are we ready? · in this issue we explore obamacare’s impact on the u.s. economy, ehr winners...

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MSP Industry Alert™

Are we reAdy?

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VI5N3 Feature Articles

IntroductionIn this issue we explore Obamacare’s impact on the U.S. economy, EHR winners that emerged at HIMSS, population health management and how to achieve it, some new Health Record Bank products, and why in spite of 9/11 and super-storm Sandy, we still aren’t really prepared for events of regional or national significance.

Surviving Incidents of Regional or National SignificancePower infrastructure is not robust, communications, gasoline, transportation, fuels, food and basic services are not designed to meet population needs. Bottom line, U.S. remains poorly prepared for the next super storm or other disaster it may encounter. Officials are totally unaccountable for these problems in spite of spending billions to supposedly fix them.

Transforming HIEs Into HRBs for Population Health Management - A New Business & Technology ModelThe nation’s physicians and hospitals are struggling to form Accountable Care Organizations (ACO) and provide the population health management services required to extract quality measures and provide quality care to patients. The core problem is database information structures, upon which most current HIEs and HRBs are based. MSP reveals a new Triad Dataspace™ technology that overcomes such problems, including those discussed in the 2010 Healthcare PCAST Report to the President. Triad offers better performance for less money - a dynamite combination.

Letter of Recommendation from NHII Advisors for Triad Dataspace™MSP was pleased to receive and is sharing a letter of recommendation about its ground-breaking Triad Dataspace™ technology from William Yasnoff, principle in NHII Advisors, and founder of the Health Record Bank Association. Mr. Yasnoff was one of President Bush’s advisors on healthcare, and his recommendations led to the creation of the Office of the National Coordinator for Healthcare (ONC) which is now well-known.

A Brief Conceptual Comparison of the MPT Blue Cheetah Platform and Triad™This White Paper explains how an advance in data representation can be just as significant as making super computing available on a time shared basis to healthcare. Fascinating contrast between better speed versus better representation written for CIOs and CTOs in hospitals and IDNs.

Obamacare: Dishonest, Reckless, Inept & Very Government Invasive!Clear, concise summary of why Obamacare will single-handedly cause the next U.S. recession within a year of the Employer Mandate going into effect, as seen through the eyes of three people adversely affected by it, and the Chairman of GE Healthcare. It dispels Administration lies about its impact.

Vendor Short TakesMergers, first MERS cases, Medtronic news and mergers with Covidien, nurse dissatisfaction with EHR products, and the first 4K resolution tablet/displays from Panasonic for healthcare -- all announced.

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Introduction

Market Instability IntensifiesHIMSS is always big, and 2014 was the biggest HIMSS yet. There were over 300 new vendors this year and attendance exceeded 38,000+, up from 34,000+ last year, and even up from the 36,000+ in 2012. It filled all 5 halls of the huge Orlando, FL conference center, with over 1,200 vendors stuffed in and bulging at the seams.

Such glowing statistics would lead one to believe that all is well in healthcare I.T. land, but that would not be correct. The conference clearly revealed the tur-bulence in the healthcare market, due to a tidal wave of change and an indus-try struggling to adopt to government policy and its impact on patients, doc-tors, hospitals and medical technology vendors. Just as in all tsunamis where there are underwater disturbances that eventually make landfall, the health-care market has also experienced erup-tions whose waves of alarming news are speeding towards the American healthcare shorelines.

ICD-10 Delayed Again!That is not to say there weren’t successes, as there clearly were, and those need to be celebrated; but for the average hospital, particularly the smaller ones that lack a cadre of I.T. experts, and the small doctor practices, HIMSS was anything but good news. At HIMSS it was confirmed that ICD-10 would be delayed, yet again. ICD-10 has to work just so each provider can continue to survive as well as to wrestle with the other demands of the “new”, more expensive, fully-integrated healthcare system envisioned by the government.

Healthcare Rationing is RealObamacare is the bus that is running over elderly Americans, based solely on their age. It denies reimbursement for certain procedures after certain ages. It is clearly the vehicle to ration healthcare for everyone, and deny some life-saving procedures to elderly Americans. It is funding itself by tapping Medicare funding, yet another broken promise.

The fact that America would allow this speaks to its lack of respect for the elderly. Bill Andrew, the first lifetime member of HIMSS, who collaborated with me for years on the MSP-Andrew EHR Survey is now 85, strong and as clear thinking as ever. However, if he develops a major problem next year that requires an expensive surgical procedure or expensive medications, CMS may not approve the expenditures. That just isn’t right!

All the ugliness of Obamacare as a social policy was emerging at HIMSS. Obamacare is throwing millions like Bill out of the bus, and then simply driving over them, apparently with voter approval (since Obama was re-elected) -- simply because they are too old to matter to the government anymore. Society should be advocating for the old and the young who are helpless. Instead, we continue to kill the unborn, viable babies who are inconvenient products of the sexual revolution, and now leave the oldest elderly to die and decrease the surplus population.

Healthcare Rationing Kills VetsThe fact that Obama Administration is allowing American Vets to die waiting

for healthcare, speaks to its lack of respect for war veterans. The fact that bonuses are paid to administrators who run a VA healthcare system that has “secret” waiting lists is outrageous.

That Obama feigns “righteous anger” just like he did toward the IRS abuses, which he later dismissed as insignifi-cant is just damage control for this-morally-bankrupt presidency. No one is fired, just more gross unaccountabil-ity for everything government inserts itself into and then mismanages. Look at the IRS.

IRS Scandal Widens Amid New Disclosures of “Lost E-mails”Indeed, now it emerges that hundreds of e-mails from the IRS to six admin-istration officials have “been lost.” Losses occurred on multiple computer running on different servers for the same messages, all at the same time, none of which were backed up. The odds of that are astronomical. It’s just another lie and cover-up campaign by this the most corrupt administration in the last 6 decades. Does any sane and rational person actually believe this is anything but a massive cover up by the Obama administration of “smoking gun” e-mails that would seal his impeachment IRS abuse? Yet the call for an independent prosecutor is ignored.

“Obamagate” IRS ScandalRemember the missing minutes in the Nixon Watergate Oval Office recordings? It’s the same thing! Where is an independent prosecu-tor? Americans didn’t ignore crimi-nal behavior of white, Republican presidents, so why are they ignoring

4 MSP Industry Alert™ Vol. 15 No. 3

it for black, Democratic presidents. Does the Constitution and federal law apply only to one side of the aisle in Washington, DC and non-African American politicians? Until Obama gets beyond his, “I can do anything I want,” mentality his exclamation that, “I’m Mad as Hell,” is simply the latest rant from Mr. Four Pinocchios.

The Big Get Bigger and Squeeze Out the Smaller I.T. VendorsEvery market consolidates, and healthcare is no exception. The difference is that the government has, in the past, been a referee to assure that the small and innovative vendors are protected from the greed of the big and powerful, and that the process of consolidation is a market and consumer driven one.

It remains a sterling example of the fact that simply dumping public money into not-for-profit organizations that lack core competency in an area, won’t make them experts or assure their work product is effective. It will however drive business away from smaller private companies (by unleveling the playing field), and with lost business comes lost jobs - the consistent hallmark and net result of the heavy-handed, government-picks-the-winner policies of Barrack Obama, and his radical liberal administration.

This administration however sees itself as the “winner maker” and has no reluctance to destroy small business as a matter of policy. Regardless of what it says publicly, policies speak louder than administration propaganda. The American healthcare market trough is very big, but so are those feeding from it. The big vendors are taking up most of the feeding room, squeezing out hundreds of smaller and hungry vendors -- who it now appears will die trying to find their niche in the U.S. healthcare I.T. market.

EHR Winners Are CrownedThe EHR wars are essentially over, and what remains is the bloody mop up. EPIC has to be the crowned winner, followed by Cerner and Allscripts. In

the second tier of survivors, there are AthenaHealth, McKesson, Siemens, NextGen, GE and Meditech. Everyone else will fights over the few scraps that fall from the big vendor’s banquet table. Yet remarkably, new EHR companies from India are showing up at this late date and trying to compete. We will be wishing you well as you are breaking into the U.S. EHR market!

Population Health ManagementThe battle ground is now switched to the “community”, which means the cloud, for repositories and for compliance with Meaningful Use Stage 2 and 3 (forthcoming) requirements for care across the continuum of providers and community-wide healthcare integration and analytics.

