Editor’s note: In this post, the technical lead from this Healthcare System explains how his team solved a complex end user performance problem with MEDITECH and Dragon Dictation which was caused by a simple Microsoft update that had not been applied correctly.

This healthcare system was experiencing Dragon Dictation issues that, quite literally, had hundreds of physicians and clinicians outraged.  They simply couldn’t use the dictation system.

Complex software causes complex problems for physicians

Earlier this year, our healthcare system’s Emergency Department implemented a dictation solution, from a major vendor, to help our physicians document their findings in MEDITECH.

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.

Troubleshooting became ‘troublesome’

In a short period of time, however, we began experiencing random failures and error messages in the environment. Specifically, the Dragon Dictation software was throwing up error messages stating, “Cannot find multimedia device.” There was seemingly no pattern when the error message was presented and the software would sporadically stop working.

Troubleshooting was challenging to say the least – mainly because none of the normal application or Windows error logs provided any insight into why the Dragon Dictation software no longer saw the microphone. Making things more complicated, the microphone actually worked outside the application and appeared to be functioning completely normal.

How we 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 of 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 need to occur to clean everything up.

GeneralTel-Goliath-Performance-Monitor

We 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 us to see a trend that would have been otherwise almost impossible to find by looking through individual workstation logs where the error may have only occurred once and would have otherwise been noise and easily overlooked.

If you’re experiencing a similar complex Citrix or EHR end user performance issue and want to see if our software can help, contact us at techninfo@goliathtechnologies.com.  See why they call Goliath the “Standard in Health IT.”

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