Home Forums Discussions Problems slow transition between tabs

I see about 40-45 pts/day, about 15 of which are new. I find myself waiting in front of the computer for between 4-10 seconds (yes, I have timed it) transitioning between tabs, such as past encounters, imported items etc. The Reminds tab in particular takes between 15-25 seconds to pop up. When you multiply that by the pt's a day I see and the number of times I click between tabs it is becomming maddening. This adds at a minimum an hour to two hours a day I am standing in front of the computer waiting. I have almost 5,000 pt's and have not yet been using AC for a year. I have a high end server (windows 2003)with a xenon chip, six workstations w XP pro Lenovo 1 gig ram each, and we are hard wired network. Is this just a function of Access or the mass of material I have already accumulated? IS there any solution? Will the eventual change to SQL make a difference. My backup is already about 30 gigs with imported items (lots of pictures). HELP!

when was the last time you did a compact/repair of your database with amazing chart utilities. Whenever we have a slowdown issue, this has resolved it.

Sam the change to SQL may help. But more importantly the normalization of the database. Database normalization rules demand that the database exist in 3rd normal form (3NF). This means that there is no duplicated data between tables. This can be difficult to do especially where the records must maintain an historical integrity.

If AC has ALL THE CODES (ICD-9). There are nearly 20,000 of the codes. The average doc probably does not use more than 200. The average patient health record does not contain more than 50. However a bottleneck in the design is that everytime you open a patient record it has to match those 50 records against the 20,000 codes...every time. A more efficient design would be for AC to only have the 200-300 most utilized codes (which are specialty grouped). This way the two matching sets are smaller.

It is easier to find 50 from 200 than it is to find 50 from 20,000.

I had this problem when my network was ailing. The genius, the so-called expert, whom I *paid* to set up my network had the server connecting *wirelessly* to the wireless router. This obviously created a terrible bottleneck. I was blaming it all on AC -- I thought I had bought a lemon. The good news is that it forced me to learn a bit about networking.

G. My problem is that in Family Practice I don't have just two hundred that I SHOULD be coding. I used to code only a small number because that was all that fit on the Superbill in type that I could read. But I follow my patients for a wide variety of things and frequently code things for follow up that cover a much wider range of topics than many specialties. You may be right, that I am never coming close to 200, but I think I am. The little yellow reminder tab is only REAL slow the first time you open it on a work station, then it is just regular slow. (LOL)

Could the design have two places to look? Look first in "my favorite 200" then if necessary go to the full 20,000. And when I use a new one, add it to "my favorite 201" etc. ?

Absolutely. That's what I think. I think we should be able to search like we do on the patients on the main screen: active vs. inactive.

DocMartin,

What I would recommend is that each doc be able to set up his "codeset" from an online master code collection. If you need to find a new code, you can find it in the master collection and add it to your codeset.

This way ONLY the codes you use will be found.

But I would have to go to the master set every day, at least once or twice.

Yes but over time you will need to go fewer and fewer times. You have a choice. You can have everything and have slow performance or build your system to match your practice. In my opinion, you have no need to search the cardiology codes or the neurology codes, everytime you need to apply a code.

g- I see your point, it sounds like it would be a lot faster. Going to the master list would be how slow? Any worse than the Google option we have now? I use that many times a day with no pain.

Doc the speed depends on the design. I know nothing of the next generation software.

I'm not an expert on this stuff, but it sounds as if you have a good setup. May be you could maximize the ram. Is it possible to set up a virtual drive and access the ICD codes from it? Also, there was a thread about having th AC program loaded onto each work station and the patient files loaded on the servor. Would that improve performance?
Tom

Listen, I have a mediocre server with last-generation PC's, some wired, many wireless, all running peer-to-peer, and the same ICD-9 database as everybody else has. I don't have this kind of lag.

OK, I am a bit confused. There are great recommendations on ICD-9 codes and favorites, but I don't see that in the question. I could be reading it wrong. If I am looking at the right place, the "Reminds" tab is not a tab but an icon that opens a window. This is different than the tabs across the top. To move between tabs, the lag should be less than a second, although this is still rather slow as it should be much less than that.

The times you are describing are WAY too long. There is DEFINITELY something wrong. It sounds more like a network issue than an AC issue. To troubleshoot, do the following:

If you have AC installed on each computer, change the path of your AC on any computer directly to the database on THAT computer. Set up that way, it should run fairly fast. Lightning fast compared to over the network. That will be YOUR fastest speed you can EVER get on your network. Accessing it from another server whether peer to peer or a client/server setup will always be slower. So, if that is much faster, then it is a networking issue (although slightly contradictory).

So to answer your questions, although I will need more information from you:

Yes SQL will speed up the network signifcantly. With SQL, the query will take place on the server rather than sending the entire demographics, visits, etc. to your client to read.

How much RAM on your server, although probably doesn't matter a lot. Are you using Cat6 or Cat5 cable.

