Healthcare System

Health System Isolates Root Cause & Resolves EHR and Nuance Dragon Dictation Speed & Reliability Issues 

Infrastructure

Citrix XenApp, Windows 7, Nuance Dragon Dictation 

Challenge

Complex software causes complex problems for physicians 

The technical lead and his team from this Health System needed a solution to help them identify and resolve a complex problem impacting speed & reliability of their clinical applications and Nuance and Dragon Dictation, as well as clinician experience. This Dragon Dictation issue left hundreds of clinicians outraged and with no ability to use the dictation system. 

The health system’s Emergency Department implemented Dragon Dictation to help their physicians document their findings in their EHR. 

“Given the complexity of the Dragon Dictation software, combined with the complexities of our Citrix XenApp-based Windows 7 desktops leveraging roaming sessions, we had many challenges presenting a USB microphone in the Citrix session and getting the dictation software to recognize the device and work reliably. After a significant amount of engineering by some of our talented staff, we felt we had a stable environment, and the Dragon Dictation software worked reliably.” 

Solution

Troubleshooting became ‘troublesome’ 

Terralogic, a managed service provider selected Goliath Technologies due to its embedded intelligence and automation for monitoring and troubleshooting Citrix and the end user experience for their managed services customers. Goliath automatically discovers the entire Citrix delivery infrastructure, identifies what to monitor, the thresholds to set, and then alerts when thresholds are exceeded for all potential events, conditions, and failure points. 

How they used Goliath’s Event Log Management Software to Troubleshoot & Remediate 

“While pouring through various log files during our troubleshooting process, we utilized Goliath Technologies Event Log Management Software and fine-tuned the filters to see what we could uncover in Windows application logs. With the help of Goliath’s software, we uncovered a relatively new and previously unseen Event ID 1000 error in the Windows Application Log that referred to a GeneralTel.dll faulting module.” 

“GeneralTel.dll has nothing to do with the microphone audio from what we could tell, but we traced back a change related to Microsoft KB2952664 where an update to the GeneralTel.dll had been applied.” 

The update in question, KB2952664, has been issued from MS several times and it appears that running a single uninstall of the KB does not remove ALL installs of it. It took multiple uninstalls to get ALL the updates cleaned off the systems. The team built a script that runs during login, checks for the presence of the generaltel.dll file, and, if it finds it, executes a command to uninstall KB2952664. Unfortunately, the actual uninstall does not take place until the next reboot, so a few reboot cycles needed to occur to clean everything up. 

Results

The issue was caused by a simple Microsoft update that had not been applied correctly. They used Goliath’s Performance Monitor Event Log Viewer for troubleshooting because it consolidated all the logs across our Citrix virtual desktop environment. This aggregated view allowed them to see a trend that would have otherwise been nearly impossible to find looking through individual workstation logs where the error may have only occurred once. This would have appeared as noise and easily overlooked. 

If you’re experiencing a similar complex Citrix or EHR speed & reliability issues and want to see if our software can help, contact us at techninfo@goliathtechnologies.com.  See why Goliath is the “Standard in Health IT.”