After being a customer of AdvancedMD for almost two years, we are looking for an alternative solution. Unfortunately we have experienced all the downsides of a web-based solution. Performance is typically slow and occasionally unusable. Support, while pleasant, is either incapable or unwilling to adequately diagnose problems and initially send you on time-consuming tangents to try and get you off the phone. Buyer beware. If you go this route and have issues, you have little leverage. AdvancedMD fully understands the time and cost involved with dumping them gives them all the power.