Home Forums Discussions General Discussion Time for the cloud?

Hello everyone,

I have been thinking about future options. We are a two provider practice, myself and a physicians assistant, we have hosted AC on-site for the last 15 years. For the first time, I am starting to seriously consider AC in the cloud.

1. Our server is 5-1/2 years old, so it is time to think about replacement. Hardware cost is an issue.
2. The recent posts on lack of AC support are concerning.
3. I think I am just sort of getting tired, and this appears to be perhaps a way to simplify life.

I know that several users, especially jimmie, seem very happy with the cloud. I have had two main reasons to want to keep our data on site.

1. Concern about Internet outage.
2. Concern about who "owns" the data.

Generally, are cloud users satisfied? Would you go with the cloud again, if you were starting over again?

Finally, some specific questions about AC cloud.

1. Any problems using Dragon Medical?
2. Any problems interfacing with EZ claim?
3. I have a request for pricing out to amazingcharts, but can someone post the approximate price structure? Do you still have the yearly fee, plus a monthly fee per user?



The other option I have been entertaining, although not as seriously, is to just switch back to a peer to peer network. I believe Jon (JBS) is still to peer. Anyone else? Your experience with this?

I greatly appreciate any comments or thoughts.

Gene

Hi Gene,

Seriously,

1. Calculate the amount of time until retirement. If you choose 65 years old, that would be 65 yo minutes 45 years old = 20 years. But, let's say seven years.
2. Get cost from AC
3. Calculate cost using your average use over "seven" years.
4. Calculate how much it would cost over seven years if your purchased a new server and upgraded any hardware such as switches or routers, etc. I use seven years because servers now last quite a bit of time. I would calculate a five year next day warranty. Then estimate a two-year extension, unless you can get seven years right off the bat.
5. Calculate how much you would save by DIY tech even if you have to pay a local tech company
6. Data may be easy to get from the cloud. Good question, but as you go into retirement mode, consider how easily and quickly you can make records, etc.
7. Drink a six-pack or a bottle of wine or both and make a decision.

Hi Bert,

Thanks for all of the above suggestions, especially #7.

Your analysis above is excellent, and more or less mirrors a lot of how I have been thinking. Cost, of course, is a big issue. I get the idea that, more or less, costs over a 5 year or 10 year period would actually be similar, whether a new server and on-site, or going with the cloud.

But there are other intangibles. I am not sure about your experience, but when AC goes down, our office essentially ceases to function. This has not happened very often over the last 15 years, but when it has, it has been memorable. So this leads to the impossible to answer questions. Which option would give greater reliability? Which would be more likely to the to a prolonged (whole day or longer) outage?

And then there are even less tangible intangible's. Which would stress me out less? Ideally, theoretically, cloud that functions perfectly seems to be the lowest stress. Cloud that goes down, without immediate support, would be a nightmare.

Which actually brings me back to peer to peer. Perhaps my memory is fading. It seems that, back in those simpler days, I had confidence that I could fix whatever went wrong. Worst came to worst, the main computer went down (like flames coming out of it), just restore from backup to another computer and point everything else to it.

Thoughts?

Thanks.

Gene

Hi Gene,

There are many more things to consider including how your office is set up if there is downage of the Internet vs AC crash. We have little issue and, in fact, when our Dell exploded (not quite that dramatic, but some wires were burned to a crisp. We were out of most, but Dell got there soon enough to watch me fix it.

With centralized management you have WAY more control over your users using Group Policy. Someone screwing around with AC folder, stop that immediately no mater who it is. Centralize logging. Etc. As one IT tech told me, he won't work on P2P, because it is too difficult.

One area I think you are failing to posit are replication backups and failover. Certainly VMs can be set to operate in the clouds and you can have failover or replication with immediate change to the good server.

I don't think you can add certain software to the cloud. Say you wanted to change to Medware as a scheduler/billing softare; I am not sure you can do that.

Plus there is always the small issue of DNS, DNS, DNS and even DNS.

You can have the best of both worlds, but it would require some upfront research. I would suggest two things since you seem to be prone to #7 above.

You should acquire as much information on the cloud services, but as to your other decision, at least look at an IT company who could recommend setups, help with an ala-cart support (sp?) and ask them if they could set up a server/cheaper server for replication. Let them take over backups. They may even have in house setups at their business which would essentially be the cloud as to getting back up and running. You shouldn't look at it as an all-or-nothing issue with a server problem.

My recommendation would have a list of scenarios and questions, problems you had in the past with being down and the cloud. But, I would go to their shop to ask the questions. If they immediately come to yours, they may charge or get into bashing your current setup, lol. Of course, they will slightly be biased toward an in-house solution just as AC may be biased toward the cloud. The failover and replication backups using VMs would be ideal. Of course, if you went that route, it would be easiest if at least an IT company set that up and/or you could call them with help in those situations.

