Home Forums Discussions Problems slow chart access

Over the last couple years my database has grown. Currently my SQL database is up to 1.7 gig. I'm not sure, but accessing charts has slowed down quite a bit, and I think it is because it is trying to read the database. I have brought this up to AC a number of times and tech support has done what they can to optimize my chart access, but still it takes a good 10-15 seconds to load up "most recent encounter" and another 5-10 secs when changing tabs for the first time. Once they have been opened once, I can switch between tabs rather quickly. My biller spends a lot of time looking at a nonresponsive screen when loading the account tab, and since I am in and out of charts all day long, I feel that my time is being wasted.

I have run the database optimizer, completed all pending orders, deleted old messages (deleted items, sent items...).

I am reaching out to the user-board to see if others are having this issue and if there are any suggestions.

Thank you,
Aaron Way, D.O.

The first thing I would recommend is faster drives on your server. If you are using SATA drives, moving to SAS or SSD will make a big difference. Also, make sure you have at least a RAID 1 array as that will cut down read times. If your computer does not have a hard drive controller that can do RAID, you can use the RAID built into Windows which is excellent for software based RAID.

Secondly, make sure you have at least 4G of RAM in your computer and uninstall any unnecessary software that you are not using.

I say all this assuming your server is less than 3 years old.

For further reading:
http://amazingcharts.com/ub/ubbthreads.php/topics/63159/Re:_Things_I_have_found_that_c#Post63159

JamesNT

I'm connecting to a server with 12 GB ram, 64- bit OS, Intel Xeon CPU 2.27 GHz. Windows Server 2008. I am not sure about the drive - will have to ask my server manager.

thanks,
Aaron

So we are down to making sure unnecessary software is uninstalled and the drives.

JamesNT

We are having similar issues on our wireless connected computers. The lag time is not as long as you are experiencing or else my partner would have pulled her hair out by now. Our lag is about 5-10 seconds on the billing screen. We just "upgraded" to version 7.1.3 Are the slow computers wired or wireless? I don't think I can be of much help but hopefully I can follow this topic and learn. Good Luck.

I'm connecting to a cloud server (not the AC cloud server), it doesn't seem to depend on internet speed or whether I am wired or wireless. Have connected both through windows and through a Linux system and still have the issue. I do not feel it has anything to do with my local computers, I have stripped the programs on the server to the bear minimum.

Regarding drives the server runs: Your server is hosted on a RAID-10 in a Enterprise SAN with hardware raid all running 15,000 RPM SAS drives.

Thank for the help!

Aaron Way

In that case you should check your Internet connection. What is your data plan? Are you getting the throughput you need to connect to AC in the cloud?

When you call your ISP to ask these questions, be sure to ask what your UPLOAD speed is as well as your download speed.

JamesNT

I just don't understand why people want to do this in the cloud when server needs are so easy with AC. You will always have connection speed/outage as a liability compared to being hard wired to the server by ethernet.

Not to jump the thread but ours is a server locked in a closet. The connection with the wired machines is good but the wireless is slow during the billing window. When creating a bill there is a 10-15 second lag with putting in CPT codes. I do not believe it is the connection because the internet is fast with the wireless machines and other aspects of AC do not have this bad of a lag time. Printing items is sometimes very delayed as well.

Chris,

Check out your wireless router and see how fast it is. Are you on a N wireless network, for example? If your wireless access point is more than three years old, an upgrade might be in order. However, be certain the wireless cards of your laptop can handle the faster speeds.

http://compnetworking.about.com/cs/wireless/f/wirelessspeed.htm

Of course, wired will always be faster.

JamesNT

I have the same delay with wireless computers when using AC. Just got a new wireless router and it did not change anything.

Aaron,

Are you using UPDOX?

Wow, this is confusing. It took three posts to realize Aaron's AC server is in the cloud. I am willing to bet it has nothing to do with AC at all. It certainly doesn't have anything to do with SQL especially if SQL 12. The queries really shouldn't have an issue with 1.7GBs. The key is to have a standard or non-express SQL. Then you get rid of the RAM limitation. Each query will then be cached as a "page" in the SQL memory.

