Home Forums Discussions General Discussion Frustrated!!!!!

HealthyPearls

Let me offer the bad news and good news views...

I personally think the ads that quote happy users as "walking right in and using it the first day" are grossly misleading. We were 4 computer savvy providers, but our practice income dropped 15% during the first year of using AC. There was a lot of debugging, re-learning, and reassigning jobs. A lot of it was having to treat each patient as a new patient when first seen. Figuring out the network and computer tweaks pretty much had IT setting up a cot and living in my office for 6 weeks. We had daily office wide lunch meetings on the problems we encountered for almost a month. We did not try to go cheap on the hardware. It cost about $50,000 in the end, all told.

Now the good news. Two and a half years into it, everything works reliably. We all know our new jobs. Most of the hardware and network issues are eliminated, or we have found ways around them. This board is crucial to that.

Summary: You are not alone. It cost a lot more than advertised due to lost revenue and IT charges. We tore our hair for probably months. It will work out for you, and you will be glad you did it. Take the problems one at a time. Remember the big picture; you do not have a lethal disease, you have a great home, you are not in danger of stormtroopers beating down your door at midnight. This is a nuisance, nothing more. It will work out.

Healthy,
You didn't come here asking for assistance, but so far offers for help are all that you have gotten. You may yet get responses from others who are equally frustrated, but the community here is mostly made up of those who are successfully using AC, and are relatively happy with it. Not to sound too Pollyannish, but our instinct is generally to pool our knowledge to try to solve problems. AC support is generally excellent, but as Bert pointed out, some issues are best addressed with the support of other users. Most of the problems you described have been seen and dealt with by others. If you want to work together on this, your next step is to share the information requested above.

Healthy,

Do not blame all of your decreased productivity to AC, blame it on the EMR in general. Along with the insistence that doctors use an EMR came other albatrosses...Meaningful Use, patient portals, document this crap, document that crap. The medical chart is no longer a simple tool. It, in many instances, is the conductor now directing us on how to practice medicine. That uses up a lot of physician productivity.

Agree with Jon and Leslie. Excellent posts.

Hey, that can be very important. Do I give you a hard time for documenting blood sugars and bp's?

And thanks to you and Martin for your foresight, and for making the big sacrifice to pass on that hike.

@Jon...you are too funny!

Healthy,

I looked at alot of systems before I chose AC a few years back. I wanted something that was not too expensive and was easy enough to use that my sister Dr C could use it. I downloaded it one Saturday AM, spent a few hours Saturday and Sunday figuring it out, and we could use it Monday. Really. Granted, this was back when AC had only JUST added the ability to scan documents, so it was less complex then.

Over the last 2 years, AC has had additional "persistant" bugs creep in it seems with the rush to meet the government mandates. I'd give them some time to fix it.

With 5 providers, your problems do sound like many may be coming from the network. That happens very easily. I only have 1 and a very few extra PCs, so we don't see them too often. The folk on this board can be very helpful, and many have strong IT backgrounds.

Saw last year a study from Texas that estimated average first year total cost for a medium size medical group was $135,000 per MD! Taking in to consideration all costs, incl lost productivity.
We transitioned from a home brewed, MS Access based system to AC, and attested, with no lost productivity. OK, later days for a while, finishing notes, but no schedule change.

I also experience no drop in volume by moving to AC. I added a few patients a day, then added messaging, then eRx, as the number of paperless patients increased over several months. Also less urgency when troubleshooting. I don't understand the reasoning of "going live" on a certain day & time, sink or swim.

John,

Since Meaningful use is associated with Medicare patients. Has anybody used their old system (which works well) and only charted Medicare patients in AC? This would make it easier to make any adjustments and slowly get the kinks out and add other patients.

Agree that Medicare only in AC definitely a reasonable approach. We are 70%++ Medicare however.

