This document summarizes performance testing done on various hardware platforms for running GE Centricity EMR and CPS software. It discusses testing of Wintel, HP, and IBM systems using different processors, storage options like SSDs and SANs, and virtualization. Recent Intel processors and SSDs show promise for improved performance. Consolidating servers through virtualization is also discussed. The document outlines hardware requirements for supporting a given number of concurrent users and provides example workload performance data.

1. GE Centricity EMR / CPS
Platform Architecture
Performance – Chris Hays &
Steven Oubre, GEHC

2. Centricity EMR/CPS – Platform
Architecture Performance
• Overview of various platforms / architectures on
which performance characterizations have been
done.
• Wintel, HP, IBM
• SAN: NetApp, EMC
• Virtualization: VMWare, HyperV, IBM LPAR, HP
• Latest developments show promise for improving
system performance
• latest Intel / processor architecture
• SSD
• Virtualization
• De-valuing Trend (platform simplification is inevitable)
• HP-UX/AIX

3. Platform Architectures
OS Platforms
• Wintel – is it ready for the “Big Time”, HP & IBM
are big players, $$
• HP/UX – Itanium to *finally* get Nehalem memory
improvements in 2010, $$$$$
• IBM AIX – Power6: very fast, very scalable, $$$$$
• Virtualization – Wintel (VMWare, HyperV)
Storage options
• SAN (traditional, Left Hand, options, options, and
MORE options) $...$$$$$
• Vendors have solutions at a variety of $ points

4. Interesting Technology
Developments that may improve
Performance and Scalability
• Intel architecture
– Nehalem, Nehalem-EX (>=2 sockets), Westmere
• Solid State Drives (SSD – not your camera
flashcard or USB jump drives)
– Intel, HP, EMC, IBM, Dell…
– You get what you pay for (more IOPS = more $)
• Virtualization
– Platform/Server consolidation opportunities
– Customer implemented already

5. “King of the Mountain”
• 1998 – HPUX PA-RISC (only EMR-supported 64-
bit platform)
• 2000 – IBM S80 (EMR scaled to 4400 concurrent
users during load simulation testing – pre CCC)
• 2005 – 4x DC Opteron / Intel (CPS only) ~1K users
• 2008 – HPUX Itanium2 / HP DL785(Opteron):
~5000 concurrent CCC/eRx users on 32 cores (full
rack SAN storage)
• 2009 – Intel Nehalem (55xx Xeon series) ~5000
concurrent users on 8 processor cores (local SSD
storage)

6. Platforms supporting 2000 EMR /
1000 CPS users
• Wintel
– 2x Intel Xeon X5550 qc or better, 5+ X25-E SSD (size according to
db growth), 2+ large SAS drives for archive / backup
• VMWare
– 2x Intel Xeon X5550 qc or better, 5+ X25-E SSD (size according to
db growth), 2+ large SAS drives for archive / backup – additional
Nehalem performance compensates for virtualization overhead.
• HP (EMR only)
– 14x1.66 GHz Itanium2 cores, 24MB L2 cache, 5+ HP SSD (size
according to db growth), 2+ large SAS drives for archive / backup
• IBM (EMR only)
– 8x5GHz Power6 cores, 4MB L2/ 32MB L3 cache, 5+ HP SSD (size
according to db growth), 2+ large SAS drives for archive / backup

7. Storage IOPS for various SSD and
SAS Drives
• Traditional 15K rpm spindle – 180 iops
• EMC SSD – 2500 iops (1 million+ hours in
production)
• HP SSD – 5K write / 20K read iops
• Intel SSD – 3.5K write /35K read iops
• Lower end SSDs are available, however iops,
performance, and reliability are lower than the
enterprise-rated SSDs

8. Workload IOPS per 1000 Concurrent
Users
Steady state measurements:
• 2K per second transaction/archive log iops
• 1K per second random read iops
• 200 – 500 per second random write iops
eRx (ePrescribing)
• 90K iops for large eRx formulary set load/reload
– Depending on patient/insurance demographic, may be a lot of these.

9. What if we fill a Rack with SSDs?
120 x 143GBx15Krpm HDD => Intel X25-E SSD
From Intel’s IDF2009:
• IOPS => 36,000 => 4,200,000
– Per device 200HDD => 2,500 (EMC, HP, Intel are 2,500 or more)
• Sustained BW 12GB/sec => 36GB (3x increase)
– HDDS good at sequential writes
• Watts => 1452 => 288 (5x reduction)
Acoustics
– SSDs significantly quieter: 0 dB SSD versus 3.8 bels (is it on?...)

10. 10 /
GE Title or job number /
09/08/15

11. Data Set Sizes
Database sizes:
• 5 GB to 620 GB
eRx dataset (ESM 3.1.1 allows scheduling window for updates)
• September 2009: 6000+ formularies
– 30GB data set, 120GB of transaction log/archive
– Typical customer load is 10-20% of this
• December 2009: 24000+ formularies
– 60GB data set, 180GB of transaction log/archive
• Changes monthly, quarterly, annually (constantly in
flux)

12. Large System Testing Environments
In-house:
• 8 core Power5+
• 8 core Itanium2
• 8 core 55xx series Xeon, 24 core Xeon (74xx
series)
• New in 2010: 32-core Nehalem EX, 12 Core
Nehalem Westmere
Off site:
• IBM Virtual Performance Center: Power6 systems
• HP Labs: Itanium2 / x64 (Intel and AMD)

13. Simulated workflows for Performance
and Scalability Testing
• EMR (with / without CCC and eRx):
– Front desk/Registration
– Nurse
– Physician
– DTS
• CPS (with / without CCC and eRx):
– Front office / Scheduling / Registration
– Back office / Billing / Visit Mgmt
– Chart (Nurse, Physician)
– DTS

14. Interesting Data Points
XEON EMR/CPS Workloads
• 1x5520 runs similar utilization to 2x5420 (Oracle,
SQLServer, Loadrunner workloads)
• Xeon 5420 similar per core utilization to Itanium2
(Oracle workload)
• Power5+ IBM 570 in-house is poorest scaling 8 core
platform – loses to rx6600, Xeon 5420, Xeon 5520. It
also costs more than all the others combined.
CCC adds 4x to 10x DB SQL traffic for
measured workflows.

15. Questions?