So guess what, everyone at HIMSS was suddenly an analytics company or a cloud-based, private portal of care access provider. Some had suddenly become Health Record Banks. The idea fits well for AthenaHealth, for the 500 other EHR hopefuls, and two or three of its larger competitors, but it doesn’t work at all for most of the government-financed HIEs, who are failing outright or on shaky financial footings.

Jobs Begin to Rapidly DisappearThe Government Accountability Office (GAO) and the Department of Labor (DOL) are now reporting the jobs lost in healthcare, while the President con-tends that these agencies are simply wrong and against him. Americans, the administration now says, don’t under-stand what the statistics really mean, which is remarkably something I abso-lutely believe Obama is correct about.

America doesn’t really understand how devastating the 17 versions (and counting) of Obamacare have actually been, and the more damaging elements of it, like the ‘Employer Mandate’, are again and again delayed, now until after the 2014 mid-term elections to hide the impact from American’s voters and elderly populations.

The bottom line is simple. Information integration is harder than expected. To integrate an EHR with an infusion

pump takes the engineering teams of both vendors over 6 months to achieve on a hospital-by-hospital basis - at least in the presentation I covered. In spite of all the “government” standards, there is still no hint of true “plug-n-play” device integration to be found in healthcare. Guess that will have to wait for HIMSS 2015 or longer, and be left to whatever vendors remain present in the market. The only certainty is that they will most likely be the big ven-dors, not the small or those now trying to emerge.

Conflicted Views of Healthcare Delivery’s FutureHIMSS showcased divergent views of the future of healthcare in America. While the government is driving healthcare in one direction by its intru-sion and various regulations (such as HITECH and the ACA); there was a strong undercurrent by dissatisfied and disenfranchised physicians who are beginning to organize and drive medi-cal care in a different direction. These two visions are shown in the figures on the next page.

Of the two views, the government view is less patient centric, and much more about control of expenditures and denial of care, and the physician view is much more patient-centric and about restoration of the direct professional physician-patient relationship with assured quality and lower cost, than the government view.

The exciting thing about these diver-gent view is that they don’t split along political party lines, but the physician view has proponents from across the all political parties. We will be discussing these two views in much more detail in our next issue of Industry Alert™. In the interim, we got a very clear view of the end-point of the government’s view, in the scandal that has emerged at the countries Veterans Administration hospitals, which while under total gov-ernment control and funding, have systematically denied care to thousand of veterans, had secret waiting lists, and showed great lack of integrity in manag-ing healthcare care delivery, while pay-ing bureaucrats bonuses by deception.


What reason is there to believe that if the government cannot manage VA hospitals for vets, that it will be any better able to manage all hospitals for Americans under Obamacare?

The VA Hospital deaths are the poster child of how well government control of a healthcare systetm works!

The government approach clearly leaves the patient with a healthcare sys-tem incentivized to under-serve them in order to survive. This is euphemis-tically described as “accountable care”, because it is delivered by accountable care organizations without regard to patient quality or timely access, the very same problems with government healthcare in other socialist regimes where it has been imposed.

Under accountable care, any American doctor who wants to remain in busi-ness and actually provide care that the elderly require, will assume risk of care and ultimately agree to the gov-ernment’s under reimbursed payment policy. The American patient becomes nothing more than the “pet” in this government-mismanaged “veterinary” healthcare system, whose voice is ignored unless he has the means to file a lawsuit for low quality outcomes delivered and injuries incurred.

A Look AheadBy this time in 2016, hundreds of EHR companies, many government-funded HIEs, will have thrown in the towel and disappeared, certainly from the ranks of HIMSS exhibitors.

The reality is that hospitals have become health systems, and are now forced to

herd attending/admitting physicians to become employees. Some are doing so, but others are resisting, but they have an uphill battle. Not a single session we found at HIMSS focused on a patient-centric form of healthcare reimbursement or delivery.

The second part is that these newly-consolidated systems are increasingly buying the vast majority of information technology from less than 10 vendors. Look to EPIC, McKesson, Cerner, Siemens, GE, Allscripts, NextGen and a few others. But certainly, they are not buying from first-time exhibitors or off-shore hopefuls from the EU, India or Middle East who still have ambitions of entering the U.S. market with successful products from their home countries. In most cases, the first timers are naive at best and stand to lose a lot of money, time and effort at worst.

What has emerged at VA and under Obamacare is not the rosy results that Obama articulated and voters agreed with, but Obamacare doesn’t deliver. Instead, we got something much more onerous and non-patient centric.

New Technology Emerges for Health Record BanksTriad Dataspace™, a new technol-ogy from Medical Strategic Planning emerges, is empowering an alterna-tive path to interoperability and popu-lation health management, needed under Obamacare. An article in this issue discusses that topic and explains the advances in security, data privacy enforcement, reduced storage cost, enhanced analytics and scalability to ensue. Hospital CIOs, particularly those

who have previously adopted best-of-breed automation solutions, will want to read this article carefully.

MSP’s Triad technology is novel, and has recently received strong recom-mendation from well-known healthcare information technology firms like NHII Advisors, a group that participated in creating the Office of the National Coordinator of Healthcare.

We are very pleased that NHII Advisors is recommending their clients consider Triad Dataspace™ as a foundation for new healthcare applications, based only on its novel performance characteris-tics. MSP has no affiliation with NHII Advisors.

Disaster PreparednessWith the increase in national disasters, whether they are weather-related, fires, biological or other, hospitals need to re-evaluate whether their current assumptions and measures to survive these events are sufficient. In this issue we discuss lessons not learned from Superstorm Sandy, that hit the east coast, which raises questions about how survivable America’s healthcare infrastructure will be after a more prolonged or extensive assault, such as a pandemic of superbugs or a disruption of the power grid for months due to a power grid collapse.

It’s a full packed issue. We hope you will find it food for thought and con-templation. As always, we welcome your comments and feedback. Contact us by e-mail at [email protected] �


Article Content Summary

• The Electronic Risk

• Supply Logistics and Transportation Failures

• Super-Storm Sandy: Lessons Not Learned

• Types of Viable Threats

• Practical Hospital Design Implications

• Redirected Resources

• Priorities

• Renovation Planning Begins Now

• Financial Planning Challenges

• MSP Medical Technology Surveys

• Call for a ‘Hospital Design for 2030’ National Conference

Surviving Incidents of Regional or National SignificanceAn editorial by Arthur Gasch - Founder, MSP

Healthcare faces challenges ahead. Not only does Obamacare impose a formidable financial challenge on phy-sicians and hospitals, but the nature of our environment and our electronic age also pose issues. Unless we plan for high risk contingencies, we will find ourselves crippled and helpless when they occur. We cannot change healthcare immediately, but we can set a course to change it gradually with each system replaced and each clin-ical unit renovated. The task will take 10-20 years, so we need to begin now. Planning begins with risk analysis, so what are the most serious risks?

The Electronic RiskJust about everything we do today depends on a plethora of electronic

devices. How would healthcare con-tinue to function without these devices? Cell phones, lights, heating, cooling, EHRs, PACs, RISs, LISs, hospital information systems, billing, automated ECG and other diagnostic tests, dictation, information storage and retrieval, alarms, alerts, informa-tional prompts, capturing encounter summaries, medication interaction checks, E-mails, web portals – all depend on electronics, and electronics depend upon stable and available power sources.

Stable power sources are in short supply in the U.S., and the potential for moderate to longer-term interrup-tions in the power grid is growing. Backup generators are only a partial answer to a short-term interruption,

Seawater from Superstorm Sandy floods the Ground Zero construction site on Monday, Oct. 29, 2012, in New York City.

©http://www.businessinsider.com/ground-zero-hurricane-sandy-photo-2012-10


because unless there is adequate on-site fuel to run them for extended periods and they are rated to run con-tinuously for extended periods, they only afford a short window of protec-tion. How many hospitals have fuel on-site to operate generators continu-ously for a month or two?

Supply Logistics and Transportation FailuresIn order to reduce costs, hospitals have embraced “just-in-time” opera-tions and delivery of resources, rather than storing resources on-site. How would health care operate without reliable transportation, without ready access to food and disposables? We need to imagine and plan for just that. What if for two to four weeks nothing could be delivered? When would the emergency department begin diverting everyone? When would the hospital stop all new admissions? How would care be documented?

