants you do do (see more patients and make them lots of money). Just after the first of the year each year, I call both the AAFP and MAFP(Missouri) and express my frustration at having to pay MAFP dues so that I can belong to AAFP. The MAFP has made it clear that its focus is on employed physicians and on trying to put down other providers. I trained in NM where NPs and PAs practice much more indepently, so I think this is silly. I think my state organization should put more effort into keeping the few docs who are still out there, IN BUSINESS. The User Boards have been a great source of support to me as a physician/owner. The Guardian Angels are great and readily avaialbe when we need them, not when they get back to us at their convenience. The fellowship and support of others out there who know the satisfaction of still having a voice in the practice of medicine.
PS Sorry for the rant
Vicki Roberts, MD Family Medicine of Southeast Missouri Sikeston, MO
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I use a 32 bit server with 4 gb ram and AC runs fine (with server 2003) - the slowest I see is about 15-20 seconds if the file has lots of imported items - I think you might have a bottleneck somewhere - what are your workstations?
Vickie - out of curiousity go the server and bring up AC - open a chart and go to imported items see how long it takes, add a prescription and time it. Then go do the same on the same pt. chart on one of your workstations and compare. There is maintenance you can do on the server and the workstations - in AC clear deleted items out of mailbox. On Windows use disk cleanup to clear out unnecessary files, etc.
I think 6.0.9 may also be the version that was just inherently slow and even with your current setup you could upgrade to the newest version online. I really ran into this problem with 6.0.9 as I recall and AC stepped up and tried to rapidly correct once they realized the gravity of the situation.
P.S. I use Server 2003, but run it as peer to peer without the hassle of using a domain and all the other bells and whistles that I do not know enough about to fully use.
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As Steven says, you'd be better off identifying the bottleneck before you go out and buy a new main computer.
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Get Gigabit network switch. A hundred bucks or two. Best bang for Buck to improve network speed. Assuming she has Gigabit NICs or she'll have to buy gigabit a NIC for each computer. Also, that may not be the issue.
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Vicki, I have helped you a lot, so please don't take this the wrong way. I ran a server system with ONE GB of RAM. You have plenty power there to run AC. There is no doubt your network is set up incorrectly. NexGen is ridiculously expensive. You talk about pros. Everyone talks about pros. You need an actual store that can set you up properly. I researched three places. This one was the best: www.softchoice.com. There are 145 miles from you.
Bert Pediatrics Brewer, Maine
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Network setup is pretty simple in terms of basic networking. There are three main components in a small office network, the router, the modem, and the switch (if necessary). In simple terms, - The modem which is from your Internet Service Provider. E.g. DSL/RoadRunner. The modem connects you to the Internet.
- The router acts as a gateway for the other computers/devices on your network. It assigns addresses to the local computers and acts as a firewall in a basic network.
- The switch is like a giant splitter. Which basically balances traffic between the connected devices. You'll see the mention of gigabit often, that's an indicator speed.
Typical layout is: Modem <- Router <- Switch <- Computer With SBS 2003, the server handles addressing and DNS requests. Think of DNS like a phone book. When you type in a name like google it gets translated into a number called an IP address. This occurs behind the scenes. As Bert always says, if it's an issue with SBS, it's almost always DNS. This happens locally too when sharing files. If I look up VICKISERVER (which AC does a lot), it gets translated into an IP address (192.168.X.X). If there's a problem with the DNS server (phone book), it can take a long time find the desired IP address ("phone number") which results in long loading times. Just as a side note, have you tried disabling hardware acceleration on the client computers? I noticed you mentioned issues on imported items and the RX Writer screen. Instructions are in my signature. As for the cost of a new server, many sites offer financing that will let you pay off the bill with a monthly charge if you truly believe the server is the problem. Some even have no interest if the sum is paid ins 6 months. As a side note about gigabit: Gigabit transfers at about 125 megabytes/second (more than enough to max out a typical hard drive) and 100 Megabit (typical) transfers at about 12.5 Megabytes/second. For a 10 fold speed increase, it's usually 20%-50% more than a non-gigabit switch. If your II are large, then you should probably use gigabit. If not, you should still use gigabit.
