Home Forums Discussions Problems When will AC just work?

More often than not, it appears the reliability of our EMR system is compromised.

Whether Updox is not working, New Crop has errors and wont transmit, or AC simply crashes, too much time and effort is required to keep this system working properly.

Some issues get resolved. Others disappear, undiagnosed or unresolved by tech, and re-appear months later.

I hate ranting, but I cant remember going through an entire WEEK since upgrading to 9.31 without ANY type of issues.

Well rants are free game, lol, and no one is better at it than I. But, let me play Devils Advocate for a minute.

First, I have never used Updox, but after seeing all the messages in the Shoutbox, I asked why do people use it given it goes down so often. Users came back with they have an issue maybe once every six months.

NewCrop rarely goes down. We had an issue with it on Monday for a few hours. I emailed the, and they said it would be fixed shortly. Charlie put it on the message board. But, NewCrop isn't AC's fault.

I do wish there weren't government mandates which caused AC and other EMRs to waste months implementing useless code, which also causes problems. I know they like the ACPM, but that is like a huge resource taker. One wonders if an entire year could be spent rewriting the code base, but I would admit I have no idea how hard that would be. Remember up to version 5 I believe, the code was written by a brilliant doctor who taught himself C++ or whatever programming language and Access database all while still working. But, there was bound to be some issues with that code.

I hate writing this, because AC likely doesn't want to read it, AND I could be dead wrong, but I don't think our beta testing is a rigorous as other programs. It seems that a lot of the beta testing is done here on the boards after the fact. But, also understand that Chris Conrad has done more to enrich the features of AC than anyone before him. And, when I say that, I don't mean to leave at the actual developers. But, it is a risk benefit to add a feature like not having to sign off on II that aren't necessary and introducing new bugs.

Question:

Do you use P2P or client/server and is your database on client software? Does anyone use that computer. And, how were things on 9.1 or 9.2?

Then there is the fact that Microsoft, in their infinite wisdom, decided in v10 to make updates mandatory.

So, to answer your question, never. But, it is still the best little program around. I hope this doesn't sound bad, but I go weeks without an issue or a crash.

I apologize is this came across the wrong way. Believe me, I have been exactly where you are at.

If you ever want to hear a story that Wendell and I can vouch for about the AC crashes and the Keystone Cops, I will be glad to write it. I pretty much convinced my partner to use AC. During v1, I thought he was going to kill me. And, believe me, Jon B. wasn't the best at keeping us informed.

Bert,

You've been more helpful and an advocate than anyone else. You're insight and advice has prevented me from leaving AC to a new EMR

But when you ask for help regarding the inability to send a medication, (the same problem you helped me with months ago) and get no help for over 10 days by New Crop or AC is just ridiculous.

And then today, to top it off, Updox which has been problematic for over a week, called to ask if we were interested in additional services!

and lastly, AC continues to crash on different computers--twice today--and AC can never replicate it so they never believe it.

Thanks for the compliments. I never mind helping. I do understand what you are saying. I have never used Updox, and I recall asking in Shoutbox why people use it given it goes down so often. At least it is announced there a lot. But, others say it never goes down.

I have a few suggestions or statements, but let's take it to private message. I will write there under NC and Updox.

We have clients on 9.3.1 that run long periods of time without issues; setting aside Updox, NewCrop issues.

We very deliberately implement very focused instances to minimize problems and downtime.

Without drifting off topic too much, when Updox works it's very handy,and it usually works. One thing Updox does that I like is they have an Updox status page so you can tell if a problem is on their end or local. It may not seem like a lot, but if I know a company has acknowledged a problem and is actively working on it I'm much more likely to cut them some slack.

NewCrop is different. I post ERx problems in the ShoutBox because I don't know if the problem is on my end or NewCrop's end. The only time I see NewCrop status problems confirmed is if AC staff calls them and posts it here.

As far as AC goes it's usually pretty stable. I have a couple of satellite computers that seem to crash more often than the others but I assume it's a configuration problem specific to those computers.

