Hi Bert,

Thanks for all of the above suggestions, especially #7.

Your analysis above is excellent, and more or less mirrors a lot of how I have been thinking. Cost, of course, is a big issue. I get the idea that, more or less, costs over a 5 year or 10 year period would actually be similar, whether a new server and on-site, or going with the cloud.

But there are other intangibles. I am not sure about your experience, but when AC goes down, our office essentially ceases to function. This has not happened very often over the last 15 years, but when it has, it has been memorable. So this leads to the impossible to answer questions. Which option would give greater reliability? Which would be more likely to the to a prolonged (whole day or longer) outage?

And then there are even less tangible intangible's. Which would stress me out less? Ideally, theoretically, cloud that functions perfectly seems to be the lowest stress. Cloud that goes down, without immediate support, would be a nightmare.

Which actually brings me back to peer to peer. Perhaps my memory is fading. It seems that, back in those simpler days, I had confidence that I could fix whatever went wrong. Worst came to worst, the main computer went down (like flames coming out of it), just restore from backup to another computer and point everything else to it.

Thoughts?

Thanks.

Gene

Gene Nallin MD solo family practice with one PA Cumberland, Md