The other issue with a tethering is that only one person can use it. SO you staff can't deal with patients and have the AC running at the desk while you are also using it to do notes...just a thought...I am always a fan of just running it locally..though i see the reasons people may want the cloud which would be to have access to it from other locations. i think that they should have it where you can run it locally and it dynamically updates the cloud you have...that way you can just use it locally but when you need to use the cloud it would work as well. just a thought