Super-Storm Sandy: Lessons Not LearnedA chain is only as strong as its weakest link(s). Power, transportation, com-munication are all weak links today, and the reality is they could all fail simultaneously, creating a cascading-failure scenario.

That happened in New Jersey during super-storm Sandy. Many entire areas lost power for 7-14 days and some areas were without power for over a month. That caused a cascade failure mode. In NJ, we simultaneously lost mobile communications (because cell towers don’t have emergency genera-tors), TV reception and the Internet. To begin with, consumers had no power for phones, lights, heat, refrig-eration, TVs and Internet routers but that also meant businesses had no power to operate unless they had backup generators.

Transportation was crippled due to inability to access roads from downed trees and power lines as well as from lack of access to gas needed by cars and trucks for mobility. More

importantly, there was limited gas to run backup generators that few people seemed to have! The few gas stations that were running and open had people standing in one line and cars waiting in another for miles in the hopes there would be gas left by the time it was their turn to fill up. Eventually the gas situation becoming dire, so New Jersey governor Chris Christie issued a gas rationing system to follow the odd–even license plate rule to ease lines in 12 counties. Many people drove to Pennsylvania just to fill up gas canisters since there was no rationing going on there.

We also lost traffic lights, increasing the time to go anywhere – assuming there was enough fuel to go in the first place or the roads were passable. Grocery stores watched food spoil and ruin. Restaurants were closed, since they had no power or refrigera-tion either. Fortunately, it wasn’t in the heart of winter, so no one froze to death, or had pipes freeze and burst, but it was pretty darn cold.

A chain is only as strong as its weakest link(s). Power, transporta-tion, communication are all weak links today, and the reality is they could all fail simultaneously, creat-ing a cascading-failure scenario.

A chain is only as strong as its weakest link(s). Power, transporta-tion, communication are all weak links today, and the reality is they

A chain is only as strong as its weakest link(s). Power, transporta-tion, communication are all weak links today, and the reality is they tion, communication are all weak links today, and the reality is they could all fail simultaneously, creat-ing a cascading-failure scenario.

Remarkably, there was not much rioting or violence although it was tense, but there would have been if the situation had gone on longer or been more widespread. Battery-operated radios were some help. So were battery-operated walkie-talkies, but they had limited range and without power, they quickly became non-functioning.

The POTS telephone system made some communication possible, but the people who needed to be con-tacted simply put up recordings, and no person could be talked to who had any real information about the status of anything. Whole communities were flooded or under water and many did not know.

There were no official communica-tions about the duration and status of the remediation, when help might arrive, nothing. People would hear that a gas station was open, but by the time anyone got there and waited in line 3-4 hours, the gas was often gone before all those in line could fill up. Work activities for many ceased since businesses without generators were off-line. No one knew how long before power restoration – hours, days, weeks, a month, longer? So folks could not intelligently plan whether to stay or leave because of uncertainty repair times. The closest comfort was in PA, further inland.

Business Does What’s Profitable, Not What’s Responsible We didn’t have mobile phones because the lobbyists from Verizon, Comcast, Time War-ner, Sprint, AT&T and others con-vinced DC lawmakers that it would be too expensive for them to have required backup generators at every cell tower. So there weren’t any – and there still aren’t today in many states, including NJ.

We didn’t have gasoline or diesel fuel, even though tens of millions of gal-lons of it were in gas station holding tanks, ready to be pumped, because Exxon, BP, Shell, Citgo and other gas companies convinced Washington law makers that backup generators for gas stations were too expensive for the megaoil companies. So, in spite of Sandy, we will be no better off during the next emergency. We are talking about less than a $10K investment per station for the 30 KW units required, but “it’s too expensive.” Often times because legislators are bought off by big company contributions to their campaigns, when it comes to a choice between what’s good for society or what’s good for big corpo-ration bottom lines, legislators far too often choose the later and sacrifice what’s good for society. That needs to change. Some people died needlessly, but not that many, so these problems and their known solutions, remain just as they were before Sandy. The next big disruption will be just about as uncoordinated as Sandy was. In this


case, hindsight was not 20-20, it was blind, and little has been done to fix the problems that were so painfully apparent during Sandy, except for building codes. However, consumer backup generator sales have increased a lot here in NJ, because people are increasingly realizing that if they want protection from an irresponsible gov-ernment, they need to act indepen-dently. Hospitals need to realize that also, and act before a crisis occurs.

What’s the Critical Failure Tipping Point? Suppose Sandy had been an incident of regional or even nation-al scope? Suppose instead of a storm it had been an EMP (electromagnet-ic pulse) attack by a foreign power or really strong solar flares, which could easily take down the entire north-east power grid in PA, NY, CT, MA, NH, VT, MD, VA, DC? What would be the impact of adjacent power grids they are connected to? How many states could fail before it would ex-haust recovery efforts and standby supplies (like power transformers, poles, and so on)? When would the whole fabric simply tear apart and collapse? How long could people sur-vive without power, fuel, refrigera-tion, transportation and any sort of emergency communication about the duration of the ordeal – when they all occur concurrently?

Suppose instead of 3-4 weeks before power was restorable, it would have been 3-4 months. Where would the new equipment to replace the failed infrastructure have to come from? What mode of transportation would it come by? At what premium cost? Trucks stuck in warehouses because they couldn’t access fuel to deliver hospitals with supplies, food, medi-cine, or fuel (for backup generators) they need, would be of no help.

We need to envision in the design of new healthcare facilities and cur-rent operations because many or all of these things may be lacking simul-taneously (cascade failure). Doing so brings disaster planning and new hospital design (or renovation) into focus. Regional or national events can

occur in any part of the country, so they need to be discussed nationally. Sure, we don’t all have high risks of earthquakes, but we all have a risk from solar flares, or EMP attacks, or the re-emergence of antibiotic-resis-tant superbugs. Those aren’t local risks, they are national and even global in scale.

It’s very clear that the frequency and scope of national disasters, whether weather-related, terrorist-instigated or environmental/microbiological-related, impose new, expensive and crucial design constraints on new facil-ities, but also on existing processes and rational modification of existing facilities in order to remain functional during “incidents of national (or even regional) significance.”

Most p lanning only covers shor t-term interrupt ions of logistics, rather than for mid-term or long-term disruptions.

Most p lanning only covers shor t-term interrupt ions of logistics, rather than for mid-term

Most p lanning only covers shor t-term interrupt ions of logistics, rather than for mid-term or long-term disruptions.

shor t-term interrupt ions of logistics, rather than for mid-term or long-term disruptions.

Types of Viable ThreatsEMP (Electromagnetic Pulse) An EMP attack on the U.S., would in an instant wipe out 99 percent of all electronic devices and infrastructures that our culture is now absolutely de-pendent upon. Just 4 EMPs located strategically could wipe out commer-cial and individual electronic infra-structure. How likely is that? Radical middle-east cultures like ISIS would love to launch such an attack against the United States or Israel, or both. However, not all EMP “attacks” come from human sources. Solar flares in some cases have the same impact but are usually limited to a smaller geo-graphic area. During the next two years however solar eruptions are an-ticipated to be more frequent and of greater strength than during the past several decades. How prepared is America’s power grid for these?

The U.S. healthcare system that is so heavily electronic, yet unprotected, would be an early casualty or greatly incapacitated at a time when demand for services would increase. Today’s

hospitals are not designed to sur-vive and continue to operate after an EMP attack or even any mid-to-long term disruption of power and logis-tical support. How many weeks of fuel is on-site for emergency genera-tion operation? Is it acceptable to our society that at a time when hospitals will be a crucial resource, they are not designed to continue to function? Do we need to wait until a disaster to conclude that is a bad strategy? Do we choose to put the interests of a few large communication and oil corporations ahead of the welfare of the American society as a whole, by not mandating backup power at gas stations, cell towers, food stores and other key resources society will need to cope with in an incident of national significance? Will maximizing share-holder ROI make any sense if the shareholders are dead?

