A few points.
First, I took Squire's implication that AC should focus on functioning as a software company as a positive. That started as their core business, and I think that it can only help them to stay focused on strong, on-time releases that do what they are supposed to do. The issue of cloud vs. home based software is a separate one.
He has a background in cloud software and he said that all of the "big" EMR's are looking to be in the cloud. On the other hand, he said nothing that suggests to me that he has decided to make that a focus for AC. Maybe he will take the company that way, but in my opinion it is likely that we will at least have the option of keeping the program in our offices (at least for the foreseeable future).
Having said that, I think it is appropriate for all EMR customers (not just those with AC) to have an exit strategy. What happens if you and the company part ways, for any one of a number of reasons (ranging from your own choice to the company going in a different, less desirable direction or even going bankrupt)? This was a topic at Laramie, not because of any specific concern about AC, but because JamesNT was smart enough to introduce the notion that we all need to plan for the possibility that someday we will choose to, or be required to, leave our current EMR. I likened it to the decision to have a will or to make your burial plans; you may not like to think about it, but it is risky to ignore the prospect. The need for such a plan brings up a number of associated issues such as getting access to your data, the ease and potential cost of acquiring it, and then your ability to enter it into your next EMR. I won't go into a full discussion of those issues here, but David's question above matched the conclusion of some at the conference. Namely, that "going off the grid" and maintaining a most recent, usable version of AC would be a viable option (and perhaps the best viable option, at least on the short term) if you don't care about MU and EMR penalties. The main thing you lose is eRx capability, and that can be maintained via stand-alone eRx software like Allscripts, albeit, as Tom points out, with a loss of integration with AC.
