Hi Robin,
You make very good points but there are two that really stand out. I agree that the best part of AC is that it does/did use a lot of 3rd party issues to others. But, not all of us use UpDox, and it would be a big step and cost to use it just to have the patient portal.
As to the PM thing, it used to, but that is the major issue between users and AC right now as everything is on hold until v7 (practice management) is built.