Peter, that is not unreasonable. Learning to use a new system slows things up a lot, and giving yourself some room to recover during the day makes sense. We did not do that, for the same reason I don't go into a cold lake slowly when I want to swim. We wanted to get the pain over with as soon as possible. But I can't fault the guy who wants to get in more slowly.

From: "France Family Medicine ?" <france.medicine@conwaycorp.net>
To: badam@riverviewpediatrics.org
Cc:
Date: Tue, 5 Jun 2012 13:06:27 -0500
Subject: frustrated & unhappy with AC

I logged in 3 times, got 2 others of my providers looking over my shoulder & still once I get to the forum to try to reply to you, it says I am NOT logged in. Is this how you deal with unhappy customers, block them out of discussions? To me this is typical of AC, what is supposed to be simple doesn't work for no particular reason.

To reply to your questions:

1. On 6.12

2. yes we're wireless & had we known or had you stated up front, that in order to work properly AC requires a wired system, we wouldn't have bought into it! So we'd have to abandon our laptops, buy more computers for every exam room?! You have got to be kidding.

3. OS Windows 7 Pro

4. NIC cards 1 Gb

5. my tech guy didn't answer this one, will get back to you

6.we have a gigabyte switch

7. RAM on clients 4GB, on main 8GB

8. Client/server in a domain environment

9. Clients running a i3 process or faster, server has quad core xeon processor



Bear in mind I do not speak computer, so I am relaying.

Healthypearls
p.s. your email address is wrong, tried 6 different variations

HealthyPearls,

Good that you don't speak computer as I don't either--

I am probably not the best to answer all of your questions, but to address #2--I started in 11/2011 and even though the AC webpage strongly recommended hardwiring, I chose not to. I utilize encrypted wifi with a laptop remoted to my main computer which only has 4ram and my nurse has the same laptop as mine (HP elite book 8460p) both laptops have 8ram--I only have two exam rooms and one nurse that manages scheduling, rooming and everything --so this has worked well for me, so before you make any major changes, ask the more computer savy users about this issue before doing anything.
we have 8 provider in our group and 4 have started AC, one has been and still uses e-clinical and 2 more to adopt AC--we all use a shared server for our lytec 11 for billing. But we each own our own AC license and some have servers, and some PC's functioning as the main data base for each doc.
Hope this helps.

Healthy Pearls:

I find your initial post and your reply rude at best. We are trying to help you and yet you seem to have some sort of attitude that none of us deserve.

I am sorry about your logging in. None of us on the board have anything to do with logging in, cookies, Internet Explorer or any other way of staying on the board. Try Firefox or Chrome. I have trouble with I.E. as well. That is Microsoft and its cookies, not AC. No we do not and I am sure AC does not block unhappy users. But, if you have issues, why don't you call them. You can reach Jon at jon AT amazingcharts.com

We are users, we are not AC. "had you stated up front" does not pertain to anyone on the board. Wireless is fine, just that sometimes it can be an issue. Wired is always better, and your IT person should know that. It is faster and more reliable.

I am not sure if you are replying to, but my email address is NOT wrong. You are correct; you do not speak computer. Many people spoof their email so SPAM bots don't scoop them up. If you used AT instead of @, it wouldn't have worked.

I will take the brunt of this and let you yell at me. Maybe try being nice to support (we are not support) and being civil to the users (none of us are AC) and you may get some help.

Healthy,
A couple of things...I am sure you will get more responses!

This forum is for AC users and is run by users, all of whom are volunteers. Bert is the administrator for the board, so if you have a problem logging on, I suppose that if you ask for help, then he will help you. On the other hand, he is not paid by the company. You are not his customer. If you are unhappy with the program, he has no interest in blocking you out of discussions. Quite the contrary; he has offered to help you with your issues (as have others) and we will try to do so, if you would like. That will involve some participation on your part.
Feel free to be angry and frustrated; at times, many of us are. On the other hand, directing your anger at the people here is unlikely to be productive.
Bert's email in his profile is accurate. It appears that you made an error and left off the "s" in Adams.

