Brandy,
I am very pleased since making the switch to AC in the cloud over a year ago. Upgrading is painless, just being sure to be logged off after touching base with AC IT support staff, and then a phone call from them when they are done, usually less than an hour. Being on the cloud has taken the local IT support out of the picture for me, and less worries of trying to get local and AC IT support on same page.
Another interesting feature of AC in the cloud I never thought of before till this happened, but I have a partner who still uses AC local server, and we lost electricity at the office, he was out of town trying to remote in to do some work and could not. I could work painlessly from home, even though there was an electrical outage at the office at the same time.
For me I have not noticed any negatives that would keep me from making the same decision if I had to do it all over again, would in a heart beat. However once in awhile I will double click too quickly or my nurse will, and the dreaded black box will appear and then a quick call or message to IT support to have the server rebooted fixes this.
I agree with Bill, even though there is a higher monthly cost with the cloud I think there will be less cost with hardware overtime.
