Home Forums Discussions Problems Problems since going onto AC cloud servers

Dear all, I wanted to give feedback for those of you who are contemplating going onto the AC servers and doing away with your in office one. We have had AC since 2007 and have come a long way with the company. I used to give all great feedback but since the last 6 months I feel the company and its customer satisfaction is lacking. We have wasted HOURS of time with the chats that you pay extra for- when available, and get different answers depending on the luck of who happens to answer. There seems to be a learning curve that the right doesn't know what the left is doing. Unfortunately you don't know until you have wasted time trying to get answers for daily errors and problems, then to find out it is not under your control anymore and it is the clouds servers. We have slowness and long times to check interactions and Google is also going onto the clouds servers for one. There a lot of changes that you are not told until after the fact. We have to have 4 users for 3 employees in order to be able to keep both exam rooms signed in as the physician. Then you can not be logged in at 2 places it will log you out. It costs much more overall and is slower and we would change back if I had known this before taking the plunge.
For the updates in AC or new changes you also do not have control over since you are on the cloud when the updates occur and the staff are not familiar with the bugs etc. I have requested an update like UPdox does with test and email alerts when they are working to fix things but they said they can not won't do that. Also right now the system boots you out when you click messages for just one user here- not sure why. The appt. search box is removed and the rolodex too now, which is so cumbersome in a busy office to find the prior appts. We can not change back since we are on the servers.

Wow!
Thanks for the heads up. Certainly would not work for us. Is is possible to migrate back to office based set up once you have gone to the web base set up?

Dru

You can always have your data and files transfered to you.

It is your data.

Does anyone know in what form the data is transferred back to you. One would think that reinstalling AC on a local server and reviving from a backup(from the cloud version, that maybe AC can provide) would be possible. Or if you decide to go with another EMR , if your data is provided to you, is it useful to start the new EMR.
Lots of questions, HOPEFULLY answers can be provided.

I have had a bit different experience with AC in the Cloud, and much more positive than sanp, but my understanding is that I could reverse to local AC at any time if I was unhappy. I in fact had a partner who did not like AC in the Cloud and did that.
I recently got a new chromebook that is much nicer than my old lap top. I am able to carry my chromebook into the exam rooms (2) and by using VNC viewer made for chrome keep my desktop AC open because my chromebook is my simulated desktop. I can also use microsoft RDP on my chromebook which if I had my desktop AC open would kick out. But I use RDP chromebook at home or at the office if I lose electricity+-internet. The chromebook via RDP works very well and I can use Updox (web based) and function as well as I can on my desktop, except I cannot use Medical Dragon One on my chromebook. So I just got the RDP chromebook up and running today.
If I were not in the Cloud with AC I would not be able to use the chromebook this way. I have envisioned the potential to use the chromebook this way for quite sometime but finally got to this point and very happy with being able to use it in and out of the office this way.
I am not posting this to take away from sanp's experience just giving another perspective is all.

I would imagine they just send you the ENC file as if you were restoring/installing AC to a new server. They would also need to credential whatever new machine you are moving to. Once restored, AC uses standard MS SQL Server.

The new EMR/EHR company can import the data from there provided they have the ability to work with SQL. If not, perhaps a third party IT person like JamesNT can transfer the data to your new EHR. MS SQL and Oracle DB are the two biggest database engines in use today. So it shouldn't be too hard to find someone that can import the data.

Personally, I've never been a huge fan of having someone else control my mission-critical data. I would never recommend a purely cloud EHR like PracticeFusion to anyone.

AC Cloud is great for smaller practices and they do give you the ability to return to an on-premise installation if needed. LogMeIn is a great example. It started off free and they just kept increasing the price. For us IT people who used Central to manage computers. The price went from $300/year to over $30,000/year in just a few years. Every year the price would double and then triple. We got out when the price was hitting $5,000 a year. We found an app that was able to be self-hosted and never looked back.

Cloud is great for auxiliary services like email, VoIP, etc. But I wouldn't want to be at the mercy of the cloud provider for my mission-critical data. AC is still leaps and bounds above most other cloud-based EHR's with the ability to switch back to on-premise.

When clients have moved to us from AC, it has been the ENC file, or literally pulling down the DB files once the database is stopped.

The larger the practice, the more time it takes to bring down all of the imported items. We typically do it over a period of days, so that once we hit the final cut-over, the transition can be made overnight.

There are multiple reasons why folks come to us, the three largest being control of your configuration, the version, and our responsiveness. We regularly have clients who have different software they want installed on the same instance, or have a version they like, and don't like being non-consenting software testers.

