Home Forums Trialing v8.2.4

This is not anything against AC. They are making moves in the right direction.

I just don't know why anyone would move to 8.2.4 without testing it first. Install it on one of the computers. See what the speeds are. Install it on another computer, and run it over the network. See what the speeds are.

Obviously, this would need to be done on the weekend or the evenings. Or use a VM. I think it is best to use it directly on computers that are on your network.

Sandeep and I trialed every which way for over three hours one night.

We have the benefit of watching a "beta" test right before our eyes. We all know there is the possibility of an issue with speed. You can't go back.

For me, I am not switching until it is nearly instantaneous. But, I have the luxury of not using ICD-10.

Hi Bert,

Why would we run this without testing? Well...... because........

Electronic medical records, and computer networking, is not "fun" for me. It's work. Troubleshooting hardware can be fun, I take great pride in the fact that I found bad memory chips recently in a few of our computers. Swapping a hard drive to an SSD is fun. Troubleshooting and repairing the autoclave is actually fun. But setting up a trial version of the Amazing Charts is clearly in the "work" category.

I devote far too much of my life, and my time, to work. I'm always behind, there are always forms to complete, labs to go over, charts to complete, and so forth, and so forth, and so forth?

So the idea of taking a considerable chunk of time, to "try out" a new version of Amazing Charts, is not appealing. And it takes time away from doing other work related things.

But I did this in the past. You may remember Amazing Charts 6.0.9., The first version for meaningful use. 2011, I think. I downloaded and installed it over the weekend, and played with it quite a bit, everything seemed fine.

Until Monday morning. I had not tried the prescription writer, which was PAINFULLY slow. AC support had no answers. We went through 2 weeks of EMR hell until a newcomer to this board, a young guy named Sandeep, solved this.....

So, even if I were to load a trial version, I'm not sure problems would necessarily be detected until it went through the rigors of a busy morning with all users actively using it.

We will require ICD 10. So my strategy is actually going to be to wait until mid-September, and upgrade to the current version of AC, presumably 8.2.4.

For various reasons, we use wireless laptops in the exam rooms. I understand speed here may be an issue. So the backup plan is to use the laptop with RDP and let the desktop (hardwired) do the work.

So if I sound like an old curmudgeon, that's probably accurate!

Gene

I don't like work either. Glad I didn't put Win 8 on all my computers without trying it first. Do, I trial a new upgrade of eMedware or BackupAssist or Macrium or any of my antivirus software? No, because I know from a LOT of experience that they have been beta tested a long time, and they will install in about five minutes and things will run perfectly. EVERY time.

Now, I wouldn't upgrade AC without "trying" it. Let's not use the word "test." Maybe they are different. Why? Because from past experience, I have had problems.

But, in this case there are two reasons why I would think one should trial it.

1. There have been numerous, numerous reports on the board that version 8 and even version 8.2.4 have been slow. A lot of the complaints haven't been 5 seconds. They have been 10, 15 seconds.

2. You can't go back. You simply cannot go back. So, there are people on the board who have installed 8.2 or 8.2.4 and state they can barely use it.

Does this happen to everyone? Apparently not.

Maybe trying it over the network isn't something everyone has time for. But, to install it on one computer takes less than 20 minutes. You make a good point that just because it works doesn't mean it will work when you really install it. No, but I would at least want to have some idea.

If someone has a positive ANA, they don't necessarily have SLE. But, if they don't have a positive ANA, then you can rule it out.

So, I am saying the same thing with 8.2.4. If you trial it, and it is fast, it doesn't necessarily mean it will be just as fast on the server. BUT...if I trial it, and it is super slow, I have little faith it will all of a sudden be much faster on a computer connected to all of the other computers.

I don't mean to come across as judging anyone for not testing. It's just that this is the hottest topic on the board. There are four threads in the MRP section.

So when I hear someone say, "Well I finally made the leap to 8.2.4, and everything is slow as hell," I am confused as to why they didn't try it first.

Maybe this thread is to help some people know you can try it both in a standalone environment and in a network environment while still maintaining their production network.

I don't like writing referral letters, but I have to. I don't think it is a matter of liking it. I think it is nearly a necessity. Especially if you are using wireless. You may be all set even in a wireless environment. Maybe it works great (over the network) with wireless. But, if it takes 15 seconds to open eRx in a wireless network environment, then one may say I better move to wired.