Not that it matters, but NC actually notifies AC. It is up to AC to let the AC community that NC is down. I wish TWC (Spectrum) had a way of letting everyone know. Of course, if they are down, you can't use the Internet. But, they could do a blast fax. It is frustrating to immediately check all your hardware to see.

I talked to NewCrop. To be honest, I can't remember their response. But, this time Charlie and support go tthe message out right away. Not sure why they don't contact me as I can get a banner message right at the top of the page. At least NC let everyone know how long it would be. Trust me, the ones I talk with hate it without a website to say. They get inundated with emails and phone calls.

I want to know when AC will just work, too. We are running Version 9.4 Windows 10 and at our practice, AC crashes every single day multiple times on every single computer (laptop or desktop). The most common error message we see?

"Amazing Charts has encountered an issue during this activity and will shutdown when you will click OK. . . . If you receive this error repeatedly, please contact Technical Support. . ."

When we contact AC Tech Support, they tell us that they need more information (more of these error messages) to be able to tell us why it is happening. Our office took screenshots of these messages and sent them to AC. I had 30 screenshots (that is 30 times that it crashed) in 30-day time frame (and those were just the ones we remembered to take screenshots of).

Then Tech Support says that since our cannot replicate the issue, they cannot help.

We love that AC is simple and user friendly. If these crashes or errors were every other week or even every other day, that would be OK. But we cannot go through a single day without AT LEAST 10 of these crashes and other errors.

Recently we contacted Support because we were experiencing slowness (5 minutes between each click) and they said we needed more RAM on our Server computer. So we more than tripled the memory on our Server computer. Today, the doctor cannot sign off on his note because he cannot take 20 or 30 minutes to complete one note.

Can I give this 10 thumbs Up please? This is an issue in my office as well. We just increased the amount of RAM on the front desk computer to 8 GB and there are no other programs running, other than Google and Updox and AC has crashed at least 4 times since 10:00 this morning. This is getting ridiculous.

Based on the behavior you are describing, I'm curious about a few tings.

>How many computers are connecting the the AC database?
>How much RAM is SQLServer using on the main( AC Server) computer?
>Is the main computer been through several upgrades, or has AC been installed recently?

Our Main computer is on a SSD, I'm unsure of the storage capacity, with my only desktop (front office) on the network. The doctor uses Team Viewer on his laptop, also on a SSD. So there are only two machines really using the database. We upgraded to AC 9.3.1 in June or thereabouts. My desktop was upgraded to W-10 in July and since then we have continued to have multiple crashes a day. At least I do on my machine.
I had tech support (Mazen E. - whom is fantastic, BTW) online two weeks ago for an entire day and he had to reinstall AC on my computer due to a corrupted file. I'd hoped that it would correct the constant crashing, but that has not been the case for me.

Trista,

>Check on the main AC server) computer in the Task Manager and tell me how much RAM(memory) is being used.
>How many computers in the office?

@Trista,

Did this only happen since upgrading to Win10? Was it stable on Win7?

@ Bert - It started as soon as we upgraded to version 9.3.1, when we were still on Win7. We didn't upgrade to Win10 until we'd had 9.3.1 for a couple of weeks. We'd hoped that would resolve the crashing, in addition to increasing the RAM on my computer to 8 GB, but it still crashes multiple times a day.
Yesterday afternoon, I checked my RAM memory usage on my computer and it was at 48% when AC "Encountered an error and needs to close"
We have 3 computers total in the office. The main is on the doctor's desk, but during patient visits, he uses a SSD laptop with Team Viewer, so it's linked to his desktop. And my computer. That's it. We don't have any additional workstations in the office.

Trying to track this down.... what may be helpful is that we only have this issue (frequent crashing, especially with e-prescribing) on only one machine. It is one of our few with Win 10. I am trying to see if a Win 10 update preceded the problem.

Let me know if you need help looking at the update history - that will answer some of what you are considering.

