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#51252 01/19/2013 11:07 PM
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My wife says her main complaint with AC these days is login speed. We have fixed laptops in each room. The CNA logs on to AC to enter vitals, then logs out. Then the Dr. enters and logs on, she says this takes around 30 seconds, which I guess is long enough to be a problem. We just got a new main machine. Laptops in room are about 5 years old.

Anyone else have this complaint with AC?

She said older versions of AC "didn't have this problem". Not sure if they were just faster to login, or if they didn't require login somehow.

I wonder about a solution:
1) Change workflow so Dr. stays logged in all day somehow, in a room she is working out of. CNA enters vitals as Dr.?? I have no idea.
2) Speed up login somehow, hardware or software?
3) Get AC to add support for fast-user-switching of some kind? For CNA/Dr. combo for example.

Thanks.


Philip, IT for wife's Family Medicine Practice
philipw #51257 01/20/2013 10:34 AM
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By "fixed laptops" do you mean wired?

Because if the laptops are wireless, this is likely the issue. You would need to reposition your wireless router, or look for competing WiFi networks in the vicinity sharing the same WiFi channel. You can use an application such as inSSIDer to sniff out an unoccupied channel.

If wired, still most likely a network problem. Test the access time to the database on your main computer or server (running the AC database) on the client laptop (using the AC Utilities), and compare it to the time to connect to the database when AC Utilities is run on the main computer. Sometimes there is a network IP address conflict -- assigning fixed IP addresses to the main computer and clients may help.

I expect you will soon get some excellent replies from our board gurus -- stay tuned!


John
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ryanjo #51267 01/20/2013 3:53 PM
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philipw Offline OP
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Originally Posted by ryanjo
By "fixed laptops" do you mean wired?


By fixed I just meant they are not carried around, they live in the rooms. But also they do use wired networking. No wireless in the office. It is 100Mbit. I have never looked at the cost of upgrading that in place. If we were to do a new office, I would do Gbit at least.

Originally Posted by ryanjo
Test the access time to the database on your main computer or server (running the AC database) on the client laptop (using the AC Utilities), and compare it to the time to connect to the database when AC Utilities is run on the main computer.


The Speed Test in AC Utilities says about 0.3 seconds from the main machine and about 0.9 seconds from one of the laptops.

It's taking us about 25 seconds to log in the first time after just starting AC, from when I hit the Log In button to when the main screen is drawn (drawing itself takes less than a second). If we Logout and then log back in, without shutting down AC, that is more like 45 seconds. Which is a bit perverse, why should it be longer?

On the main machine which is a far faster machine than the laptop, and with no networking involved, I'm getting about 14 seconds the first time or during a re-login.

That suggests to me I'm never going see under 14 seconds on the laptops even if we were to get new fast ones. Because how could we beat the main machine?

I'd be curious what times other people get, from the Log In button to the main screen. What I really wish is that AC had some kind of fast-user-switching, so the Dr. and CNA are both logged in at once, but they can switch back and forth in less than a second.

Otherwise is there some way to avoid the login penalty? If the Dr. carried a laptop around it goes away, but that is a big change and has its own issues.



Philip, IT for wife's Family Medicine Practice
philipw #51269 01/20/2013 5:25 PM
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Changing my router to gigabit helped AC responsiveness a lot in my office. My clients are all 0.30-0.32 seconds connecting to the main computer database.

Does it take a long time to log onto AC on the main computer?


John
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philipw #51278 01/20/2013 9:38 PM
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I'd be curious what times other people get, from the Log In button to the main screen. What I really wish is that AC had some kind of fast-user-switching, so the Dr. and CNA are both logged in at once, but they can switch back and forth in less than a second.

Windows has this feature. You can just have each user logged in with AC open and lock it when he or she needs to leave.

Quote
By fixed I just meant they are not carried around, they live in the rooms. But also they do use wired networking. No wireless in the office. It is 100Mbit. I have never looked at the cost of upgrading that in place. If we were to do a new office, I would do Gbit at least.