Did it take me extra time to test it? Yes, I actually spent over three hours. But, that was because Sandeep and I ran multiple tests trying to find the root cause of the slowness. But, I would much rather take that time than to take up hours and hours of time.

Speaking of trialing. I ran it in a VM. I ran it on that VM not over the network. I had 8GBs of memory, an i7 processor and SSD hard drive. I gave a list of the new features (this is from 6.1.2) to my staff. They were very excited. Then I ran the program. To a person, they said, "Thanks but no thanks." Just couldn't get past the 7 seconds to open a chart, 4 seconds to open Demographics and other tabs, and 10 or more seconds to open eRx.

If AC is reading this, are they thinking, damn, this is a post that will turn people off from AC. On the contrary. AC knows there are performance issues with version 8. They are specificalaly working on it. In fact, 8.2.4 is mainly to improve performance. So, if people are staying with version 7 and waiting on version 8 and/or trying v8 first, then there will be less posts on the board with users saying they really need help.

Hi Bert,

I don't think your comparison with Windows 8 holds up.

Let's say I test. And let's say it's slow.

What then? Stay on version 6.3.3 and not have ICD 10? I don't think this is viable.

Switch to another EMR?

When I order a medical test, my basic principle is, "What will the result cause me to do?"

I think upgrading to AC version 8 is inevitable, regardless of slowness. So I really don't think that testing in advance would accomplish anything.

If I'm missing something, please let me know.

Gene

I think you are missing something. And, the comparison to a test doesn't hold up.

I heard about the slowness issues way before I tested it. So, did I say, "Damn, I guess I have to install it anyway. I can't wait to see how fast it runs." I wanted to know a little bit of an idea.

Maybe the people who are complaining have a Pentium II. Maybe they don't have a good server. I don't know.

But, I want to have some idea. I want to know if I can expect 5 seconds or 20 seconds. I want my staff to say yeah or nay.

If you have mostly Medicare or Medicaid, ICD-10 isn't nearly as much of an issue anyway.

Maybe I should add to the thread and say, "Why would people install v8 who possibly don't need ICD-10 not trial it."

I would much rather wait the two months and see if a newer version works better. But, going back to the hardware, at least I could say, yeah even on this hardware, it is slow. So, what can I possibly do to make it faster. What if I try it with full SQL. Maybe I try dual processors.

All I know is that I know of two people who are seriously considering going back to v7 and re-entering all of the charts over the past three weeks. They wouldn't be there if they had tried it first.

Maybe the tone of my thread was too much for you. Maybe I should apologize. I am not calling anyone stupid for blindly installing when they knew it may have performance issues. The biggest thing would be trying wired vs wireless. If you try it on one computer, and it is 3 seconds to open a chart, then you try it wireless, and it is 10 seconds, then maybe you wait and wire your office first.

It just confuses me, that is all. I guess it doesn't confuse you. That's OK.

Bert said something very important in his post.
The issue is not whether to trial or not.

The issue is that AC RELEASES BUGGY SOFTWARE.

Why is that that AC is the ONLY program that I use that I agonize over whether to upgrade? I had hoped that when Pri-Med took over, and had more resources to devote to development, that AC would become a truly professional operation with reliable updates. Yet, they continue to create new problems with new releases, and break existing features that worked in previous versions. Why don't they test adequately before release? It should not be up to users to to vet releases during our work day.

I pay for support just to be able to upgrade, yet I am reluctant to upgrade because of problematic releases. Shame on you, AC.

Hi Donna,

Agreed, totally, completely, 100%!!!

However, given the reality of what we face over the next 2 months, will you test as Bert described? Upgrade without testing? Or try to stay on an older version and "work around" ICD 10?

Thanks.

Gene

Yeah, I think we really don't have a choice. For me, part of it is to see what features it has and see if I want to update. Here there is no choice for a lot of users.

Unfortunately, I think AC has to play catchup, because some versions are put out quickly to fix the bugs in the previous version. I, like everyone, wish I could just see a new version and upgrade.

As Donna says, I don't use any other software where I wait until I hear about it for two months to install it. Occasionally, a feature of software such as Windows 8.0 having the Metro UI made me trial it quite a while before deciding not to use it.

From my perspective, the beta testing should be way longer and more rigid prior to releases. Just my opinion. Fortunately, I don't have many.

