Once you've installed the Digidesign HD1 Accel Core Card, there isn't anything that you need to do. It will do it's well and without errors, like it is designed to do. It can support sampling rates up to 192 kHz and will run even faster if you have an HD 2 or HD 3 card to go along with this. However, the HD1 card is all that is necessary to run Pro Tools HD in terms of core cards. While the Pro Tools HD systems that I've used have had at least two HD cards, I can't say that I've ever had an issue running as many tracks and effects as I'd like in a Pro Tools HD system.
Since I don't own a Pro Tools HD system at home, and therefore do not own a Digidesign HD1 Accel Core Card, I never had to install it in a computer on my own. All of the studios that I've worked out of have one of these, but it was already installed and set to go, so there wasn't anything that needed to be done to get it going. It doesn't seem like it would be too hard to install one of these, but again I can't speak from experience.
The Digidesign HD1 Accel Core Card is really something that is more of a necessity than a choice for Pro Tools HD users. If you want a Pro Tools HD system, you need this! If you're just running Pro Tools LE, this isn't necessary. I can't really say anything about the bad about this, except for the price, which is really a lot. However, if you're putting together a Pro Tools HD system you should already understand that it's going to cost you a good amount of change. Overall, the Digidesign HD1 Accel Core Card is a powerful piece of gear that runs Pro Tools HD in professional studios everywhere.