Home Forums Discussions General Discussion Version 6.3.3 - should I upgrade?

Hello all,

We are still on 6.3.3 because we're not doing MU. We did the first year of MU in 2013 with this version. I tried to upgrade in early 2014 but AC had bugs in the link with our PM software so I reverted back.

Now it's been a year and I'm wondering if I should upgrade? Is there another stable version that's newer than 6.3.3? We would like to do MU this year but not if it significantly slows us down. Right now we have no problems with 6.3.3.

I am using AC ver 7.1.3 and have no problems. Certified for MU2 stage 2 without any problems.
You will need to check with AC support for minimum requirement for your Server before you decide to upgrade.
Hope this helps
Grenville.

Great. Thank you, Grenville!

no i wouldn't upgrade...i don't do MU either cause i am sports med and all...but honestly the annoyance of a couple things sucks! 1. if you send stuff for your doc to sign off on, when he/she signs it, it no longer deletes from his/her box...then you have to at the end of the day manually hit delete multiple and clear them out...

2. slow as hell

It depends on the setup of your server/computers/memory/processor speed... etc. I am running AC 7.1.3 in 2 settings. One as a backup with a server running WIN2008R2 and the other in LINUX PROXMOX as a virtual machine using the same WIN2008R2. I have had no problems with slowing down at all.
Grenville.

Please check into when it will be encouraged/mandatory (I am not certain) to go to 8.2 to have ICD-10 compatibility.

6.3.3
Stable -- only crashes every couple of weeks. Reboot server every Monday morning and most problems are avoided.
We gave up on MU in our office. I am sure we could demonstrate that it is possible -- but as a practical matter I would never leave the office before the next day's documentation and meaninful use began.

It won't work for ICD-10, so if that really happens, there is going to have to be some kind of upgrade.

They will have upgrade. I would upgrade to 8.2 after testing on a Sandbox.

6.3.3 is supposed to be stable.

Tom, please don't take this the wrong way. I think it is all relative, and you gave good information. But, a program crashing every two weeks is not acceptable in my opinion.

Again, my apologies. I am not trying to correct you.

Sorry Bert.
I don't really mean "crash". Things just slow way down, and sometimes it actually seems to be the result of Microsoft security and stability "improvements", not anything that AC is responsible for. 6.3.3. has been very stable, and I am loathe to switch, but it won't work for ICD-10

In any event, we seem to have to reboot the server every couple of weeks -- and there are all sorts of reasons why that is so.

thank you for hanging in and being there

How much RAM do you have on the server?

Tom,

Do you use UPDOX?

Next time you are not able to connect Amazing Charts from your workstations , remote into your SERVER from any workstation and start Amazing Charts and all your workstations will reconnect. I am not sure why AC on the server goes to ?sleep. You do not have to reboot the server.
Hope this helps
Grenville

I'm with Bert, you will be forced to upgrade eventually...

Bert -- 8GB now. TaskManager says we use about 6 of it.

Grenville -- thanks.
There are some other oddities -- sometimes when I boot a workstation I get an error message that says "AC is not running on the Main Server" and tells me to run it in Admin at the server. Funny thing is, the program runs just fine on the workstation, even without doing anything.

Christopher -- I haven't seen anyone give a good reason for going beyond 6.3.3 except for MU2 or for ICD-10.
Presumably, we will be forced to do that later this year.

Marty -- yes, we use UpDox. Couldn't handle all the garbage from the hospitals if it weren't for Updox, though we pay a lot for multiple "bundles" to receive reams of what amounts to useless eructation from their EMRs

This happens as the memory allocated to SQL reaches a maximum of 1GB. The cache gets filled and you have to start reading from the disk. Rebooting flushes the cache and things speed up again. You can also just restart the Amazing SQL database instead of restarting.

net stop mssql$AmazingCharts
net start mssql$AmazingCharts

A long term/hands-off solution would be to schedule it nightly or weekly or switch to SSD's/full SQL for even greater performance.

But, then you lose your cache. Everything shouldn't slow down with 2GBs left. And, with AC, you could limit your cache to a lesser amount.

But the cache has mainly filled up with information you no longer need. So losing it doesn't matter, that's why the speed boost comes after the restart. If you decrease the cache, it would fill up faster meaning you would have to restart sooner. you can have 8GB free, but SQL has already cached the max number of pages. It will still slow down. Move it to a faster drive (e.g. SSD) or restart the SQL instance.

Most slowness for those with decreased memory comes from the RAM devoted to the cache. So, rebooting the server gives the memory back to the OS. Filling up SQL's cache doesn't slow down your computer except due to the RAM being used. So, if you only have 300MBs allotted to it, and it is filled, rebooting will not give back as much memory.

That's not the issue though. I've seen plenty of servers with 50% free RAM (16 GB total with 8GB free) who experience slowness. It's due to the RAM devoted to the SQL cache being full. It has to constantly cycle data in and out. When it's empty, there's mainly one operation and that's data entering the cache (one-way). Once it fills up, it has to flush out bits of information. So for something to go into the cache, something needs to go back to the disk (two-way). That's where the slowness happens.

