I had a chance to finally benchmark performance between the DSTU2 and R4 environments using
fhir-open.cerner.com and I actually see the inverse behavior: most condition calls actually perform slower for DSTU2 vs. R4.
DSTU request parameters:
Category=Diagnosis
ClinicalStatus=active,relapse,remission,resolved
R4 request parameters
Category=encounter-diagnosis
ClinicalStatus=active,relapse,remission,resolved
Attaching the comparison since I don't see an easy way in Google Groups to display a data table. The R4 API calls consistently return more items (I assume they're pointed to different databases), but not a sufficiently larger volume of items that it would change performance. And in no cases does the R4 API perform significantly faster (or even faster) than the DSTU2 API that we currently implement.