An unstable NHS clinical system

[soopytwist]

I work in NHS primary care and use a clinical system called EMIS Web. For sometime it has become increasingly unstable, freezing, crashing and more specifically running out of memory. Support for the past year has been almost non-existent with all of their workforce working from home and unwilling to escalate problems beyond “turn it off and on again”. For a software system so critical for safe patient management this is completely unacceptable and you only have to read through the constant streams of Facebook group post from irate users to understand how widely this is affecting practices across the UK.

For my pennies worth I’ve long suspected, despite it being known as a 64 bit application, that it is 32bit software running in 64bit Windows 10 (apart from the practices that are still, unfortunately, on Windows 7!!).

Is there a sure-fire way to check if an application is 32 or 64 bit? I have admin rights in Windows 10 so I can dive into protected folders, unlike most of my colleagues.

All our Dell PC’s have only 8Gb of system RAM. This should really be enough unless EMIS Web only has access to half of this, or less than half. This may explain the constant crashes and messages of “ran out of memory” - although recently things have become so unstable that it doesn’t even have enough memory to display this message and simply exits without warning, often during a doctors consultation, losing everything - several times a day, for everyone.

If it is a 64bit application, does it have enough from the paging file? Or is there a memory leak - how would I check that?

I feel like I need to do something. Things are stressful enough trying to organise and run Covid vaccination clinics without these constant disruptions. Other than talking to NHS Digital directly it is a total waste of time brining my concerns to the developers of the software who are unwilling to discuss these issues beyond the simple “workarounds”.

[alms]

Sorry to hear about your woes.

Is there a sure-fire way to check if an application is 32 or 64 bit?

The most simplistic way to go about this, is to check if the program has been installed under Program Files.

On an AMD64 system, 64-bit applications go under Program Files, while 32-bit go under Program Files (x86).

If the application has been installed into a different folder, there are two other easy ways:

1. would be to check whether the executable ends with 32 or 64, as sometimes this reflects the architecture of the build.
2. the other, to open the Task Manager (Ctrl-Shift-Esc) and check the Processes tab whether, next to the program’s name, it says 32-bit between parentheses.

If all else fails, select the Details tab of the Task Manager, then right click on the column header, click on Select Columns, and a put a check next to Platform. Finally click OK.

This will result in the information being unequivocally displayed for each application that is running on the system presently.

Broadly speaking, an OoM error might be caused by a number of circumstances. You might be able to find extra pointers in the Event Viewer, or in the app’s log files, assuming you can locate them.

[BillButNotBen]

It sure doesn’t look like it should be needing 8Gb of ram…

I can’t find much useful about it, other than people complaining about crashes from 2013 onwards(!)

Process Explorer used to be good for tracking down root causes of issues, but I haven’t messed around with that kind of thing in years and so I’m not sure if it’s still recommended. Alms probably knows. I’d check the Event Log first.

Process Explorer - Windows Sysinternals

(There are also a few other tools there like VMMap or RAMMap that might be handy, but they’re all pretty technical. )

Would it be worth messing around with things like Windows Compatibility settings or running as an administrator etc…? It’s unlikely to help, but if you have a spare PC you can use to mess around with and try everything… I’ve heard stories of running as admin fixing memory issues with older software.

If so, you could also try using MSCONFIG to switch to Diagnostic Startup or Selective Startup with stuff disabled and just check it’s not clashing with something else on the PCs.

MS also has something called the Debug Diagnostic Tool which you can point at a process to capture info. Might need to google a tutorial on using it though.

Is the ‘out of memory’ error a windows error, an application error or a specific EMIS Web error message?

[alms]

Process Explorer is still great, but definitely not needed/overkill for this task (actually most tasks, as Task Manager in Windows 10 is also fairly good).

Winternals has been incorporated into Microsoft but that was a long time ago, and I’m sure you are aware.

Besides software, Russinovich also writes horrible novels so don’t read them, if you ask me

[soopytwist]

I can remote access over Virtual Desktop while I’m at home this weekend but that isn’t going to help, I need to be on my work PC. So I’ll have a poke around on Monday.

@BillButNotBen The OOM message is an EMIS specific error. It says “There is not enough available memory for EMIS Web to remain fully functional”. And gives two options: to continue and hope the error goes away (it doesn’t) or close it (which it does and then often gives a KD error number). On rare occasions the OOM message comes just after large red crosses start to appear on areas of the screen and icons disappear.

Having said that though, recently the OOM message no longer appear, EMIS Web just quits.