Properly planned, moving to our managed environment, or to a server in your office is a straightforward and drama-free experience that we have a decade of experience in performing.

We have transitioned practice data To and From many other systems and/or AC. Over the last decade, we have integrated with most other EMR systems. The limits are always the system/vendor, not our expertise.

Bottomline, the data is yours, and there are new options coming online later this year so that Physicians/Practices are no longer dependent on vendors allowing them access to their data and rent-seeking.

Indy does an AMAZING job managing our AC in the cloud. Changing between rooms is super easy.
An unpaid but verified advertisement!

David Lee, MD
IM
Dallas, TX

Indy,

you mentioned in your post about new options coming later this year. Can you expand on that statement?

ddd

It has been 5 months? Have things changed?

@Indy:
What is the difference between AC hosted and your service?

[
@Indy:
What is the difference between AC hosted and your service? [/quote]

Unfortunately Indy passed away earlier this year so his option no longer exists.

Gene

Gerardo,

You probably already know this, but consider checking with Sandeep Luthra of LTMedical.net above in this thread, whose company I think still hosts AC in the cloud.

Cheers,

Carl Fogel

Hopefully Sandeep will see this and respond. Until that time, I do not think that Sandeep actually hosts on the cloud.

He set up our server, and provides excellent service and support, and does backup for this. But, the actual server is on your site.

Gene

Thanks for the kind words

The only time we host AC is in an emergency situation (E.g. major hardware failure, office flooded, cloud provider down, etc.) We've always been big proponents of keeping mission-critical infrastructure in-house. Our new servers are pretty similar to hosted AC but we try to run everything (scans, faxes, PM software, etc.) just a bit faster. We're just lacking an integrated phone system which is our next project for 2020.

Sandeep definitely has the best icon. Better than Under Armor, that's for sure. I can look past the ever changing signature, lol. I think his company should be called Sandeep - 9, but that is an inside joke that I will never divulge. Hell, I doubt he will even figure that one out.

Hi all,
Joined AC in 2009, left in 2016 and returned in 2017. Decided to go to the cloud to avoid the hassles of a server. Four logins. Cruising along until most recent cloud host switch a month ago. You cannot imagine the tremendous frustration and anxiety/expense this has cost. AC hampers my ability to document a note, 5-8 seconds for the typed word to appear before it gets completely lost and the system reboots. My front desk cannot schedule appointments or open charts without everything freezing and being extremely delayed. Chatting with support almost everyday for the last 4 weeks, multiple emails and phone calls as well. "all info is being forwarded to our hosting team" is the most common response. We were told it was our internet connection, our IT tech also chatted with support and showed them our internet/connection was perfectly fine (then charged us $650 for his time spent here). NOTHING is getting better, nothing is being solved. We are at the end of our rope here.

-Aldo Ciccotelli and Staff
Langhorne, PA

Sorry to hear about your issues. Why did you come back? Specifically to try the cloud? If you are planning to stay with AC, why not go back to a server. It can't have as many hassles as a server.

Just to be clear, it was your IT person who charged $650? How much does he get an hour? Seems like it shouldn't take more than an hour to check Internet speed and network.

What are the hassles of using your own server? Or even P2P?

IT suggested it was the fastest way to get up and running after I repurchased the practice. "the future of emr is cloud computing". No server, security risk analysis, data breaches etc. IT spent hours trying to solve the problem after AC claimed the slowness and dropped connection was on my end. End result...computers work well with i7 processors, enough memory, no internal problems (he compared wireless and wired connections and speed is virtually the same) and the fastest internet Fiber can supply. Confirmed by speedtest. He emailed AC support to suggest a "direct channel" connection but no response after several weeks. When we first went to the cloud with AC, there was slowness and some hanging up. We could see that the AC server had 4 Gig memory, we asked AC to fix this and we saw they increased the memory to 6 Gig with some improvement.(matched memory?) Since the recent upgrade, we are all pulling out our hair. I can type 3 words and wait 5-7 seconds for the words to appear. NUMEROUS episode of downright freezing...especially when choosing something in the orders section...click on the box and wait for it to show up. try to scroll down a list of lab results and it "stutters" with several second delays. MA downloaded 15 faxes from UPDOX and none yesterday transferred to AC, she had to redo all. UPDOX says the problem is with AC. Very hard to see patients in the 20 mins allotted when I have multiple pauses when documenting the encounter and print lab/x-ray request. Switch from current encounter to imported items and see 4 seconds of black to partial to full screen, this is on all 4 computers.
I asked to speak to a supervisor and was told my request was "escalated" but she had others ahead of mine.
Am thinking of purchasing a server for the office or moving to hospital sponsored EPIC. I'm in a part-time practice with 2.5 support staff, therefore max 4 people logging in at any time. At night when I'm the only log-in, speed is much less of a problem.
Sorry for the rant, No one should be expected to work like this.
Appreciate any advice.

