Home Forums Discussions Problems Slow Response Time

@Chris

No one is going to listen to you. You have been officially jinxed by the ePrescribe gremelins, thererore, everything happens to you, lol

Doc still suffering from issues but refuses to leave Amazing Charts. Done basically everything I possibly can, including moving it to a standalone gaming rig and still insufferable to use. I think there may be something in his database that is causing the issues, but Amazing Charts support doesnt want to take the time to fix it.

Rock...meet hard place.

Stop blaming AC. Your setup is just wrong most likely. Let a SQL expert come in and measure your query times. It doesn't matter if you put the system on the Pentagon's servers. How much RAM are dedicating to the SQL server? Plus RAID 10 is the way to go. Or at least RAID 10 or RAID 6. Like James said, RAID 10 not used only due to cost, which I doubt is your issue.

We have two SQL experts. JamesNT and the guy I talked about in the private messages. Nothing against James, he knows his stuff. Just giving you another option. Like James, has 20 years of experience working for major companies. You need to have them jump in use SSMS to pull a chart and see if it is SQL or AC. On mine even with Express, the queries are like 2 ms and AC is about 5 seconds. Again, getting back to the amount of RAM on SQL. It needs more than 1 GB of RAM. Probably at least 5 to 10 GB to handle the pages. You are asking AC to bring over a lot of data for speed which, of course, does just the opposite.

Please don't take this wrong, but if this is a problem with your SQL-AC setup, then AC can't fix it. They have probably never seen this problem because it has never happened before. No SSDs, that is a problem. But, still 2 minutes to open a chart? Crazy.

This is my final piece of advice. Not sure what James charges. My friend, just to give a second opinion, is very reasonable. It is your setup, pure and simple. You could have the fastest CPU and hard drives and RAID 0 for speed (no redundancy) and it isn't going to fix the problem. How much RAM is dedicated to Standard?

Someone with SQl server experience could delete your log files and get your space down to 6 GBs. Hire James. Hire my friend (sorry James -- just giving him options based on time factors). This is obviously too difficult for AC -- I don't blame them at all -- and not solved by you yet. Spend the money and have a SQL
EXPERT look at your query times when you pull a chart. I am taking you installed SQL Server Standard yourself. It is extraordinary fast, no limit that know of on RAM or database (I could be wrong), but if someone who is SQL only didn't set it all up, then there is probably an issue there.

We are using SQL 2016 Enterprise and the SQL can use as much RAM as it wants (I dont have a cap on it), but usually it is using about 28GB of RAM.

Damn. That is a lot of RAM. ITFACTOR, obviously I have been following this thread (didn't mean to be so harsh -- just AC probably will have a hard time figuring this out).

It sounds like you know what you are doing. BUT, would you be opposed to having a verified Microsoft Certified SQL Server specialist remote in and look around and see if there are any issues you may be overlooking?

Yea, just ran a test today and the SQL service gets to about 28GB. But I also can assume that he has outgrown amazing charts. He has about 16K active patients, sees about 50-70 patients a day and even his imported items folder (scans) is about 250GB in size. But he has been using AC for about 12 years?

60 to 70 patients per day? It may not be too big. Still think you should take the free offer for my friend who is a SQL expert look around and make sure everythig is set properly. Not sure why you won't do this? Or JamesNT.

See private message. I am really trying to help here.

Actually over this weekend I performed a reformat of the server, reinstalled amazing charts and restored the data and now it seems to be running smoother. Doc is going to test it today but hopefully that fixed it.

That's good news. Hope it fixes it. Pulling a chart really shouldn't take more than 5 to 8 seconds. Especially if you are seeing 70 patients.

There are two mistakes I see.

First, the purchase of SQL Server Enterprise was unnecessary. That's a near $20,000 purchase by itself. Assuming single provider practice, how you got the doctor to spring that kind of coin is beyond me. My clients would have skinned me alive.

Second, the H700 controller. That tells me you are running all this on a Dell R710. You are attempting to run modern software on 2008 model hardware. The H700 simple can't handle the throughput of those SSDs and is choking. You would be considerably better off to get a Dell R740 server with the H750 controller.

You sunk all your client's money into software when it should have been hardware.

JamesNT

He is running a Dell R820 and the SQL is something he got previously before I took over.

But I have tried convincing him to get something newer but he doesn't want to spend any money on it. Much the same to go with something like Athena or some other cloud based EMR as they are too expensive. So basically I'm stuck doing what I can with what I can.

I would request the client show you the purchase of SQL Server Enterprise. SQL Server Enterprise is one of the most expensive things Microsoft sells and they are quite serious with the licensing of that software. Microsoft audits, which I have been involved with 14 of in the past 8 years, go one of two ways:

1. You are missing some CALs, need to get a copy of Windows Standard for the extra VM you are running. No worries, just show us proof of purchase in two weeks and we are good!

2. You have over $20,000 of our stuff in production that you never paid for. We are sending over one of our lawyers that makes per hour what you make per week. May Bill Gates have mercy on your soul.

If the client is pirating that kind of software, you may wish to walk away or at least insist that the client purchase the correct software. SQL Standard is the most you will ever need.

That Dell R820 is still 2012 technology and the H700 is still your bottleneck. All servers I'm selling now are R740 or higher with H740 controllers or higher. But if you are stuck with it, you are stuck with it.

James

If the doc is waiting 90-120 seconds to open every chart, HE (or SHE) is the one "stuck with it".

Hard to imagine anyone willing to live with a set up like that. If they think they are "saving money", they are deluding themselves.

James, how does the Dell T430 with an E5-2620 processor at 2.10 GHz 8 cores 16 logical processors with 96GB of RAM compare with the H740?

@ITFACTOR My recommendation has always been to allow my friend Raja or JamesNT (both SQL experts) assess your setup and possibly remote in to check the configuration of you SQL server. Both are doing it for free right now. You're getting a lot of free advice.

If I were you, I would simply do what James is recommending.

Agree with Jon.

And this is why this board is so valuable.

Bert,

I'm afraid you are not making an apples-to-apples comparison. The H740 is a hard drive controller card, only, not an entire computer.

If you gave me the specs on RAM, CPU, etc. with an H700 controller and then compared those same specs on RAM, CPU, etc. with an H740 controller, you would see a world of difference.

James

I was giving an apples to pineapples comparison. Sorry. Thanks for the info.

I think you're onto something. It's likely something inside AC.

Most server processors and going to be slower than your test bench. If it's slow for one user, it's going to be slower when you add the rest. New hardware won't make a difference.

Upgrading from SQL Express to Standard/Enterprise doesn't really make a massive performance difference given how AC is programmed. Most people end up getting because they exceeded the 10GB database limit rather than performance.

I would dig around and see where it locks and slows down. That will give you a hint of what needs to be cleaned up.

The T430 comes with a E5-2620V4 which is pretty old now. It came out in 2016. If you have a server with that processor in it, the warranty is probably over or is going to end very soon.

Just a heads up

They are covering it at least another 3 years.

Nice if AC reps would chime in:

What processors/storage/architecture is AC cloud running?

Does AC play well with AMD cpus?

Is AC essentially single threaded? Then 2012 20-core slowish processor will choke on multiple users.

Is there an upper limit to self-hosted database size/user #? If so how does AC cloud circumvent the issues?

We could ask Jon Bertman to help interface with AC? Come up with our top 10 questions / requests for AC

I am confused. How is it an Amazing Charts issue when no one else has the problem?