GE Centricity EMR / CPSPlatform Architecture Performance – Chris Hays & Steven Oubre, GEHC

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

Platform ArchitecturesOS 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

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

“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)

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

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

Workload IOPS per 1000 Concurrent UsersSteady state measurements:• 2K per second transaction/archive log iops• 1K per second random read iops• 200 – 500 per second random write iopseRx (ePrescribing)• 90K iops for large eRx formulary set

load/reload– Depending on patient/insurance demographic, may be a lot

of these.

What if we fill a Rack with SSDs?120 x 143GBx15Krpm HDD => Intel X25-E SSDFrom 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 /GE Title or job number /

05/02/23

Data Set Sizes

Database sizes: • 5 GB to 620 GBeRx 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)

Large System Testing EnvironmentsIn-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 WestmereOff site:• IBM Virtual Performance Center: Power6 systems• HP Labs: Itanium2 / x64 (Intel and AMD)

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

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.

Questions?