Aldo,
Tell AC and your IT person that you want to move to an in-house, peer-to-peer or server set-up. You should be able to have it up and running by Monday. Stop banging your head against this wall!

Hi Aldo,

I'm curious what your speeds are in up and down mbps:

"(he compared wireless and wired connections and speed is virtually the same) and the fastest internet Fiber can supply. Confirmed by speedtest."

Are your wired and wireless systems actually running at the same speeds?

Who is your ISP?

You can run such tests yourself in a minute or two by googling "speed test" or just going to https://www.speedtest.net/

Cheers,

Cark Fogel

Hi Mr. Fogel,

I did the speed test via the site you provided. It is showing 150.46 download mbps and 160.16 upload mbps, 9 ping ms.
Our ISP is Verizon.


-Kelly (Office Manager)

Also just to mention that I believe we are currently hosted in AC. When we chat with support about freezing/slowness, etc, they sometimes "reset the server" on their end.

Hope this is all making sense.


-Kelly

Hi Kelly,

This may not apply . . .

But if you have a remote desktop connection to AC that seems weirdly slow at times . . .

Then I'd check two things to eliminate your end as the problem.

I'm curious, since most AC cloud users aren't complaining about this kind of trouble.

***

First, I'd try to run AC from someone else's home or office computer through a non-Verizon ISP.

You can probably ask another doctor for a favor like this or even do it from your own home.

If you can run AC at a normal speed from a different computer through a different ISP, then the problem is at your end, not AC.

Otherwise, the problem is at AC's end.

***

I'd also run a ping trap from one of your computers for a day to see if your apparently excellent high-speed connection is actually flaky and losing packets.

(You can get excellent speed results if a brief speed test happens to run between the packet-loss raindrops, so to speak.)

Preferably you'd run the ping test to the ip address of your remote AC connection if it responds to ping.

Otherwise, settle pinging to a reliable site like google's dns service at 8.8.8.8

You can do a bare-bones test by opening a command window and typing this command:

ping 8.8.8.8 -t

The -t option pings once per second endlessly.

You end it with CRTL-C or pause it and resume it with CTRL-BREAK (often marked as the PB key for Pause-Break).

The screen statistics at the end show the loss as a percentage.

(A no-t test sends just 4 pings and rarely finds flaky connections--you need at least a thousand 1-second pings and preferably a whole working day.)

You can minimize the command window and keep working. Ping doesn't slow anything down. Let it run for hours.

If you see even 1% ping loss when you stop or pause the program, you've got a flaky connection that will seem slow when dropping packets.

***

If you want a much more elaborate graphical ping test, here's one that I often use:

https://www.dropbox.com/s/habh38mii0dxpzq/pngplt_241.exe?dl=0

You have to set the time and fool with the display and what to show, but failures show as dramatic red lines on the graph.

Cheers,

Carl Fogel

I was moved to the new server and upgraded to the newest version 10.2.0 about a month ago, and initially had some printing issues. My understanding is that the new server is Microsoft Azure and we were unable to use TS Print default after the move to the new server. Updox is working on a new print driver (version 5) that should help expedite margin issues with version 4 and speed up the printing delay we were seeing with the updox central printer. But I have not had any issues as you describe. We were having some intermittent copy and paste issues affecting my Medical Dragon One, in the cloud application but that seems to have been rectified after I got AC IT and the Medical Dragon IT guys on it, could not reproduce the problem then of course. Hope you get it figured out.

Thanks all for your help.

Carl, I'll try implementing your suggestion over the next 2 days. I'm not technically as astute as I was in the early days of WIN 95.
In any case, when I use AC at home, at night, the flow is much better with minimal shuddering. But, if at home during the day and the staff is also logged in, the problems are the same as when in the office.

Aldo

Also, with 4 users, what do I need from a server if we return to in-house AC? My IT guy asked to find out if SQL is needed.

SQL Express is automatically installed when AC is installed. Contrary to what AC or any company may say, cloud computing is not necessarily a turnkey thing.

My sense is there is something in your setup that is causing this. But, there are issues with a cloud setup that could be a problem as well. Remember with RDP, you are only sending key strokes and mouse clicks. You have more than enough bandwidth.

With four users, you need very little for the network. A good server could handle tons of users. There are just other things to look at.

