Home Forums Discussions Problems SLOW Program

It's a trade-off security for speed!

>>> That being said, people buy what the need. There are those people who need support, and I recommend they pay for it. I don't so I won't.

Alas, this is true. It's such a waste of money, though. Also, while one waits for a techie to come to your office, everything IT remains dead.

>>> 680 Insperion duel core also with 4 gigs of ram and the same coverage to. And this one only went for about $1200

I just looked at some of the Dell laptops, and WOW!!! Some come with just about the same configuration as my son's desktop for about the same price. Amazing!!! And they come with 17" screens, too.

>>> Paul I am extremely wary of "terabyte" drive configurations in anything except RAID5. Paul I am extremely wary of "terabyte" drive configurations in anything except RAID5. The reason is very large drives are difficult to back up. If they are not backed up and they fail...that's a lot of stuff to lose.

I never thought of those issues.

You can place several partitions covering several computers on your LAN. Overall, though, I don't see me using them anytime soon. I'd rather still ghost drives on the same computer, locally.

George,

I had two extra drives and a RAID card. One extra system board. There is still nothing like a next day 24/7 warranty. My problem with mine was a crossover shorted out Video card that I would have never figured out as video was fine.

If your warrant can be bought for under $150, I will buy it for you. Friends are friends. Think about it.

Bert

It all comes back to your level of comfort and knowledge verses the importance of the machine. Now that I have an extra laptop I guess we could live with one down for a few weeks while I try to repair it myself. But if we were tight on computers and need it now, or it is the only file server, then one needs go reliable service. That is also why I am glad I do have an extra tower now, in a pinch I could always put the AC folders on one of the extras, the old one and get by for a day or two until the main one is back up and running.

Comfort level, how critical is it, and knowledge and obviously we are all playing with and paying attention to all of these in our own way. But keep up the banter, this is how we all share ideas and help keep each other safe and running....

Paul

Clients are one thing. I have no warranties. An actual server which your entire domain is on, would benefit from a warranty. I found out the hard way. There is a huge difference in having parts available (HP will send them overnight) and having a problem with your server due to an issue that can't be fixed by us. There is also a difference between a domain setup where changing the "server" for the databases is quite a chore and a peer to peer where you simply copy and paste the database to another PC and change your paths.

But, these is just thoughts to think about.

>>> There is also a difference between a domain setup where changing the "server" for the databases is quite a chore and a peer to peer where you simply copy and paste the database to another PC and change your paths.

That's what I like about a P2P, ideally suited for offices where you will always have no more than 10 concurrent clients logged into one computer (a WinXP limitation). If my server goes down, I simply point everyone onto another computer!

Definitely a benefit of a peer to peer where you also get the collected bandwidth of all computers.

So where are the real advantages of the extra expense and learning curve of a server again for micro smalls like us again??? Sounds like you just blew half your argument out of the water to me...

Now about this 10 peers things. I was under the impression that the limitation was only on XP home, cheapo version, not XP Pro or Tablet (really just a version of Pro anyway). But I have heard this one point bantered back and forth and nobody seems to know for sure.... I'd love a real rock solid, final chapter and verse answer on this one point. And I have heard various finite numnbers for the max number of peers as well... Half a dozen, a dozen, now 10... I'm so confused.....

Hi Paul:

Yeah, I agree- people tend to buy servers like they were buying Maserati's. If they have any limitations, it'll be with Jet 4 rather than with a server hosting the back-end tables.

Anyhow, WinXP Pro limit is 10; Win XP Home limit is 5 for peer to peer networking. This means the max Home will see is 5 other machines. Win XP Home cannot join a domain, either, plus it has a host of other restrictions (including restricted login permissions).

It's discussed here, for example:
http://www.computing.net/answers/networking/xp-network-size-limitation/23912.html

Numerous other Google sites discuss this issue, although it sometimes seems to be like a needle in a haystack!

So it sounds like the amount plus one, so a single machine and five other peers, so would that mean we can have one file serving machine and ten other peers too??? So in reality it is 6 total for home and 11 total for Pro???

But again, if one has two or three decently fast hardwired peers, at a moments notice anyone of them can jump in and become the file server for a small AC office and almost never loss a beat. As with a dedicated server, server down and BAM, you are dead in the water... So why would any of us truely micro offices really want to incure this added expense and EXPOSURE no less??? Personally, I'm shooting for creating the best, full use, P2P network I can create, much like DocM is shooting for his perfect patient record.

