Our experience with hosted services is that it works great right up until the point that it doesn't work. Then it is a catastrophe, and you can't stay up until midnight to fix the problem, because it is not under your control. I have learned my lesson about not being self-sufficient.
Everyone needs to have a backup plan for when *stuff happens*. Part of our on-boarding is focused on plans for various *stuff happening*. Being paranoid is an under appreciated skill set.
The weekend after Sandy we spent some time helping some practices come back up - that means everything from battery power, a way to access your DB backups if you need to restore to an alternate laptop, accessing backups without Internet, etc.
Living above the snow line (we were @ 8600 ft), we had to have plans for days/weeks without power or road access. Food, water, wood, lanterns, battery power for antenna amplifiers, even a walk-out plan. Lori also always had Uncle Mossy in the event that I was on he road. We kept our office at Lake level, near the co-lo, so it was almost always up. Of course, chaining up to just check email is a serious de-motivator.
