InterSystems and VMware Increase Database Scalability for Epic EMR Workload by 60 Percent with Intel Xeon Processor E7 v3 Family

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1 White Paper processor E7 v3 family InterSystems Caché Epic EMR Software VMware vsphere ESXi Healthcare InterSystems and VMware Increase Database Scalability for Epic EMR Workload by 60 Percent with Processor E7 v3 Family Delivering reliable, affordable performance for healthcare, InterSystems Caché , VMware vsphere ESXi 6.0, and the processor E v3 achieve 7 million database accesses per second with an Epic EMR workload compared to 4.2 million on previous-generation technologies. Moving from the Intel Xeon processor E v2 with Caché and vsphere ESXi 5.5 to the processor E v3 with Caché and vsphere ESXi 6.0, we saw the scalability of a single operational database server increase by 60 percent. With these gains, we expect our customers to scale further with a smaller data center footprint and lower TCO. Seth Hain Senior Performance Engineer Epic Executive Summary From regulatory changes to demographic trends, healthcare systems face unprecedented pressure to deliver higher-quality care in a more coordinated, cost-effective, and sustainable fashion. These changes are causing both the volumes of medical data to grow and the number of simultaneous user requests against the healthcare database to soar. Now, a new generation of technologies from Intel, InterSystems, and VMware offers significant advances in scalable, high-throughput solutions for Epic s electronic medical record (EMR) systems. To explore the scalability impact of these new technologies, Epic and InterSystems engineers conducted a series of performance tests with the four-socket processor E v3, InterSystems Caché , Epic EMR software, and a beta version of VMware ESXi 6.0. Running workloads that reflect realistic healthcare environments, they achieved 7 million database accesses per second (measured as global references or GREFs in the Caché environment) on a single system while maintaining responsiveness for users. This is a 60 percent increase over the 4.2 million GREFs the test team recorded using Epic software with Caché and VMware ESXi 5.5 on the Intel Xeon processor E v2. It is also more than triple the 1.9 million GREFs achieved on the processor E with Epic software, Caché , and VMware ESXi ,2 (For details, see Table 1.) These results highlight the increased performance and scalability of the processor E7 v3 family. They illustrate the synergies that can result when technology innovators collaborate to optimize their solutions and address customer requirements. Building on this next-generation foundation, even very large healthcare systems can implement their Epic and InterSystems software on the Intel Xeon processor E7 v3 family with confidence. By taking advantage of the platform s headroom and scalability, they can accommodate larger patient volumes and a higher volume of user requests against the database on a single, scale-up platform. If an organization exceeds the vertical scalability of the Intel Xeon processor E7 v3 family, it can use InterSystems Caché s Enterprise Cache Protocol (ECP) to scale horizontally. Tests with Caché and ECP technology on the Intel Xeon processor E v2 achieved over three times more enduser database accesses per second than Caché on the virtualized platform based on the Intel Xeon processor E The result of this combination of technologies is steadily expanding scalability that keeps pace with the rising demands on the healthcare enterprise while creating a more reliable, cost-effective and agile data center.