Lack of Planning Bacteriological Pan-demics All that said, perhaps the greatest risk to the future functional-ity of hospitals is the growing spread of antibiotic resistant viruses and bacteria, including: MERS (Middle East Respiratory Syndrome), MRSA (Methicillin-resistant Staphylococcus aureus), VRE (Vancomycin-Resistant Enterococci) and others. The second case of MERS has now appeared in Florida. The first case was in Indi-ana and they are not related cases. We have created superbugs that are resistant to every known antibiotic, and unlike the past where they were primarily contained within health-care facilities, they are now popping up in communities and increasing-ly infecting otherwise healthy chil-dren and adults. In a 2013 report released by the Centers for Disease Control (CDC), researchers estab-lished a 10 percent per year rise in MRSA infections in kids from 2005-2010, and the proportion of those cases involving community-associ-ated MRSA jumped by 55 percent. The CDC tracks “invasive” MRSA infections—where the bacteria have reached the bloodstream or invaded internal organs—and 80,500 invasive MRSA cases were recorded in 2011, the most recent year of data available,


which was celebrated as a significant decline from previous years. But that same year, there were nearly 460,000 hospitalizations involving a MRSA diagnosis, according to hospital bill-ing data collected by the U.S. Agen-cy for Healthcare Research and Qual-ity—meaning that the CDC’s figures excluded more than 375,000 MRSA infections that were severe enough to involve hospital care.

Hospitals are struggling also. In a rare moment of candor the National Institute of Health facility in Bethesda related the struggles they had to con-tain such superbugs to a single con-taminated intensive care unit and pre-vent it from going hospital wide. Many hospitals are also struggling with this problem but it is only quietly whis-pered about among hospital infection control officers.

New Antibiotic Research Not a Nation-al Priority A couple of years ago, Pfizer, one of the last drug companies to have had a large-scale antibiotic re-search effort, shut it down because it wasn’t economically viable. So, the an-tibiotic pipeline to fight MRSA, MERS and VRE is essentially empty. This is one area where the government could step in and hasn’t. Now Pfizer has re-located corporate offices to Britain be-cause the corporate environment is better there. If antibiotic research is not profitable for a company (because antibiotic use is limited to actual cas-es, since widespread use ultimately makes the antibiotic ineffective be-cause all the “bugs and viruses” it can kill are already dead, and only the re-sistant ones are left), then the govern-ment should fund it. Funding antibi-otic research would be a better use of $500M than wasting it on the www.healthcare.gov website and another $474 million of failed state exchang-es. That’s almost enough to launch one new drug! Where is government plan-ning and programs to combat super-bugs? Have you heard of any?

Practical Hospital Design ImplicationsBut what does all this mean practically? Basic design and patient care concepts

are two things we need to take a very close look at. For example, in the design of emergency room when we are dealing with superbugs, biological or chemical weapon attacks, we can no longer have stretchers/beds separated from each other by curtains – because this is the area of the hospital that will be exposed first. Individual emergency “rooms” need to allow switching from positive to negative airflow, so they can ultimately provide either isola-tion or reverse isolation depending on the nature of the patients being seen. They need dedicated, rather than mobile equipment because there is little means to decontaminate a monitor when moving it from one “room” to another. Staff-carried, spot-check devices are a “no-no.” There needs to be gowning areas and decon-tamination areas within emergency department for all staff and perhaps for emergency responders (EMT and ambulance teams) as well. Technology like monitors and ventilators needs to be more stationary, less mobile, and more able to be decontaminated than current designs provide. We need to ask, how will we monitor patients during transport for ED to OR or ED to ICU? How will we “resterilize” the ED environment, the EMT environ-ment, and key medical staff?

Making such facility changes takes time so we must start now. Making such facility changes takes Making such facility changes takes time so we must start now. Making such facility changes takes time so we must start now.

If we want to make EDs more superbug survivable, what are the top 10 things we must do? Which can be done in a year? Which in 5 years? Does anyone have a list? Are the top 10 items the same on every-one’s list? How much on-site storage is enough? What resources need to be stored on-site for a hospital to con-tinue to operate for a month? For four months? How many reusable devices would the hospital need if disposable devices were unavailable? How would hospitals re-sterilize them on-site? These are a few of the questions that need to be considered and answered.

We need administrative leadership in hospitals and awareness creation in communities, to begin to tackle such issues. We cannot wait until the emer-gency room is inundated and over-flowing with patients suffering from a SARIN gas attack or an outbreak of MERS or VER infections to redesign the emergency department. That will be too late, and the purpose of those hundred million body bags that FEMA has inconspicuously spread around the country, will become very clear. We need to do this if for no other reason than during a pandemic we will not only wipe out average Americans on-the-street, but also a large percentage of the entire medical staff at hospitals and other healthcare facilities who care for them, and these folks take years to replace. Can you envision a return to medicine two centuries ago, or the loss of folks who know how to deliver anesthesia or perform a suc-cessful operation or make a differen-tial diagnosis? That could happen if we don’t plan and begin to act now.

Redirected ResourcesWhat does $974M of federal money buy? Obama spent that already on a website that doesn’t work and isn’t secure. It could have also/alternatively been used to purchase and install 90,000 or more (30 KW) backup generators.

Suppose they were installed at one of every four of the 121,000 gas stations in America. That would use up about 30,000 generators. Since many gas sta-tions have convenience stores, they should be the first to be equipped, since they could also provide food supply and water, in addition to gaso-line and diesel fuels in the case of a disastrous event.

Suppose every third house in each neighborhood had a 20 KW standby generator that ran off natural gas and had one extra refrigerator in their garage. They could act as a recharging station for cell phones, and supply emergency refrigeration for the neighbor on each side’s critical foods or medicines. Access to fuel, means


access to transportation, which means delivery of needed consumables, and mobility to get to work. It means the ability to help a neighbor. During Sandy, we ran 24 hours a day for 10 days off our backup generator, and it was a game changer. We had power. We had refrigeration. We had lights, computer, Internet access, and if we had needed it we would have had heat.

Suppose the government provided a tax credit of the full amount for each recipient who agreed to help their neighbor in such an emergency, paid over a three year period? There are 125 million homes in America, so about 40 million generators would be needed. If the cost per generator was $2K in such quantities, and the install cost was another $2K, then the cost of the program would be about $160 billion dollars. The government spent more than that to bail out GE, GM, various banks, etc. – so why not a nationwide emergency power distri-bution plan? That’s more important to me than whether GM stays in busi-ness. It would create a lot of jobs in the private sector, strengthen the U.S. power grid, make us less vulnerable to disruptions, and focus the nation on natural gas, which it has a lot of. It could be administered by existing gas and electric utilities whose com-puter and billing systems work, and not depend on a $500M boondoggle website the government has proven it is incompetent to build. How about a national generator design that ALL generator suppliers build to and get a piece of (in proportion to their cur-rent market shares)? It could include a metal-case Faraday cage and other provisions to make it more survivable. It could run off of natural gas, which there is an abundance of. It could be designed to be switched on by utilities, to provide part of the power needs of 40 million homes during peak demand or when the power grid was in trouble. For the time the generator supplied power during emergencies, the increased cost could be shared by the three families sharing the power. Suppose the local power company

provided the installation. That could be accomplished within 5 years, if we start now.

Good ideas? Bad ideas? Practical ideas? These are just strawman ideas, but entertaining them would teach us what can and can’t be done and what it might cost. Would we be better off with 36,000 more ICD codes or a shored-up, more stable power grid and better emergency preparedness? Are our national priorities logical, sensible, or correct? Do they even exist?

PrioritiesI get that we are out of ICD codes, but the cost and amount of effort to move to the twice delayed ICD-10 coding system is enormous. If any of the events mentioned above occur, billing for healthcare services will be way down on the survival and uninter-rupted delivery of safe healthcare pri-ority list. What if the same resources and use of human talent were invested in disaster planning and advance mit-igation, rather than on the change to ICD-10 coding?

Renovation Planning Begins NowWho is responsible for such plan-ning? Everyone is! Prior to estab-lishing Medical Strategic Planning in 1992, back in the late 1970’s, I was involved in planning and staging the operational relocation of hospitals from existing, operating facilities to newly constructed ones, including the transfer of all patients, equipment and processes in a manner that had the least negative impact on health-care operations and cash flow during the transition. I helped coordinate the plan and successful relocation of Orangeburg Regional, Coatesville/Brandywine, and others. I was per-sonally on site on “move” day at such facilities. What was the ‘secret’ to suc-cessful relocations?

