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2 Sites, 1 Database Server, site to site vpn = slow...branchcache or something else???

Scenario is for a dental office with 2 locations, less than 5 users.  Split schedule for entire staff during week, at office A mon,wed,thurs @ office B tues, fri, sat.  Database server running Practiceworks (office mgmt db server) on top of Pervasive SQL 10 at office A.  Sites connected via Cisco site to site VPN, tunnel speed tested at about 3 to 4 mbps.  Accessing files\shares is not a problem, problem is strictly with Practice Mgmt Software and Imaging software (gendex-vixwin application).  Very slow from office B.  Patient comes in, open up their Chart, it's very very slow.  To View, Save Xrays, make appointments, update patient info, etc.  

-Term services not an option, Imaging software and hardware will not work, confirmed with support.
-Adding local server to site b and replicating to site A nightly, much to0 expensive to get a 2nd license of Practiceworks and file sync not supported.
-Physical connection between locations (about 30 miles apart) much to expensive.
-WAN Acceleration, an option, a bit pricey but an option at the moment.
-Branchcache?  Server is running W2008r2 enterprise at site A and workstations are Win 7 at site B, so it can be installed\configured but would it help in this scenario with the Office Management and Imaging programs?
-Any other recommended solutions\options?  Any insight at all would be greatly appreciated, have been banging my head against a wall here for a few months now researching\testing solutions!!!

Thanks!
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kevhein

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At last test, bytes 32\time 22ms\ttl=126   - did contact Cisco support to see if any tweaks could be made to the tunnel and firewall, but no changes of impact were made.  

I know WAN acceleration is not cheap, I've been shopping all around looking near the lower end of the money scale I guess, I did find an interesting VPN solution from xroads networks and a software based solution from Replify software, but price tag is in the $4,000 to 5,000 range.  Was hoping to find something cheaper, but that may be a pipe dream?

Recently started researching 'Branchcache', couldn't hurt to test  (I have the necessary components) but wasn't sure if it would help in a database type environment?
22ms actually isn't bad but if the application is very "chatty" all that roundtrip time can add up.  I've tested Riverbed WAN Accelerators over a VPN with 75-100 ms latency and it made a HUGE difference.  The difference might not be as huge with 22ms.  But I'm sure it would still help.

Can't speak to Branchcache, sorry.
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On a 20/20 mbps link, 75-100ms latency end to end, Riverbed improved our maximum throughput by a factor of 10: from 1.5mbps to 15mbps.  We ultimately worked around the problem by spawning multiple parallel data transfers.  The Riverbed was too expensive for us and the parallel transfers worked fine.  Of course that won't work in every situation.
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-Term services option is out, practice mgmt. software will work but the image acquisition software will not, checked with their support and tested for myself.
-Checked with PW support re: Client Cache Engine, it is not supported.
-Adding a 2nd DB server at site B is on the table, doing nightly replication\sync, but the price tag for a 2nd pw license is hefty.
-WAN acceleration, though how much of an impact it would make remains to be seen, if I can find something not too pricey and do a 'try before you buy', it would interesting to see, I know it would not be like having a server down the hall from you but any uptick in speed\response time would be a plus.

Little bit more homework to be done, thanks for the info\responses it's been very helpful.
You can try a WAN accelerator, but I believe it will be a waste of time.  Remember the 22ms round trip times?  comparing with a 0.1ms RTT on the local network, the WAN will be 220 times slower than the local access.  The ONLY option is to reduce latency, and the WAN accelerator will reduce bandwidth, but may actually increase latency.

If you want to tell for sure, fire up a network analyzer like Wireshark on the LAN client and do something in PW.  Then do the same thing over the WAN and compare the traces.  You'll see there exactly how big each packet is, along with the response times, and you can compare the two directly.  

I really like the suggestion from dcj21 (and wish I'd thought of it) about moving the server to a VM and then pushing the VM across the link each night when you lock up, so that it is ready to go at the other location in the AM.  I don't think this would require a second PW license, but it might require a second Pervasive license.
WAN Accelerators like Riverbed do more than just data compression.  It attacks the latency issue by reducing the "chatty" behavior of everything moving across the link.

http://www.riverbed.com/us/solutions/compare_riverbed/wafs.php
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This one is on hold for the moment, not sure what the next step is but I appreciate the feedback from everyone.
Why not close it and award partial points to each person who added value?
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Sorry, my bad - your'e right.  As there are viable options on the table, it basically comes down to the person controlling the purse strings to inve$t in a solution and pull the trigger.
Have you considered any of the free WAN optimizers? Silver Peak's VX-X (http://bit.ly/IdzqN3)  practically eliminates packet loss in real time and works on all IP-based apps. It's the full commercial  Silver Peak  software with no hidden charges or time limits. WANs are limited to  4M of optimized WAN capacity.  You might also look into TrafficSqueezer (http://bit.ly/JYgvBY),  the open source project. I don’t think there are any restrictions, but I hear it’s a bit rough around the edges.  
Dave
PS I work for Silver Peak, but how invested can I be in  a product that doesn’t make any money? :-)
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Interesting, I'll take a look.  I have the hardware to run it on, I've got nothing to lose.  Thanks for the info.
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Dave, just to confirm, I would need vx-x running on a server at each site (there are only 2 sites)?