It would be helpful to have more information on your setup. Is this Indy's hosted AC? If not, how are you connected to the cloud? I can't be certain due to the setup, but when I load a chart, I am loading all of that patient's chart into RAM. So moving between tabs is nearly instantaneous. If you are accessing AC via the Internet, each tab would be another page to load, correct? When you compare your setup with Boondoc's you have two obstacles he doesn't have. A partial wireless setup and the Internet.

Run a speedtest at http://www.dslreports.com/speedtest or use your ISP's version if they have it. Time-Warner has their own. Compare the download speed (I don't think upload speed will matter nearly as much until you load and save data), and report them here. Compare the speeds with Gb speed on a wired LAN.

I completely agree with Boondoc. When using AC all day to see patients, I would think that everyone would want the fastest and most secure setup. That would be hard wired to a server at your location.

When you load a web page, it is cached on your computer. The next time you go to that page, it will load extremely fast. This may be what is happening with your tabs being faster the second time around.

You have just answered your own question. It is the wireless. Also, how does the Internet influence your speed on your LAN?

Bert I understand wireless will be slower. I don't have a lot of problems with other parts of A/C. The problem is primarily in the billing module. While trying to finish a bill placing the diagnosis codes or procedure codes on the bill there is a delay of 10-20 second for each thing. This may not seem like a long delay but as you know when your trying to finish a chart it seems like forever and if there are 3-4 things to added then there is an additional 1-2 minutes of down time. The delay is significant enough that we will sometimes forward the chart to ourselves and reopen on a wired computer. Again, this is the only area with this much delay. Other things may have a little delay but not as long as the billing window. There is no problems with going to the internet and down loading files or the like so the system seems to be fast enough. We did not have this type of delay before changing to version 7.1.3 so this is why I feel it is something with the way AC is transferring the data to the remote computer. Again, our server is in house and yes we are using a wireless N Network, Cisco wireless router with Amped wireless wi-fi range extender to. It is an old building (metal beams)about 1700 sq ft that really shouldn't need an extender but it has helped the signal just not the AC delay. We do not use updox. Thanks for the help.

Ok just came out of patient room and brought the laptop out. While in the room I was able to order labs and print these with about a 2-3 second delay to the printer and almost instantaneous closure of the print and order window on closing. Closed out the chart and went to the super bill placed the code for the visit (wellness established) on the bill and hit save with no or very little delay. There was no changing of diagnosis codes needed and no additional CPT's to be added where we normally see the delay, so there was no delay. This is why I feel it is a programming or transfer of data for AC causing the problem. Is this what others are experiencing? Can there be some type of data transfer that "clogs" the wireless during this time? I am tech savvy just enough to get by but do have an IT that comes in to help when needed. Thanks in advance

I guess this is the only part I am confused about. I don't use the Superbill, so I am not a good person to help.

I understand. It is a weird phenomenon. From what I understand with the speed of our system there is no reason there is such a lag. I am hoping someone from AC might be able to help or duplicate the problem and fix in an update. It was not this slow in version 6 and the update to 7 is the only change. We started using the superbill portion about 5-6 months ago due to some billing issues. we are now trying to convert to in office billing, Kareo interfaced with AC so this portion becomes even more important. (Thus my reasons for getting back on the board looking for answers to issues) Thanks for the help.

I have noticed the same thing. Lag of up to 25 sec at times on wireless while adding CPT codes to superbill. This is definitely a new "feature" with v7.1.2

But, if it seems to work faster on the wired computers (why worry about it and just change). Don't me wrong. I understand that is a band-aid when it shouldn't do that. It seems like that particular issue.

I will send you a PM to see if my suggestion will work. If it is a certain problem, I can help you get it fixed.

My problems with changing are 1.the expense of dropping lines to the 4 additional exam rooms in an old building I only have 1 year left on lease (property management will not cover this) 2. either plugging and unplugging the lap top in and out of the room or 3. buying 4 more computers to cover each of the exam rooms. I know these are trivial but I like the ease of moving room to room with the laptop and have thought about trying a tablet.

Have you guys considered using a Terminal Server? PM me for details.