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AI?
by Bert - 06/25/2025 7:52 AM
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#67812
12/07/2015 3:50 PM
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Our AC in the clouds is SOOOO slow. I just realized we are getting 35 MBPS download speed, but only 5 MBPS upload speed. I assume this is going to majorly impact our AC speed??? Any thoughts on how fast we should shoot for?
David Lee, MD IM Dallas, TX
David Lee, MD IM Dallas, TX
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David,
That should be more than enough if you are small/medium practice - how many connections are you using?
We had a client that recently went to AC-Cloud, and found that they needed 64bit SQL to function in an acceptable fashion.
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Indy, We have around 20 users. I suppose the 64bit SQL is not standard with AC in the clouds? Thanks, David
David Lee, MD IM Dallas, TX
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Indy, We have around 20 users. I suppose the 64bit SQL is not standard with AC in the clouds? Thanks, David You definitely should be on SQL 64 if you aren't already - if you will go to our website and fill out a contact request, I'll reach out to AC concerning your setup.
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According to AC:
Your hosted server is using SQL 2012 X64 Express.
Is this the same???
Thanks, David Lee, MD Dallas, TX
David Lee, MD IM Dallas, TX
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Your hosted server is using SQL 2012 X64 Express.
Is this the same??? Yes it is. Is it taking a while for the screen to refresh? I.e. Window is being drawn horizontally. Or is it more of a loading time issue? I.e. time to open the chart window. The former suggests a problem with your Internet connection. The latter suggests insufficient resources for your hosted instance.
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According to AC:
Your hosted server is using SQL 2012 X64 Express.
Is this the same???
Thanks, David Lee, MD Dallas, TX Concur with Sandeep. At your number of users, you probably need full SQL. A similar sized practice in our managed environment is running 6G (they are OK but could use more), and a practice with a local server and terminal services is running 16G of RAM with full SQL. Let us know how that goes.
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Got version 8.3.0 last night. Slight improvement in speed, but nothing like I was hoping. Going to push for the full SQL to see if this helps...
David Lee, MD IM Dallas, TX
David Lee, MD IM Dallas, TX
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David,
Could you please let us know what AC is running on? Is it running on a server with 32GBs of RAM or a Dell Optiplex with 8GBs of RAM?
Bert Pediatrics Brewer, Maine
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... similar sized practice in our managed environment is running 6G (they are OK but could use more), and a practice with a local server and terminal services is running 16G of RAM with full SQL.
Let us know how that goes. It may not have been clear - that is how much RAM that SQL Server is consuming in each instance. One server has 60G installed, the other has 32G installed.
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David,
Could you please let us know what AC is running on? Is it running on a server with 32GBs of RAM or a Dell Optiplex with 8GBs of RAM? It will be interesting to hear how much RAM they have allocated to your instance. Also curious which virtualization technology they are using, as that is sometimes pertinent to how RAM is "balloned"
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Bert Pediatrics Brewer, Maine
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When I log in, it shows 8 core 2.27 GHz machine with 49,140 MB memory.
Why oh why didn't I take more computer courses instead of anatomy courses???
David Lee, MD IM Dallas, TX
David Lee, MD IM Dallas, TX
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Not sure what screen states that when you log in. That would be a good amount of memory, although 49GBs is a weird amount but a lot.
It's a good idea to give a lot of information in the beginning: Like,
Type of server or main computer OS Amount of RAM Processor Hard drives: SSD vs HDD 32bit OS vs 64bit OS, although we can generally figure that out
Type of clients Above information
For istance, if you are using Win 7, going to System Properties will give your exact processor and RAM, generally displayed in Gigabytes.
Bottom line that much RAM would be sufficient to allow the full SQL to access quite a bit.
Bert Pediatrics Brewer, Maine
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We're in the cloud with AC, so I was just giving the info I could find from remoting into the cloud. I'll check with AC and get back to you. Thanks.
David Lee, MD IM Dallas, TX
David Lee, MD IM Dallas, TX
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Here is our AC in the cloud configuration:
2008 R2 Dedicated Host (not virtual) 49140 GB of Ram with 29GB available at full load Dual Intel Xeon L5520 processors Raid 10 array consisting of 15k RPM drives (currently 511gb free) 64 Bit OS
Sounds good to me, but alas AC in the clouds still very slow. AC thinks the slowness may be a RDP protocol limitation for how fast (or slow) data can be transferred, especially for labs. AC thinks full SQL MIGHT speed up our AC, but they aren't sure and the cost of full SQL is another issue.
Any thoughts???
David Lee, MD IM Dallas, TX
David Lee, MD IM Dallas, TX
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Well, I should not even be commenting since I know very little about cloud computing, but from my understanding, AC does not use a web-based interface but rather connects using RDP connectivity. But, I would think you would connect via an RD Gateway with an RDP client on your desktop. So, if there is any slowness related to RDP, it would either be on their end, which obviously, they control or on your end, and why would they not be able to tell you what the problem is? What would be different about your RDC client and another office's.
