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#57970
11/07/2013 6:56 PM
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Good Day Forum,
I have a couple of doctors that will take out their stop watch and time how long it takes from the moment they click say "new order" until the time it actually pops up to let them start working. Its routinely 20 seconds for this example, the length of time it takes to open Amazing Charts, etc. My question is this normal indicating something wrong with my network, or is this just how Amazing Charts runs. We are hosting it internally on a 64-bit, Windows 2008 Server, R2, Standard with 16GB Ram and 2, 2.4GHz Processors. I've allocated more processor resources but really didn't see any significant improvement to speed. When I look at task manager its pretty normal to see 15.1GB of memory used as SQL seems to grab what's available.
We are on version 6.6.1 of Amazing Charts.
I would love to hear your thoughts.
~Shane
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On our system it does take some time to open Amazing Charts. For that reason, we log off but do not exit Amazing Charts. Sounds like we have the same server type set up.
Have you checked how many orders you have pending? I know having a lot of orders slows the system down. You can view this by going to CTRL-O
Marty
Marty Physician Assistant Fullerton, CA
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Marty,
Thanks for the response, I'll have the physicians check this. Amazing Charts always makes reference to cleaning out the inbox and deleted items box. My physicians tell me this isn't practical because the deleted items folder is referred to for various reasons and it only gives the option to delete all. Does this sound right in your experience? I know that many of them are carrying a large number of items in both places.
~Shane
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I noticed on our system last year that AC was slowing down quite a bit. When I went into the Orders window there was 2 years worth of orders in there. Clearing out the orders definitely made our AC run faster.
There is an option that you can select to automatically clear out your deleted items folder. But I think you are right, you can only delete all not just a select few.
If your physicians are having to frequently refer to the deleted items folder, maybe they need to stop deleting everything. I rarely look at that folder.
Marty Physician Assistant Fullerton, CA
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What kind of hard drives do you have in the server? If you have SATA drives, that is a mistake right there. Go SAS.
Also, if you are wireless, another performance hit.
JamesNT
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Is there a way to select and clear all orders with one function? I just discovered I have tons of orders, and it's taking forever to delete them....
E. Luis Prieto, MD, FACP Internal Medicine Sebastian, FL
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Are you deleting orders???? I Select View....Orders......highlight them all while holding down the CTRL Key and then basically hold the mouse button and scroll through them until all highlighted and then Hit Change to Completed or whatever you want to do and then you are done.....did not do this for a year and had hundreds now I do whenever I remember and then it gets rid of them. I also delete all the deleted items regularly also.
I am not sure why anyone looks in the deleted items - why do you need them if they were deleted???? Seems like if you did it would be immediately when you delete something and then realize your error. I think you need to check with your docs why they feel need to go into deleted items.
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The first time I had mark all orders as completed it took all night. Now I have a monthly calendar alert that reminds me of this and a couple of similar tasks. I select all by clicking the first, scrolling to the bottom and doing a shift-cluck. For sone reason cntrl-A doesn't work.
But, to the original question, there are some tasks that seem maddeningly slow. Imported items can take ages, even if all folders are left closed. Looking up a lab is much slower in AC than it was with paper.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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My physicians tell me this isn't practical because the deleted items folder is referred to for various reasons I can think of no good reason to keep deleted items. The only purpose it serves (from my viewpoint) is to be able to retrieve a progress note you deleted by mistake. We delete ours every Friday. Otherwise, you get a performance hit.
Bert Pediatrics Brewer, Maine
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A technical question-When the items are deleted, are they deleted permanently, do they go to a recycle bin or somewhere else? I have the same question about backups that I delete from my hard drive. Is there anything else that needs to be done to free up memory on the drive that is hosting Amazing Charts?
Doctor Mel Family Practice, FAAFP
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Windows erase/delete typically only marks the space on the disk that was occupied as now 'open' and available to be written to (written over). Unless you are using a shredder type erase program the data remains somewhere unless it got written over.
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I just realized I have about five years worth of orders to delete; just deleted about 50-100 of them (which only took me back about 2-3 weeks or so), and it took the system about 5 min to delete. I presume it would take days to weeks to get those all cleared out..... Not sure if it is really worth it to go through all that, or leave them alone (i.e. will there really be a substantial increase in AC speed/performance in doing so?)?
E. Luis Prieto, MD, FACP Internal Medicine Sebastian, FL
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Luis, in answer to your question, "yes", if your performance is slow, I think you might gain significantly by deleting thousands of orders and clearing deleted messages. I am not sure why it takes so long to delete those orders. Are you using the method David describes above? If so, perhaps you should select a year or so's worth, and delete them at the end of the day. I bet if you come back in an hour they will be gone; if not, they should disappear over night. Once you "select and delete", you don't need to watch the process.
Jon GI Baltimore
Reduce needless clicks!