And, the biggest question of all: The comptuers are probably all connected to the server via a switch or hub -- possibly the router. Are you using a switch or a hub. And, what is the speed of each? Basically, we need to know the speed of:

Your network cards
Your switch
Or, do you have a hub (hopefully not)
if so, throw it as far away as possible and get a switch.

Now, I have about 1/4 the patients you have. 5,000 patients translates to a much bigger demographics table, a much bigger visits table, a much bigger everything. While Access will accommodate 2 GBs, you will notice an appreciable slowdown in speed even when close to that. Again, the entire database you are querying has to traverse the network.

I'm surprised that you are able to use a 30GB backup mdb back-end at all... the MS Access limitation is 2GB, for both Jet 4 and for MSDE. Check out this article here- http://sqlserver2000.databases.aspfaq.com/what-are-the-capacities-of-access-sql-server-and-msde.html . I believe in taking things to the limit, but this is way too extreme.

Bert asks very pertinent questions about the cards, switch/hub, cables, etc. you might wish to try the newer 1000 mbps cards, switches, and cables. BTW, what type of CPUs do the Lenovo clients have?

If you get rid of the pictures, then compact your back-end your system should fly. With a Jet 4 back-end you shouldn't have any pictures- none, nichts, никой, कोई नहीं, καμία, nada, لا شيء, rien, nic, ingen ting, 何もない, niente.*

I've seen well over 15000 patients over 20 years with a partner, and without pics my back-end still is under 100MB. As you can see from the article above, it's not the number of patients, diagnoses, etc... it's the overall size of a database which is the problem.

Are the pictures that important to you? If so, you might wish to place them into a container of choice, s.a. OneNote, Evernote, GoBinder, Powerpoint, PDFs, or Word and make virtual "charts" of graphic files. You can use Windows Explorer or any other of the many document management systems (do a search on emrupdate for the numerous threads on DMS programs).

*versions of "none" thanks to Google Translate.

I wish I had been talking to you guys before I bought my server. It sounds like Sam will have the chance to find a problem, (a hub perhaps?) just by a little poking around. I am not sure we could have found the bad cable, but it would have been nice!

Sam, I had this problem on my desktops. They all had 1GB RAM, so I recently bought more from www.crucial.com. Now all desktops have 2 GB RAM, and everything runs WAY smoother. I would consider this strongly.

I have a problem that could be one reason affecting a slow transition between tabs.

A couple days ago I ran a battery of tests to see why a computer which my associate uses runs Microsoft Access somewhat slower than the computer that I use. Here are the specs to his computer:

-- bare-bones computer, 3.4 GHz CPU, 2 GB RAM, 80 GB Seagate EIDE HD. The HD runs with a 7200 RPM rotational speed, and has 8 MB of onboard cache memory ( http://www.wdc.com/en/products/products.asp?DriveID=301 ).

Here are the specs to my computer:

-- Dell desktop with a 3 GHz CPU, 2 GB RAM, 500 GB Western Digital SATA HD. The HD runs with a 7200 RPM rotational speed, and has 16 MB of onboard cache memory ( http://support.dell.com/support/edocs/storage/P93472/specs.htm ).

The test that I ran showed that his computer (the 3.4 GHz desktop) was indeed faster in 2-D and 3-D graphics as well as mathematical computation. This software, though, could not test of HD read and write access.

One particular form which highlights the flawed EIDE HD compared to the faster SATA HD is shown by this applet which is a hyperlink form that looks into a Windows folder, gathers up all files in that folder, and displays them as active hyperlinks. A working applet of this form can be found here -- http://www.box.net/shared/static/w0juje9kwg.mdb.



The tool that I use to check to compare the actual speed of my computers to his other computers from the Celeron to the dual core computers can be found here -- http://www.passmark.com/ftp/petst.exe (it's use is free for 30 days).



Next week I'll be placing in a SATA drive into his computer... we'll see if that makes the big difference that I think will occur.

Anyone discover this problem before? Could this be the answer to the slowness noted in this thread?


(Case of the Week, new to the AC Forum-> do you know what this is? )

Alborg before I start changing the harddisks, I would want to know what other differences there are between machines WHEN THEY ARE RUNNING. Are they running the same programs at start-up? What processes are running in memory...are they the same?

Remember that windows uses a process called TimeSlicing to load programs into RAM before they are processed. So depending on how much is running an app may run slower on one machine than the next.

They are running virtually the exact programs- ZoneAlarm and Skype. Both have WinXP Professional and all the XP updates.

TimeSlicing- learned something new about multitasking! Unfortunately, can't do much to change any variables (see http://www.technologyquestions.com/...time-operation-dos-emulation-mode-2.html ).

I will check, though, to see if the virtual memory settings are the same (they should be, though).

What is neat about the Hyperlink applet is that it's a MS Access front-end intensive program that does not involve any of the back-end tables, LAN or other external processes. It can isolate the speed of the processes in the front-end computer system. Any more ideas?