Just to clarify, there is a difference between SQL Server 2012 Standard and SQL Server 2012 Express (both 64-bit). The former will give you a LOT more RAM but will cost you a lot more in licensing based on how they do this with a SaaS. SQL Server 2012 Express or any Express SQL will only give you 1GB of RAM.
You also mention 49,000MBs of RAM in one post = 49GBs and then 49,000GBs of RAM, which is a ton of RAM especially since you say there is 29GBs available. This would mean you are using 49,111GBs of RAM. I would always state RAM in GBs.
Your bandwidth should be plenty using RDP. Given this guess by support ask them to remote to your computer and set up RDP so it isn't slow. I don't see how you made your RDP slow.
Otherwise, I would move your AC back to in house on a server you can control.
Bert Pediatrics Brewer, Maine
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Bert,
I actually copy/pasted what AC sent, so the 49140 was a typo. Yes I was thinking about moving AC back in house, but what a pain! You have to upgrade each computer when upgrades occur. They made it seem like the RDP is limited by Microsoft, and that is as fast as it can go. Aren't there other companies that can host AC for us???
David Lee, MD IM Dallas, TX
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I thought Indy does. RDP is one of the fastest connection protocolos there is, if not the fastest.
As to your upgrade point, not that this matters, but I was on 6.1.2 up until three months ago. I certainly don't upgrade with each new version, but only because I get a little nervous with the main server upgrade with permissions and other things. But, ironically, with RDP on your own computer, and a shared .exe file on the server (or wherever), you should be able to install AC on 10 computers in under 15 minutes.
Plus............it's faster.
Bert Pediatrics Brewer, Maine
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Bert,
I actually copy/pasted what AC sent, so the 49140 was a typo. Yes I was thinking about moving AC back in house, but what a pain! You have to upgrade each computer when upgrades occur. They made it seem like the RDP is limited by Microsoft, and that is as fast as it can go. Aren't there other companies that can host AC for us???
David Lee, MD IM Dallas, TX David, Bert is correct, we have been providing fully managed AC environments since 2011, and it was only after Jon Bertman saw how fast our platform was that he had his staff ask us how we did it before they decided to compete with us. LOL I go out of my way to not draw attention to what we do commercially, but since you ask, you may find that solution more to your liking. We service clients in almost 40 different states across 4 times zones. You can hit me up with a PM or fill out our contact form if you would like to connect to one of our demo instances and try it out.
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I thought Indy does. RDP is one of the fastest connection protocols there is, if not the fastest.... Bert, Thank you for the nod! BTW, 8.3 is being installed, so I'm guessing that we will start another round of upgrades once we know Shamu isn't feeding. Remember, don't be the first penguin.
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If you look at how long I was on 6. 1. 2, one can see I am definitely not the first penguin in the water. 9.0 should be interesting. Kudos to the 100 features, but that will have to come with at least one bug.
Bert Pediatrics Brewer, Maine
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Yep, I agree. If cloud is your goal, Indy was the running his hosted Amazing Charts for years before AC even started the offering. But, if max performance is the goal, local is the best.
For larger practices, it makes more sense to build a "private cloud" meaning your run your hosted AC/terminal server in house. Even smaller practices like the in-house terminal server approach. You can use wired or wireless. Performance is the same. It also makes setup really easy. Multiple Offices/etc. without needing new hardware. If an office has no existing infrastructure in place, that's our go-to approach.
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There you go. The big three have spoken. Wait, let's make that the Big Two, Sandeep and Indy for the IT. I am more head of the complaint department, lol.
Bert Pediatrics Brewer, Maine
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Many thanks for all your thoughts/opinions. Indy I'll be in touch!
David Lee, MD IM Dallas, TX
David Lee, MD IM Dallas, TX
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Maybe I will start a forum called Amazing Thoughts. 
Bert Pediatrics Brewer, Maine
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Maybe I will start a forum called Amazing Thoughts.  And who will determine which thoughts are amazing enough to qualify? Gene
Gene Nallin MD solo family practice with one PA Cumberland, Md
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I was going to ask you to moderate that forum.
Bert Pediatrics Brewer, Maine
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Actually, maybe I will call it Deep Thoughts.  For those who don't get this, you can probably Google/You Tube SNL and Deep Thoughts.
Bert Pediatrics Brewer, Maine
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OK, for those who want to accuse me of hijacking the thread, David made the thread anti-hijackable with his closing post. 
Bert Pediatrics Brewer, Maine
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Thread totally open to hijacking...  David Lee, MD IM Dallas, TX
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To address the original question about bandwidth allocation for AC-Cloud, each active RDP session uses anywhere from 0 to 100 Kbps down and very, very little up (unless you're uploading large documents). Typical office applications via RDP are under 20 Kbps, as the information on the screen doesn't change very much, compared to something like streaming a video or viewing a Powerpoint presentation.
The RD protocol is set up so that a static image on a screen uses no data. The client session receives "updates" of only what changed on the screen, and sends mouse commands and keystrokes back to the host computer.
Pete Practice Manager Physician's Office Resource, Inc.
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