When it comes to RAM - the key is how much is being used on the AC server computer. The newer versions use more server resources.

So, it sounds like the doctor is using his personal computer for the database. I think that is always a bad idea. Not saying it is the problem.

RAM is important, but you had the same RAM. I know it is slightly more RAM hungry, but I doubt it is the RAM. Can't hurt to upgrade the main computer with more RAM. It is cheap.

Just a thought, but the previous version worked. Why not have AC take you back to that version. The updates are rather easy to find. Just bring up Windows updates and go through the recent ones.

I can tell you something else to try later. I don't think Win 10 will help much. I would seriously consider at least getting a separate computer for the database. You can even make sure it is a bit more powerful with a better processor and more RAM. AMD is making some killer processors now that are more powerful and less expensive than the i9 that are coming out, if not already out.

Our practice has a computer dedicated as the Server computer and we have 24GB RAM on it now. We have 8 desktops and 5 laptops as workstations. And this error happens every single day.

Having diagnosed this same kind of error probably 30+ times, the key issue is how much RAM is being used on the AC server.

Pull up the Task Manager and see how much RAM SQL Server is using.

About 5 GB

That tells me a couple of things.
>You have the 64bit SQL Express installed - which is good
>You are at the top end of what SQL Express can do without time-out/crash errors - not good

Try this over lunch or in the morning before folks start
>Go into Control Panel>Administrative Tools>Services and select SQL Server (AmazingCharts) service - restart it.

IF restarting SQL solves the problem for a while, it is time to consider upgrading to SQL Standard. It is our experience that between 10-12 users, AC will start to error/crash from SQL timeouts.

Let me know if you want help with doing that process, it is a regular operation for us (we work with AC to accomplish it for you).

This is happening daily to me too, about once a day. I originally posted about this here:

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Re: Crashing [Re: Scott]
SoCalFP Online content
Member

Registered: 12/08/11
Posts: 25
Loc: Southern California
Happens to me too. Rather exclusive to Main Computer, rare on clients, which can still use AC even when AC crashes on Main computer (Peer to Peer set up). Began about 6m ago v8, persisted upon upgrade to v9.4.2 At first was few times a week, now daily, sometimes twice a day. Appears to be completely random as to what is going on at the time with use of AC or concurrently running unrelated software. Only AC crashes, all other software hums along unaffected as does the OS (Browser: Chrome, email client Thunderbird, windows 10 file explorer, LibreOffice, MS Paint). Time of day also appears random, as likely in middle of business day with all staff logged on as it is late at night when I'm here alone. I have a pending tech service appt in a few weeks to have them investigate. When it crashes, all work in progress is lost, upon restart it does not recover last chart. Anytime I've been working on charting a single patient more than 15 minutes at a time I save work, otherwise it is lost if crashes. Sometimes I get impression it is associated with clicking too rapidly among a series of controls, but other times happens with a single click.
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Since then I can offer this update:
1.) I had my AC tech remote log in. Unfortunately this was not productive for a couple of reasons. After getting in line and waiting for 3 weeks for my appointment, Windows 10 auto-upgraded to Creator's version and wiped clean all the EventLogs 2days before. The AC Audit log did not capture the problem. The tech could not reproduce the problem, but he did find that confounding the problem Updox is overwhelming Windows EventViewer with 60000 events per day all the same "sqlportnumber value: 61067 has been found." about six times a second. The tech said he was changing some setting to stop this, but it continues to this day. Unless I immediately run EventViewer after a crash, the prior crash events have been lost off the bottom of the stack due to the overwhelming number of Updox events.