Servers have their place, but after all I have learned about the usefullness and ease of use of P2P networking unless I'm hosting my own content at a massive scale, I'm sticking with my little baby network. Now having decent equipment so they can all talk quickly and nicely with one another is never a bad idea, but one would want that in a server enviornment anyway. But now I have the best "D" day plan availible, an entire extra working machine just waiting in the wings to take over in a pinch. Now that's dual redundency....

Shooting for the perfect P2P network,
Paul

Paul,

As Al states, XP Pro is a limit of ten. If you are using one database such as Access and one program, peer to peer is fine. If you are using an office which needs a file server, application server, possible web server (although never a good idea to support a web on your main server and possible Exchange Server (numerous advantages), then you need a server. A server in and of itself has many advantages with way greater throughput. Also, a server sits there doing its job for weeks, sometimes, month at a time with barely a hiccup for the reasons above and not needing to be tweaked that often. It also tends to run a server-based OS which offers things like Active Director and a domain controler. Running a domain on a network, although harder at first, again, has numerous advantages.

But, like the volkswagen vs the Maserative, some times all these aren't necessary. If one were first deciding, sitting down and weighing the advantages of each would be helpful. While a volkswagen is nice, I think given the option of the two, if someone offered me a $4,000 server with a $500 OS, a $1,000 back up program, $1,000 or more Exchange (all of which come with SBS), possible Sharepoint (company web), Active Directory, and extremely more redundancy than a peer to peer, it would be hard not to go for the latter.

Just my three cents.

Servers aren't that much of a learning curve. Sometimes you have to break down and pay the IT guy $500 to set it up.

No question we would be peer to peer if we could. There are sixteen employees (counting the Docs.) and some days as many as 3 Residents and a student. There are 22 computers on our net and we have a lot of managed care, all of which now uses the internet for authorizations and referrals.

We went P2P cause it had to be something I could put in, I could do it fairly quickly, was low cost. It fit the bill, but I do understand what you say about "higher reliability" in the server. Cause I get glitches all the time with our network that I solve by rebooting the machine, and I suspect if I had a real server sitting in the corner being left alone these things wouldnt happen so much.

With some time & effort, and probably some emails from you guys I could prob. get a server up and running. I just need some time and monney to do so. And we only currently have a max of 5 pcs and a printer running at any one time, so I"m not too pressed.

I am a little confused. But, why would you go peer to peer with 22 computers and a limit of 10 PCs peer to peer with XP Pro. For me, a real server with server/client (although AC is not truly server/client within its own structure), would facilitate 22 machines on a domain much better than a peer to peer.

Wayne -- you are right. Multiple reboots on a peer to peer seems likely. Is anyone using the pseudoserver. That would be not good. Which brings you back to a dedicated machine hosting the data and do you want that being an XP machine or a server machine with Server 2003 or 2008 or SBS 2003.

And, yes, we could help you set up a server, although I would recommend someone being onsite. I could do it if I were close enough. Or, again, get an IT guy. We have to start looking at the network guy being part of the whole package.

I agree with Bert that the client-server best optimizes your resources. Small Biz Server should fit the bill for most practices using AC. However, as I have watched this thread go to 6 pages now, about primarily one thing: slow performance.

The issue as I see it is in the architecture. Until the architecture is changed, you will keep throwing bigger and bigger hardware to try to solve what is essentially an architecture issue.

It would be interesting from a technical perspective to know how much the mdb file grows with each day of work. Remember you have to pull the entire file to your client every time you use it. So if the file growth is significant, it may be a matter of months before your new super-duper server starts to slowdown.

George is completely correct. Look at the architecture first not your hardware.

One thing though. Once set up, your AmazingCharts.mdb database should grow rather slowly unless you have quite a few doctors. For instance, after five years with two doctors our database is 80 Mbs.

I shouldn't even be on this thread as I am so ignorant in this matter. Forgive me Bert, I was trying to say that we would, If We Could, be peer to peer. And we could, if we were one Dr. with a front office, back office laptop and one on my desk, (four) The mess we have belongs on a server, period. To many people and many are looking at the net, (using epocrates, looking at x-rays, getting authorizations, etc.) But as I gain more knowledge here, I am suspecting that we still could be using a much smaller, and simpler server, Oh well.

Well, I have looked at expensive alternatives to the problems with people getting on the net. Of course, if you take out the default gateway, then can still see computers on your network but can't access the Internet. The problem there is they can't use Google or other helpful sites.

After using these expensive alternatives on expensive OSs, I finally just changed to (yes believe it not) high-tech NetNanny. It works and it monitors everything.

I have a fine line between people's having fun looking up Yahoo for a second and being on eBay for an hour.

But, I will tell you this, IF you even need help setting up a domain with SBS, I would be glad to help.

