I would definitely look for another option if this became only cloud based. Internet is nearly 100% reliable, but the only time it's ever down is when we NEED it to be up. What about that? What if one doesn't have internet up/download speeds that a good enough to handle the massive data exchange, especially with importing image files and patient photos? What if the host server is down?
I want things to be in my control as much as possible, keeping the variables of things that are out of my control to a minimum. That's why I don't want cloud based EHR.