Are you asking for help with your issues with AC? Which would you say is/are most pressing?

No offense Healthy Pearls, but you need to calm down. First off, most of us do not work for AC. This is a user forum consisting, mainly, of physicians who are currently using AC. No need to get mad at Bert. He helps people in his free time and does not work for AC like many of the users on here (although, we don't put in nearly as much time as he does ).


You have to check the "Remember me on each visit" box when you login if you are leaving and coming back when your provider isn't looking over your shoulder.

Peter,
This is a reasonable way to gradually change-over to AC, if you would prefer to make the process a gradual one. Keep in mind that to receive the MU incentive, you are supposed to report on ALL of your patients, not just those in the EMR. I am not trying to be overly cautious; I just want to be sure you are aware of this. While CMS may not be likely to check on it, if they decided to audit your attestation, they could see fairly easily if you were following this rule or not.

Healthy,

We aren't AC. We are users of the system with varying amounts of experience. I used to have this problem you described when logging into the forum. Then one day I was sure to write down the password I used (could have sworn I'd memorized it) and checked off "stay logged in" or "remember me" whichever it says. Well, that solved that problem. As unlikely as it may seem to you, maybe (just maybe) you were mistyping your password. Just your pinky finger hitting the wrong key lightly. Happens to the best and worst of us.

Now, I see you are running strictly wireless with multiple doctors. Plus extra PCs for others, and one in each exam room. That's alot of pcs to depend on a strictly wireless system for what is your primary software tool for your business. Now, maybe AC SHOULD run on that pretty well. Even if it did, I wouldn't do it. I just wouldn't trust wireless that way. And I'd be shocked if your IT person didn't say so. Shucks, for your computers that pretty much stay in one place, drop in a router and some cable. I'm saying, AC or no AC, I wouldn't try that set-up.

I have had problems with logging in with IE myself. I now rarely use IE because I will log in, go back to a post I want to comment on and.... I'm not logged in. ONLY happens in IE. just another reason I have been weaned off IE.

Healthy, wireless works. Most of us here do not like it because it simply is not as reliable and it is slower. It does seem that your issue is a networking problem and not AC. My system is WAYYY less competent (older dual cores and quad cores as servers) but works well. There any many on the forum who have successfully used wireless. Didn't work well for me when I tried it as extensions.

While you state you would change in a heartbeat, your money was spent on hardware more so than software. What you spent on software for AC would probably be less than the yearly maintenance costs of many EMRs. If you achieve meaningful use, there will be no outlay for equipment, I can't address the lost efficiency. While true of many EMRs, I don't have that issue.

I have been using it for so long it seems I have always worked that way. I can tell you I can see 25-30 people a day and have completed charting on everyone.

I will not beat you over the head about the fact we are users not staff of AC. Everyone else has made that abundantly clear. I don't know what your interactions have been with AC support, but I have never found them rude or unhelpful when I have called.

Again, I think you need to have your IT person look at your network. What you describe is NOT typical of AC. If you cannot solve the problem, I suspect you will have the same issues with any other EMR.

Hi healthy,

We use wireless laptops with no problems, speed only slightly slower than hardwired PCs.

Overall AC is a very very good, and very very usable product.

Good luck!

Gene

An apology would be nice.

My 14 year old daughter got her driving learner's permit 5 days ago, and I have been teaching her how to drive. Trying to do so, I am reminded of what it was like to suddenly be faced with what seemed to be 10,000 things, all happening at once, and carrying with them serious consequences if I screwed up. I have some sympathy here for a circumstance where demonstrating optimum manners might for a while be a luxury I could not afford.

Please remember, Bert, when I first came on this board I asked you a couple of times to clarify its relationship to AC. AC and its web site make this look like an "official" part of the company, and the disclaimer on the front page only clarifies matters after you have been around it a bit. Add to that someone who is frustrated, losing revenue, and very possibly not familiar with the entire milieu of the internet and user's groups, and I can see a myself going a little sideways also.

