I agree with both of you. The state of software and systems in IT is untenable, and it will be huge anchor on productivity. Absolutely no mid-sized medical pr

I agree with both of you. The state of software and systems in IT is untenable, and it will be huge anchor on productivity. Absolutely no mid-sized medical practice is capable of maintaining these systems to any level of standard, and I do believe this is one of those areas that is far better served as a centralized SaaS model. As you mention, this opens up a new set of systemic vulnerabilities that should not be ignored. I see this becoming more like a large app that lives in the cloud, with a "black box" that acts as a local cache for any medical records assigned to the practice in question. Basically you get access to the "global interchange" of medical records/billing/whatever - and you still have the digital equivalent to a basement full of filing cabinets for the records you need on-site. Yes, if the "uplinks" go down you will lose access to the wider network - but at least the problem of accessing things you need during emergencies and outages is very solvable. Nothing I've seen related to healthcare IT has be very optimistic of something like that being implemented in a competent manner however.