The secret was getting the local staff to focus on and do the actual planning. It was leadership, mentoring and cre-ating a friendly planning framework. The staff was best qualified to do the

actual planning, they just needed to set aside time and have a conducive environment in which to consider the ‘what ifs.’ They were stakeholders in the outcome. It affected their jobs, their hospital, and their patients. In every case, they came up with good ideas once presented with the prob-lems, which I would not have thought of. National survivability begins with community survivability, and that’s a local issue.

Financial Planning ChallengesMaking construction design changes is a costly business. Repurposing some-thing is always more expensive than building it from scratch, yet in this current economic climate new hospital construction is nearly unaffordable. Obamacare has created that problem by systematically under reimbursing hospitals to care for government-paid patients at a loss – where previ-ously the same patients were privately insured and generated a small profit to the hospital. When Obama became president, about one-third of hospitals were at financial risk.

Once the Obamacare employer man-date kicks in, it is likely that they will either fail outright, or the quality of care they deliver will plummet. Where will the money come from for modifi-cations to mitigate in advance, the types of disasters described above?

It is clear that while government has made resources available to it-self to build EMP-survivable facili-ties and infrastructure, it has made no such investments on behalf of the average American citizen, or local hospitals, or for local mobile phones, or gas stations, or food stores.

It is clear that while government has made resources available to it-self to build EMP-survivable facili-

It is clear that while government has made resources available to it-self to build EMP-survivable facili-

local hospitals, or for local mobile phones, or gas stations, or food

It’s as if the federal government doesn’t want average Americans to survive in the event of either of man-made or a biological catastrophe. The average American will be on their own, and good luck to them! Hospitals will also be on their own.


MSP Medical Technology SurveysMuch of the market research MSP does on critical medical monitoring and diagnostic devices (vital signs monitors, infusion pumps, ventila-tors, electronic health record systems, communications systems, and so on) started in the days of managing inven-tories of all movable equipment and hospitals as a prelude activity to hos-pital relocation into new facilities.

We can’t figure out what to move if we don’t know what we have. Planning began with a solid inven-tory. We found that the CFO’s records show what we have is never more than about 75% correct. Think your hospital’s inventory is any more accu-rate? Do a physical audit, tag every-thing, catalog it, and you will see it isn’t. Stuff that is supposed to be there simply cannot be found, and stuff is found for which there is no record of it ever having been purchased on the CFO’s books! No one knows or cares where it came from. Knowing what we don’t have tells us what we need to acquire for the new facility. A physi-cian inventory should be conducted at least every 10 years, with asset tagging to re-calibrate capital asset records. How many hospitals do that? When was the last time your hospital did a physical inventory?

Call for a ‘Hospital Design for 2030’ National ConferenceThe point is, we need to understand the implications of our actions, and the demands that will be placed on our institutions by natural disasters, human irresponsibility or biological mutation, and adapt our systems and approaches to assure that we survive these calami-ties, rather than succumb to them. We need to make doing so a priority, taking time to pause and reflect on the challenges these issues present. What better way to start than with a national conference? Visit the www.medsp.com website and volunteer to help us orga-nize one.

In 1999, President Bush sponsored a conference focused on the “The ICU

for 2010”. Many of the recommenda-tions flushed out at that conference, (at which I and dozens of other speakers from all disciplines made suggestions) were adopted and ICUs today are more functional because of that con-ference. Kirk Hamilton was the mod-erator of that conference, and the editor of the book which documented its findings. Well, it’s now 2014 and time for another conference. Perhaps it should be called, “The Hospital of 2030,” which is only about a decade and a half from now. Ten years is too short a time period for planning and implementation. Fifteen to twenty years is more realistic.

The amount of change and even the potential collapse of the United States economy in that time frame are rea-sonable risks to consider and topics to discuss. Survivability and availability of the power grid, backup power, com-munications, transportation and supply chain logistics, and redesign to miti-gate the spread of superbugs (MERS, MRSA, etc.) are important topics to include in any conference.

Reality 2014 on Launch Pad MSP is about to launch its 2014 Reality™ medical equipment moni-toring survey by contacting the Director of Biomedical/Clinical Engineering in thousands of U.S. hos-pitals to catalog the quantities, sup-pliers, and age of medical technology infrastructure in each facility. It is only when, as a result of these surveys, the information is consolidated at the national level, that we can even answer basic questions about how many bed-side monitors or ventilators or infu-sion pumps actually are installed, how old they are, when they are likely to be replaced, and what the require-ments for replacement unit should be in order to move to a more sustain-able and integrated healthcare opera-tion that is “more-survivable, more-affordable, more-integrated” than the technology it replaces. We typically find about 70% of U.S. hospitals are willing to participate in our surveys. It would be wonderful if that figure

was more like 85%, because we need a representative sample of all hospital sizes, types, and missions in order to present an accurate picture of what will happen in healthcare technology markets over the next five years.

Readers need to get involved and per-haps take the lead. Hospitals need to be involved and inform patients and staff. MSP will be calling your hospital to collect the hard data on medical technology. The survey takes perhaps 10 minutes. We have been doing this since 1999, so that the basis of any discussion can be hard facts rather than bureaucratic fantasy. Please par-ticipate. Feel free to contact us with your thoughts. If we all work together, whatever we accomplish will better prepare us for future adverse events. Shouldn’t that be our shared objec-tive? �



• Introduction & Purpose

• Health Record Bank Principles

• The T-HRB Diagram

• Where’s The T-HRB Data Center?

• PATIENTS - Groups of T-HRBs

• HIE Technology Limitations

• Databases - A Technology Whose Time Has Passed

• The Triad Dataspace Breakthrough

• I.T. Implications of Triad™ Technology

• Triad™ as a HRB Foundation

• MSP's T-HRB Building Blocks

• Master Patient Index (MPI) Services

• A National-Level MPI

• User Authentication Services

• Off site PHI MD Office Data Backup Services

• Third-Party Open-Source EHR Services

• ACO & Other Group Formation Services

• Public Health Data Services

• T-HRB Researcher Support

• Unstructured Data & NLP

• Population Health Management

• HIEs are Faltering

• Emergence of Health Record Banks

Introduction & PurposeThis article explains the limitations of current Health Information Exchanges (HIEs) and why a metamorphoses to Health Record Banks (HRBs) is essen-tial to achieve a sustainable (profitable) business model that supports popula-tion health management and discovery of assured quality processes.

It introduces a new technology called Triad Dataspace™, an advance in elec-tronic data representation, aggrega-tion and fusion that overcomes the limitations of databases. Without this advance, HRBs will be plagued by the same database limitations that have stifled HIEs, and limited the ability to achieve robust performance and support the full spectrum of business models needed by various stakeholders.

Health Record Bank (HRB) PrinciplesIn our opinion, HRBs should achieve:

• Patient Data Access Control: Since patients own their PHI data, they should have the ability to control who has access to it and for what purposes it is used. Today they don’t have such control. HRBs should restore data owner data control.

• Data Access Integrity: PHI data must be stored by a trusted organization, not by any individual provider, or provider group or IDN. Data should be held in a commercial record bank, in which no depositor owns the bank or controls another depositor’s data.

• Population Health Management:An HRB needs to simplify deter-mination of causative factors that

Transforming HIEs Into HRBs for Population Health Management - A New Business & Technology ModelAn editorial by Arthur Gasch - Founder, MSP


are related to desired outcomes. It should support an assured-quality™ process, constantly deter-mining multi-parameter corrections between current record content and content associated with desired outcomes. Assured quality™ calcu-lation is the key to effective popu-lation health management and evi-denced-based practice.

• Data Access Accountability: An HRB needs to should provide ad hoc, item-level reporting of PHI data use on request. This audit trail must not be circumventable by any person or software process that runs in the HRB.

• Data Security: PHI data keep in HRBs should be stored and que-ried while encrypted. This prevents captured or intercepted data from being decipherable. HRBs should support homeomorphic lookup.

• Authentication: Mul t i -Fac tor authentication, like MSP’s patented You Take Control, is essential in a HRB. The HRB needs to know for sure with whom it’s interacting and through what device. Both should be authenticated. MSP uses 4 fac-tors to authenticate users.

• Business Model Agnostic: The HRB foundational technology must to support a variety of business models.

• Ease of Use: An HRB should be simple and intuitive with GUIs custom designed for each class of users.

• Single Point Storage: Each patient’s PHI data should be stored in one HRB location apart from the pro-vider-encounter location. The HRB must be securely mirrored to a second location for disaster mitiga-tion purposes.