2.)The problem which mysteriously had not happened for about a week before the AC tech service remote call began happening again the very next day, on a daily basis, persisting. I had been watching him remotely operating my screen, and tried to duplicate some of his investigation. Here is what I have discovered so far:

a.) AC administrator Audit Log never captures the problem, only the previous successfully completed task.
b.) Windows10Pro EventViewer last six events:
faulting module name AcroPDF.dll_unloaded
Faulting module name: AcroPDF.dll_unloaded, version: 11.0.10.32, time stamp: 0x547e970c
Faulting module name: Flash.ocx_unloaded, version: 26.0.0.137, time stamp: 0x594d5a27
not captured
AcroPDF.dll_unloaded, version: 11.0.10.32, time stamp: 0x547e970c
AcroPDF.dll_unloaded, version: 11.0.10.32, time stamp: 0x547e970c


4 of the 6 events involve "AcroPDF.dll_unloaded, version: 11.0.10.32" whatever that is.

I don't know if this helps the sleuths. It will be a month or two before I have time to try AC support again.

SQL Server is using 3.3GB if that helps per Task Manager. 16GB RAM installed.

Hope that helps.

Some observations:
>The Acrobat plugin is part of the mix, which makes me wonder about ImportedItems.
>BTW, as long as they patch Acro 11, I'll never go to their DC - serious resource pig, constantly phoning home. Eventually clients will mostly move to Foxit or Sumatra PDF viewers
>3.3 G for SQL - sounds like you are still running the 32bit version of SQL Express. Typically happens when the same installation has been upgraded multiple times
>How many machines are running AC in the practice?
>I would try restarting SQLServer in the morning and over lunch and see if the behavior changes

First, everyone needs to make sure we are talking apples to apples. For instance, what version exactly and what SQL Server you are on. The default now should be SQL Server Express 2012. I think some may also be getting the Server RAM confused with the SQL RAM. SQL RAM can only use what the OS has to give it. That is key with Standard and Enterprise editions as they have a much higher capacity for RAM. But, Express is limited to 1 GB of RAM and 10 GB of database space per SQL Engine. Express is free. So they put limitations on it. What you need for the amount of SQL RAM is dependent on many things. Not only the number of users but also how many queries those users are making. But, in general, the more people, the more queries.

SQL Server Express 2012 is usually sufficient for small practices, because most of the RAM is used for its buffer pool. This will contain "pages" of past queries which are saved in the buffer pool (think RAM). Pages are key because SQL remembers your latest queries given that they are most likely to be used again soon. You can set these manually, but you are better off leaving it dynamic. SQL Server Express will allocate RAM taking and dumping as needed. Once the pages reach their maximum, the oldest one will be deleted making room for new pages. When you restart SQL, you lose all this RAM back to the OS and you will also lose the pages. While you do get a clean slate, you also lose all of the pages.

While having a dedicated "main computer" or "server" doesn't always change the equation and may not here, it is considered best practices to not have anyone use the "main computer" for a variety of reasons. Plus, you can purchase a very fast computer with a lot of RAM and an SSD that specifically only runs billing and AC. BTW, AC itself can crash all it wants on the main computer and not affect the other clients. In fact, it shouldn't. Only by turning off the computer would you run into that. Or if it froze, hence not using it. The database has nothing to do with the program. Think of the program on the main computer as just one more application. I wouldn't use AC on the main computer. You can also use System Properties --> Advance to change the settings to run most efficiently and to use background services over programs. Then you can leave it alone except for updates, but we all know what can happen here.

The adoPDF.dll error may be significant as Indy stated. It is interesting that people have talked about Updox. DOES EVERYONE POSTING HERE USE UPDOX. I do remember issues in the past with Adobe or PDF programs. You could delete it temporarily or you could try doing some troubleshooting steps that could be helpful.

You can go to Search or Run and type in "msconfig" without the quotes. You will see the Services tab and the Startup tab. You can run only AC with all the other programs turned off that aren't essential or just turn off Adobe and then run AC. If it doesn't crash, then add three or four programs at a time and continue. Then with Services, Hide all Microsoft services, then turn off all services that have nothing to do with AC and try it then. If it runs fine, then add some services back until it crashes again. These changes aren't permanent. You can change it back easily.