I will give you two biases about people helping you, and you will see it with the BEST IT person ever and you will see it on here:

1. People who help or charge for IT tend to recommend hardware and software and setups that THEY are comfortable with. Why would I recommends Windows Server 2008, when I have never used it. I couldn't help you.

2. People who help love to live vicariously through those who help. For instance, I would recommend A RAID1 for OS, RAID 5 with a hot spare for data even though I have only a RAID5.

Bert,

A very good and inexpensive alternative to netnanny is the D-Link SecureSpot. This baby protects up to 4 computers and provides a hardware content filter.
http://www.dlink.com/products/?sec=0&pid=486

It works!!!

An alternative to netnanny is SpecterPro. This works either for employees or your teenagers.

http://www.spectorsoft.com/products/SpectorPro_Windows/

"Awarded PC Magazine Editors' Choice
Spector Pro has been awarded PC Magazine Editors' Choice TWICE as the best Internet monitoring software for recording computer activity. PC Magazine reviewers stated, "Spector Pro offers the most powerful and complete assortment of monitoring and reporting tools."

Eric, the Issue I have with the software based content managers is that they can be defeated at the pc. The Hardware based ones are placed between your internet connection and your router.

Your PC --- Router --- ContentFilter --- Internet

As you can see, the end user has no direct contact with the content filter. The only way for them to bypass it is to physically remove it.

George,

That is true, except that the averague user does not know how to access Device Manager, the Command Prompt form the Run Command, do a Print Screen to Paint, etc. Most of the software applications can be hidden well enough to stop the "average" user. Besides, while I suppose I can discipline someone from abusing the Internet policy (although difficult with allowing them some freedoms), they would be in quite a bit of trouble in they uninstalled or changed settings on a program. And, that's the beauty again of a domain. You could completely shut off their ability to use or change a certain application. But, you do raise a very valid point.

Bert,

The average user may not know how, but the average 15 year old and/or his friends do. I've had this experience first hand! lol

Yes, but we have no 15 year olds or their friends working for us.

Monitoring software on the PC is OK as long as you don't give your employees or kids administrative rights. Restricted, user level permissions should be the rule otherwise they could indeed circumvent or outright disable the monitoring. Also, if you have a laptop that can be used away from your content filter, you would need locally installed software to have successful monitoring.

There is another software package that I didn't mention, called Systrack from Lakeside Software, that I personally had deployed on several thousand clients with great success and no circumvention. However, for a small medical practice, I think that the SpecterPro would be more advisable as it is easier to deploy and gain useful reports.

Talking about limiting your kids access to tech. I just went up stairs to check on the kids. I had earlier taken my daughter's Nintendo DS away for playing when she shouldn't (she was playing in the bathroom doing you know what, when I kept calling for her because I was serving dinner).

Well I went upstairs and could tell just from her body position that she was awake and had something of interest under her pillow, as always. It was her little brother's gameboy that he had left in her room. So I'm like, "Naomi what do you have under the pillow?" "Nothing"... So I go into Bugs Bunny mode... "AH ha, so he's hidin' in the stove!" Being properly raised to apperciate the finer things in life, and smart as all heck, my beautiful little girl immediately knew what I was referring to and started to laugh, "No, No he's not hiding in the stove", "would I throw a lit match in there if your nintendo was in there???" "You might daddy, you might"

If only it was as easy as taking it away from them... I can't wait 'til they get a bit older (ahhhhhhhhh!!!!!) And George I am not a bit suprised that "your children" already know how to hack into the defense dept servers to "play a game of thermo-nuclear war".... I'm sure daddy taught them too well...

Ah, kids gotta love 'em....

This is a good reason for offices to use server-client network configurations rather than P2P. Better control over group policies and privileges.

Hi, this is my opinion about Server and Citrix

I just joined the board but I have used A/C for 5 years already.
I agreed with Bert that Log Me In is not as solid as Citrix or Terminal services. I have considered Citrix before but I think Terminal Services has more advantages.
Basically, when you used Terminal Services, you run application
as if you are in the same room with the server. (same with CItrix). We have two offices with a third location for billing. We used VPN with Firewall SONIC devices. The bandwidth is 1.5 Meg up and down. Up means the direction of data from a site back to the server like UPLOADING, down is from the server to the other sites.
Pay more attention on the UPLOAD traffic then download.
Once I reduce about 30 % of UP bandwidth and increase significantly the DOWN traffic, it still slows the systems completely.

