I don't dictate, only type.
Internet connection is DSL at the office, Verizon FIOS at home.
Internet problems don't happen for very long, very often. But once some folks working on plumbing in the basement of our office building sliced through a big fat Verizon cable, cutting off phone and DSL connection to several buildings. It took two or three days to get it back, and I ended up cancelling a number of patients as I couldn't access their charts easily. I was able to tether using my cellphone, but the connection was so spotty it was almost useless. I would certainly recommend having some sort of emergency internet backup, though I admit I don't have one right now.
Our internet goes down for a few minutes every couple of days, and though that's not a problem per se, whenever it happens I have visions of being incapacitated for a long time, which is unpleasant.
I don't have concerns about patient data being stored off site. The cloud service provider has to have a business service agreement, HIPAA compliant, and I assume that's good enough.
I would think if one wanted to go back from cloud to local, you would just have to download everything back to your local computer, which would take a while (imported items) but is feasible.
Michael