2 Table of Contents Executive Summary...1 Driving the Need for Scale-Up Performance in Healthcare...2 Benchmarking to Help Ensure a Robust Experience for Users...2 System Configurations...3 Workloads...4 Methodology...4 Results...4 Moving Forward with Confidence on a Sustainable Foundation...5 Driving the Need for Scale-Up Performance in Healthcare Healthcare systems around the world are transforming to address a common challenge: How do we provide affordable, high-quality care as our population grows, ages, and increasingly develops lifestyle-related chronic conditions? The efforts to meet this challenge are triggering a cascade of changes. Healthcare systems are expanding and consolidating to achieve economies of scale. They re focusing on teamoriented services and collaborating with community- and home-based health organizations to ensure a positive patient experience across the continuum of care. They re coping with a shifting set of regulatory and reporting requirements, a more complex healthcare ecosystem, intense cost pressures, and higher patient loads. These changes are having a dramatic impact on EMR systems and healthcare databases, which must maintain responsiveness while handling more concurrent users, more diverse workflows, and a greater range of application functionality accessing the database. As a result, database scalability is more crucial than ever to patient care, provider productivity, and enterprise success. Now, a new generation of Intel s most robust server processors provides exceptional scalability, performance, and headroom to help healthcare organizations meet the challenges. By cost-effectively scaling their databases with the Intel Xeon processor E7 v3 family, hospital systems can position themselves to not only deliver outstanding care for their patients, but also thrive in the fast-changing new world of healthcare. Benchmarking to Help Ensure a Robust Experience for Users Epic maintains a rigorous evaluation process that includes scalability and performance tests. Epic uses these results, along with a variety of additional factors, to develop comprehensive sizing guidelines and configuration recommendations aimed at ensuring reliable, productive experiences for users of its EMR software. With the introduction of a new generation of hardware and software elements, engineers from Epic and InterSystems ran a series of tests using the Intel Xeon processor E v3, InterSystems Caché , Epic EMR software, and a beta version of VMware ESXi 6.0. (See sidebar, A New Generation of Key Technologies.) The test engineers compared their results to those achieved with previousgeneration technologies, including the Intel Xeon processor E v2 and the Intel Xeon processor E Tests with the newest technologies were performed in January 2015 at Epic s headquarters in Verona, Wisconsin. Intel engineers provided configuration assistance. 2

3 A New Generation of Key Technologies When Intel, InterSystems, and VMware made major advances in their flagship products, Epic wanted to understand what this might mean for organizations using its EMR software. Epic engineers benchmarked their software using the three new technologies: Processor E7 v3 Family. Intel s newest server processor line, the Intel Xeon processor E7 v3 family is designed for the most demanding, businesscritical computing workloads. Now available with up to 72 cores, it improves scalability through higher performance, up to 12 TB of memory, and a range of I/O enhancements. Meeting the highest enterprise requirements for reliability and uptime, it includes more than 40 reliability, availability, and serviceability (RAS) features. The resulting balanced of high performance and throughput allows for highly scalable platforms. 4 An open, industry-standard ecosystem helps reduce costs and accelerate innovation by offering a broad choice of applications, tools, and peripherals. InterSystems Caché InterSystems Caché is the industry s leading SQL/ NoSQL data platform designed to deliver high performance and massive scalability. Identified as a Leader in the Gartner Magic Quadrant 5 for operational database management systems, Caché combines advanced data management, integration, and analytics. For Caché , InterSystems engineers worked with Intel to take maximum advantage of the Intel multi-core architecture and instruction set. InterSystems code optimizations enhance performance for non-uniform memory access (NUMA), memory management, thread management, and other areas. This enables Caché to optimize its use of CPU resources and increase performance and scalability as the number of cores and threads increases. VMware vsphere ESXi 6.0. VMware solutions use the capabilities of Intel Virtualization Technology (Intel VT) 4 to enhance performance and availability on Intel processor-based platforms. VMware vsphere 6.0 provides more than 650 new features and innovations, enabling organizations to create a highly available, resilient, on-demand infrastructure that can help reduce data center costs and increase both system and application uptime. Higher configuration maximums in vsphere 6.0 allow for a one-to-one mapping of physical cores to vcpus with the Intel Xeon processor E7 v3 