Mike, did you really have to wait three weeks for an appointment. That is unacceptable. Or was your schedule just not working with their schedule.

Upon further review, the four event involving "AcroPDF" all appear to have occurred as I was "Save/Append"ing to a previous note. Typically I have a subsequently returned interfaced imaging report open from imported items on the Main computer and am copy and pasting the interpretation to the end of my prior note also on Main computer. Or I am transcribing by hand subsequently returned interfaced lab reports open on my laptop or faxed records from Updox on my laptop into the "Save/Append" text box on the Main computer (so I can see two monitors at once).

Not sure of SQL version. From TaskManager after quitting AC (original install was version 4, two computers ago, now running 9.4.2):



From Settings/Apps:




Peer to Peer network: 5 computers total, 4 users total
Main(i7 desktop Win10Pro ethernet)
Client(i3 desktop Win10Pro ethernet)
Client (three i3 laptops Win10Home wireless)


Can I do this just by "Restart"ing the main computer, or is there something more to this?


Request made 7/13/2017, AC replied "anytime after 7/31/2017", 8/2/2017 fit into my schedule, I figured I could tolerate crashing once a day until then, and other users might have more pressing problems.

What's important is how much memory you are using in your buffer cache. SQL will use other memory for other non-buffer memory pools. If you are using SQL Express, then your buffer pool is limited to 1 GB. Unless you change the max settings on SQL, it will eventually take as much memory as it can get. SQL basically things that the OS is only for it.

The memory will be used to store pages, which are about 8 KB in size. These pages will be former queries made. (not the actual returned data), but the path it took to get the data. All the tables it went to, etc. Some paths or queries aren't efficient, so storing queries which may be used again it helpful. There is a reason SQL has a buffer pool. And, there is a reason it grabs memory. With five computers, I simply don't see why you would need SQL Standard or Enterprise. First, it is rather expensive. And, second, you would need help with the install. It sounds like Indy would be willing to help you. Certainly, offices with a much larger amount of users can benefit from using Standard. Of course, a standard version would have to be limited to the maximum memory or it would take all of the OS's memory. Yes, you can simply reboot the server to release all the RAM. Or you can type services.msc in the run box and Restart the AmazingCharts SQL instance either by right-clicking on it or using the choice at the top left. You can also run a script to do this. But, this is a little akin to your using your computer and running six apps perfectly well on the amount of RAM you have, then deciding to logg off to free all the RAM. Now you log back on, and great, you have all your RAM back, but all of your apps are gone. Just an analogy. So, you restart SQL, and it releases all the RAM it took, and releases all the pages as well. So, you lose the benefit of stored queries in the pages, therefore, every query you make will have to hit the database on your hard drive, decreasing performance. What can happen in an office that is making a lot more queries is that while SQL is dropping the oldest and dirtiest pages, it may not be able to keep up and have slower performance. Standard and Enterprise editions will allow a lot more RAM, are more efficient and will have more time to delete dirty pages. I will defer to Indy on the fact that he has solved this problem with full versions of SQL, and if that were something you wanted to do, trying a restarted SQL would be the first step. If this solved your problem, it would be worth it, but SQL Server Standard 2012 isn't cheap depending on the licensing. It would run you at least $700.

It would also be more helpful to use Process Explorer and Perfmon (found on your computer) as they give tons more information, and they are more accurate.

I still don't know the amount of RAM memory for the OS you have on your main computer.

You can see my PM for further info.

Today a Windows update on one machine, Update KB4021572, resulted in repeated crashes of AC and inability to view imported items. After uninstalling it, the issues were resolved.

The reason I recommend restarting SQL because that is a quick way to troubleshoot the problem. If it doesn't help, you keep looking; if it helps then you know that it is a resources issue.

We have tuned AC to run in environments of 50+ users, and that takes custom tweaking, but it can be done.

All of our larger practices are now on SQL Standard, and it regularly runs 12-16G of RAM.

I'm glad you were able to isolate the issue and get it back online. Didn't produce problems for other machines?