Sorry, not buying it. She was rude. As a doctor, I am sure she has integrity. So show it here and apologize.

Can't buy the fact that this board looks like it is sponsored by AC. Look around. Read.

If I were a practice of five, and I were losing money, I think I could find out how to get hold of AC. There are at least three ways on www.amazingcharts.com.

You didn't approve her registration less than one minute after she signed up. You didn't read her post not five minutes later. You didn't feel bad for her then and, like I always do, take the time to try to help her (then). I then waited for a reply so I could engage in a few posts to try to help her. What do I get? A rude reply. Twice. 48 hours later.

So, yes, I think an apology would be nice. I think being on the board or looking at AC (a few patients at a time) hardly compares with driving a car for the first time.

And, yes, when you came on the board, you asked me some questions. And, I answered them. And, you were grateful.

No, she may not understand the Internet. If not, then tread lightly. But, my guess is, one of five doctors must have some idea of how to use the Internet. And, while she may not be able to use a user board, she must know how to navigate the Internet.

She was upset with us because she thought we were Amazing Charts staff. OK. But, once she knew we weren't, an apology would be nice.

HealthyPearls, you need to have a talk with your IT Person. He or she clearly did not implement the system properly. Getting booted off, random disconnects, etc. are all indications that your network is not set up correctly rather than a problem with AC. Especially considering more than 5000 practices have it running.

A few pointers:
1) Wireless does work and can work. But it's not recommended. Even says so in bold letters on the AC website. You can't really blame them when whoever set up the network decided to ignore the recommendation.


2) Laptops have ethernet ports too, you don't really need to throw all of the old ones away. Just plug them in. If the issues disappear, it should be pretty clear that wireless is the problem.

3) If you want to use wireless, get better access points preferably with Wireless N. Maybe a dual band access point so it won't interfere with any other nearby networks. Maybe get multiple ones. 1000FT of CAT6 Ethernet Cable is only $100 so choose wisely.

4) If you really want to use wireless, consider getting a Terminal Server. That will essentially eliminate your speed issues. All operations would be conducted on the attached server. You'd just be getting screen updates on the laptop.

Determine the costs, going wired (workstations) vs going heavier wireless (dual band and more access points) vs using a Terminal Server (remote desktop in house). The third option is gaining a lot of popularity.

Mea culpa, yes I was rude, shouldn't post at end of long day, I am sorry. Didn't realize you weren't part of AC. Did use @, as another pointed out, I left off s.
We (my office manager & partners) have called AC for help with different issues & frequent reply is "that's a known problem, we're working on it" and has been months & still not corrected (having to close out twice in order to get restarted, cursor jumps to beginning while typing in plan textbox, takes 10 seconds for 'orders' to open) If hard wiring will solve the sudden closing of AC with loss of notes(yes do know how to resurrect, but that takes time!), or 'Not Responding', then we'll try that.

Interesting that they stated these were known problems.
1)having to close out twice in order to get restarted
Not quite sure what you mean, but occasionally if you quit, AC doesn't quite shut down promptly, might have to go to task manager, but not common. Why close out anyway, for speed? I rarely shut down AC, just do windows button and L to lock the screen.
2) cursor jumps to beginning while typing in plan textbox
Is this after doing templates? This is just how it works. That you adapt, it isn't a problem.
3) takes 10 seconds for 'orders' to open
With the high grade hardware you have, I am surprised this is an issue. On Sandeep's message at the very bottom is a link to "disable hardware acceleration." Try that. It may work. There is a known fix for some of the V6 slowness and has been there for a while. It could also be a network issue.
Hope these help.
I agree with Sandeep, talk to IT about your network. The earlier things you mentioned just are not typical of AC on a competent system as you describe. Even if you have to direct connect a few computers just to see the problems disappear, you will confirm it as a wireless problem. Again, wireless can work but....
Good luck, keep us updated. Perhaps have your IT person look over the postings for ideas or post him or her self.