Most offices have CAT5E cable which can handle gigabit speeds just fine. You can get a gigabit switch for a reasonable price. I think a *24* port dlink is 130-150.

philipw #51279 01/20/2013 9:44 PM
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That suggests to me I'm never going see under 14 seconds on the laptops even if we were to get new fast ones. Because how could we beat the main machine?

Have you ever defragged the main machine? High levels of fragmentation can result in very slow speeds. For me it's about 5-10 seconds to start AC after a cold boot. Maybe 1-3s to login (switching users is the same amount). I think you may want to look into SSDs. Just because a computer is new does not mean it's fast. Most times using a solid state drive will give you a much larger benefit than getting i7 instead of i5 or increasing your RAM from 4GB to 8GB. If you still feel performance is weak, try using one your server.

philipw #51282 01/20/2013 9:50 PM
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Also, before you go buying all new equipment, try clearing your deleted messages.

philipw #51289 01/21/2013 12:18 PM
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I would agree with the ideas above. Our time to start up AC is 20-30 seconds; log out takes a second, and logging into a new user is about 4 seconds.
The idea of buying new equipment might seem logical, but may not be necessary. If you can easily change your work flow, then go ahead, but that should not be necessary either.
I like Sandeep's suggestions: use Windows to log on and off, rather than AC. (That may also help determine if this is a networking or equipment issue, vs. something specific to AC).

Your wife's idea that this started with newer versions may be a useful hint. I think the newer versions handle deleted messages differently. Ctrl-U (user preferences)- General settings- Automatically clear 'deleted messages box' when logging out. See how many are in her deleted box and empty it.


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ryanjo #51293 01/21/2013 5:11 PM
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philipw Offline OP
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Originally Posted by ryanjo
My clients are all 0.30-0.32 seconds connecting to the main computer database.

Ours is 0.9 seconds from the laptop. I wonder what that is really measuring. Ping time between machines is less then 1ms so 0.001 seconds. So where is all the time spent, what exactly are they measuring and why is it so slow?

Originally Posted by ryanjo
Does it take a long time to log onto AC on the main computer?

It's 14s on the machine machine. On the laptop it's 25 - 45 seconds depending on if it is a fresh login or a re-login. This suggests 3 levels of problem:
A) Why is main machine 14s, that's slow right there with no networking
B) Moving to laptop adds 10 seconds, seems like a lot to pay
C) Switching to re-login instead of fresh adds 20 seconds, that is a total mystery and big price to pay because that is in fact how they are logging in.

Other ideas mentioned:
1) Use Windows Fast User Switching. This is a good idea. Right now we use 1 user account on all machines and it's always logged on. So this would be a change for people to get used it, but might be worth doing.

2) Upgrade to gigibit. I think if I got the Gbit router only the new main machine and the NAS drives would use it. I'm pretty sure the 5 year old laptops don't have it, but maybe the next rev.

3) Defrag, haven't done it but the machine is pretty new, but worth a try.

4) SSD, well we just got the new main machine with regular drives, RAID 1. I certainly wouldn't want to switch unless I was sure that would fix the problem. The way disk caching by the OS works pretty much everything should be sitting in RAM. We have 24GB of RAM. So a completely fresh start after booting the server might be slow. But for the testing I was logging in/out dozens of times, at that point everything should be in RAM that can possibly be in RAM. I can run tools to see exactly how many bytes are being moved around on the main machine when one of these re-login happens. Does anyway have an apples-to-apples AC-specific benchmark of HDD vs. SSD? Would be interesting to see.

5) Deleted messages. Will try this. If it's spending 40 seconds because it has deleted messages that would be a huge bug IMO. But certainly easy to try.

So Sandeep says 1-3s to login and JBS says ~4 seconds. That does indicate my times (14, 25, 45) are way slow.

Thanks for all ideas. I'll experiment and see. Very frustrating!

EDIT: this is all with AC 6.3.3 BTW.






Philip, IT for wife's Family Medicine Practice
philipw #51377 01/24/2013 11:37 AM
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The Speed Test in AC Utilities says about 0.3 seconds from the main machine and about 0.9 seconds from one of the laptops.This could a better hint to fix the problem.

ryanjo #51399 01/25/2013 9:21 AM
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Originally Posted by ryanjo
Changing my router to gigabit helped AC responsiveness a lot in my office.