CAVEAT: In the distant past, discussions such as these deteriorated into a C/S vs P2P setup. Certainly, P2P is enough to run AC. I believe we got into that too much. We didn't get into both work. What are the advantages to an office that uses C/S. I was about as much to blame for perpetuating this "discussion" and I tried as much as I could to develop flame wars, which only turned out to be "embers." (A slight political statement).

So, we shouldn't get onto that. It should be should you stay in house and, if so, use a C/S setup vs a P2P and what would be most efficient and reliable vs using the cloud. There are many other situations here that would push you one way or the other, but I don't have enough room, and I do not have Bert A. MVP, MCITP credentials and Sandeep-qualified behind my name.

In the end, I wouldn't make any decision without talking to local experts. I would also be right up front with you are looking at various IT vendors looking for advice and possible implementation without resorting to el cheapo, but also wanting to compare. This will keep their prices down some. As an FYI: I lease from a doctor who uses client/server. The score right now is Bert:190 hours plus untangling ethernet cables and reading manuals and on my back connecting and troubleshooting vs Gary's 0 given he has IT. OK, he had one issue. But, I fixed it. But, he never, ever touches it. IT support from a local vendor does all that remotely. But, again, they are still on Win 7. I also do a lot of projects and add software, etc., which helps me tremendously and also goes out of its way to break everything.

HTH.

Hi Gene

We have had AC hosted in our office for years. I don't think it's ever "gone down" except the one time when power was off all night and the UPS didn't last. We had our server and backup system set up by Sandeep. It has been extremely reliable. With the number of times our internet goes out, the in house system is more reliable.

I have to admit if the server does go out, I don't remember how to get the backups restored and I haven't talked to Sandeep in years, so that will be challenging if he's not around to restore immediately. In that case, cloud AC might be better. I'm just hoping it doesn't happen. I probably need to get the servers rechecked soon to make sure everything is good or maybe upgrade it, but I don't know if Sandeep will be available to do this.

Edit: I posted before I read Bert's response. Sandeep set up our backups as in-house. The backups go to an external drive. It's not a cloud backup but then we don't have to pay any monthly fees for cloud. At the time, we didn't choose the replication backup option. Before we hired Sandeep, we had a P2P network and had network problems ALL THE TIME. I could figure some things out but obviously it was not an ideal situation. I recommend hiring Sandeep to set up your server (he did it all remotely, of course) but he might be too busy now? Last time I tried to contact him I didn't hear back.

This is why it is not enough to backup and routinely test the backup. It must be tested as a restore. Obviously, it is not good to do on a production server. There are three good methods to do this.

1. Use a backup solution that can run the backup in a sandbox.
2. Use a backup solution where you can restore online.
3. Have a replication backup to a second server (expensive, but this allows you to weekly check the backup server). Plus if you are down, you simply switch over. With failover, it happens automatically, but I think that is a bit much.

I think restoring immediately would be something that even Google would not want to do. I wouldn't. I would rather have really good UPS on the server and a computer with printing abilities so I could quickly print the rest of the schedule. The paper notes can be put into AC later. Trying to restore quickly in the middle of the day would result in disaster. I would rather get coffee, chill out, figure out when everything happened and restore from there. Then add the notes.

But, here is the thing. Are we talking about a complete crash of the server? Or it is down for some reason. Personally, I would rather try to figure out what happened. Like the Power Supply went down and the redundant one didn't kick in. Or, a cable fried.

You can use VMs (which is the way to go) as you can simply copy and paste them to another server or even computer with Hyper-V. Or you can "restore" what would be backups of a VM to Amazon S3 or Azure, etc. and now you can work from there. I believe the best way to go is to use Acronis and do backups. A little pricey, but you can back up incrementals to Acronis' own cloud servers. These can be accessed and run from.

I think even Sandeep would not want to restore immediately. Plus, you would have to have readily available drives to throw in or slide in if you are using RAID. But, these are all plans you want to have in advance.

Thanks Bert and Serene!

BTW this is post #800 for me

Gene

Don't get too excited. 801 and above is considered a super poster.

Of course, when you reply to this, you will be a super poster. But, don't get too excited. I can go in and delete some of them, lol.

Always break up your posts so you get a higher post count. I would never do that, but I have heard....

Gene,

Send me a pm or an email. I have good news for you.

One option I have if I lose both internet and electricity in the office is that I can still work on my chromebook by making a hotspot on my phone, connect the chromebook, sign in to AC in the Cloud and Updox (just cannot dictate with Dragon) my chromebook has 12 hour battery life and my Phone running as a hotspot I think can last several hours if charged. Not ideal but can get me by if needed, I could also have my wife swing the mifi device which lasts for 10+ hours on a charge if my phone starts to run low. I have not had to use this scenario. However I used my chromebook exclusively for nearly 3 weeks on my mifi device when I had to be out of state and keep the office going. No problem because I had 4g access on the way out and back and my destination. I brought my desktop, thinking I would dictate with Dragon, but never turned it on and typed stuff instead because the chromebook was so easy to turn off and on, wasn't worth the hassle each day.