CDR Performance

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

Our experience with the new OpenEMR 4.1.0

OpenEMR 4.1 is very slow

Patient Reminders (4.1.0) fails on large db

Issues

Patient Summary page widgets related to CDR are slow

• Notable, this gets slower as the number of patients in the database increases.
• 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.

Plan

Jquery

• Upgrade Jquery, since this should improve the ajax calls from the main patient summary screen, hopefully avoiding the CDR-unrelated ajax calls from being effected by the CDR-related ajax calls. Note this has already been done by yehster in the 'master' branch: http://github.com/openemr/openemr/commit/a23f3e34e5410f4cdd61f3304b9e0900a8c3e699

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

MySQL

• Potentially related to mysql indexing since performance gets worse as the number of patients increases. Awaiting further testing/debugging to locate performance bottlenecks before taking any action here.

• Proposed mysql indexes (It has been confirmed that these indexes drastically improve performance of the Patient Summary page and other CDR related page)

• '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

• If add indexes need to also include in the upgrade script and can take advantage of the SHOW INDEX and CREATE INDEX mysql commands to do this in a safe fashion.

Code

• Potentially related to coding. Awaiting further testing/debugging to locate performance bottlenecks before taking any action here.

• 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

• Also add a javascript processing animation to the scripts that will take awhile.

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).