It only helps if the client-machines can do gigabit though right? Our main machine is new and has 10/100/1000 but our laptops are older and have only 10/100. I'm fine with throwing in a gigabit router, but it doesn't seem like it would help until I upgrade the laptops to something newer.

I'm most curious about the 14 second login time from the main machine. That seems really wrong if other people are seeing 4 second login times from anywhere. Although I take that with a grain of salt, the people responding to this thread probably have the most invested in infrastructure and have it most tweaked. I wonder what a typical login time is.

We got our main machine May 2012 so it's fairly new. It's not a server but did cost $5k and seems at least competent: Dell T5500, Six Core Xeon 2.4Ghz, 24GB RAM, 2 x 1TB SATA 3.0Gb/s 7200 RPM drives RAID 1. It was a big step up from our old main machine.

I haven't tried any of the many suggestions here yet, so those are all on my todo list.



Philip, IT for wife's Family Medicine Practice
kallis #51400 01/25/2013 9:24 AM
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philipw Offline OP
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Originally Posted by kallis
The Speed Test in AC Utilities says about 0.3 seconds from the main machine and about 0.9 seconds from one of the laptops.This could a better hint to fix the problem.

So ryanjo said he gets 0.3 from clients. That doesn't sound like a huge difference. Has anyone else done the test, can report the times they are getting?

What is the test measuring anyway. As I said ping times are 0.001 seconds, so it's not a ping. It must consist of a bunch of back and forths? And then login itself must consist of still more back and forths?



Philip, IT for wife's Family Medicine Practice
philipw #51404 01/25/2013 9:39 AM
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1) Use Windows Fast User Switching. This is a good idea. Right now we use 1 user account on all machines and it's always logged on. So this would be a change for people to get used it, but might be worth doing.
Do you have AD or P2P?

Quote
2) Upgrade to gigibit. I think if I got the Gbit router only the new main machine and the NAS drives would use it. I'm pretty sure the 5 year old laptops don't have it, but maybe the next rev.
As long as the server has it, that should be good. Think about it. Your server can now supply those laptops with their full 100 mbit bandwith. Gigabit can give 10 laptops the max bandwith they support where as with a 100 mbit, you have the 100 mbit shared between all devices.

Quote
3) Defrag, haven't done it but the machine is pretty new, but worth a try.
You should definitely do that then. Especially if it's on 24/7, the hard drives will get very fragmented. SSDs don't need to be defragged which is another reason why I like to use them. Don't really need any maintenance.

Quote
4) SSD, well we just got the new main machine with regular drives, RAID 1. I certainly wouldn't want to switch unless I was sure that would fix the problem. The way disk caching by the OS works pretty much everything should be sitting in RAM. We have 24GB of RAM. So a completely fresh start after booting the server might be slow. But for the testing I was logging in/out dozens of times, at that point everything should be in RAM that can possibly be in RAM. I can run tools to see exactly how many bytes are being moved around on the main machine when one of these re-login happens. Does anyway have an apples-to-apples AC-specific benchmark of HDD vs. SSD? Would be interesting to see.

That's not correct. SQL Express will only cache a max of 1GB in memory. As time goes on, the extra pages go to the page file goes to the hard disk which may possible make it even slower. That's why a lot of people see a speed boost after a reboot.

I should probably record a video. I installed several computers in an office. The doctor bought his own computer from Dell with an HDD. He wouldn't stop complaining that AC was slow on his computer after using mine in the exam rooms (with SSDs). He actually started doing all of his work in the exam rooms. Then I upgraded him to an SSD and he's back in his office. For some people, it's a big difference. Ever since I got my first SSD, I ended up getting them for the rest as well. I now don't have a single computer without one.

philipw #51405 01/25/2013 9:46 AM
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We got our main machine May 2012 so it's fairly new. It's not a server but did cost $5k and seems at least competent: Dell T5500, Six Core Xeon 2.4Ghz, 24GB RAM, 2 x 1TB SATA 3.0Gb/s 7200 RPM drives RAID 1. It was a big step up from our old main machine.

