Home Forums Discussions General Discussion Switching to AC in the Cloud

I have just switched from using the standard AC over to AC in the Cloud. Perhaps others on the Board might find this of interest especially if you have considered making the switch. I'd also be interested in hearing from others who have switched.

My situation was of course different from someone who starts fresh with AC in the Cloud. I have been using AC for about 2 years. I'm not very technically savvy and wanted an EMR solution which minimized my hassles. With the regular AC I was having to spend significant amounts of time troubleshooting problems with the network and AC. I was dreading having to handle the update of AC and how much time and emotional energy that would involve. One of the advantages of AC in the Cloud is that THEY do the upgrade, not me. Another big factor in pushing me to made the switch was anxiety about my backup system. I just wasn't really comfortable that my data was secure. I was using the AC offsite backup service, Jungledisk and backing up to an external HD in my office. But I didn't know how to test to see if I could really restore my system if my server crashed. So I decided to switch to AC in the Cloud.

I've had a number of glitches along the way and it's taken longer (2 months) and involved more hassle than I expected to make the switch. The basic process is that someone from AC tech support logged into all my office computers. Then they installed the AC in the Cloud software on each computer. Then they tried to upload my data to the Cloud server. Unfortunately, 12 hours later it still didn't finish. It turned out that my internet speed was too slow. I had DSL with upload speed ~5mbps. So I had to switch to a cable internet service. Now I have 50mbps service. The folks at AC told me that the Cloud system requires at least 18mbps upload speed.

I won't go into all the details, but finally today we got the system running. This time it took about 2 hours for tech support to upload my data (including imported items) and set things up. I then spent another 2 hours working out various issues. In our office there are three of us, a secretary, medical assistant and myself. My secretary uses one computer and my MA and I each have two work stations that we use. This was a problem with AC in the Cloud. Each user gets a login to connect to the Cloud. Only one connection per user. There is a workaround--they can set up two logins for each of us so we can run two different computers at the same time. I'm waiting for that to get worked out.

Other issues that needed to be resolved included being able to import documents into AC in the Cloud. We use Excel spreadsheets to track patient labs. To do this requires that the folks at AC do some fix at the Cloud server. Then we had problems with my Mac. I had been told that AC in the Cloud works fine on the Mac--without having to use Parallels (which is how I was using AC). But it required installing Remote Desktop Connection for Mac software and some other issues. Then there was the problem with Updox. We're still trying to get that fixed so that my documents go to AC in the Cloud. I still need to get my hospital lab to transfer my interface so that lab reports will import into AC in the Cloud.

But I was able to begin using AC in the Cloud tonight to document on a couple of patients I saw earlier in the day. So far I am pleasantly surprised by the performance of the system. It's actually faster than my old in-house system. It appears that I won't have the problem of occasionally losing a note. With my system if I was charting on a patient and the system froze I would lose data. Even "LastNote" never seemed to work very well. With AC in the Cloud, if I lose internet connection while in the middle of a note, nothing appears to get lost. I like that!

Anyway, that's been my experience so far.

Great post, John. Thanks.

The internet speed requirements are daunting. There are an awful lot of smaller communities where 18 Mbps is not possible.

I am a little surprised that it was as difficult as you experienced. It strikes me as an indication of immaturity of a product that the tech support people have to supervise the transition, let alone that it takes a couple of months to work out all the bugs. It suggests a product rushed into release, and gives me further cause to not jump into using 6.5 until it has been in general use for some time.

Someone who's tech savvy and under 50 would probably have been able to negotiate the transition to AC in the Cloud in a couple of days. Most of the difficulty was on my end--a busy, aging family doc who has trouble reading directions. :-)

John,

Thanks for the detailed info.

How much will this cost per month/year?

Thanks. Gene

18 mbps??!
I can't even get that with cable around here-Santa Fe, NM.
That is a ridiculous requirement.
I am glad it is working for you but I would say that it is a service that is dead on arrival.

I have 5 computers on at the same time. 1 receptionist, 1 MA, 2 exam rooms and my office. Cost to me for cloud-$500/month IN ADDITION to the usual licensing fees. Yeah right. Dream on Amazing Charts/Primemed.
I think AC has lost its way. I am looking at other products.

Bill,

I understand your frustration, but it doesn't have to cost that much. Without marketing, I will say that we have been offering an AC managed environment before AC jumped in, and the long-term costs are less than a third what you have indicated.

I have to wonder if that is a mis-print, or just an inflated requirement.

We have folks using our platform in rural areas where they use DSL [I hate DSL btw], or even fixed wireless. There can be a bit more lag, but they are very satisfied.

Indy,
Not sure what you mean. I called AC to get a quote for my office. Do you offer a different service??

Yes, he does.
Click on his website below his name.

I suspect that AC tried to develop a PM to make the AC in the Cloud service more attractive, which would provide another revenue stream and ensure enough money to remain competitive as the industry shakes out. And it would allow AC to keep the license fees relatively low.

