The siren call of off site servers is very, very strong. There are a few folks locally running e-Clinical works like that. The local power company (!) hosts the servers, deals with the backups, offers wonderful IT, and maintains the fiberoptic cable (!!!) to their offices (the only fiber show available in town.) They say it is reliable and blindingly fast. It costs something like $1,000 per month per provider. It's enough to make me wish I were an interventional cardiologist....
I dread bottlenecks and single-point failures. Despite my best efforts I keep finding them; the last one was that I found our big UPS supply could not be bypassed easily if it failed (which it did), leaving me stringing extention cords in the dustbunnies at 7:45 one Monday. The internet connection is one I can't control.
I checked out World of Warcraft one weekend a couple of years back. I became aware of this great sucking sound, which I realized was my mind getting ready to depart my body, leaving an empty husk staring at the screen forever. I escaped just in time. I don't even want to hear about more recent games.
