>>I'm not so sure that is true. If you co-locate with a local ISP or even host within your own company you can also have outages. I suspect actually that outages are far more likely in that environment than with one of the big host providers. The vast majority of sites online today already aren't in-house hosted today. It doesn't really matter if it's major provider or a local ISP that goes down - down is down :-)

Sure. FWIW many of my customers start out thinking they want Cloud because of all the obvious benefits, but then they reconsider the value of controlling their own destiny. If it's on Amazon and it goes down for most of the working day (as happened repeatedly in 2012) and when it comes back there's unquantified data loss, that could be enough for a facility to start losing physicians or even go broke, while unplanned release of patient data is a disaster on so many levels. So far customers are unanimous in choosing to manage everything inside their own firewalls.

>>I agree though - I'm a big fan of having full control over my hardware/software. Ironically cloud solutions are making it much easier to host your own full Windows VM as opposed to just hosting a site somewhere which is much more scary IMHO.

FWIW we have both cloud and co-located servers which are almost trouble free. We also use a so-called Cloud accounting system (Xero.com) which so far works well. But if I were a healthcare provider I think I'd still want to look after my data and systems myself.

>>The biggest issue to me with cloud hosting/storage is that it's still too expensive.

It is costly, though some of the co-location companies now offer dedicated dual core servers (standalone, not virtual) with 10Mbps unmetered bandwidth for $70/month including 24/7 onsite support. That's for a Linux box: Windows Server is considerably more.