One of the things I learned at the clinical advisory board meeting last week is that AC knows this. They recognize that unplanned, patch releases were frequently needed. In fact, they are making major efforts to address this and perform appropriate testing before a new release. They are working toward a schedule of quarterly, reliable releases with less need for "emergency fixes".
In the post-Pri-Med period, AC has created an entire quality assurance department and has hired a number of engineers to test new releases. You can imagine that it is a challenge to retest every aspect of the program when changes are made. Keep in mind that the program has hundreds of interacting features (many of which most of us don't regularly-or ever- use). When the product is released, it is used on hundreds of differing network configurations with different OS's, hardware, wired/wireless set-ups, etc.
So testing is not a trivial or quick proposition, especially since everyone wants new features and fixes, and they want them delivered promptly. What they have done is invest in more QA people AND create and expand an automated testing process. This vastly accelerates testing and makes much more comprehensive testing possible in a shorter time interval. They believe that this is already significantly reducing the number of bugs and broken features in new releases.
Time will tell, but this is an area in which they are acutely aware of the problem and have taken major steps to address it, in my opinion.

So how is Windows 10 running in the office for you guys?

This is why companies beta test. They send out enough applications so it is used in all of these environments. You can't do it in two weeks. How long has Pri-Med been involved? I don't see the difference in the number of engineers decreasing bugs. Also, the more features you add, the longer you should beta test.

The only slack I will cut AC is the government mandates. But, if 8.2.4 is faster than 8.2, then AC should have been aware of the problem and worked on it before releasing it.

AC is a great program. It is probably the fastest program out there. It wins a number of awards. But, it will never win an award for the least bugs in new software. For many people who have installed AC on their production network (testing first or not), the speed issue has significantly hampered their workflow. That is not acceptable.

This is an interesting article on beta testing. Beta testing is a significanat part of the development process. I imagine there are hundreds of these articles out there. I just don't think a company can learn there is a small percentage of beta testers who are reporting a significant issue.

http://www.epictrends.com/resources/usability/betatesting.shtml

In the time I have used AC, there have been three issues that have created severe problems. There was one time where two of these came up.

The first time it was:

Inability to use the Star Printer.
An inordinate amount of time to use ePrescribe

This was during Jon Bertman's tenure.

The second time is the current issue:

How can you tell when it is a significant issue? When the issue is discussed on the user board ad nauseum. The performance issue is not a bug. It is a significant usability and work flow issue that likely should have been looked at before the release. I don't have the complete answer as to how to determine when to release a certain version due to ICD-10. But, I don't think you can release this one even with ICD-10 looming around the corner.

Amazing Charts cannot use the reason that new versions have more and more features so they are bound to be slower. As I look down the road to newer versions which have really cool features, am I supposed to also think the newer version will be inherently slower? Most or all other software is not any slower and they all have a larger code base. If anything, they are faster.

The main reason I started this thread was to encourage testing prior to installation to your production system. It has evolved somewhat, which is a good thing.

I am not sure what the reference to Windows 10 is. Would I install it on my computers and not worry about the performance? Yes. In a heartbeat. Would I do it without first taking it for a spin to see if it has enough of an increase in features that it is worth doing the changeover? Yes. As stated in my earlier posts, there are two reasons to test. One is to make sure the software is reliable and compatible with current software. But, the other is to insure it is worth the upgrade. Version 8.0 had no major bugs. It was just a workflow issue. I had difficulty working with Metro UI. So, I figured my users would as well. Windows 10 fixes that.

Jon,

I appreciate your information, but, I must say, I am skeptical. It all sounds good, but we have heard it before. We all know that "action speaks louder than words", and the Version 8 release has been disastrous for some users. This does not indicate enhanced quality testing. Breaking prior features seems particularly sloppy to me. So, Version 8 has been patched a couple of times already, with incomplete resolution of problems.

Why is AC spending time adding "coupons" and "patient education", rather than concentrating on basic problems in the software? They could stop adding these "features". Priorities are not aligned with user needs.


Gene,

I am trialing AC 8.2.4 on a stand alone computer at home to familiarize myself with its features and problems. Right now, I do not have a plan to use it in the office. I refuse to enter vaccine VIS information hundreds of times since V8 can no longer remember this information. Also, I depend on a wireless laptop for my exam rooms, so I am very concerned about the wireless speed issue.