HIE Technology LimitationsEach advance in information tech-nology has spurred an associated advance in healthcare applica-tions. The Internet and the database advanced healthcare I.T. from CHINs to HIEs. But databases introduced

their own unique set of issues, which need to be overcome. To date, no DBMS-driven HIE solutions have met

the seven criteria listed above.

The T-HRB DiagramEveryone has seen a graphic like the one that begins this article. It has doc-tors and other providers/stake holders huddled around some central tech-nology. Such diagrams have existed for decades, to the point that no one really takes very seriously.

If you look more closely at this dia-gram, you’ll notice the little diamonds by each user and the Triad Dataspace™ symbol at the center. These repre-sent breakthrough data representa-tion technology that empower MSP’s Triad-HRB.

Each user has their own “view” of what T-HRB is, but is oblivious to other users and their views. Each doctor can “see” a T-HRB as a simply (out-of-office) extension of their electronic (EHR, CPM) record room or whatever other services Triad Dataspace™ may be providing. No individual doctor is aware of other doctors that the HRB is concurrently serving, until they establish a HIPAA Business Partner agreement with another doctor, or a hospital, or an IDN or an ACO that shares risk for some of their patients.

Likewise for patients. They see a T-HRB as Personal Information Exchange (PIE) where they store their personal life style or PHR data or access health-care applications on their smartphones, tablets or home computers. Their PIE allows them to interact with their physician(s)’ branded portals, to retrieve their encounter summaries, lab results, or request Rx refills, appointments, ask questions securely and so on.

A T-HRB data depositor must choose to become more “connected,” in order for the scope of what they see becomes “wider.” A group of patients in Houston using a T-HRB won’t be aware that a group of patients in Dallas can be using the same T-HRB (or perhaps a different, intercon-nected one). The Internet and leased

fiber communications make such dis-tribution possible. Where a T-HRB is located becomes less crucial than what member services it provides.

Where’s a T-HRB Data Center?If a group of patients, doctors, hospi-tals, SNFs and ACOs wants to estab-lish their very own T-HRB in their own community and underwrite all its development and operational costs, MSP is pleased to do that. If they want to pay less by using an existing T-HRB without worrying about it’s physi-cally location, they can do that and save a lot of money. Every depositor’s records are physically stored in ONE primary T-HRB location, and at a mir-rored BACKUP T-HRB location (for disaster mitigation purposes during incidents of regional or national significance).

PATIENTS™ - Groups of T-HRBsPATIENTS™ is an MSP acronym for Patient Archive, Tracking and Integrated EHR Network Transactions System. PATIENTS™ is a method of integrating and linking various Triad Data Linkers™ or T-HRBs to form an distributed virtual repository of enor-mous size.

One of the things that makes this much simpler than conventional data-base network integration, is that all information in a T-HRB is already in one universal format, and does not have to undergo data type conver-sions to be aggregated at a “higher” level. The Triad foundation pro-vides both T-HRB upward-scalability and PATIENTS integration where required – which means it could sup-port aggregations that included the entire U.S. population running on var-ious computers and sites, but always stored in one universal representation.

In the future, if a nation-wide system needs to be established and integrated, the integration of T-HRBs would be both fast, scalable, and the least com-plex method to achieve it.


That’s the big picture. Let’s see what HIE technology limitations must be overcome to create true HRB’s.

Databases – A Technology Whose Time Has PassedWhat’s wrong with databases?

1. Require Data Relationships to be Known in Advance: They presume that all the data relationships are known and can be expressed in advance in the database schema. This is of course not true in health-care which includes issues of life and death, sickness and wellness, disease and treatment, or the details of metabolic pathways or molecular chemistry. In fact, across healthcare, there are many “relationships” that are unknown and need to be dis-covered and validated if health and wellness are to advance. Yet data-bases lock the process into defining a schema in advance of collecting the data and lock out any changes in relational structure that may later be revealed by the data itself.

2. Databases Impose Data Types: Database data types don’t exist in the information domain, but are required due to the manner in which data is stored in computers. Each data type then gets its own opera-tors. If the data type is integer, the operation “add” is meaningful, if the type is string, the operation “add” may not be. What do we get if we “add” Chicago to Detroit, or if we “multiply” them, or “divide” them?

3. Lack of Security: Databases aren’t very secure. No user of databases, from individual doctors to hospitals, to payers, to the government, has been immune to being hacked and hundreds of thousand to millions of PHI data records have been lost in a single breach. That is a serious problem with databases because in order for the CPU to do simple functions like “query” or “look-up” information, it must not be encrypted.

4. Limited Interoperability and Data Aggregation Problems: Records

from one database product are not stored the same way as records from another. In fact, data stored by the same database on a Windows system, are not stored in the same way they are on an Apple com-puter, even if they have the same schemas (which they never do even with “standards”).

Can anyone dispute these problems with databases?

Database Management Systems (DBMS) in all their flavors: rela-tional, entity-relational, associative, object-oriented, Hadoop, distributed – all share these problems. No DBMS provides an easy way for systems to exchange data, because the interface engine program has to convert the data types from a source system into the data structure (which was pre-defined) on some target system that in the end, has exactly the same issues as the source database had. ODBC is a partial answer at the lower layers of the ISO model, but aren’t much help at layers 6 and 7. Nor is HL7, par-ticularly for free form or unstructured text. Computer understanding of level 7, which some describe as semantic interoperability is still challenging.

The best that can achieved is a many-to-one conversion of data types, but we never escape the bonds of data types, inefficient information repre-sentation, static data descriptions, lack of security and so on.

The Triad Dataspace™ BreakthroughTo fathom what this paper is saying, I invite you to temporarily suspend what you think you know about data and its relationship(s) to information. What this paper reveals is unknown commercially. It’s not like anything you are aware of. It was developed for national interest applications. Imagine you are on the Starship Enterprise, and don’t ask how the Warp Engines work Accept the concepts presented as true and demonstrable, without formal proof (because space and time prevent proof here). If seeing is believing, we have a demo you are invited to view.

Triad Dataspace™ is a breakthrough in the way information is represented and stored electronically. Here’s how to get your arms around it.

1. A Dataspace™ is NOT a database, it is a new and fundamentally dif-ferent information storage struc-ture! Why?

Dataspaces™ have no preconceived notion of what types of informa-tion structures they are going to store. Databases do and must have. Dataspaces™ have no a-priori schemas. Databases all do. The Dataspace™ structure is formed as a result of the storing of actual data presented to it, and is self-struc-turing. A database schema is static and unaffected by the data it stores.

2. Triad™ data storage structure is organized by data differences from data already encountered and stored (by anomaly). Database storage is ordered by similarities based on its schema.

3. A Triad Dataspace™ stores the pro-cess description of information. A process description can regenerate the data whenever needed at full accuracy, e.g. 100% bit lossless. A database stores raw data, which is the static data itself.

4. A Triad Dataspace™ uses one uni-versal data representation and no other data types. Triad automati-cally converts all data from every source, regardless of the commer-cially-available database that is its source, into one, universal, normalized, distortion free, information representation that has one set of arithmetic and algebraic operators. Database data types including: integer, floating


point, Boolean, string, and blob (bit-mapped) images and have many different types of operators that depend on data types.

5. A Dataspace™ aggregates data and stores the entire record, taking into account the original source metrics, units, and data types. A database stores raw data without regard to units, metrics and data types.

6. A Dataspace™ format is encrypted but queryable. If data in a database system is encrypted, it must be decrypted to be queried. Generally databases are not encrypted.

7. A Dataspace™ processes queries much faster than a database, because a database has to contend with non-indexed field values in a SQL query, and a Dataspace™ doesn’t. Query speed, regardless of com-plexity, remains near-real time in a Triad Dataspace™.

That’s a peek inside the very novel and remarkable Triad Dataspace™ technology. The I.T. world, like the real world, is no longer flat. The earth is round and Triad™ is multi-dimensional.

Let’s now ponder the information technology implications of using Triad Dataspaces™.

I.T. Implications of Triad™ Technology1. Interoperability: Interface engines

are no longer needed to convert all data types into one set of datatypes used by the Cloud Server’s database product. Triad’s universal format is data type, unit, and metric agnostic, and encrypted. Using the industry standard, ODBC (or JDBC) drivers to any database, and MSP’s unique

representation, all elements of a record are aggregated and fused.

