I wasn't thinking of having AC be the host. I was thinking of an independent tech company/person who would "vet" "upgrades" and install them when appropriate.
While I will be purposely opaque as to details, I can confirm that there is a environment implemented and already operational that offers a high-performing platform in operation for AC in multiple locations.
There is the additional capability to have the database and imported items copied down on a regular basis so that the practice can fail-over to the practice location in the event of a connection outage.
So, it has been done, and is running, this I know.