You could probably use another set of eyes looking at the entire network and possibly installing a new server. Sandeep not only knows servers and networking, he sets up many with AC in mind right out of the box. I would give him a call.

It is beyond doing it piecemeal on here with us.

Hi Aldo,

That's interesting.

If your home remote connection is noticeably better than your office connection at night when the office is not operating . . .

Then your office connection might be tying up your remote AC server with a flaky connection.

When the remote AC server isn't dealing with static from the office, so to speak, it might be able to talk to your home system normally.

****

At your office, you can search for "command" in the Windows 10 search box . . .

Use the result to open a command prompt window . . .

And run a ping -t ipaddress from 9am to 5pm to see if packets are being dropped.

You can minimize the ping window and work normally--it won't slow you down.

Use 8.8.8.8 as an ipaddress if your AC ipaddress doesn't respond--some sites block ping.

CTRL-C will exit from ping, and CTRL-BREAK will pause ping and show the current error percentage.

This is just a way to try to rule out some less than obvious problems at your end.

Cheers,

Carl Fogel

Carl makes some good points. But building on the home performance, try to reproduce at the office. The fact you state it is much better when you are the only one using it could mean something. One user, maybe on wired, it is fine. When you are using it alone, then start another user on a different computer. Does it slow down. This could still mean it is on the other end, but it could also mean it is on your end.

Work yourself with a different computer (when alone).

Humans tend to look at what seems obvious. AC Cloud. Possibly. But, still consider there may be a networking problem on your side. Again, though, another user shouldn't slow it down that much given the work is being done on their side.

Ask AC if over the weekend, they will set AC up with just a test user on a different server in the cloud. See how it works then. If it still has issues, it imay be their side. If blazing speed with four connections then likely their side.

When your IT looks at the network performance, it should be done when the problem is occurring as well as when not.

Hello again,

Thanks for your advice, I didn't take up your suggestion to ping the server and with good reason. I connected my workstation to a hot spot, thus avoiding all of the internal wiring at the office. The problems persisted, this tells me that the problem is on the AC side and not our internet since we bypassed all of that using the hot spot. AC needs to fix this soon, imagine trying to scroll down a lab and having it pause every 10-15 sentences. The staff has already smashed a keyboard while threatening to quit.

We were contacted by a product manager who saw the post. He offered to put us back on the original hosting environment, however he never responded to my message about how soon we could do that. We then contacted support through chat to try to move things forward and it's been a week now with no idea when that will happen. I understand with the holiday that things might be delayed but I am losing more patience with AC by the day. My staff has been talking with support multiple times a week for over a month and never once was that option given to us to move back to the old hosting cloud until they fixed these issues.



Aldo

Hi Aldo,

You may be right about the problem being at AC's end . . .

But now I wonder why your remote connection from home was noticeably better than the office, yet the problems persisted through a hot spot connection.

Starting a command-prompt ping test takes only a minute or two, doesn't slow down the station it runs on, and will tell you at the end of the day if there's steady or erratic packet loss.

One client compared it to asking a patient to wear a Holter monitor, only not as inconvenient and much simpler to read.

I don't know of any other way to check for packet loss.

Cheers,

Carl Fogel

Hi Aldo,

First, it doesn't seem like you are getting much help from support. This means you may need to get your help from the forum and/or have someone remote in to look at your set up.

One thing about allowing others to help you when troubleshooting is to try to do the things suggested and report back. Their suggestions may be helpful or may not be, but if you skip around, then they don't have the information they can use to offer the next step. I am not sure what the speeds of your hot spot are. If it were me, I would make sure I had a Gb router and with the modem connected directly to the router and only one computer connected to the router, what speeds are you getting. And, what is the download speed and upload speed of your Internet at the office? And, what is the speed of your Ethernet card on the workstation.

As JBS suggested, you can knock your head against the wall forever, but at some point if you are going to continue using AC, you will have to move back to a LAN. It really isn't that difficult to maintain an LAN, and there are plenty of companies who can set one up and even maintain it.

If it has gotten to the point where staff are throwing keyboards against the wall, then it is time to take the next step. Set up a network, ask for your data, and start working again.

150 Megabit Fiber is pretty much the ideal connection for cloud usage so it shouldn't be an Internet issue. I suspect it's a resource issue on the cloud side if it mainly happens when multiple people are logged in. Azure isn't known for being very fast and resources are pricey.

