I guess I see the issue as more of a consequence of using SQL Express rather than poor optimization. AC could force everyone to use full SQL and all performance issues would likely disappear. The hard drive speed has always been an issue for many practices. This new version pushes it to the limit. However, adding an SSD is not a bad alternative. I sent this recommendation to Chris Conrad in an email. Making SSD's part of the hardware requirements would help them more than anything. Most other EHR's require you to purchase the full version of database software. E.g. Praxis makes you buy Oracle DB for $5,000 on top of the $10K licensing cost for the EHR. SQL Express is severely capped by disk I/O.

ICD10 has 60K+ codes. These are going to take a toll on your setup. There's only so much you can optimize before improved hardware is needed. People had to upgrade hardware to go from XP to Win 7. I think of this as a similar situation. I mean if they are forcing everyone to upgrade, might as well just get the SSD's. I was seeking a solution to the problem rather than waiting for them to fix it if even possible. They may not be caching the charts but all the new stuff like ICD10 codes which could cause some significant slowdown. It would be trivial for someone on the dev team to track down what it is exactly, but will require some significant time investment on my side to figure out what it is exactly. I wonder if it has anything to do with the new AuthService/network encryption.

Sandeep Luthra | LTMedical.net
2023 Practice Systems now available