With MSP’s Clinical Context Data Dictionary (C2D2), you can import data from any database into a Triad Dataspace™, and then export it to any other (ODBC/JDBC-compliant) database from Triad™. What does that do to the healthcare record migration problem?

2. Security: Data is stored in an encrypted format and is therefore secure; e.g. look at the Triad™ data below in Fig. 1. Try to figure out what it means. It’s real data but gives no clue as to what it represents. It is undecipherable by itself therefore its fully HIPAA compliant, even published here.

Triad™ eliminates most types of data theft because having a double-blind encryption of information, without the mechanism to create or decipher it, doesn’t allow the infor-mation content to be breached.

3. Storage Cost Reduction: Since the universal, encrypted representation is much smaller than the data stored in databases, the cost of storage is dramatically reduced. By how much?

Our demo takes a database with 1.2 million records that contain 19 text and numeric data fields and occu-pies 45 Mbytes of space. In Triad format the data storage footprint is 23,000 bytes!. This is 1/1900th the size of the original 45 Mbyte file. When we process the same file through 7Z, the space taken is 8.4 Mbytes. Triad™ takes 352 times less storage space than 7Z would.

Do we always get 1900 times storage footprint reduction? No. It depends on the data in the file.

Was the file you cite rigged to be highly compressible? No, if it were, 7Z would have compressed it as well as we did, but 7Z couldn’t. It was a real world file typical of healthcare database information.

What about smaller files? With smaller files, we get less reduction in storage footprint size, however even a file with as few as 30 records, is smaller in Triad’s universal format than in 7Z.

Practical implication – store up to 3.8 Exabytes of data or 36 Petabytes of images (100% bit lossless) in 10 sq. ft. of data center floor space.

Do the math. Storage costs reduced by 75% or more. Think $100,000 in hard drive in a T-HRB versus $20M in hard drives in the same data center that uses conventional database storage.

Imagine how much less costly it will be to build a T-HRB than to build any current database technology. What does that do for the “cost” side of the HRB business model?

4. Faster Query Processing & Enhanced Throughput: Triad enhances data query speed. The Triad universal format puts all components of information (a “record”) in one small storage area, the location of which can be calculated (rather than searched for). Given that a data searches are concatenation of logic conditions formatted as a SQL query that specifies a set of attri-butes being searched for, Triad™ answers it without decrypting or expanding the representation, and

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Fig. 1 - Triad Dataspace™ Universal, Sparse, Searchable, Double Blind-Encrypted Representation - expressed as ASCII characters


without! The technical term is homeomorphic lookup.1 Sign an NDA and we will explain how. Triad™ query processing has three remarkable consequences.

• First, queries happen in a time that is similar to initial data storage time for a new record regardless of data storage mass size in the reposi-tory. Put another way – to query a billion records, Triad™ query time is near-real time indepen-dent of whether a “field” is indexed or not, because Triad doesn’t have the notion of “indexed fields (or unindexed ones).”

• Second, information did not have to be inflated or unencrypted to be queried. Nor was it “searched.” Searching records is an obsolete con-cept related to non-indexed fields that has no meaning in Triad Dataspace™.

• Third, the data was never exposed in a human readable format . Information was always securely encrypted, even while being que-ried, even inside the Triad data center. This brings a level of “security” to cloud data centers that does not exist today!

5. Item-Level Audit and Cost-Accounting Trails: Triad manages information at the item-level, as explained above regarding a SQL query. The exact combination of field values are located. Then Triad™ logs the query items, along with the information about where it came from, what terminal was used, who was authenticated and using it, why it was done, and that becomes an “item-level” audit trail entry in the Triad Dataspace™.

All queries create audit trail logs. Triad™ logs the exact content of the information requested (and pro-vided) for every query – from the beginning of the Dataspace until now, and makes it available to the data owner or his trustee. This access

1 A one-to-one correspondence, continuous in both directions, between the points of two geometric fig-ures or between two topological spaces.

log can also be used for accounting and billing (e-commerce) purposes.

Triad™ is the only data structure to our knowledge that provides an item-level audit trail in compli-ance with DHHS recommendations (which DHHS didn’t follow in the design of its own healthcare.gov website).

All this leads to one conclusion; databases are an obsolete data representation concept.

Databases are no longer the best way of organizing information in open knowledge domains like healthcare. Databases are outliving their utility and in the future will be less prevalent.

For a successful HRB business model, those desiring to build HRBs should consider building them on a Triad Dataspace™ new technology founda-tion, rather than products like Oracle, Sybase, Filemaker, SqlServer, or rented space in a datacenter like Microsoft Health Vault, Dell, Merge Healthcare, the HP loud, InterSystems, Amazon, EMC, IBM or others using conven-tional database technology. Using this older technology will translate into fewer capabilities for more money.

Triad™ as a HRB FoundationGiven these new properties of storing information, here is what that means for the implementation of HRBs.

• A much broader range of business models can now be supported. A T-HRB can have a very diverse set of “account holders,” which can be a mix of data depositors, service providers, and data users. Each T-HRB client can fill more than one role. For example, a pharmaceutical company could “deposit” its research data into the HRB (and share it with no one); but access some data from thou-sands of other data depositors who have given permission for their de-identified information to be used for research purposes in exchange for a small interest “fee” the pharmaceutical company pays to access the information. In this

case the same client has two roles. This may be typical in a T-HRB depending on its underlying busi-ness model.

• Triad™ provides the mechanism to allow patients to own and con-trol use of their data. Triad™ also provides the means to see who has used the data and for what pur-poses, on an ad-hoc basis, when-ever a data owner cares to look. Full item-level audit trail logging empowers that. It’s a feature of interest to every data contributor to a T-HRB, including: patients, doctors, pharmaceutical compa-nies, quality organization, and so on – every data contributor.

• T-HRB can be far less expensive to build and operate than HRBs using commercial database tech-nology. A T-HRB is a technology base upon which EHR, PHR, CPM, LIS, MPI, cloud-based por-tals, Quality, Population Health Management, Public Health, pharmaceutical, medical-legal and many other healthcare business models can be quickly and easily built; and just as easily expanded as grows demands – since T-HRBs are very inexpensively upward-scalable technologies.

• T-HRBs can provide enhanced throughput which will be substantially faster than a HRB using commercial technology, because all queries will be as fast, or faster, and can be processed at optical data rate speeds.

• T-HRBs will be more secure than any HRB using any commercial database.

• Fusion without Interface Engines. Assuming owner-granted permis-sions allow, the fusion of information from all sources creates a population-wide information set that can be operated on as a whole by one set of opera-tors and is therefore ideal for detect-ing new quality measures and managing the health of various populations (such as those with chronic diseases like


diabetes, asthma, COPD, ESRD, and others.)

• MSP offers a PATIENTS solution for T-HRBs, and NHII Advisors has overlaid its HAPPI HRB business model on a T-HRB foundation. A third organization is now laying a national quality organization business model on top of a T-HRB model. The flexibility of the information structure, and the power of iConsent, YTC, C2D2 and other Triad™ attributes, make doing all of these models straight-forward.

MSP's T-HRB Building BlocksThe T-HRB technology offers several building blocks needed for a variety of medical applications. The more of these services utilized, the less that has to be written to empower an HRB or any other healthcare application. Here are some of the pieces.

Cloud Repository Licensing Most HRB’s outsource the cloud data stor-age to some third party organiza-tion that didn’t create the core data-base technology that empowers it. They pay a flat cost per Terabyte (or Petabyte or Exabyte for their data). As data mass grows, and applications move beyond simple data storage and sharing to analytics and data mining for outcomes and quality measures, the apparent low initial costs disap-pear and data processing costs become quite significant.

Triad™ dramatically reduces data storage costs. Since storage density per square foot is much higher in a Triad™ cloud center than in a conventional one, expansion costs do not become space intensive.

Data mass of up to 3.6 exabytes per 10 square feet are possible in an HRB based on a Triad Dataspace™ for text and numeric data.

Master Patient Index (MPI) ServicesAn important concern in any HRB is patient identity management. Is the record from patient John Smith, con-tributed by Doctor Jones in Houston, the same as the John Smith record contributed by Doctor Allen in

Houston – even if they show two dif-ferent addresses or phone numbers or even social security numbers? Are the two John Smiths the same person, or two different people? Has one stolen the identity of the other?

