Home Forums Discussions General Discussion Amazing Charts perfect but....

Probably said this before, but it is so weird, thought I would mention it again.

First with the new network, AC hasn't crashed or frozen in over a month. It runs as it should.

However, one time out of 15, when you open AC and log in it just disappears. Doesn't crash or given an error message. Just goes away. You have to go to Programs and Features and right-click and select change and repair. That will take care of it. Very strange. Wonder if it is a Windows 11 incompatibility thing?

Mark@AC?

Glad to hear things are running a little smoother for you. The disappearing AC thing is something tech is aware of. Currently the fix is running a repair as you have done. Not sure if this is related to Windows 11 or not.

I know our upcoming version, V11.2, has been tested on Windows 11 and it works. That should be coming out soon.... and has a lot of other really awesome features that should get the users excited. I don't know how much I can say without getting into trouble with Chris Conrad, but its going to be a good release. Some the features were even recommended by the UBB (that's all I am saying for now).

I'll post details once I get the ok.

That's awesome. I was hoping it was a known bug. It sure is freaky.

@ Bert what new network? Give us deets on your stable setup please. Server version, hardware, etc.

Well, first I will give a few details on the other. It used to be that I had a pretty fast server with two VMs. One was the domain controller, Active Directory, DNS and DHCP server and the other what is known as RDS (remote desktop service) (the old Terminal Services. Everyone would remote RDP into the RDS server and the apps would run from there. Think of RDPing into your computer at work. Only keystrokes and mouse clicks but the apps all ran on your computer. With RDS one app is used by all the users in sessions. The benefits are installing only one app like one AC, but you weren't taking advantage of running the app from your own more powerful computer. The VMs were also on regular spindle hard drives and not on SSDs. There is debate on that, but I find it slower. Anyway, the negatives outweigh the benefits. Remote Desktop Services is meant for more of a company with 1,000 users and the IT can simply manage the one RDS server. It was driving me crazy so I changed. Took a lot of time and money but I made the switch and the difference is amazing.

I got all Dell clients with 16 GBs of RAM, N2RVM M.2 NVMe 12 Gbps SSDs (cards) in a with the top-of-the-line Intel i9s. Started wit Win11 Pro, which I find faster than 10 Pro anyway.

For the server:

2 times 512 GB SAS SSDs @ 6 Gbps in a RAID 1 for the OS which is Windows Server 2019 Standard Hyper-V
2 times 1TB SAS SSDs @ 6 Gbps in a RAID 1 for the VMs.
1 VM with the DC, DNS, AD and DHCP (Windows Server 2019 Standard)
1 VM with all of the Apps and databases including SQL Server for AC. (Windows Server 2019 Standard)
96 GBs of DDR4 Buffered RAM
2 times Xeon CUP E5 2560 2.1 Ghz (older server -- probably the weakest link in the server)
Of course all Cat6 cables using a 26 port LinkSys PoE Smart Switch for the computers and printers
1 Eight port Cisco PoE Smart Switch for the VoIP phones and wireless via Ubiquiti
pFsense with the latest OS for the firewall/router
Bitdefender Antivirus/Malware/Ransomware for the VMs and Windows Defender for the Hyper-V and the clients
Veeam Backup and Replication for backup of the VMs (although sorry - sorry JamesNT - considering switching to Altara).
2 local backups (one USB air gapped) and one to another server, one online nightly and one to take home weekly.

FINALLY!! One Microsoft Certified IT specialist with 30 years of experience in networking to set it all up CORRECTLY

The remote for users is RDP via VPN with two factor authentication to satisfy HIPAA.

I got the Dells on sale, the Dell Server was already here and was upgraded to the 96 of RAM, the OS was already on 512 GB SSDs, just swapped out the data drive to SSD so the cost wasn't that great.

The key thing is the IT specialist who will let an error message slide by for a day but has to stamp it out by the following day.

It sounds like a lot but I had a lot of it and the Dells were the most expensive and the IT support available 25/7 via phone/text/email.

The setup is smoking fast and the program just hums along. If the prescription writer wasn't written the way it was and SQL didn't bring over all of the inactive medications for each patient), you wouldn't know it was AC.

Of course, it helps to have a membership with Experts-Exchange and to make the necessary registry hacks to nearly make Windows 11 appear and run like Windows 10.

