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The biggest slowdown in our office comes when the front office is scanning in piles of correspondence and old records -- this is done sort of in batches as they have time. That seems to suck resources and slows down the performance in the exam rooms. Does SBS fix that, or is it a property of the database program that AC uses? Or would I be better off just sticking with Win7 and getting a faster "server" machine?

It's probably the network then. If you're scanning to a folder on the server. On a 100 megabits it only has about 12.5 Megabytes to distribute among all the computers on your LAN. When you do those large scans, sometimes the output files end up being 20 or 30 MB depending on the resolution. Scanning one of those would consume all of the bandwith intermittently, resulting in slowdowns. Also with the server handling DNS, DHCP, and all that other good stuff. Your router is basically acting as internet gateway. All traffic goes between the computers/server and the switch