I disagree! Wireless works fine for us. We are a one provider office. A main desktop with another wired desktop, and three laptops they are wireless since two are being moved around all the time. I never experience any slowness at all. I think her problem is the number of providers!

AC is great for a solo office, but once the # of provider exceeds 5, you will have some problems. That's also what I heard from my biller who has a lot of customers using AC.

healthyPearls,

As I said before we have 8 providers, and 2 have not gone with electronic records yet, but 6 have and one is hard wired the rest of us(no more than 2 providers per wireless N router access point) are using wireless modes that are all going into a gigabyte ethernet switch and none of what you describe is occuring with our set up.

Healthy,
Here is the way I see it: any software company needs to state requirements for hardware and networking. If you think about it, this is a pretty challenging task. They don't want to set the requirements too high (so people won't buy the software) or too low (and it won't work). Part of the problem is that there are so many variables; what works for one group may not work for another. Clearly some people run a wireless network and have no problems.
If I was using a wireless network and had significant issues, the FIRST thing I would do is try to eliminate that as a source of the problems. To do so is pretty simple; connect your laptops with a wire to the server, and see how much of an improvement you get.

Healthy,

I agree completely with Jon (JBS). Remember, though, the laptop usually has to be plugged in to a wall electric outlet (not running on batteries) to look for and connect to a hard wired network connection. If the laptop is running on battery and you connect the network cable, it may still use the wireless connection.

Gene

Hi healthy,

Welcome to AC! The best help you can get is right here. Believe me, we have all been through the network and AC issue.

As far as wireless vs wired: Yes, for the hundredth time (nothing against anyone who uses wireless), wireless can work. But, for the most part everyone who posts here that uses wireless, eventually changes. First, it is SLOWER period. Second, it drops connects.

As for closing twice. Yes that does happen. That IS an AC thing. I do have to use Task Manager a few times per month. Shouldn't happen more than that.

I am extremely proud of you (sorry Jon -- actually you will use this against us) (by the way healthy, there is Jon (JBS) one of the nicest and more knowledgeable users and there is Jon (JB -- Jonathan Bertman) who is the owner of the company. One thing you can do is email him jon@AmazingCharts_removespam. Use the "n" lol. 1. He can be slow to answer his email, 2) once he does, I think he will be very helpful. Remember, he learned visual basic while working full time. If you wish, I can email him for you...I tend to get responses a little faster.

If you take a look at this guy you will see a networking that is incredible. Nothing against your IT guy or even my local IT guy, he knows networking.

One of the thing he ALWAYS tells me is the issue is almost always DNS. You know how doctors always use the multiple diagnoses in lists such as abdominal pain is usually constipation, constipation, constipation, then pancreatitis. This is networks version. It is DNS, DNS, DNS. Without proper setup of Domain Name Services, you can try AC all the want.

Quick question: Is your server set up to handle DHCP, or are you using static? Are you getting DHCP from your router or God forbid, from both?

When troubleshooting, the rule is to get rid of all the possibilities, then add back. So, disconnect everything from the switch except for the server. Does AC run well? Over and over? Yes. Then get a small unmanaged switch and plug one computer directly into that switch. Wired. Does it work? If it does, you've fixed it. You have a network. Now, you just need to add the computers back one by one. Even if you have to carry them to the switch. Before doing that, take the computer on the Linksys unmanaged switch and plug it into the large switch does it work? If so leave it there. You have a network on the main network.

Slowly add each computer to your switch. Make sure the switch, as you said, is Gb. Make sure the computers are Gb NICs. Going back to the one computer on the small switch (Gb), make sure the NIC card from the device manager is set to Auto-negotiation. You can set it to 1000Mbs, but better to Auto-negotiate.

