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Posted: 10/31/2013
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TPP Clinical Software Easily Supports Thousands of New Users and Helps Doctors Save Lives

Clinical software provider TPP needed to increase its application’s scalability and performance to prepare for ambitious global expansion. TPP tested a next-generation version of the application, taking advantage of the in-memory online transaction processing (OLTP) capabilities in SQL Server 2014 Enterprise. Initial results showed the application ran seven times faster, and the company was better equipped to scale its system to reach thousands of new users. TPP will ultimately save development resources by implementing SQL Server 2014.

Business Needs

TPP, headquartered in Leeds, England, is a software company that aims to connect different healthcare organizations through comprehensive IT solutions. The company’s SystmOne clinical software application, used by physicians and other health professionals across England, accurately and securely documents every appointment, medication, allergy, and physician contact a patient has ever had.

Based on Microsoft SQL Server 2008 R2 Enterprise software, SystmOne manages more than 30 million patient records, which equates to more than half the population of England. There are 200,000 active registered users from the National Health Service (NHS) on the system in the United Kingdom, with a peak concurrency of more than 72,000 users.

Because TPP was exploring expansion opportunities in a number of countries , it needed to make sure SystmOne could easily scale to handle tens of thousands of new users. “We have some ambitious international expansion plans, and the technology needs to support that,” says Phil Grayson, Technical Operations Lead, TPP. However, TPP realized that its current technology could not meet the potential demand. “We identified a bottleneck in one of the heavily accessed SQL Server tables, so we knew we could run into scalability issues,” Grayson says.

TPP also had to maintain or exceed the solution’s extremely fast response times. “SystmOne delivers patient records to doctors in 250 milliseconds on average,” says Grayson. “In the United Kingdom, where doctors typically only get five minutes with a patient, that sort of response time is critical. In the most extreme scenario, if a doctor can’t access the system fast enough, patients’ lives could be at stake. The speed of the system is essential.”

To increase scalability and performance, TPP began searching for new database technologies in November 2012.

* In testing, we saw seven times faster processing performance using in-memory OLTP in SQL Server 2014. *

Phil Grayson
Technical Operations Lead


While engaged in discussions with Microsoft, TPP learned about a new in-memory online transaction processing (OLTP) solution in SQL Server 2014. This high-performance, memory-optimized solution relies on no-locking/no-latching concurrency control, which serves to eliminate system bottlenecks resulting from scaling up to handle additional users. “SQL Server 2014 was already on our roadmap, and this new feature really stood out for us,” says Grayson. “We knew it could help us scale our solution more easily.”

TPP decided to test a next-generation version of SystmOne, based on SQL Server 2014. The company easily migrated the SystmOne performance-critical tables and business logic accessing those tables from SQL Server 2008 R2 to the new OLTP feature in SQL Server 2014. “We got the solution up and running in half a day, and we had people testing it that same day,” says Grayson. “Unlike other in-memory solutions that require the purchase of an expensive appliance or migration to a completely separate system, we didn’t have to make any significant changes to turn on the in-memory capabilities. It was an incredibly simple process.”

TPP has a SQL Server environment of more than 700 terabytes, with an 8-terabyte primary transactional database. TPP servers handle 640 million transactions per day, peaking at about 34,700 transactions per second. Doctors using the updated version of SystmOne will be able to retrieve patient records in less than 250 milliseconds.


Using in-memory OLTP in SQL Server 2014 in testing, TPP saw seven times faster processing performance for SystmOne and the ability to scale to handle hundreds of thousands of additional users. The company expects to save time and money by not having to create its own database system.

Improves Application Response Times, Better Equips Doctors to Serve Patients

SQL Server 2014 will make the already-speedy SystmOne application even faster. “In testing, we saw seven times faster processing performance using in-memory OLTP in SQL Server 2014,” says Grayson. “SQL Server 2014 will greatly improve the overall performance of SystmOne, making it more responsive than ever.”

A faster, more responsive system means that doctors using the new version of SystmOne are better equipped to serve patients—and save lives. “With our previous version of SystmOne, we had already heard of examples where doctors had been able to quickly see which drugs an overdose patient had been prescribed,” says Grayson. “Those doctors were able to save lives because of the high speed at which the system retrieved those patient records. This new version would further increase those retrieval speeds.”

Helps TPP Easily Expand into New Markets

Using in-memory OLTP, SystmOne will be able to scale to hundreds of thousands of requests per second, which will ensure that TPP has the scalability it needs when it introduces SystmOne to international markets. “Using SQL Server 2014, we can comfortably say we can scale our system when we expand to new international markets,” says Grayson. “And we know that more data from additional countries will not impact system performance. With SQL Server 2014, we’ve proven that we can scale, and we’ll eventually be able to handle many more users.”

Saves Development Time and Costs

Because TPP was able to move to SQL Server 2014 quickly and easily during testing, it did not have to use resources creating its own internal database solution. “SQL Server 2014 helps us scale our system without doing any significant code changes, so there’s a host of development work we don't have to do,” says Grayson. “And to get the performance and scalability we saw during testing of SQL Server 2014, we likely would have needed to invest in several costly new servers. But we were able to get huge performance gains with very little cost, because we implemented this solution on our existing servers. It’s an incredible technology.”

This case study is for informational purposes only.
Solution Overview

Organization Size: 189 employees

Organization Profile

TPP produces SystmOne software and other applications to support the National Health Service vision of “one patient, one record” healthcare in England. SystmOne currently hosts more than 30 million patient records.

Software and Services
Microsoft SQL Server 2014

Vertical Industries
IT Services

United Kingdom

Business Need
Mission Critical

IT Issue
  • Document and Records Management
  • Regulatory Compliance and Controls