We have now 2 T1 in the server site, T1 in each site.
We have about 35 users logged at any time, with Voice over IP.
Our systems are almost always up. I have to reboot it maybe once every 3 months.
I do not use Citrix, so I cannot compare Terminal Services and
with it but I think Terminal Services are better choice for us
because for almost the same cost. you have a full local computer
that can do a lot of things such as word processing, scanning.
Right now our Amazing Chards database is about 500 Meg
the ImporItems folder is about 31 Gigs, with 150,000 documents and about 16,000 folders.It is still fast enough.

The reason that Terminal Services enviroment is faster because
only a small number of data of the keyboards are sending back
and forth from the remote desk to the server.

Ciao

CYL

Completely agree. And, the key again is that most on here would need help setting something like this up. And T1 speed and connectivity is essential. T1s dont necessarily have to run over the public Internet.

As I have watched this board especially this topic I am increasingly dismayed that people, even the most brilliant of us, are so willing to reject things we are not experts in.

I was FLAMED for very first issue I raised about AC: the architecture. I suggested a SQL Server DB Architecture would allow the program to run optimally.

When I suggested a web interface HockeyRef found it very "offensive." Missing the point entirely that an INTRANET application would still allow you to OWN the app and run it on YOUR servers.

So far here is what I have seen.

One Doc spent 8,000 on a server. Why? To make AC Run FASTER. This is an architecture issue, SQL Server would solve.

Another Doc is paying for 2 T1 lines, a minimum cost of $600/month - That's $7200/year. To be able to run AC from multiple locations. Again, the addition of infratructure to solve what is fundamentally an architecture issue.

Another Doc wonders if it will work on a Mac. An issue which can be addressed by a web wersion.

Everyone loves AC because everyone believes "THEY HAVE A STAKE" in it. They were there at its conception, and have influenced its development thus far. Any suggestions from an outsider as to how to improve the application is greeted with derision and flames!

Those people who rave about the low cost, completely miss the fact that others are spending huge sums to get it to run optimally. Over a 5 year period, CYL will spend 35K on T1 lines, to run a great little EHR that didn't cost much.

My point here is a very simple one: while everyone loves the useability of AC, it appears people have ignored performance issues. Taking offense to issues of architecture that impact performance only means throwing more money at hardware and infrastructure.

Is George talking about you, or me, Bert?

But seriously.

I know there are people here who agree with what you're saying. They're just not posting about it (tsk,tsk). Contrariwise, the disagreements provide the stimulus to make your points more and more clearly, until even I can understand them!

I don't entirely disagree with what you're saying, but there are a lot of other issues to be considered.

As far as SQL goes, Jon's doing it. It's in process. And, not being an expert, I can only trust that it makes a big difference.

Meanwhile, Jon is also working on creating Health Maintenance and Practice Management features for the program. These features have been long-requested and long-promised.

I have stated many times that my sincere hope all these new capabilities do not compromise AC’s main function, or distract from its main mission, to help the struggling primary care physician whose life sucks.

The appeal of Amazing Charts lies not only in its affordability, but in its simplicity.

The road to hell is paved with good intentions (forgive the cliche), and the path to an EMR becoming bloatware is very wide, and most EMR companies are marching right down that path.

I understand that users demand more features, and a lot of these enhancements must happen. But, how do you make something more complex and still retain its simplicity? It’s not impossible, but it’s very, very difficult, which is why most people aren’t doing it.

Add a little more complexity, a little more cost, and you put Amazing Charts on a progressively higher shelf, out of reach of the struggling docs who need it.

My secondary concern is that there are still a lot of areas where the core features of AC need polish, and I don’t want those issues to get overlooked as we begin to work out the details on these secondary features.

As to the two examples you mentioned:

One guy is using T1 technology to deliver Amazing Charts to a much larger group of doctors than it was intended for, and good for him! However, if you "improve" AC to be better for that situation, what about the guy that keeps his whole practice on his laptop, and depends on ultra-low overhead for his cash-only practice?

The other guy spent more on his server than he probably needed to (sorry, Marty!).

Gee,
I'm sorry, I'm sorry, I'm sorry. But the issue is none of the ASP vendors directly want to sell you a copy of the program so you can still have and hold and that is where we got hung up. yeah, hosting your own, sounds intertesting and perhaps like a decent solution long term for many people, perhaps even ourselves. I only know of one company and they do it thru VAR's not themselves, that will host for you ala ASP model while actually insisting that you purchase working licensed copies of the product.

Now that we are clear and as of our phonecall no less, we actual share this desire to control and own our content, (George and I are kissing and making up, don't tell our wives, OK?) I myself and perhaps many others might like to hear more about your hosting and remoting via high speed internet to all clients and or peers.