@Mark@AC,

I'll handle Conrad. Say what you will on this forum.

JamesNT

hey Bert-

What kind of RAM did you have on your workstations prior to your most recent workstations/server upgrade?

On occasion, my staff report that AC just shuts down in the middle of the day on their workstations with little warning (other than hanging for a few seconds). I work on the server as my workstation, and I have had that happen to me on occasion, but not very often.
Were you having this issue prior to your upgrades?

Just trying to narrow down what might be causing the random AC shutdowns in the middle of the day.

Thanks!
Dana

I do not know the specifics of the computers and not t the office to check but will chime in. You are not alone.

Some of our machines date back to 2011, Dell and Lenovo! Our system is more stable now with MS updates and the latest version of AC 11.1.4. We do still have the occasional shut down but less than in the past.

We are run peer to peer with 6 desktops and 2 laptops. Both providers use a desktop and laptop which speeds things up a bit and the office staff all have 2 screens. I have a newer LG laptop and was having it lock up around 11-12 every day but that has resolved itself the last few weeks. It has Intel(R) Core(TM) i5-10210U CPU @ 1.60GHz 2.11 GHz with 8 ram and seems to work fine 99% of the time. Everyone that uses it loves the keyboard, sounds weird but true.

The workstations all have 16GBs of synchronous DDR4 RAM. Shouldn't matter too much. AC should be able to run in most RAM configurations. Hard to say what causing your shutdowns. AC is a program that opens multiple windows to do certain things which I am sure increases the chance of crashes. My only thing was AC disappearing when I went to log in. It still happens occasionally but much less often. Once it happens on a given day, it doesn't usually happen again on that machine.

Amazing Charts will always be a slightly buggy program. One just has to learn to live with that. This is my opinion only, but I think AC can find the bugs but it means a new update, and as you can see from the board lately, updates and upgrades aren't always plug and play or just click and install the update in minutes without a thought.

Yes; as I've often said, "Better the bugs you know..."

Bugs are to be expected. We all learn to wait for a fix, live with the bug, or develop work arounds.

The big disappointment is product development.
Put aside mandates and upgrades dictated by tech requirements... tell me the 5 biggest improvements to the program in the past year. Or three years. Or five.

I have thought about creating a separate thread about this, but did not want to appear too negative.

If anyone is best for this it is you. You have a way with words. Starting a new thread can only be productive.

Jon,
It sounds like the next version has a few "big" changes in the scheduling portion of the program and prescribing. I hope some of the prescribing bugs get fixed at that time. That being said, the newest version should be out already but as usual we are waiting.

One improvement that happened within the last year or 2 was the addition of the whole visit template. I don't use it often but it could be useful if I would remember! Old habits are hard to break and I just go back to y standard templates and change what I need.

Bert et al, server optimization questions:

You running SQL express or Standard? How many simultaneous users?

Express can only use 1-2Gb cache RAM, 1 cpu max 4 cores + minimal parallelism.

SQL express limits

Given the limits, guessing that SQL express would prefer faster clock speed over higher core count and fast queue depth 1 SSD database access to compensate for limited memory cache. I'm trying out an Optane 905p which has fastest random queue depth 1 speeds (should be ideal for SQL)

For start up and erx start time (which sends a lot of info) maybe 2.5Gb networking will help? Or are we limited by AC server software?

Anyone test for which components make the biggest difference in AC performance?

When you click on the prescriber and it takes five to six seconds to open, and the query took 8 ms, you will gain little or no speed using standard over express. Nearly everything is limited by the software.

I was looking at an online EMR. It's $350 per month per physician and $200 per month per mid-level. That includes the EMR, practice management and the reminder texts to patients.

We pay $155 for AC + more for eRx + 125 for Medware which isn't even PM, and $75 a month for texts. Which is $5,00 more than the other EMR. Of course, there are add-ons.

Or you can have two doctors and each note is 50 cents so 20 patients would be $10.00 for the one physician and $10.00 for the second if she did 20 patients. If you add a doctor, there is no other fee for that doctor, just 50 cents a note.

The nice thing is testing. It is 50 notes a month for free for eternity until you are ready to start. I looked at it and since I have received over 150 emails (about 2.5 per week) talking about webinars and conferences and this and that. It has the best knowledgebase of any I have seen. And, the templates you can put into the notes are very, very good.

yes but do they have a users forum.........