The next step is to go back and figure out if our "problem machine" has that update, and others do not. Will look after hours.

Amazing Charts first told us that it was an issue with the PDF we use, but I have different versions of Adobe on different computers, and even the computers with the AC-recommended versions of Adobe have the same exact issue.

Have you simply tried turning off Adobe on one machine? Or uninstalling. I would just turn it off via msconfig. It will take a few seconds. Adobe is infamous for causing issues with programs especially AC.

I don't post here ever, (notice this is my first) but after reading through this thread, I felt I needed to put in my 2 cents. After almost 2 years of fighting AC and AC support on my own server, I eventually found myself here looking for help. One gentleman in particular helped me on here, then by reaching out and helping me via paid phone service and remote calls. The help was incredibly appreciated. I no longer felt alone in my battle against the machine.
He never pushed, but eventually, kindly offered to host my AC on his server and give me full support for a very, very reasonable cost. (which for us, as a start-up primary care office was important to consider, because his cost was above what I was going to be paying AC as well.)
The turning point was my server losing an entire RAID array and the AC database with it! This person was on the phone with me late into the night and worked hours logged in remotely to restore my AC, yet again, for the patients the next day. That was it. I had had enough. I paid the bill and moved my AC to his servers the next month. That was early 2015...
Since then, we have had very minimal down time, maybe 2 or 3 days added all up. When AC does have a hiccup, His team responds in minutes (MINUTES!!) even from a remote computer in an airport!
AC runs fast and reliable. With the peace of mind that if something happens, they are just a phone call away.

That man is none other than Indy, from right here on these boards. This is no paid advertisement. In fact I pay him! But after reading through all the troubles above, remembering being in those situations, I'm am SOOO happy to have made the move. BestForYourPractice is worth every penny and more. Its the bill I pay every month with peace. And I haven't had to talk to an AC service tech in 2 years.

Reach out to him, make the move. Take his advice. You won't regret it...

Nic - what a pleasant surprise to see you pop up here!

Thank you for your kind words, and it has been a pleasure to work with you and your team as you have grown.

There are no perfect systems, but we work proactively to keep systems up and operational, so AC is much more reliable dependable.

I look forward to meeting you and your team when I'm through town this year.

Hi everyone,

I will echo the above sentiment about Indy. I have not used him professionally, but he has been EXCEPTIONALLY helpful on this board.

We have had a server set up by Sandeep (he is in California and we are in Maryland) for the last 3 years. Virtually trouble free. Sandeep remotes in when necessary. Extraordinarily talented, very caring and helpful.

Gene

Gene, thank you for your vocal support. Hopefully my next time through your neck of the woods, our schedules will line up. We have some unfinished business to accomplish, and I share the story of my transmission blowing out on that long grade West of Cumberland.

Update on interval interventions and effect or lack thereof:
There appear to be two forum topics concurrently exploring this issue
?When will AC just work?? and
?Crashing?
The latter title appears to be more specific, and I have added my subsequent response there.

There are 3 professional IT persons, it would appear, that regularly are active on the board: Indy, Sandeep and James.

I have known Indy for a very long time. We initially met at one of the early Jon Bertman ACUC meetings and have clicked ever since. He has helped me out numerous times. More echo on the sentiment!

I've also learned many things from the posts by Sandeep and James. I have learned even more from Sandeep's website. They are all a tremendous resource (along with Bert (I cannot sing enough praises for him) who might as well be considered and IT pro as well as a pediatrician)

Yes, they have a business just as we do, but the time they spend responding to issues on the user board is invaluable. They really know AC!!! Note that both Indy and Sandeep are in the top posters on the board. James is up there but gets tied up with other things from time to time.

Although we do not allow advertising on the site, I have no issues about recommending any of them. They do NOT "toot their horns" or really try to advertise their services, although they will sometimes state what they can do professionally. For all they have done, it's worth a plug.

Thank you, Wendell. Most kind.

JamesNT