I plan on manually converting ICD codes for now. I have my list of frequently used codes, and it is manageable. I don't use AC for billing.

Looking at AC 8 briefly, one irritant to me is that the ICD codes can no longer be modified, and whereas the diagnoses used to be in ALL CAPS, they are now formatted with a leading cap then lower case. All caps helped me to "highlight" the diagnoses to see them quickly in my notes. Since AC allows no other text formatting, having the diagnoses in caps was useful. It is also much easier to read on the screen for my aging eyes. Does a developer not using the program daily for charting even think about this issue? Perhaps this is nit-picky, but it is an example of something that just worked, which has now been eliminated. I like to modify the text of the codes to remove excess verbiage, and streamline my notes. We have all seen plenty of EMR notes with 10 pages of useless crap.

PLEASE bring back the ability to modify ICD codes, and capitalize the ICD codes.

Hi everyone,

It seems like there are three themes in this thread.

1). Amazing Charts should do a better job. Agreed. Absolutely.

2). Pre installation testing is an option. Bert makes a very good point, if hardware upgrades would be helpful, to have sufficient lead time to accomplish this prior to installing the new version would be quite helpful. If it's just "the nature of the beast" and hardware upgrades would not help, then I don't see where action would be possible based on testing.

3). How mandatory is version 8 update? I had been assuming that, essentially, we had no choice. I know Indy has made references to staying on an older version, and it looks like Donna maybe trying the same.

To me, this is the most important issue. If we can stay on an older version, then testing and deciding whether/when to upgrade makes lots of sense.

But if we have to do it, all of the above becomes irrelevant.

Thoughts?

Thanks.

Gene

I believe you only have to do it if you use AC in anyway to do billing via ICD-10.

For instance with me, I can just do fever (xxx.xx), and my biller can then figure out what the code is and convert it.

Donna's post illustrates one of my major points. Sure here wireless laptops are a big reason she is not upgrading. But, she heard that on the board.

It isn't bugs so much as it is changes. She is testing it, and in doing so, realized the VIS problem (which will be fixed in a future release) and the all caps issue.

That's the one thing I can't really give them a pass on. There were users on their cloud service (an environment that they control) that complained of speed issues. That should've been a dead giveaway version 8 wasn't ready.

On it right now and upgrading the rest of the workstations throughout the day.

Upgraded to W10 and ran into a printing issue - see other post under W10 header.

Dinosaur logging in...

I'm sure V8 will eventually get most of the kinks worked out, but since most of those kinks are likely related to trying to attain "meaningful" use -- I am certain it will be a major challenge.

I will stay with V.6 for now --

I have given up on MU -- costs way too much in time and resources to justify the attempt -- and worse yet, risk an audit (like one of my colleagues who did nothing wrong except try to be an early adopter)

Medicare has stated they will not penalize for inacurate ICD-10 codes as long as the right family of code is used. To me, this means that we can code as usual in 6.3.3 and the billing clerk can use a simple cross-walk program to come up with an approximate ICD10 code.

I wouldn't even consider switching EMR -- talk about a major pain. I surely will quit medicine if AC becomes unusable.

I'm not sure if this question belongs in this thread, but here goes anyway. Please feel free to move this or ignore if you think that is the right response.
I've seen multiple complaints (justified) about version 8 and slow response times for several operations. That has been my experience as well. Comments were made that this affected a few/or many users , but no one has asked the following question.
HOW MANY USERS OF 8.2.4 (OR OTHER 8.?.? RELEASES) HAVE REALLY GOOD RESPONSE TIMES? NEAR INSTANTANEOUS?
I'd be curious, if the question were posed in this way, to see if AC would be more inclined to work harder on this issue.

I repeat the question to keep it alive:

Is there anyone out there in AC-land who has found v. 8.2.4 usable? Seems like all we read is the complaints.

If so, is it because of the physical setup, or because of the way the program is used?
I plan to stay with 6.3.3 until I find an extra weekend with nothing to do, and then I will put 8.4 in a test bed. But I don't foresee such a weekend any time soon.

We don't bill with AC, and we don't do MU any more.
It's true that the ICD10 codes won't be in the database -- so any searches we do will have to be by ICD9. I don't see that as a big problem for a small family practice.