We are about to probably purchase a PM module to take back control of our billing before we go broke. Whether we do today or in the near future I would love to hear more about your host AC and your PM.

Now G-Money you quoted me some very cheap prices for hosting a simple blog the other day (and I will get back to you on that shortly, just need to take care of my practice, promise). Now are you talking about similarly inexpensive rates to have someone like yourself "host" our programs on their servers for us, do all that basic back up, and other more headache care issues for a similar price structure? So now we only have to all have as many PC's of our choice connected to the net to always have access to our programs and data at almost any location around the world?

Same Idea... how hard or expensive would it be for folks like ourselves with different levels of understand and ablility to sort of do the hosting oursleves from our own little servers. Then we could either network in house and access via hosting out side the office or to other office sites? Am I now getting you or am I still office base here???

Once George and I spoke on the phone it became clear that he and I share a lot of the same concerns and desires about content control and control and access to one's data. As much as I enjoy banging away at the keys here sometimes, It's amazing how quickly a phonecall over this type stuff can clear things up.

Brian, I understand and share your concerns. If Jon's development with the next version of AC is to MODULARIZE it then the users will be served well. This is what I mean:

Build the core module of AC to be the best at what it does now. Polish the rough edges.

Add new modules, whose code interacts with the database but the code is a separate and distinct application.

So you would have:
The Health Maintenance Module
The Practice Management Module
The Document Management Module
The Vaccine Tracking Module
The Web-Schedule Module
The Hospital Charge Capture Module
The SmartDevice Module
The Online Medical History Module
The ECG/Holter Module
The Data Visualization/Graphs Module
The QuickBooks Integration Module
The Peachtree Integration Module
The HealthVault Integration Module
The GoogleHealth Integration Module

To name a few...
BTW, all of these modules DO NOT HAVE TO BE DEVELOPED BY JON. They can be developed following GUIDELINES which are MANAGED by Jon. In essence Jon would develop an Amazing Charts SDK (Software Developer's Kit) which would allow developers to EXTEND THE PRODUCT and add features.

This would also increase the number of features of AC while allowing users to only purchse the modules they need!!!

It also allows Jon to have a community of developers who have a vested interest in the success of AC, but not the overhead of having to hire them.

HockeyRef,

When it comes to hosting your Practice Management app, I strongly recommend you do it IN HOUSE. There are SERIOUS HIPAA when that data begins to traverse the internet.

That being said, I am in full agreement with Bert that Small Business Server is the best way to go. Hire a professional to set it up with your PM application and you should not go wrong.

Oh for those people who constantly sing the praises of MySQL because it's "free/cheap" please take note of the following: SUN Microsystems purchased MySQL last year for 1 Billion dollars, yes, I said 1 billion dollars. If you believe they paid 1 billion for a RDBMS, to give it away for free...that bridge is going on sale in New York...

I agree with you George. And, at the risk of doing what we all do, which is to second guess Jon, I think the product would be much better served by adding modules which add to the functionality of hte product and not links to labs all over the place.

The SDK kit is a great idea. There are a few of us out there already with software written to work directly with AC. And, Jon is rightfully worried that it will cause problems with the database or support issues. But, this is not necessarily the case as there is something such as Let The Buyer Beward.

Great example: Microsoft Outlook certainly has "hooks" for all sorts of addins. I used to use Sperry, but I think their code must be done in less than an hour. You could add one, but add another and Outlook would crash. But, I kept track as most would that I had just added a product and now Outlook didn't work correctly. So, I uninstalled the product. Most troubleshooting algorithms in the knowledgebase would suggest turning off your addons.

So, the same would work with AC. If the user purchases a module or addon that causes the program to crash, then the user goes after the author of the software. There are, of course, issues with database data, but that can be worked with as well.

No argument from me on your last point, George.

Bert wrote: ""Jon is rightfully worried that it will cause problems with the database or support issues"

The SDK would solve the problems. Let's say for example Jon developed Amazing Objects. Which would be a series of objects which would expose the data and provide access to manipulate it but not provide direct access to the database. For example the Amazing Patient Object, would expose the patient demographic data. It would allow Methods and Properties for each "patient" some of those methods would allow an external application to get the patient demographic data, and consume it, say for a document management system.

The Amazing Schedule Object would expose the scheduling component and allow an external app to consume and write to the schedule tables. Because all of these would be handled by Jon's objects, the external program will have to BEHAVE in a manner that is CONSTRAINED by THE OBJECTS.

In development we purchase COMPONENTS every day. We don't change the core functionality of those components...we simply integrate them the way we want to.