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It will definitely not take weeks. I have heard few people about how to delete all of them, but I have always just clicked Delete All. I would be willing to bet if you clicked Delete All on Friday, they would be gone by Monday, if not way sooner. We do them every week, and it takes about 20 seconds. So 50 times 5 times 20 seconds.
Mel, you only get hard drive space back. Not memory. And, the data is still there, but it isn't linked to AC anymore. This is another great thing AC could do to improve their product. Let you set the amount you want to keep. I would say anything over 100 does nothing.
David has a good idea for having a reminder. You can also set a reminder in AC for a month.
Bert Pediatrics Brewer, Maine
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Please help me clarify how to delete orders.
I am only able to delete them when they are in the ordered status.
If they are Completed or in the Deleted tab, I have to convert these back to Ordered status =to delete them. In my practice the checkout changes the ordered status to results pending, hen a test is completed.
When results come in it gets completed to Completed and is linked to the test result.
How does all this play into CMS Meaning fulluse of CPOM. The progress note shows what was ordered before the chart is signed off. So there is at least some proof for the auditors.
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Also, to clarify, I am actually not "Deleting".... I don't see a Delete tab... I only see an option to change the order status to "Completed"..... Is that correct, or am I missing something??
In answer to Jon above, my performance lately has been extraordinarly slow (see other active thread re: "amazingcharts to a crawl..."). Every day at least three or four times I get some type "AmazingCharts is shutting down..." freeze all of a sudden. In addition, when I login, it says "Preloading data for speed.... please wait", and that alone takes about 2 to 2.5 minutes before it actually loads (not sure how normal that is or isn't, but it wasn't that slow in the past). I checked the memory on my desktop, and it has a total of 4G RAM, most of which is occupied by either active applications/processes, including 800MG to 1G that is cached. Basically the machine is running on 10-100MB of "Free" memory. The same is true of my "Main Computer", where the databases, Imported Items, etc are held. Is it safe to assume that I should perhaps focus on fixing this by adding memory before I do the order deletion thing??
Thanks for everyone's help.
E. Luis Prieto, MD, FACP Internal Medicine Sebastian, FL
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LUIS,
Have you logged in AC as administrator and run the data base tuner, checked Amaing Charts, etc? Log in under administrator options under view tab. In regards to orders, I went in, selected the old orders and "completed orders" and that cleared out the old orders. You can click the date tab in the view orders section to bring up the orders from oldest to newest and this makes it much easier to delete the old orders.
Doctor Mel Family Practice, FAAFP
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Havent done that recently; I'll certainly try it to see if it helps
E. Luis Prieto, MD, FACP Internal Medicine Sebastian, FL
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Sorry to rehash this thread, but I still want to be sure I'm not missing something. ... When I select multiple orders and right click, it does indeed give me the option to Delete, but yet will only delete one at a time, not all of the selected ones.
However, when I select multiple orders, and change their order status to "completed", it DOES do it for all of the selected...
Is that the goal? To get them all changed over to "Completed", or is it necessary to "Delete" them in order to free up space?? Its an important distinction for me, since we're talking about 5 years worth of orders, which to do one at a time would be impossible....
Thanks
E. Luis Prieto, MD, FACP Internal Medicine Sebastian, FL
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Luis, I am not certain, but I believe that the performance boost comes from "completing" the order. It is hard to know, and might be something that AC could best answer. I know you are experiencing several issues now. I would suggest that you go through and "complete" them all, which should be pretty fast. Then see if that helps you...
Jon GI Baltimore
Reduce needless clicks!
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Very helpful. I am lurking around here looking for a fix, the system is very slow, and many users are kicked and can't restart, getting a message, "you have loaded a new version and need to run the database tuner". V. 6.9.6 has been in for a long time, so I have been reluctant to run the database tuner. I will reboot the server tonight, if that doesn't do it I will run (reluctantly) the database tuner, and if I ever get it running I will try deleting the the FOUR YEARS of orders I just found out I have pending, (Control "O" who knew?). Thanks all, what a great forum.
But I wish I was still running version 3 or 4! lol
Martin T. Sechrist, D.O. Striving for the "Outcome Oriented Medical Record".
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I wish you were still Dutch oven cooking 
Leslie Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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I wish you were still Dutch oven cooking  Martin, We have a location that you could reach with one of your bikes if you don't want to cook this time! San Diego Mission Bay Although we also have a gas firepit and fire-rings on the beach. Leslie says she will light the fire for you - whatever she meant by that. 
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Indy, Indy, Indy.....tsk, tsk. But, in reality, there is enough used paper in my wastebasket right now (from Epic not having a document management module and nearly everything having to be printed) that I could signal the ISS from the beach!
Leslie Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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I seem to remember a pineapple upside down cake.
Always great to hear from Leslie. Nothing like a topic "Regarding Performance Expectations" to bring her back.
Jon GI Baltimore
Reduce needless clicks!
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@Jon....... ![[Linked Image from ]](/ub/attachments/usergals/2014/01/full-80-587-paper.jpg)
Leslie Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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