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Another option may be to move the AC "server" off the genuine server and onto another machine. Do a full install/resintall on a machine (saying this is the main database) Then open it up and create a dummy system (must have one to do a restore) then go to the AC folder and find Backup Restore Utility click on it You then have to find the backup file in the original backup folder (unless you move a copy to that computer (makes life faster)) Then it will ask you if you want to override the current system (the dummy system) say OK Then let it complete it's work You need to go to Amazing Utilities in all the other computers and move them to see the database on the new main.
If this system works better, then you know it's not a network problem and perhaps a new server would help. If it's not better then it may be a network issue.
I agree with all the other comments above.
Wendell Pediatrician in Chicago
The patient's expectation is that you have all the answers, sometimes they just don't like the answer you have for them
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Vicki, I know you have been around here a long time, but I also think that you were not on the board for awhile. I mention that because I wonder if you did not hear about the painful period of time late last year, soon after V6 was released. The bottom line: according to Jon B, about 15% of AC users experienced severe slowing issues...exactly like what you describe...after upgrading to V6. Many were using the same version that you are on. After a difficult period, AC released a rapid release beta which resolved the problem. Steven mentioned it above. Please, before you buy any hardware or take any other major steps, I would suggest that you simply upgrade to V6.12 and see if this solves your slowness issues. If you talk to the Guardian Angels, I would think they would suggest the same.
Jon GI Baltimore
Reduce needless clicks!
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I'm with Jon. You will end up buy a $5,000 Dell and a $1,000 Linksys switch, a $780 Cisco router and your problem won't be solved until you upgrade.
Pure and simple, v6.09 is and was the worst version ever put out and v6.12 is the best.
Bert Pediatrics Brewer, Maine
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I think most would agree that upgrading to a newer version of AC has to be first on your list. AC 6,xxx still runs on my Windows XP workstation with 1gb ram. Still is much faster than Vicki's I pmed her and I think I have her convinced to take workstation out of loop and install her current AC, upgrade to current version and see if her last many months of misery were for naught. AC really does not need high horsepower machines to run.
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Yep, the only reason we recommend high powered servers is for all the other stuff we run. Exchange, SharePoint, Fax Servers, SQL, etc. all on one machine. AC doesn't need that much.
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AC hardly needs anything. Well the instance does.
Bert Pediatrics Brewer, Maine
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It will run faster with more memory and faster processors, but until V6 I still had an instance running on a Pentium 2 450 MHz with Windows 2K. It ran at a decent speed, more because Win 2K doesn't require much overhead, and neither did AC.
V6 is NOT compatible with Win 2K, oh well, life moves on.
Wendell Pediatrician in Chicago
The patient's expectation is that you have all the answers, sometimes they just don't like the answer you have for them
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There comes a point where memory won't do anything though. Remember SQL Express is limited 1GB of RAM. Then again most people's databases are <200MB.
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But, it will still run queries faster if it has more RAM. The only thing 200MB will do is make sure you have less patients to run queries on.
As a comparison, with SQL 3.5 years, solo practice, 1.2GBs database.
Bert Pediatrics Brewer, Maine
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I'm just going to add our experience to the above. (I don't know as much as Bert or Sandeep, but I know what I know.)
About a year ago, running v5 (??5.0.29??) on a Pentium probably dual core about 3.2 G processor, 4 GB memory, XP Pro, we were noticing significant speed issues, which would often be worse in the afternoon. Both wireless and hard wired computers affected, we even ran AC at the main computer and it would be slow. System would occasionally crash.
Switched to an i7 processor, 12 GB memory, much much much faster. No crashes.
Our experience was that AC v5 ran much more quickly with faster processors. v6 seems to have even more of a speed difference.
Since v6 we have gotten some new laptops. i5 laptops run AC MUCH more quickly than older Pentium single core with 2 GB memory.
