Home Forums Discussions General Discussion Why is 8.2.2 slow and how do we fix it?

This is the first time I have encountered the prescribed meds showing up in the current meds list. But I am running v8.02 and I was under the impression that the bug was in v8.2.2. This happened last night when I was finishing charts I forwarded to myself. It only happened in ONE chart. I am going to pay close attention to every chart before I sign off. Interestingly when you go in the current meds before closing the chart and remove it the medication does disappear. You do have to state in the dialogue box the reason for removing the med. I just put one letter "m". Bet it does appear somewhere in the meds list for the patient's chart.

I noticed first slowdown going to 6.6.7 esp when entering demographics
Now with 8.0.2 most every tab significantly slow both in office where I have a lot of patient info scanned into the patient database. Running 8.2 in my laptop that I take to assisted living and other than office visit notes not much scanned into database is still slow but not like office; does make me wonder about SQL cache and all that scanned info. I run peer to peer am all SSD'd up with lots of RAM and mainly work at the computer where the database lives.

Sandeep, you are 100% correct.

But, there is absolutely no way you could force everyone to install SQL 2012 Standard. Just too costly. Plus, it would take a lot of support time probably not even from AC. And, it would interrupt a low of work flow.

As you know, the reason Microsoft makes Express is to allow companies to package it in with their software.

Where the hell is JamesNT on this discussion?

Yea I wouldn't expect them to make everyone switch to Standard. I'm just saying SSD's allow you to use Express better. It's time they at least add SSD's to the recommended hardware.

Gotcha. That makes more sense.

Hi Sandeep,

SSDs for server? Will they significantly help speed if used on workstations too?

Thanks

Gene

Well, Sandeep can give you a more definitive answer -- likely a more correct answer.

In general, SSDs on the clients improve their performance significantly. If you have never tried one, then you would never go back. Reboots are 14 seconds, if not less. Word opens almost immediately. AC opens faster, but it still takes a while since it has to access the server over the network and load a lot of things from the server.

I am not sure how it would improve performance much once it is open. Everything you do is dependent on querying the database on the server and pulling the data to AC. So, when you open a chart, you are asking the server to send the patient to AC. So, while I am sure there would be a slight increase overall due to some minor use of the hard drive on the client, it would be on the server where the difference would be best.

But, as stated, I would wait for the resident guru.

Hi Bert,

This is actually my question.

I have SSDs in several laptops, and a desktop, MUCH faster start/reboot/etc.

I am somewhat concerned about the speed issues described for v8, and I am wondering whether switching all workststions over to SSD will be necessary.

Thanks.

Gene

No, I don't think it would be necessary to do that. What I would do is take one of the laptops or desktop and uninstall the AC program and install 8.2.2 (temporarily).

Then install 8.2.2 (obviously without SQL) on another computer. Like one of the laptops. See how well that works. Just be sure to put a big sign on the computers with 8.2.2 on them so others don't use them by mistake. While I have imported all of the data using the AC backup -- which helps with all of the other settings, I tend to stick with just loading one patient. This way, if someone uses it accidentally, they will notice right away.

I doubt you will leave it set up that way anyway. If you do, you can also change the name of the AmazingCharts.xml file to AmazingCharts.xyz, and the other computer wouldn't be able to access that database.

I would test, test, test. If you put 8.2.2 temporarily on a computer with an SSD and you put 8.2.2 on a client on an SSD and it is very fast, you may want to install one on a computer without an HDD just to see if there is a difference.

Obviously, this is something you want to do at night or the weekend.

Also, if you find that it works MUCH better, please post back so we all know the outcome.

I am scheduled with tech to have 8. Installed today. I already have SQL enterprise ready to install they told me that is was not needed for 7. But with these horror stories about speed I am wondering if I should install SQL full? How will amazing charts install onto the full version of SQL in past it still installed SQL express

sounds like you are getting a lower tech to do the install , think I'd have AC have a second level tech who can move the data to full Sql(if they have such a person) do the install

I think the chances are less than 1 in 100 that AC would have a tech who could set up an AC instance on a SQL Standard version. I think this would be past their technical knowledge. Not only that, increased performance or not, doing so has generally voided your warranty.

They also have literally hundreds of these installs to do, and they are excited to get everyone on the same setup. If users wish to change to SQL Standard or Enterprise versions on their own after, I imagine they don't care.

Hate to be a downer bemoaning what the end user needs are and having to settle for lackluster performance issues/delays every time I am in a chart; so instead will just keep playing the theme song from the LEGO Movie in my head..."Everything Is Awesome"

I am just not going to upgrade until the issue is fixed. And changing to SQL Standard just doesn't seem to be the answer. Maybe an SSD would be helpful.

I've got the latest Samsung SSD I sit at the 'server' (peer to peer) still slower than crap but I have scanned so much information into the patient databases that I think this is the bottleneck in the SQL cache, is there a way to check this, i.e. SQL cache performance?