Review:

1. Server only -- it works (yes, generally don't do things on the server
2. Connect ONE computer with a 1Gb NIC set to auto-negotiate through device manager. Wired.
3. If works, connect that computer to your larger 1Gb switch.
4. Make sure your server is DHCP and is giving the computers their IPs, subnet masks, default gateways and DNS. If one octet is not correct in any of those, it won't work properly.
5. That is the beauty of Server DHCP. Sure, you can use static, but then you introduce the human element into it.
6. I couldn't find whether or not you were using SBS vs Windows Server 2008 Standard or Premium. If SBS, you CANNOT HAVE ANOTHER SUB ON THE SAME NETWORK. That will definitely give you these issues.
7. Make sure when you click on Network from your server, all the computers show up including the server. First time may be slow. Second time and thereafter, should be fast.
8. Go to the Amazing Charts folder and make a text file. Inside the notepad, write something like "Bert is a jerk." From every computer, make sure they can browse to the server, open Amazing Charts, open that text, delete the text, write text and save it. I would suggest, "Bert is amazing." If you can do that, you have read, write, modify from all computers.
9. Healthy, I have never understood that while Microsoft dominates OS and the Office Suites, they have to have everything. This is why the EU sued them. While every browser has its advantages, the bloated I.E. is horrible at dropping and finding cookies. This is why I use Firefox, which as no problem finding the Keebler Elves or Oreos. This is why you may way to this.

Try these and let me/us know.

Everyone: I don't think anyone here is suggesting the wireless does not work. It works fine. It is just when one is in troubleshooting mode, it can be something to look at. No matter how you look at it, it is slower and more apt to lost packets or disconnecting. Also, no matter how much WAP2, (sorry if I got that wrong you use) security is still an issue.

That doesn't mean you can't have a successful network with it especially in situations where running cable is difficult or you don't own the building.

I apologize and I am certain others do too if we come across as wireless doesn't work. In fact, I appreciate and so do others down the road for knowing it can work flawlessly.

Then I must be a nobody, 6 years and 9 months wireless and no plans to change.

Gene

Put that server on WiFi too haha.

I went back and read that, and I guess it was a bit harsh. But, I suppose you will change at seven years. Remember, everybody does.

One thing that people don't seem to take into consideration is when Sandeep or I post a technical post that is 50 lines long. Tend to throw in something that alienates someone. I can certainly understand your quote and wireless works better for some than others, and I wrote that in my posts.

There is something in networking or computers which is similar to one in medicine. In medicine, they call it Evidence-Based Medicine. In computing, they call it Best Practices. There are thousands of articles and blogs online that refer to best practices. That isn't to say that something other than BP isn't going to work. It just isn't what Microsoft or Dell or AC recommend.

I don't know why so many people get defensive when it comes to wireless or other different setups. I am sure it works just fine for you Cindy. The author didn't say that wireless didn't work. He merely suggested changing to wired as a troubleshooing step. Certainly, you would have to agree that there are more potential issues with wireless than wired. If changing a few computers to wired, then you have your answer.

While the number of computers can add to bandwidth problems, there is no five provider limit with AC. On the contrary, there are practices of 15 to 20 providers that do just fine. It would be interesting to know whether the practices your biller is talking about use wired vs wireless networks.

Bert,

You are a man of strong opinions, and we love you for it. I just can't resist jerking your chain now and then!

If all my diabetics had A1Cs of 7 or less, and all my smokers quit, and everyone lost the 20 (or 120) pounds they needed to lose, we would be in a perfect world. And I would be hard wired with a real server. Until then, I will be plugging along on my wireless peer-to-peer network, with nothing but admiration for those of you with the setup that Bert has.

Gene

To weigh in on the wired/wireless issue, I sure agree that going Ethernet for a test is valuable. If you have >1 exam room per provider however, having a wired terminal in each room may not be practical. We had wireless issues initially with a 2.4 GHz WAP which is far and away the commonest unit around. We put in a dedicated 5 GHz Cisco WAP and all of our troubles disappeared. I can no longer tell the difference between wired and wireless.

Buffalo just released an 802.11ac draft router. That looks appealing. Supposed 1.3 gbps (5G WiFi).