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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I think most would agree that upgrading to a newer version of AC has to be first on your list. AC 6,xxx still runs on my Windows XP workstation with 1gb ram. Still is much faster than Vicki's I pmed her and I think I have her convinced to take workstation out of loop and install her current AC, upgrade to current version and see if her last many months of misery were for naught. AC really does not need high horsepower machines to run. Almost all large software companies or small for that matter, will recommend upgrading to the latest version BEFORE they do anything else. Especially when there are over 10,000 posts on this matter including from the big man himself.
Bert Pediatrics Brewer, Maine
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I wonder how much RAM would be too much.
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Gene,
I don't even know where I am in this post. But, there is no doubt that faster processors will speed up your computer and will allow your computer to process the demands and therefore the queries. Moving to 12GB of RAM doesn't seem like it would have that much of a difference. It would have given you 11GB of free RAM rather than 3GB, so XP would have run faster. Still wouldn't have allowed SQL to work faster as far as how it stores and delivers data. It WOULD all SQL itself to work faster IF the 4GB had not been enough.
The cutoff for me has always been 5GB, which most people don't use. Generally, with 6GB of RAM you won't find yourself rebooting your server once a week. Of course this must have been 64-bit.
Bert Pediatrics Brewer, Maine
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Bert, Please don't get me wrong- Vicki should definitely upgrade to 6.1.2. I said that here. http://amazingcharts.com/ub/ubbthreads.php/topics/45010/What_are_major_differences_in_#Post45010But starting with v5, I really noticed some speed issues. Much much worse, of course, with 6.0.9 (Vicki's version.) On 6.1.2, the i3/i5/17 machines are a good bit faster than the older single core Pentiums. These have 4 GB memory, so I do not think that this is a memory issue, but one of processor speed. So my actual recommendation to Vicki is to spend $1000, get an i7 PC, put AC 6.1.2 on it, and enjoy the difference. If she wants to get a new server at some point, then the i7 PC would make a really nice workstation. Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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Upgrade to v6.12 Don't get new server Don't put it on its own server Don't use computer for someone else
People will gasp, but you DON'T need a server for AC. If you did, there would be no ACUC, because the first two letters wouldn't exist.
Bert Pediatrics Brewer, Maine
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Quick! Notify the moderators!
Someone has hacked Bert's account and is posting under his name!!!!
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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They have been notified.
"SERVERS SHOULD BE USED FOR ALL APPLICATIONS ESPECIALLY AMAZING CHARTS!"
Too funny.
Bert Pediatrics Brewer, Maine
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Order has been restored to the universe.
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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I think Amazing Charts should be ported to Linux. Linux is a superior operating system that offers better security and ease of use over Windoze. Also, AC should use Postgres for their database.
JamesNT
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I sense a great disturbance in the force, as if thousands of voices cried out at once, and then all sanity left the ACUB...
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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While we are busy disturbing the Force, I think that AC should run native on the MacOS. No reason except I just like Macs.
John Internal Medicine
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If we are going through the wish list, how about telepathic charting? AC would record your thoughts, and automatically record enough of them to make the visit a 99214.
Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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I am going to have to go into James' profile and remove his Avatar. ![[Linked Image from ]](/ub/attachments/usergals/2012/05/full-4-271-hdr_left.png) I was considering actually replacing it, but I figured that may be too much. Plus, I have been responsible for a flame war already this week. 
Bert Pediatrics Brewer, Maine
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If we are going through the wish list, how about telepathic charting? AC would record your thoughts, and automatically record enough of them to make the visit a 99214.
Gene Yeah, but what else would go in the chart, lol.
Bert Pediatrics Brewer, Maine
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Yeah, but what else would go in the chart, lol. I'm pretty sure all those body part pictures in AC would become considerably more interesting. JamesNT
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I sense a great disturbance in the force, as if thousands of voices cried out at once, and then all sanity left the ACUB... Now THAT was an awesome movie reference! Obi Wan Kenobi right after the first Death Star destroyed Alderran. JamesNT
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James,
You are on a roll! Light day before a holiday weekend?
Gene
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