That price seems fairly high for those specs. Did you get some expensive software to go with it?

philipw #51406 01/25/2013 9:47 AM
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Originally Posted by philipw
Originally Posted by kallis
The Speed Test in AC Utilities says about 0.3 seconds from the main machine and about 0.9 seconds from one of the laptops.This could a better hint to fix the problem.

So ryanjo said he gets 0.3 from clients. That doesn't sound like a huge difference. Has anyone else done the test, can report the times they are getting?

What is the test measuring anyway. As I said ping times are 0.001 seconds, so it's not a ping. It must consist of a bunch of back and forths? And then login itself must consist of still more back and forths?

Actually I read that as .3 from the main machine, and .9 from clients. YMMV

I haven't ever run a SQL monitor to see what it is, but I strongly suspect that it is running one or more DB queries, then reporting the time to run them and then get the results. The effect is to give you a more realistic measurement of end-to-end speed.

because SQL databases cache results they suggest running it several times; that is then minimizing variability due to disk I/O. If your first number is consistently slower (from the main machine in particular), this tells you your disk performance is part of the problem.


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philipw #51411 01/25/2013 10:12 AM
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Originally Posted by philipw
I haven't tried any of the many suggestions here yet, so those are all on my todo list.
Move "empty deleted items from mailboxes" to the top of the list; only takes a minute and may do the job.


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JBS #51437 01/26/2013 12:29 PM
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Originally Posted by JBS
Move "empty deleted items from mailboxes" to the top of the list; only takes a minute and may do the job.


Wow, okay that worked. The Dr. had about 30,000 deleted messages, since 2010. I guess we had deleted them once before, because we have been using AC since 2008.

These are the times I measure before -> after deleting:
On machine machine: 14s -> 2.5s
On laptop, fresh login: 25s -> 2.5s
On laptop, re-login: 45s -> 2.5s

Interesting that it slowed down the laptop so much more. But with the problem fixed login on the laptop is the same as the main machine. I asked the Dr. about doing on auto-delete-on-logout and she said no, she does fairly often have to retrieve a delete item from a few days a go.

So I guess we just have to do this monthly or something.

This is really a design flaw with AC. It should not slow down so much from deleted items.

Thanks for all the suggestions. Probably we could optimize things even more but 2.5 seconds I think is good enough. Way better than 45s which is what the Dr. was putting up with.


Philip, IT for wife's Family Medicine Practice
philipw #51449 01/26/2013 10:05 PM
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Originally Posted by philipw
This is really a design flaw with AC. It should not slow down so much from deleted items.

Loading 30k messages from the main computer's database is an awesome task for any CPU.

As some famous programmer said "It's not a bug, it's an undocumented feature." As your doc commented, access to deleted messages is a frequent necessity. I'd rather it be me that chose when to empty the trash. The problem is that nobody told you. Until now.


John
Internal Medicine
ryanjo #51455 01/27/2013 11:10 PM
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Originally Posted by ryanjo
Loading 30k messages from the main computer's database is an awesome task for any CPU.


Firstly, yes very glad to know about this. Easy to fix and super effective. So we are completely happy.

It just seems like the client should not need to load the deleted messages unless the user is viewing the deleted messages. So when I just login, going to my inbox, it should not matter if I have 2M deleted messages, it shouldn't look at them or load them at all. Load them when I go to view my deleted messages. And put up a progress dialog if it's taking more then 3 seconds, that would make it obvious. Loading N of 30,000 messages...tick...tick...tick would suggest to anyone they had too many deleted messages.

I would bet a good fraction of AC installations are unknowingly experiencing slow logins.

So our re-login scenario was 45 seconds, of which 42 seconds was fluff. We evidently do 2 logins per patient (CNA then Dr.) so that's 84 seconds of waiting per patient, if you see 20 patients a day that's actually 28 minutes of the day right there. People are multi-tasking, they aren't literally sitting there waiting to login, but still, the computer is logging in 30 minutes out of the day. That's 120 hours out of the year, for one Dr. at one practice. If you have a 1000 practices with this problem, it starts to really add up!


Philip, IT for wife's Family Medicine Practice

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