I could be wrong, but II is in a separate folder and not in a database. So I would think you are just pulling it directly from that folder. Since, I don't use II, I don't see why AC would cache those every time you pull a patient. It would make more sense for AC to access the document when you need it.

If you are sitting right at the server then it doesn't matter if it is peer to peer or Client/Server or anything. If it is on an SSD and it is slow then that is concerning. I am running mine in a VM with 2 GBs of RAM, and it pops right up. But, not over the network.

But, if you want to test it, make a dummy patient, make one note with only a CC, no meds, FH, exam, anything. No II. Then pull it. If it is slow, then it is AC.

Dummy Patient took 5 sec to open chart, 5 sec to close chart nothing added to chart, 8 sec to close if a 'new' plan added
Real patient lots of data 6 sec to open, 6 sec to close with no new info, 8 sec to close if a 'new' plan

That's about what I got. Doesn't seem to matter how big a patient's chart is. In other words it isn't AC caching data in AC. Not talking about SQL cache.

Thanks for the feedback.

Hello guys,

I've studied this closer and found this new version of AC to be heavily network bound. Speeds exceed 150 megabits/s during sign in. That means it's passing a lot of data on and off the server. I've seen it pull 500 megabits at one point. Also while switching tabs, 100 megabits just to load an empty demographics tab.

This will be very bad for wireless users and people on 100 Mbit networks. They're not caching information in the chart, but caching parts of the program. Something they're caching on the demographics tab is causing a lot of slowdown. Reading 100 Mb/s.

I am slowing down my network to gigabit speeds for further testing to be more realistic. (Our network is 6 gigabits.)

EDIT: I think I've found the cause. Bert can you PM me, I want to test it in your environment.

Is there a way to catch/identify (where,to whom,resources allocated) network traffic goes whenever a chart is opened/closed/tab clicked/Rx written etc. Sounds like this is what you are investigating Sandeep

Yes, there is. Here is one tool. There are many, many others.

http://www.microsoft.com/en-us/download/details.aspx?id=44226

JamesNT

Quite a few of us are troubleshooting 8.2.2. Hopefully, Sandeep is onto something. I am working with Raja, my SQL expert, and he is looking at things as well. He doesn't really thing moving to Standard would necessarily be that helpful, BUT, at least it is much easier to make the switch than it was with 2005.

He feels SSDs are much faster but not necessarily with a database for what its worth. He has more to do, but he tends to look at Amazing Charts as more of the culprit.

I am holding off on upgrade until the dust settles (still on 6.6.5)
Since I use MediSoft for billing, the billing part of ICD10 will be taken care of, and clinically (notes, care given) need not be driven by the 1 Oct date for ICD10-CM

I'd go backwards if I could

I will be holding on upgrade to 8 (currently I am on version 6.6.7 ) until dust settles also. I use a separate program for billing so can wait past the ICD-10 deadline if needed.

I was under the impression that Medisoft was dead. New versions are still being released? Have you tested your current version with your clearinghouse?

JamesNT

I think McKesson bought them. Anyway, it is under mckesson.com, but Medisoft redirects.

Dear James,

Medisoft is up to V20 now:

http://www.mckesson.com/bps/solutions/technology/medisoft/

Have a client using it.

Cheers,

Carl FOgel

Several on this board are using 6.6.7
When I log on, a message tells me a "new" version is available -- 6.6.5

I am using 6.6.3 and it works very well.
After all this discussion, reluctant to do anything -- is there any value in upgrades within version 6?

Not currently punishing myself with MU2 -- so will hold off on v8 until it is clear I have no choice. (maybe have to do that to get ICD10 support?)

Some things required for MU are nice and handy and I'd used them anyway. And would like to. We had a portal before President Obama was even running for president.

The DIRECT email system is one of those things too. Iff you have other physicians or your hospital using it.

It's also nice to be able to log in a patients payment at the front desk. So I don't think there is anything really pressing, just nice-to-haves.

@Tom

The message that 6.6.5 is the new update should be for all those who use a version prior. I have used 6.1.2 for over two years now, and I am not budging.

My guess is you would need to be on 8.2 to get ICD-10 support. I like the ICD-10 in AC, but I don't like waiting 15 to 20 seconds to open eRx.

I don't use AC for anything billing so I am not budging until this is fixed.

Thanks.
Sticking with 6.3.3
I hope they continue to support it.
I might be able to find a standalone conversion to ICD-10, or some such workaround, to avoid the apparently disruptive transition to AC version 8

I agree. What do you call "continue to support it."

It is improving. I have gotten my ePrescribe delay from 24 seconds to 22 seconds.

Hi Bert,

Please tell us that this is a joke.....

Thanks

Gene

No, but AC is working on it. Seriously. Hopefully, it will get better. I am not using it in production.

Allowing us to use it for E-prescribe.
Answering the phone if there are problems.

I agree with the first one, lol.