family. This empowers organizations to more efficiently utilize the physical hardware and to virtualize highly demanding scale-up applications with unparalleled confidence. System Configurations Table 1 summarizes the test platform configurations and provides the platform-level database throughput (in global references) achieved by three generations of Intel processors. The test team focused on practical, realworld relevance rather than aiming for artificial peak performance. Platforms Table 1. System Configurations Technology Processor E7 v3 Family were configured to Epic s best practices for Caché configurations, and in many cases used default settings and standard system elements such as DIMMs. All systems were configured to ensure that elements such as memory, network, and storage capacity would not artificially limit scalability. The BIOS was configured to run in highperformance mode. Processor E7 v2 Family Processor E7 Family Family Launched May 2015 February 2014 April 2011 Processor Platform-Level Sizing processor E v3 processor E v2 processor E million GREFs 4.2 million GREFs 1.9 million GREFs Application Epic Epic Epic Database Virtualization Number of vcpus Configured in the Virtual Machine Operating System Caché vsphere 6.0 Caché Caché vsphere 5.5 vsphere Red Hat Enterprise Linux* 7 Red Hat Enterprise Linux* 6 Clock Frequency 2.5 GHz 2.8 GHz 2.4 GHz Cores per Socket Total Cores Total Memory 512 GB 512 GB 512 GB Red Hat Enterprise Linux* 6 Memory Speed 2133 MHz 1600 MHz 1066 MHz Network Speed 10GbE 10GbE 10GbE Hyperthreading Enabled Enabled Enabled Intel Virtualization Technology Enabled Enabled Enabled NUMA Enabled Enabled Enabled 3

4 Workloads Reflecting the focus on practical results, Epic has designed the workloads and data sets used in the tests to reflect realistic, meaningful work scenarios of clinicians at large healthcare enterprises. Epic increases the validity and usefulness of the test results by working with a customer site to obtain a copy of its database. (Potential personal health information such as patient identifiers is scrambled, and relevant privacy protections are in place to protect data confidentiality.) For the benchmarks described in this paper, Epic collaborated with a large healthcare organization to obtain a sanitized copy of its multi-terabyte database. Methodology The testing used actual elements of the Epic application suite and their associated database code the same code base used by Epic users, the same suite and scope of enterprise application code, and the same network protocols. InterSystems Caché is configured for symmetric multiprocessing (SMP) operation in a virtualized environment with one virtual machine (VM) per system. Client-side user loads are generated by Epic simulation tools. These user loads simulate the second-to-second activities of a broad range of EMR users, including physicians, nurses, pharmacists, and others. The loads also model health systems scale-up activities realistically, reflecting the addition of more users and application functionality. Epic and InterSystems engineers set out to validate the level of throughput the systems could achieve (in GREFs) while maintaining acceptable responsiveness. They stressed the database by incrementally increasing the volume of connected users and thus the volume of database accesses. As the loads increased, the test team measured system metrics and application response times at each load level. Load levels were considered valid only if the application response times were deemed fast and system metrics remained within a specified range. Results The Intel Xeon processor E v3, InterSystems Caché , Epic, and a beta version of VMware ESXi 6.0 delivered sustained performance of 7 million GREFs on a single system while maintaining excellent response times (see Figure 1) E M GREFs (database accesses/sec) This was 60 percent more than the 4.2 million GREFs sustained with the Intel Xeon processor E v2, Caché , Epic software, and VMware ESXi 5.5. The new solution delivered more than a threefold increase over the 1.9 million GREFs achieved on the Intel Xeon processor E with Epic software, Caché , and VMware ESXi 5.0. E v2 4.2M GREFs (database accesses/sec) E v3 7.0M GREFs (database accesses/sec) Application Epic Epic Epic Database Caché Caché Caché Virtualization vsphere 5.0 vsphere 5.5 vsphere 6.0 Maximum vcpus Figure 1. More Than Triple the Platform-Level Sizing Capacity Over Three Generations 1,2 4