Yes, kinda, but it is pretty weak....

I would have to start one there

Hosted?? Say it ain't so Bert. You'd be cursing general lag and random outages out of your control.

Your server and machines would be reduced to mere web-surfing clients. An insult to your good silicon.

Is this Charm? I wish we had some clear value-priced market leaders in the EHR space. AC was that player years ago.

Well you don't have much choice if you move to another EMR. There are still some that let you choose client/server. But, more and more things are moving to the web. When I tested six different EMRs, all of them were in the cloud. They are smooth and allow a greater amount of things that can be done.

The only downtime would be one's Internet provider (rare), and the company's servers. I am not sure if you can back up locally, but the backups would all be done for you.

Whether you are in the cloud or your own platform, I would just love updates and major version upgrades to be automatic. Something you woudn't think about. Like in Medware, Quickbooks, Adobe, My communication software to name a few. I don't even look at the update. I simply update it, and it updates from v6.132 to v6.286. It is done without thought, because the chance of introducing bugs and SHOWSTOPPERS are nearly non-existent. This is for several reasons, but one of the main reasons is proper beta testing. Anyway, I am going regressing here.

Bert have you looked into Office Practicum or PCC? They are pediatric specific and from what I've heard, the pediatricians and staff using them love them. We've never demoed bc our doctor will be retiring in a few years and doesn't want to switch right now. A lot of our complaints with AC are related to how it's not for pediatrics AT ALL.

Thanks for the tip. I will check them out.

I added up all the recurring expenses we have for AC, PM software, clearinghouse, automatic reminders, telehealth, IT support. It costs $1365 per month for us with just 1 physician. Now the other EHRs that was over $1000/month (but can do most of these other things that AC does not do and we have to pay extra for) are starting to look good.

I completely agree. When you look at many of the other programs, Charmhealth for example, it is easy to see where the savings are. Just looking at the fact that we pay $75.00 a month for text reminders and many do it at no cost....there you go.

Most of the cloud versions are like Firefox and Microsoft Edge, etc. When you open Firefox every week, it will say adding updates, you hardly have a choice. Perfect. ALL of my other programs, when they come out with a new version, I simply install it. I don't wait for others. There is no penalty for using a different computer: some you have to take off one computer to put it on another. They don't have to install it.

Some will have a bug, but then they put out a patch and it is fixed within days to weeks at the most. Why? Because their beta testing is robust. A large group of users who get some reward, generally a year of support, to do ALL OF THE STEPS THEY HAVE OUTLINED MULTIPLE TIMES. You don't just use it and randomly send in bugs or talk about it on a forum. Showstoppers stop the release.

Every upgrade, if you are smart, you have to wait and see what happens to the brave souls who have gone where anyone else fears to tread.

On another note, change the default to "unspecified" instead of "Add UOM" or whatever it is. Would save a lot of time. Just have it tab to the pharmacy comment section and leave the UOM unspecified. Of course, you can get around this by simply taking the plunge and entering either 6.7 grams, 8.5 grams or 18 grams for an albuterol MDI. Or if you know that the small box of albuterol is 20 containers of 3 mLs a piece, you can write for 60 mLs.

Bert,
Do you have any pricing on Charmhealth?
Is it all cloud-based on can you host in our office?

It is all web based. Most EMRs are web based, although some give you both options. I demoed about six, and this was the best one, although I haven't looked at Office Practicum which is pediatric based. I am sure there are others that are similarly priced. (Whether web based or in house, updates to most EMRs are seamless with likely a few bugs which are corrected with patches or quick updates). I also left a message with sales to find out if dictation into Charm is possible which would likely be a big thing with a lot of practices and consultants.

We looked at one provider = $350 per month. We used to pay for:

Text reminders (without email option) 75.00 per month
Billing software: $110 per month
eRx, EPCS (with support) $150 per month (priority email and chat support included in Charm price) (not sure about phone call support)
QuickBooks in cloud $25.00 per month

What we pay now: $360.00 per month

With Charm:
Provider plan $350 per month
QB in house (I can't remember what we paid)
* to be fair even expensive EMRs like Athena Health, we would be paying something like $450 per month

*** If any biller/coder/office manager out there uses QB in house if you could state how you pay for it.



$350 per provider
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