Need IT help. Internet slow at work.

[rox]

Oh my a Citrix server? Oh yeah I can see how that would be sub optimal.
Right or wrong I always think of a Citrix server this way. The application runs on the server, the application does the work over there and then what it does is it sends a message back to your computer monitor telling your monitor which dots of lights to light up on your monitor to show you an image of the output of the servers work. Basically it sends you screenshots to your computer of what is done over on the server. There is no application on your computer, the apps are over on the server so basically all you are seeing is screenshots. That is why there is such limited functionality on your side.

 

[N80]

I think what I would do is, instruct everyone to power down their computers & laptops at the close of business. Then I would ask the IT dept to come over after hours and check your system. You can't very well have your entire doctors office shut down off the internet during the day, but at night you can.

Correct. There is no way we could shut anyone down from 7:30 am to 5:30 pm.

In this way the IT dept can check simply the access points with nobody on the network, as mentioned they will probably start with the router.

Sadly, I have no faith in our IT department and honestly doubt that they will do anything at all unless 1) 16 Mbps is, in fact, unreasonably slow (it sure seems that way to me) and 2) I complain to much higher management if 16 Mbps is in fact too slow.

There is a lot of junk cable from China being used. Your access points should be hard wired back to the router.

I remember when it was installed but couldn't tell you anything about it. Each office and exam room is also hard wired.

Ask the IT guys to examine the cables being used in your office for markings of the manufacturer.

I will. But they will laugh at me, if not to my face, definitely behind my back. As mentioned, for as long as I remember they have never fixed _anything_. Management said they were going to fire one of them a year ago because of complaints from all over the region. But he's still the main guy.

A 25 person doctors office is not that large square footage wise

It is actually huge. Two stories, something like 9000 square feet. We used to have 9 doctors in here and 50 employees. We were devastated by the ACA. Now you can't hire a primary care doctor anywhere. Anyway, the size could actually be a problem. Large closets upstairs and downstairs with all the lines,routers, etc etc.

Best of luck to you and don't give up! It's to annoying to have slow internet, I bet you can work this and get it resolved.

Thank you and everyone else for helping out. I'm going to push management hard on this. The EHR (in general) is an inefficient way to do medicine at this point. My volume has contracted considerably since they were mandated by the ACA and seeing fewer patients does not equate to spending more time with them since that time is monopolized by data entry. The net result is less access to care (volume=access!), less time with patients, epidemic levels of physician burn-out and falling income. When you make any worker do less work he likes to do, more meaningless work he does not like to do and pay him less you have a problem. And around here primary care physicians are leaving medicine. Sorry about the rant, but my point is, a slow EHR is an even greater frustration. If I could get some real internet speed with this new EHR, which is a huge step in the right direction, my job will be much more pleasant and patient care much more efficient and appropriate.

 

[N80]

I guess another question I need to ask you guys is: Does 16 Mbps seem unreasonably slow for a practice that runs 100% from check-in to check-out on web based software? If it is normal then I might just have to shut up and accept it. But it is slow in practice, feels slow all day and is slower than my home account. I noticed that even residential users can get gigabit internet for fairly reasonable prices around here.

 

[hawkeye08]

There are many variables and causes, but if I read correctly, all the devices are slow. Are there any security cameras streaming back to remote location? I had a period of slower than normal internet at home and find out by changing to a different DNS server, things sped up.

Things to suspect,

problem with a device consuming bandwidth
problem with configuration
someone outside your office stealing bandwidth (like a neighbor in next office using your network)

Also note, the same provider does not mean you will get the same speed at home, especially if your connection is DSL (the distance to central office might be much different).

 

[/pine]

FWIW...If "logging" is enabled on the router(s)...it should list the bandwidth usage on each node by IP

 

[N80]

Oh my a Citrix server? Oh yeah I can see how that would be sub optimal.
Right or wrong I always think of a Citrix server this way. The application runs on the server, the application does the work over there and then what it does is it sends a message back to your computer monitor telling your monitor which dots of lights to light up on your monitor to show you an image of the output of the servers work. Basically it sends you screenshots to your computer of what is done over on the server. There is no application on your computer, the apps are over on the server so basically all you are seeing is screenshots. That is why there is such limited functionality on your side.

That is exactly what it felt like. Fortunately we are done with Citrix.

 

[N80]

Also note, the same provider does not mean you will get the same speed at home, especially if your connection is DSL (the distance to central office might be much different).

It is the same provider. It is a local, privately owned tele-com company and they has a monopoly in this are. My account is cable modem but according to their map, it is fiber-optic and gigabit internet is available. Again, my account is a 25 mbps download and something like 1.5 mbps upload. I am a few blocks from their central office.

I certainly hope our office is paying for something better than 25 mbps. I'm going to find out exactly what we have if I can. I doubt that fiber optic has reached out to where our office is yet but it might have.

 

[KubotainNH]

If it's all web based and constantly being used then the bandwidth may be too small but you should prove that first. As mentioned, powering down or at least disabling the internet on all the PC's but one to test with should help narrow it down. Citrix is supposed to be faster for people that have a slow connection because all the work is being done at the server and all you see is a picture of it so the only data back in forth is that picture. Sadly it's a pig unless it's got better recently. It's not used anymore at my really large company, most items are browser based now. You may find that it's the back end server that is the bottleneck. Any peer sites that use the same system so you can call and see how fast there's is?

 

[JimRB]

For giggles have you ever been in the office on a weekend when no one else was in and tried this application?

Some cable systems put lots of user on the same connection. The same connection can only do so much. In days of old DSL, was really crummy from 4 PM until 10 PM. Or maybe it was old cable modems.

At one of our country offices they have 20/20 internet that works pretty well with Citrix applications. As mentioned, Citrix is keyboard strokes and mouse clicks, with screen refreshes coming back. Only when scanning does the bandwidth start to get eaten up.

My primary care physician left his hospital affiliation which was using Cerner. He moved to another hospital system affiliation and is using Epic. I have not heard how he likes it. The practice I work for uses Epic from the same hospital system. Some of my doctors fuss and cuss. Others suffer quietly. Some of the doctors use scribes so they can pay attention to the patients. Of course they are not primary care physicians so they have a little bit more mad money to spend on scribes. They also use Dragon Medical when they are not in the exam rooms or procedure rooms. Some guys can talk at over a 100 words a minute.

If you keep fussing about this you will force me to visit some weekend to take a look. Bicycle racing on the weekends for the next month, but after that I am more free.

 

[MossRoad]

You've said your internet is slow... but you never really said how you know its slow.

Is it just your medical software that is slow to respond, or is it all things, like surfing the internet, watching youtube, etc... that's also slow?

And you also have to find out if you're on a VPN (virtual private network) type connection back to your home office, and if ALL traffic goes through that VPN, or just your medical software goes through that VPN.

If you are on a VPN back to your office, then your home office is acting like your internet service provider, and they are the ones controlling the speed, not your local telecom company.

You could have a 50 pipe and only being allowed 15 by the home office.... and that's my guess as to what's happening.