Dom,
The problem is not AC, the problem is Nuance crippling DNS so only v10 Medical will work with EMRs. There's been lots of thunder and lightning over this move. Yes, it was a stupid move on Nuance's part and probably alienated a good bit of their potential client base. Personally, I just go ahead and use v10 Medical. It works well with AC and makes your life a lot easier. Don't lose sleep over this, you'll make up the extra cost in no time.
Dave