Good post, John.
I think I and maybe we have always been fascinated by a dual system of a cloud solution downloaded every night to a hardware and networked solution.
I am just going to throw a point out there and see where everyone runs with it. I agree with what JB and I think Jon has posted about how it is difficult for AC to provide support when it may involve AC but many times it involves the network. Anytime a program involves a database which resides on a central computer whether P2P or Client/Server, there are going to be issues. There will be issues with the computer savvy, but there will definitely be issues with those who are not. Permissions and DNS, DNS, DNS are going to play havoc with connection issues of a network database system. And, for those who don't know what DNS is, you have proven my point. And, I don't mean that in a mean way. I have contact the Guardian Angels three times in eight years, two for ePrescribe NewCrop issues and one for a printing issue.
Now throw in as JB says different OS, 32-bit vs 64-bit, Dell vs Gateway, wireless vs wired, Cat5 vs Cat5e vs Cat6, P2P vs server oriented and at least three different versions at the same time. While it isn't always a networking issue, I can recall during the time when things were a bit bleak many users stating it had to be SQL Server or AC, when it was clear that it was not.
How to solve this issue? One way is simply for AC to state when it is not an AC issue. If I call Microsoft because one of my computers keeps blue screening, they will just say to call Lenovo. And, this is a company which charges $259 per incident. Of course some times it is difficult to know when it is AC vs network.
You could charge more for support and have AC cover everything but that doesn't sound doable as how would you know what the issue is.
Many EMR companies (and I know as I looked at many) make in mandatory that you have $10,000 of support and training right up front. That is clearly a money-making ploy.
But one has to wonder, given what someone posted above about docs setting up networks, if AC shouldn't offer a package whereby they come out, set up a network using their hardware and do training for a certain price, which would cover three years of network support. Of course, that would mean more support but, hopefully, they would be covered by those users who opted for this.
I have not had connection issues with AC, and that is due to not having connection issues with the server, but when I do have issues with my network usually due to DNS, one email to my friend who has 20 years of networking experience as a Microsoft Certified Engineer and Networking specialist and it is usually resolved within a day.
But, after all this, it really comes down to hiring an actual IT Microsoft certified specialist to come out and go over your entire system, recommend changes and know your system so they can make changes over the phone or remotely.
The doctor I leased from recently bought five new computers and a server, hired a local company, and they installed the entire thing in less in an afternoon including eMDs without ever having seen it.