I would change to onsite,

Thanks everyone.
Between the holiday and my daughter's upcoming wedding, I've been quite overwhelmed.
Agree that implementing the tests described above makes sense but can't find the time. My $50/hour IT guy is against on-site server due to the cost of upkeep and security management. He suggested a direct line connection to AC server to make sure the antivirus wasn't causing an issue and wanted a AC conference call but the email to support was never answered/lost.
On 1/3 AC will move the data base to their in-house server, so we'll see how that goes. Right now, I need to look up a patient and send out a prescription. Can't log into AC because after connection established I get a "runtime error" and am disconnected. Tried another computer with same problem/error message. left a message with AC support...we'll see how that goes.
Aldo

Well, AC fixed the runtime error in a timely fashion and I was able to log in, but now I have 91 (ninety-one) "back-up failed" messages in my inbox and one "database integrity errors, contact technical support immediately" message. I thought going to the cloud would avoid these issues!

Aldo,

I am going to be extremely honest with you, and your IT guy isn't going to like it. I pay my IT guy $140.00 an hour. Your IT guy must be very gracious. Here is the thing. Let's say you are sitting around the table one Saturday afternoon deciding Cloud vs In-house. Then it would look like this:

AC Cloud:

Advantages: They do backup and support. They do all upgrades. No need to keep a server going, etc.

Disadvantages: All of the above.

In house:

Advantages:

Complete control of your data. All issues related to your infrastructure. Can fix and maintain (maybe some extra work but how difficult is maintenance on a very small SMB). Mine and the doctor next door has it does remotely. No increase in per line cost to AC. NEVER WORRYING ABOUT HAVING YOUR DATA.

Disadvantages: Needs closer IT support. Possibly costs more.

Now this decision is about 50/50 IF YOUR AC CLOUD WORKS. BUT IT DOESN'T WORK!! Therefore it has no advantages and all disadvantages.

You have made the biggest mistake happy customers make when using the cloud. No plan as to what to do in a situation like this.

________________________________

I don't blame AC as much as you do. The only thing that bothers me about AC support in general and in this particular issue specifically, is the lack of speedy communication and one person working on it all.

__________________________________________________________________________________
__________________________________________________________________________________

This started on 12/17/19. Fourteen days without a working AC network. With no end in site. You have computers, monitors, cables, Internet. I imagine a switch and a router. You can either get a server or for now use a decent computer for a server. Install AC on the server (you would need AC to do or use one that already has it installed), turn on DHCP, and start using AC. See patients. Then call AC and tell them you want you data. Close your AC cloud connection.

Here is what would happen if I walked in at 7 am and all 10 of my computers weren't working. Dell, for whatever reason, just remoted in and shut off every computer. I would make one phone call to Dell, and then after a screaming match between Michael and me, I would open a box, take out 10 refurbished Lenovos all with more power than my computers I have now. And, I would:

1. move power cords to refurbished computers
2. move monitor cable to new computers
3. change the ethernet cable from Dells to Lenovos
4. connect mice and keyboards to new computers

Turn them on and wait for my server to give them IP address.

Start seeing patients my 9 am. In reality with a few issues probably by lunch.

This is all due to planning ahead of time. I am not saying you didn't. But, while in an in house network has more moving parts to prepare for, a cloud connection, is one big bottleneck that MUST be prepared for. What if the whole thing goes down. We already have an example of that. And, AC was extremely accommodating in helping there.

The step by step troubleshooting with you and AC and all of us who really are not trained enough to figure it out. You need someone trained with AC and networking, etc. to look at your setup.

It all depends on whether you wish to stay with AC, warts and all. If you do, then no more pinging and testing of speeds, etc. Just change and deal with the support situation later.

Finally, and given this board is for the users and users are free to post good and bad, these long threads that continues to be critical of AC support (and I have been critical enough to cover the entire AC community) just doesn't help your case and, to be truthful, doesn't help AC either.

I think it is fine to start or jump in a thread and bring your issue to the board and hope we can help. It is important to name what AC has done in the process. Remember AC has their side and you have yours, and it can be difficult for them to be able to completely troubleshoot that.

These are the types of threads that led to AC deleting the other one. Please understand everyone, I am not here to edit posts that are derogatory of AC. But, this thread started with (and not from Aldo) with DON'T DO IT!! You can see where future customers would see something that bold and move on. They can still read and ask questions and research the cloud, and let the buyer beware.

The new forum has been incredibly received by both users and AC support and head of program development. Constructive criticism is welcome. But, not just wholesale bashing of AC

Also, this is being done piecemeal at your office, on here and at AC. One thing that would help would be one support person completely on your case. It seems like they are trying a big move this week.

Oh, and congrats on your daughter's upcoming wedding. All the more reason to turn this whole thing over to a support IT on both of your sides.