Cloud computing is a long ways from reaching its zenith. Its not a solution for everyone, and unless you're dealing with terabytes of data or logic or have a really high number of users (hundreds of thousands+) the cloud is probably not a good fit.

Along side of the complexities to determine the need to go to a 'cloud' environment are the even more complex engineering tasks of databases and security compliance.

Yes there databases in the cloud, yes there are successful implementations of data layers being stored across hundreds or thousands of servers BUT ensuring continuity and that the software is well maintained (including patching as needed) is a virtual (and real) nightmare. Compound this with not being able to test patches before they are applied is a logistical crisis. Whether it is on OS or a database update, the actual integration is out of your hands (remember you're in a cloud now). No programmer or engineer wants updates rolled out without their knowledge, so stuff can be tested to ensure nothing breaks or to fix it before its actually live. So just how does one ensure their content, data, or logic will perform as intended with updates? Ah, let me know when you can answer that.

Then there is the issue of security, namely HIPPA compliance and/or other mandated regulations. Do you really want your medical data flying around in the cloud? A lot of discussion is currently surrounding this very issue. Lots of pros and cons out there. Privacy versus access to accurate information by medical providers is the key pivot point in many of the arguments. We're talking way more than simple SSL encryption here. SSL is only good for the transport of the data, it doesn't affect the actual encryption of the data. Image 1 medical record, where almost every data point is stored on a different server in the cloud - thats lotsa data and lotsa servers. Now extend this to thousands or millions of records. The cloud just isn't THAT specialized yet.