Roger,
There is a much longer answer, but the short one is this:
Going beyond 6.3.3 requires going from SQL2005 to SQL2012, there is a hefty price to be paid for that, which is just part of SQL2012. There is a secondary price in more Meaningless Usury, but that is less of the issue.
In going to the v8 series, there is a "MU2 Tax" that you will pay, although we are working with AC to address performance improvements so that the impact is minimalized.
You have 3 choices about what to do, but they are all focused on work on the server.
[We are setting aside issues of network, clients, topology, and other factors to focus on the main AC machine]
===A SideBar about Meaningless Usury===
Because Doctors and users regularly ask for it when we bring it up, we have expressed to AC that some would pay more for a "Turbo" version of AC that kept the core functionality and new improvements, but turned off ALL of the MU garbage. That concept is not warmly embraced, because it would take time and money. However, of those folks staying in private practice, more are considering going non-par or leaving the government payer business altogether and just talking what their patients can afford, which they can't do when they participate.
Thus, we believe that more, not less will tell CMS where to place their MU if they stay in practice.
===End SideBar===
So, once you move to SQL2012, here are your chocies.
1.Suck it up and do nothing, or buy newer server hardware
This is really the worst choice, because it will have least effect going forward
2.Upgrade to 64bit SQL2012 Express
We can help you do this, and there are no licensing costs, just labor time to do the upgrade. This will allow SQL to access far more of that memory you already ahve.
3.Depending on your number of users, it may be adviseable to upgrade to SQL Standard. There are licensing costs with this, but dependent on your server OS, SQL can use up to 64Gigs of memory. Obviously, we can help with this if you choose this path.
Depending on a host of other factors, clients begin to see performace impacts starting around 10 users.
Somewhere between 12 and 18 users, the performance [before/after upgrade] becomes significant that they seek us out.
Around 20 concurrent users, the practice begins to experience AC crash-outs, lost charts, and they call or email us.
YMMV, but this something we have been hearing since last year, and now that AC is working with us to address these realities in a holistic fashion, it is appropriate for us to outline the options as lots of folks are looking to finally upgrade again.
The SSD and RAM are fine, and you really don't have much room to upgrade the chip [http://www.cpubenchmark.net/CPU_mega_page.html - socket LGA775 it appears], so the logical place to focus on is your server.
Let me know if you have questions, and we can talk directly.