I wonder how people are really going to search their databases in a few years, when there is a mixture of old ICD9 and new ICD10? Surely the "upgrade" process to 8.4 doesn't convert the codes stored in the database?

We went from 6.3.3 to 8.2.3.

It is certainly usable and has some nice features and improvements.

It is slightly slower with chart opening and eRx but is very usable.

Tom,

I asked that question repeatedly about code conversion. Recently, JBS told me that there is code conversion. In trialing 8.2.4, I confirmed that when you write a note after the conversion date, and you pull down your list of the patient's diagnoses, they are now coded with ICD10. This happens when there is a good 1:1 match. I am not sure what the program does when there is not a 1:1 conversion.

First day with 8.2.4 (from 6.3.3). There still are some things I need to learn but overall it went pretty well. The ERx is slower. The delays opening certain windows for the first time are a little longer but once they are loaded they come up pretty quickly. There is something like a 10 second delay after saving a chart where the messages won't refresh. The ICD-10 stuff is pretty easy to figure out.

Stability-wise I had no problems at all (knock on wood). My network is part wired, part wireless with 2 providers.

Overall it's a bit slower but still very usable. I do wish they could speed up the ERx as my patients seem to have a knack for remembering they need a refill of something else immediately after I push the send button.

I have been on 8.2.4 for a month now. No major issues. I am still using my old wireless Lenovo x200 tablet laptop. The one drug reps used to use before they all have switched to iPads. I put new RAM, SSD, windows 7. No speed issues. It works.

Guess I'll just have to learn to chill out I mean what's a 10 second delay the other stuff can wait!
Perhaps AC should pipe in some Muzak during the delays or maybe I should smoke some pot been 45 years, must have lost the buzz.
Kind of like dialup internet days when I put dumbbells on my computer desk and would do a quick set waiting for web pages to load.
OK done, this satirical interlude brought to you by a grumpy old FP.

We have been using 8.2.4 for over a month and it is usable. Speed an issue and worse with e-prescribing but certainly not too slow to be usable.
We did upgrade our server to an i7 machine when we upgraded.
Like new features like the spelling check that is on all the time, but had to get used to doing Shift right click for templates.
The ability to have multiple pharmacy preferences is also nice

Greg

8.2.4 very usable, transitioned to AC in cloud a while back and upgraded our bandwidth to 30/30. 2-3 seconds to open and less than a second to close. I too like the multiple pharmacy preferences and the increased # of codes to fit with ICD10 transition.
Biggest pain was having to do new templates for letter writer but took a couple of hours to get right.

This takes about 4 seconds for us. This has been one of the slowest aspects of AC for some time (going back at least to V5). A 4 second delay for sign off never seemed to bother me, I guess because at that point I am ready to take a breath. (As opposed to when I am clicking from box to box, or in and out of charts when I would like things to be instantaneous). This is an area where a little slowing is not a big deal (to me).

Thank you all!
I am feeling a lot better about AC.
Not quite ready to take the plunge -- 6.3.3 works so well, and we have most of the kinks worked out.

Hate the thought of more nights and weekends just getting the system tuned. But maybe this time I can delegate some of the duties -- our staff is a lot more IT-savvy now.

If you don't have to do it . . . DON'T. I run a micropractice: me as physician/triage nurse/phlebotomist/referral specialist/receptionist. AC 6.3.3 works beautifully. I don't bill Medicare or Medicaid, so don't need pursue MU. Just upgraded to v8.2.4. Now I can't see any Imported Items in preview window. Clicking on an Imported Item asks me if I want to save the file (WTH?). I edit PDFs regularly. Not with the new AC. It doesn't play well with Adobe products which I need for PDF editing (while AC 6.3.3 did)

Appreciate the comments.
I'm learning towards hanging with 6.3.7 for a while longer, especially since the specificity rules on ICD-10 have been relaxed for a year. I'm not seeing a compelling reason to rush to upgrade since I don't use AC to do billing.

Maybe if I wait till version 9 the speed issues will be fixed?

Tom

Get ready for some big bonuses for your staff. V6 has NO bugs. Will never leave. Can't do "doable"

This problem crops up occasionally, Bert just recently responded to it here:

http://amazingcharts.com/ub/ubbthreads.php/ubb/showflat/Number/66435/Searchpage/1/Main/7546/Words/import+adobe/Search/true/Re:_Windows_10#Post66435