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CDR Performance

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Contents

Issues

Several issues have been brought up in the forums, regarding performance of the CDR engine. Here are the forum threads:


Summary:

  • Patient Summary page widgets related to CDR are slow
  • Notable, this gets slower as the number of patients in the database increases(this has been fixed).
  • Also, the other non-CDR related widgets(with ajax calls) appear to be slowed down by the CDR related widgets(ajax calls).
  • CDR engine based reports are slow
  • So far, the Administration-Reminders reports has been reported to not work with a patient database size of 4500 users. Suspect this issue will also be encountered in other CDR engine based reports. (this has been fixed, albeit the reports take a very long time)

Plan/Fixes

Jquery Optimization

  • Awaiting feedback if this helps performance of the larger databases.

MySQL Optimization

  • Partially related to mysql indexing.
  • mysql indexes below have shown to drastically improve performance of the Patient Summary page and other CDR engine related pages:
  • 'pid' and 'type' indexes on the 'lists' table
  • 'pid' index in the 'form_vitals' table
  • 'pid' index in the 'forms' table
  • 'pid' index in the 'form_encounter' table (only in the upgrade script)
  • 'patient_id' index in the 'immunizations' table
  • 'patient_id' index in the 'procedure_order' table
  • 'pid' index in the 'pnotes' table
  • 'pid' index in the 'transactions' table
  • 'patient_id' index in the 'extended_log' table (stores disclosures)
  • 'patient_id' index in the 'prescriptions' table
  • The above indexes have been added to OpenEMR 4.1.1 development version and the database upgrade script for that version. It was also included in the most recent 4.1.0 patch.
  • Apparently checking redundant diagnosis codes in mysql standard rules. Since it is checked via LIKE %.Value.% then seems like no need to check redundant dx codes (for example, for diabetes ICD9:250 is checked, so seems to be no reason to check the more specific codes ICD9:250.xx). Can probably remove/optimize these all for the diabetes and HTN codes.

Code Optimization

  • Remove php time limit for scripts:
  • openemr/interface/patient_file/reminder/patient_reminders.php
  • Place set_time_limit(0); php command at top of script under the require_once stuff
  • The above time limit mod has been added to OpenEMR 4.1.1 development version. It was also included in the most recent 4.1.0 patch.
  • Also plan to add the set_time_limit(0); to the CDR report script
  • The above time limit mod has been added to OpenEMR 4.1.1 development version. It was also included in the most recent 4.1.0 patch.
  • Add a non-ajax batching mechanism to decrease memory usage and improve performance. (included in 4.1.1 patch)
  • Incorporating session optimizations ( session_write_close() ). (included in 4.1.1 patch)
  • Have the CDR engine sql queries bypass the logging engine. (included in 4.1.1 patch)
  • Consider optimizing the diagnois filter/target code within the library/clinical_rules.php and CQM/AMC class functions(basically building a middle layer).
  • For example, could aggregate the diagnosis filters query check into one query (rather than doing a query for each check).
  • Consider incorporating the above non-ajax batching mechanism into a ajax mechanism which would allow progress monitoring and possibly improve performance (this may not be very helpful since already incorporating non-ajax batching):

Testing

  • Debug and reporting from users/developers/vendors with large databases.
  • Can either do this via tools(such as Firebug, XDEBUG, KcacheGrind, and/or monitoring sql query freq/time) or via observations and reporting of the following:
  • Going through adminstration->alerts and working through the rules one at a time.
  • Set as Patient Reminder to test the Administration->Reminders page or the Patient Reminder widget on the Patient Summary page.
  • Set as Passive Reminders to test the Clinical Reminder widget on the Patient Summary page.
  • Testing all the reports in Reports->Clinical to see which ones are running fine and which ones aren't
  • Reporting the results in one of the above sourceforge threads or on this wiki page (when reporting, very useful to know the size of the following mysql tables: patient_data, form_encounter, form_vitals, lists).