Well you don't have much choice if you move to another EMR. There are still some that let you choose client/server. But, more and more things are moving to the web. When I tested six different EMRs, all of them were in the cloud. They are smooth and allow a greater amount of things that can be done.
The only downtime would be one's Internet provider (rare), and the company's servers. I am not sure if you can back up locally, but the backups would all be done for you.
Whether you are in the cloud or your own platform, I would just love updates and major version upgrades to be automatic. Something you woudn't think about. Like in Medware, Quickbooks, Adobe, My communication software to name a few. I don't even look at the update. I simply update it, and it updates from v6.132 to v6.286. It is done without thought, because the chance of introducing bugs and SHOWSTOPPERS are nearly non-existent. This is for several reasons, but one of the main reasons is proper beta testing. Anyway, I am going regressing here.