A lot of doctors around here have cloud based eClinicalWorks due to the lower upfront costs.

When the PM failed, AC had to find a white knight. AC in the Cloud isn't going to be popular if you have to maintain a network anyway for a PM.

And that, I believe, is the rest of the story.

Not only the 18Mbs upload bandwidth (would cost me $300/mo in Central Florida), but 1 login per user on a single computer? As someone said, DOA!

The fastest I can get is 15 Down / 5 Up for $379.95 a month.

Our practice had our main computer go down, and we took it as a sign that we needed to find a better solution. We found Indy's company Best for your Practice, which offers a managed environment for Amazing Charts. He was able to help us quickly, and at a very reasonable price. We have been very happy with how Amazing Charts functions on his server.

Nice try, Indy. Nice try.
____________________

Reading how expensive these low-rate plans are is depressing. Evidence of the culture of stagnation of telecom industries. Google Fiber, currently only available in Kansas City, offers gigabit internet (up and down) for $70 a month. It's expanding to Austin, TX now. I hope it spreads everywhere, and quick.

Yeah. If anything that would make me hesitate to use his service.

Mario, Bill... I am not sure why you are reacting negatively. There are some clear reasons to have a cloud-based EMR. While it is not for me, for some people it provides tremendous advantages. AC offers a cloud based version of the program. Indy also has a business to set people up with a web-based version. They both have their satisfied customers and their own pricing schedules. I am happy to see a discussion about this.

Hi everyone,

Disclaimer: I am only familiar with Indy as a poster on this board. I have no personal, professional, or financial relationship with him.

I have been on this board for about 2 years. I have found Indy helpful in his posts. I have never seen any evidence of dishonesty or unscrupulous behavior on his part.

Let's not jump to conclusions!

Gene

I am not sure what you are referring to by saying "nice try Indy". If you are indicating that Indy by anyway influenced this post you are mistaken. We are a real practice that is using Indy's system. Anybody is welcome to pm me if they want more information about our experience. Our practice is in Naperville, Il, Riverwalk Family Medicine. I am sure that others on the board will back me up that Indy has been very helpful in his posts, and this is how we found out about his services. He does not go out of his way to promote himself or his services.

Sorry if anyone took it that way. It was a joke.

I would be one of those to back you up in your assertion that Indy has been extremely helpful in this forum.

Over the years, I have had a number of computer-based "solutions" in which the programs and/or data were not under my physical control. Many ended badly. Maybe it is the frontier self-reliance thing I suffer from, but relying on promises or performance from third parties when it comes to my money, security, practice or data just does not typically end well for me. I hope you "cloud people" have better luck.

As I said earlier at the beginning of this thread, we had to switch from DSL to Charter business internet (cable). This increased our cost from $42/m to $125/m. It sounds like we are fortunate to be able to get high speeds at this cost.

For me the value of AC in the Cloud is well worth the cost. I was spending many hours a month dealing with the various issues related to AC and the network to support it in my office. My time is valuable and I'd rather spend it seeing patients or taking a walk with my wife. For those of you who are more tech savvy and enjoy troubleshooting (or have an office manager to assume this role), the cost of AC in the Cloud may not be worth it. But I now believe that a cloud-based EMR like AC in the Cloud is the way to go, especially for docs in solo-practice like myself.

John,

More than one way to skin a cat. I wish you well and walking with the wife sounds much better than sitting in the office tinkering!!!!

I think a lot of people are looking for managed services instead of a cloud provider or doing IT themselves. Have someone do the IT work for you. If you are dealing with someone who is experienced, you shouldn't even notice the system. Networks built on a strong foundation from the start tend to have minimal issues. I am managing several practices of from as little as 4 people to 20 people without having to leave my desk. I try to automate as much as possible (keeps costs low for everyone). Getting daily email reports to make sure everything is okay and backups are happening, etc.

Disclaimer: This is what I do.

I have made these assertions on this forum before but I'll make them again for those who may be new to the scene.

Disclaimer: I'm a narcissistic IT/Software Development Genius with sociopathic ego problems.

* If your system is constantly crashing you need to do one or more of the following: Stop buying cheap crap. Fire your IT person. Get an IT person. Train employees to stop going to download.com and downloading everything they can find.

* Your antivirus should be up-to-date. Always.

* Your computers should be properly patched and updated. If you are still using Internet Explorer 6 on Windows XP, you should either fire your IT person or get an IT person.

* See my post on what causes the most problems with AC running properly. It can be found here.

JamesNT

I looked and looked and I cannot find this in ICD-9. Is it a new ICD-10 code?????

Gene

DSM-5

My impression of you James just went up

We are all defective and some kinda crazy.

I am in total agreement with James and Sandeep. Running a medical office on electronics takes you out of the hobbyist mode. Doctors have big egos, and it is tough to admit that you no longer have the skills or time needed to acquire them to maintain multiple networked computers properly. This is not an area to try to go for cheap.

