Cloudflare or equivalent for performance?


Has anyone implemented Cloudflare or something similar to help with performance? I realize that the majority of the CPU usage will come from mysql and clourflare will only help with static resources, but I’m looking at ways to optimize the performance of the site. Plus the security and analytics aspect of it is an added bonus.

Are there downsides to using something like this with Clouflare? Are there a sort of standard set of optimization settings you would recommend? I’m still on php5.XX. Does 7.XX run better? Etc.

I do see CPU spikes, but not high enough and sustained long enough that I would think it would consistently hinder performance. Though I do hear of complaints from staff occasionally.


Let me maybe ask this a different way.

I’ve got an OpenEMR instance that has been upgraded over and over throughout the years (not sure if that’s relevant). We are on the most recent version and patch level. Staff continues to complain about performance, especially as it relates to the calendar.

Are there specific performance recommendations/suggestions that I could try and implement?

I see these executing quite often. We don’t use any reminders for pts. Can this be disabled?


Hi @midder, have you looked at into mysql innodb settings ?

Yes I’ve played with that a bit. Is there a list of recommended settings for this application?

I actually see the php execution spike more often and higher than mysqld. Any recommendations there?

Can I disable patient reminders? We don’t use this feature. I see this running for a very long time:


I also see these executing more often and longer than I am comfortable with:


Are all of these scripts required to run? Are there some I can just disable somehow? If so, how?

hi @midder, try Admin->Globals->CDR , sounds like you might be able to relax the logging too?

here’s a recent and relevant php post OpenEMR takes big development step with composer and npm

Hello Brian,
Over the years, we heard about OpenEMR performance issues specifically related to Calendar.
We decided to develop some performance platform to identify the areas where perforamnce is a challenge.

Could you please share what screen on the calendar which is causing the response challenge for you?

We are setting up a platform using NeoLoad to validate OpenEMR performance and if any one has any suggestion please chime in!
-ViSolve OpenEMR support team.

Thank you both.

@stephenwaite I have disabled pretty much everything in CDR. When you say relax logging, what would you suggest in order to stay compliant for various auditing purposes? I’m not much of a clinician! Here’s what I’ve got enabled:


As for the PHP, I suppose I ought to update it anyway based on the security concerns.

@visolve it’s hard to say. Staff complains about pretty much everything, but particularly when they view “All Users” in the calendar. We have around 20 providers.

I got this complaint today, which was included with a general “it’s slow” message:

“The front desk when trying to delete an appointment, it is showing back up on the patients chart. Provider Jane Doe is unable to delete appointments.”

Thank you for your information. This helps us to isolate the problem.