5 Highlighting the significant advances in scalability InterSystems achieved with Caché , global references rose from 4.2 million with Caché on the Intel Xeon processor E v2 and ESXi 5.5, to 4.9 million with Caché on the same system. The test team found that VMware showed minimal consumption of resources as the system scaled (see Figure 2). Even using the beta version of VMware ESXi 6.0, the hypervisor was extremely frugal in its use of CPU resources. This efficiency, along with the increase in the number of vcpus and the size of the VMs, enables organizations to improve scalability and availability while leaving nearly all virtual CPU resources for the VM. Figure 2 depicts raw performance, and shows scaling beyond the 7 million GREFs shown in Figure 1, where more practical constraints were imposed. Tests such as those described in this paper play an important role in the sizing advice Epic provides for its customers. However, many other factors are important. Epic s detailed sizing advice also encompasses factors such as variance across different types of workload patterns, maintaining Compute Utilization - CPU Used% Host_Util Guest_Util 0 1,770,000 real-time replicated environments, and other conditions. To achieve optimal performance for your Epic deployment, consult your Epic representative. Moving Forward with Confidence on a Sustainable Foundation Today s healthcare environment presents significant challenges and opportunities. With rich digital data and intelligent applications, healthcare organizations can improve collaboration and deliver personalized, team-oriented care. With increasingly sophisticated analytics, these organizations can turn clinical data into actionable insight, improving treatment plans and, ultimately, patient outcomes. Empowered with insights, they can improve quality and costs, reducing waste and enhancing the experience for patients and providers alike. They can capitalize on rapid advances in areas ranging from wearables to genomics, envisioning whole new ways of delivering care. The Intel Xeon processor E7 v3 family gives healthcare organizations the sustainable foundation they need to address their challenges and make the most of the opportunities. By choosing 3,430,000 5,190,000 7,040,000 8,080,000 8,670,000 Database Accesses Per Second Intel s newest and most powerful server processors with VMware ESXi 6.0 for their InterSystems Caché data platform, Epic customers gain a powerful, affordable, and highly available platform for scalable, data-intensive computing. With the outstanding performance and scalability these technologies provide, even very large medical systems can confidently choose Intel architecturebased platforms for their critical EMR software and healthcare databases. These systems can support more users cost-effectively and provide answers more rapidly, enabling organizations to potentially reduce per-patient costs, deliver a better patient and clinician experience and prepare to thrive as leaders in a data-enabled, value-based healthcare environment. The new processor E7 v3 family is a huge win for healthcare organizations that want to deliver breakthroughs in patient care while controlling costs. With generation scalability of 60 percent, organizations implementing Epic with Caché get much more power to implement their connected health strategy to link data, applications, and processes, and make smarter decisions and provide the best possible care for their patients. Robert Nagle Vice President, Data Platforms InterSystems Corporation Figure 2. Minimal Hypervisor Impact on CPU Resources (Guest versus Host CPU Utilization) 5

6 Learn More InterSystems Caché Epic Intel Xeon Processor E7 Family VMware ESXi 1 Software and workloads used in performance tests may have been optimized for performance only on Intel microprocessors. Performance tests, such as SYSmark and MobileMark, are measured using specific computer systems, components, software, operations and functions. Any change to any of those factors may cause the results to vary. You should consult other information and performance tests to assist you in fully evaluating your contemplated purchases, including the performance of that product when combined with other products. For more information go to 2 Intel does not control or audit the design or implementation of third party benchmark data or Web sites referenced in this document. Intel encourages all of its customers to visit the referenced Web sites or others where similar performance benchmark data are reported and confirm whether the referenced benchmark data are accurate and reflect performance of systems available for purchase. 3 For more on these results, see Data Scalability with InterSystems Caché and Intel Processors, Intel technologies features and benefits depend on system configuration and may require enabled hardware, software or service activation. Performance varies depending on system configuration. Check with your system manufacturer or retailer or learn more at [intel.com]. 5 InterSystems Recognized As a Leader in Gartner Magic Quadrant for Operational DBMS, October 16, Intel disclaims all express and implied warranties, including without limitation, the implied warranties of merchantability, fitness for a particular purpose, and non-infringement, as well as any warranty arising from course of performance, course of dealing, or usage in trade. Copyright 2015 Intel Corporation. All rights reserved. Intel, the Intel logo, and Xeon are trademarks of Intel Corporation in the U.S. and/or other countries. InterSystems, Caché, and ECP are trademarks or registered trademarks of InterSystems Corporation. Epic is a registered trademark of Epic Systems Corporation. VMware, vsphere, and ESXi are trademarks or registered trademarks of VMware, Inc. in the United States and/or other jurisdictions. *Other names and brands may be the property of their respective owners. Printed in USA 0415/SA/MESH/PDF Please Recycle US