I disagree on the issue of updates. I am reluctant to install updates without doing some research first. That's the benefit of going with external IT. They keep up on things that are quite time consuming. For instance, I know a lot of people that run SBS Standard stopped updating them due to updates bringing them down. That's one major reason Microsoft is scrapping SBS Standard. The update roll ups are notorious for bringing down servers. I always test them in my test bed before applying them to any client servers.

Even on Windows 7, updates can bring down a computer. It's unrealistic to expect someone doing their own IT, while practicing medicine, to keep track of all the Windows updates. There are several examples of this as well. Hey, look there is one from today: http://nakedsecurity.sophos.com/2013/04/12/patch-tuesday-fatal-system-error/

Training employees to practice safe browsing habits with protect you from more malware than any antivirus product ever could or you can lock everything down. E.g. using Firefox with Adblock, NoScript, etc. or blocking all sites and programs except those that are necessary.

Interesting to read your comments, James and Sandeep. My problem is I don't know what I don't know. When I started with AC I tried to do what I was told. I have had a couple of IT people who are in my area help with my system. Nevertheless, there were always "issues" that chewed up my time and patience. Often when I needed help, I couldn't reach the IT guys. I didn't even realize that you both provided IT support for AC users--though I have been following things on the ACUB for quite a while. So I've stumbled along. As I said in my earlier post, I'm hoping that the Cloud version of AC will smooth out some of the issues.

By the way, I have more problems with the hospital EMR. By comparison, AC works like a charm!

Nice thread. I agree with everyone here.

If I could just wish for one thing, well maybe two or three things, it would be that users wouldn't refer to their IT people as IT people. If they would list what their credentials are. Someone who has worked in Microsoft networking for 15 years or lists MCITP or MVP next to their names is helpful. Not to use the same cliche' all the time, but the 19 yo down the street who is really good at Special Ops (the video game) and is also very good even with servers is not likely going to be monitoring your system or doing it correctly.

So many people on here refer to "IT people."

Good point Bert. This raises a more general question--IT support. I'll start a new thread. I think it might be generally helpful, especially to us non-techies.

John,

Keep us updated on your transition to the cloud.
You make some very compelling arguments for the transition, and some of us with a small number of users, and quick internet, and hard to find IT support may feel the cost is justified.
I am partially in the cloud with Updox already, but will be interested to hear from you in the next several months to year or so how things are for you in the "AC cloud".

Well, it's been a month since I started this thread and switched from using AC in-house to using AC in the Cloud. As I said earlier it took a while to get switched over, but I have to say the staff at AC were very helpful and accommodating throughout the process.

As far as the user experience of AC in the Cloud, I am very pleased. I no longer suffer from Chronic "what if my server goes down on Monday morning"-itis. I am spending much less time dealing with technical issues with computers at the office and spending more time just doing my job, seeing patients. The look and feel of using AC in the Cloud is identical to in-house AC only better. I never really liked using AC remotely via LogMeIn--the screen resolution was always a bit off and it gave me a headache trying to do much. I find AC in the Cloud is much better for remote use.

One other aspect that is better is the way Excel spreadsheets work with AC in the Cloud. Before I had issues with compatibility--I could open the patient's spreadsheet on my Mac but couldn't enter data. With AC in the Cloud it works fine on all the office computers.

I have also found that. although I was told I needed at least an 18mbps connection for AC to run well in the Cloud, it works quit well with much slower connection. I can even run AC in the Cloud on my Mac tethered to my iPhone as a personal hotspot. This is nice for use of AC when out and about or as a backup in case my cable internet were to go down at the office.

So, overall my experience of the Cloud version is "two thumbs up". Is it worth the added expense? For me, the answer is, yes.

John

Great news!

Have the solved the problem of one password for a user logged in on one computer at one time?

Yes, John. We got two passwords for my medical assistant and two for me--we both use two computers.

Do you know if it would feasible to use a laptop with a wireless connection to the internet to save on the number of needed licenses? I have two exam rooms, my nurse has one workstation, and then my office, plus the front desk. If I used a laptop for my office and the two exam rooms, that would be one license instead of three. I could get by with 5 licenses instead of jumping to the 10.

Dale Gray MD
Illinois

Dale,

If you go to Administrative Options and under Practice & Users | Practice (Licensing Info), you will see Licensing Information for your Pracice.

Under Licensed Providers, you will probably have a 1 corresponding to you. You may or may not have a paragraph beneath it in red giving you more licensing information. But, if you have more providers than licenses, it will tell you that in red.

Amazing Charts is licensed PER PROVIDER, not how many exam rooms or computers or nurses. The only licenses you will need to purchase will be for actual providers, etc. MDs, DOs, FNPs, PAs, etc. From reading your post, it sounds as though you are the only one practicing, which would mean you would only need one license whether you use one computer or 100 computers, 10 desktops and 10 tablets.

@Bert

I think he is talking about the Amazing Charts Cloud service. Solid in packs of 5.