Rebooting essentially flushes that cache. When you restart SQL server will only be using 50-100MB, as the week or weeks go on, this will get closer and closer to the 1GB limit. Once it gets there, that's when you feel the slowdown. You could have as much free memory on your system as you want, won't make a difference since it has to go back to the disk.

Fortunately, it is easy to reboot the server!
All the discussion is interesting, but I can just hit the reboot button -- even my staff can do it, and they are gratified by the results, and the fact that they could fix something. Feeling powerless is one of the worst attributes of the IT revolution.

It depends what you are referring to. If you are talking about a full blown server like a Dell 2900 or T410 with a server OS, then I don't think rebooting the server over and over is a great idea. First, unless using SSDs, then a reboot can take up to 15 minutes.

And, I wouldn't want a staff member anywhere near a server. I know it doesn't sound like a big deal, but there can be issues. There are times when updates force you to reboot, but otherwise, your server is meant to run without a reboot for quite a while. Reboots should work without an issue, but if there is one, I want to be the one there when it happens.

My opinion only.

Every time I reboot my server I always think of that clip from Jurassic Park when they reboot the server. "Here we go...hold on to your butts!" lol

Agreed. I dislike rebooting servers remotely unless I have hardware KVM access. There's always a chance someone left something in the drive or you might have to strike a key to continue.

That's why I suggest just restarting the SQL instance:
net stop mssql$AmazingCharts
net start mssql$AmazingCharts

You'll get the same speed difference. I know several people who schedule that command to run nightly. Keeps things running nice and smooth.

Thanks -- that certainly is easier and faster.
Have to run command prompt as administrator, though.

You should be able to right click and run as administrator. Or is that what you meant?

Are you running your server with a non-admin account?

No -- I have a non-admin shortcut to Command on the taskbar at the bottom of the screen.
It won't allow access for net stop. Stumped me for a bit until I figured out it has to be run as administrator.

I made a batch file out of it for the desktop -- you just have to right-click the icon and run as administrator.
Ever so much easier that rebooting the whole server!

Thank you and Sandeep so much.

Can you describe step by step how you made the batch file. I believe you type the two line command in word and save it as a .bat file. Is this right.?

But to run the .bat file dont you have to get to the command prompt first before running the .bat file?

I hate saying this, because I am 100% against it, but to make a batch file, just copy and paste the two lines into notepad. Close it and save it as whatevername.bat. To run it just click on it.

So, did everyone see the bulletin from AC that we will all be required to upgrade to version 8.2 by September for ICD 10?
Given the poor track of AC with upgrades leading to slowness and bugs, I am reluctant to move off Version 6.3.3.
I am no longer doing MU, and I don't use AC for billing, so 6.3.3 suits me fine.
Anyone else in this situation have a plan for what to do?

I plan on upgrading, but also concerned about past slow performance issues with new upgrades, I am still on 6.6.5
I wonder what other parts are involved in the ICD-10 change/upgrade?
Will you still be able to e-prescribe with older version (if you are now)?
Will you be able to get support for older versions?
I think your license allows you to keep using ad infinitum for no additional cost, but without support or e-prescribing.

Greg

Hi Donna,

I agree with you completely, but I think we will need ICD 10 diagnoses in our encounters, and I do not see how this can be accomplished without upgrading.

Did you have any thoughts on a workaround?


Thanks.


Gene

Gene,
I don't have a workaround at present. I am wondering whether AC, with this announcement, is telling us that we won't have access to an ICD 10 list in older versions? I do not recall a time where AC required users to upgrade or lose functionality. And, if Version 8 is not out until April, how do they plan to upgrade everyone by September? Since, for those of us on older versions, they are requiring appointments for upgrade and migrating to the newer SQL. It sounds like a recipe for disaster to me.

Migrating to SQL 12 should be rather seamless. Getting everyone on the same version will make support and maintenance much easier. This will be the first time since v1 that everyone will be on the same version. Whether it is cchit, mu or icd-10, no EMR company has had a choice but to upgrade.

Four months should be plenty of time to upgrade. It is really only a matter of downloading v8 and running the installer, codifying the insurance.

Version 8.0.2 is being used by many people and seems pretty stable. The only real spot I see as slow is Imported Items with charts that have hundreds of items (using since 2001) - Many of the new features are good and there really looks like no way they can upgrade to ICD 10 without forcing upgrade. I think you will not have any major problems and I have been amazed that AC has not done this before - trying to support 5 different versions in support is awful.

Hi Donna,

I think that will be the case!

Gene

I would agree with Steve and would recommend that anyone on earlier versions at least download and try V8 to get a feel for what has been added.

That said, there is still a speed issue compared with V6, but not that serious. Not much speed difference with V7.

Is version 8.0.2 available to everyone now?