Clearly a Master Patient Index (MPI) that can work correctly in one doctor’s office, may not work for all patients in a hospital, nor in the city with many hospitals or other doctors.

Moreover, an MPI for a city, may not work at the county or state level. A state-level MPI may not work at the regional or national level.

Bottom line, building an MPI even at the single practice level, the con-cepts used need to be compatible with MPIs built for the entire country, even though it will initially serve a much smaller patient population. That means it has a mechanism to incorpo-rate all languages, countries of origin, birth dates going back say 120 years, and all viable forms of Hispanic and other ethnic names. How many EHRs or HIEs have an MPI that is built like that today?

A National-Level MPI Dr. Richard Dick, Ph.D., MSP’s CMIO was a principal in an organization that defined (over a decade ago) and cre-ated the largest MPI to collect and aggregate drug fulfillment data for hundreds of millions of Americans daily. It’s still in use today.

What Richard learned resulted in the patent-pending Clinical Context Data Dictionary or C2D2. C2D2 includes methods to authenticate patients and parse their names in all languages, and in all geographic settings independent of the legal variations that can occur. MSP employs the C2D2 framework in all its T-HRBs, whether they are serving a single physician, a group of physicians, or an entire nation. MSP can offer MPI as a service on a Triad Dataspace™.

User Authentication ServicesThe more information that exists about a patient, the less likely that an identity can be misconstrued. With as few as 6

pieces of information, the majority of inconsistencies about identity can be resolved. MSP’s ‘You Take Control’ patent addresses issues related to user authentication and in conjunction with iConsent™, manages user permission administration in every T-HRB.

Off site PHI MD Office Data Backup ServicesMSP can provide real-time, off-site data streaming backup storage in a T-HRB for doctors’ EHR, CPM and other systems, including ALL their patient records for $1 a day. This is the most basic service we offer. In fact, by engaging patients, backup services of patient records may become a revenue generator to physicians to help offset their EHR or other office I.T. costs.

Third-Party Open-Source EHR ServicesDoctors who have not yet purchased EHRs can obtain EHR services through a T-HRB. A T-HRB can sup-port a number of open-source EHR products, although MSP does not offer any of these directly. They are provided by third party contractors using the T-HRB as a backup storage repository for all EHR patient records.

ACO & Other Group Formation ServicesWhen any individual doctor joins a T-HRB, they see it as their own, pri-vate repository. When the doctor then wants to become part of a group of doctors who have shared patient responsibilities (such as under an ACO), there are two steps.

Step 1 – the doctor grants data access rights to the group, and

Step 2 – the group grants the doctor group access privileges. That’s it.

Either party can revoke permissions extended at any time, ending the rela-tionship. It’s that simple. There is no transfer of actual data between the parties in a T-HRB, only extension (or revocation) of data access/viewing rights. All records remain in the HRB account of whomever deposited them.


T-HRBs will strengthen and enhance the doctor-patent relationship, and place BOTH at the center of PHI data control and access.

Public Health Data ServicesTo comply with regulations that require specific conditions to be reported to public health agencies or to CDC, the HRB can make such information available if the Public Health Agency (PHA) is part of the HRB. If not, the doctor’s EHR can interact with PHAs or CDC directly.

Likewise, PHAs can tag combinations of items that they wish to track for detection of analysis of an emerging disease or attack vector, and when records are seen with this combination of features, the T-HRB will flag them to their providers.

A T-HRBs can grant PHAs access to Triad’s extensive Knowledge Manifold™ data analytic and epide-miologic analysis capabilities so that the need for the PHA to maintain staff and programs can be reduced. PHAs could be rewarded for providing benchmarks and alerts to all HRB depending on the business models.2

PHA costs can be substantially reduced by not having to maintain their own statisticians or programming profes-sionals, not having to do format and data type conversions and multi-vari-able scaling that is otherwise involved in conventional program operating costs. A single T-HRB can support concurrently different business models between different users, and earn a small fee based on the level of HRB data use that occurs. The core HRB technology should be business model agnostic and the foundation of several different HRB user business models.

T-HRB Researcher SupportHRB’s must also support a variety of research uses of a de-identified indi-vidual’s PHI data. With appropriated HIPAA permissions, a de-identified search can be made of all user profiles of patients who wish to be considered for drug studies – in exchange for a

2 The HAPPI business model provides incentives to PHAs to join. Contact MSP for more information.

small fee (that is credited to the data owner’s account). Initially, it’s impor-tant that the permissions-manage-ment system limits access to only the necessary, de-identified summary of each patient profile and include only patients who wish to be included.

The T-HRB has the mechanism to anonymously contact the prospective patient for the researcher, to determine their willingness to reveal their identi-ties and participate in the actual study. These can be either pre-approval clin-ical trials, or post-FDA approval sur-veillance studies. In both cases the phar-maceutical company is paying a small fee to the patient who has allowed their PHI data to be searched.

Finding New Quality MeasuresCare cost reimbursement is suppos-edly being shifted to quality metrics, yet we have great limitations in mea-suring quality or developing quality standards.

A quality measure is a group of param-eters that are consistently causative of a desired outcome – the key word being “causative.”

Many parameters are coincidentally associated with desired outcomes, but don’t cause them. Determining “cau-sation” is the heart of data analytics. The magic is finding the distinction(s) that separate causative and non-caus-ative factors at some level of resolu-tion across the entire HRB without resorting to Herculean efforts and massive expenditures of computer resources (and costs).

There are two problems with quality measures.

• First, the quality measures we now have aren’t monitored and applied consistently to all patient groups.

Most studies show much improve-ment in outcomes could be achieved by simply more consis-tent application of care based on existing quality standards. Having all diabetic patients get yearly eye exams, etc. This requires no new insight into quality measures.

• Second, there isn’t a good way of determining more sensitive quality measures.

This quality void leads to reducing reimbursement to the point where the healthcare system is finan-cially unstable, and/or patient care becomes harmful to patients. Without a real analytic basis for Quality Metrics, we simply reduce operating expenses (by laying off staff, delaying system replace-ments, etc.) to try to balance them with smaller reimbursements (in order to remain in business), until adverse events escalate to unac-ceptable levels.

This is how the government bureau-crats run things and it has nothing to do with improving quality. Studies have already documented this in Medicaid patients, whose survival rates are sometimes worse than patients who receive no care. Moreover, the recent VA scandal shows that gov-ernment bureaucrats are willing to lie about what’s happening and cover-up problems to the point of being crimi-nally negligent, to earn bonuses for denying needed care to American’s veterans. Bureaucrats who run such a system will measure themselves as run-ning a high quality system, and award themselves bonuses for their efficiency – as patients who can’t access care die.

Valid quality measure extraction and compliance measurement is a crucial component of all population health management approaches, and is best derived from the fused patient records, that many current HIEs (based on data-base storage foundations) are not orga-nized or do not effectively provide.

Unstructured Data & NLPIt’s important to use the complete patient record that includes all of the narrative and unstructured (freeform) information, as well as the structured information. That means that nat-ural language processing (NLP) will be required, and NLP is an applica-tion that can very much benefit from Triad Dataspace™ organizational and processing. MSP has not yet imple-mented NLP in commercial versions


of Triad™, but has plans to reincar-nate previous NLP uses of it.

Population Health ManagementPopulation health management and discovery of quality metrics is not a one or two doctor affair. Quality mea-sure researchers need population-level data to discover quality measures, and an awareness of all ‘distinctions’ that actually exist in the data itself, not just the schema definitions in current DBMS products, which actually mask and obscure quality measures. Triad Dataspace™ is a new information struc-ture that causes all data distinctions to emerge, while databases do not. It’s a major difference and advantage.

Patient record HRB membership can expand quickly across an IDN or ACO, which may include from hun-dreds to thousands of 900 doctors in a community/metropolitan area, each of whom have data records for 700-900 patients each.

Triad™ allows an HRB to be initially implemented at a community-level, and scaled up to larger populations by simply adding storage and other components to the initial Triad cloud-based data center(s). Even T-HRBs that start at the community level will need to support millions of patients and thousands of doctors and other providers practices.

Doctors should also not be naive about the costs involved in scaling commer-cial HRBs or of supporting program-mers, statisticians and epidemiologists who will work with the information they contain.

Population health management resources are available not only to public health, quality organizations, ACOs and IDNs, but to EVERY data contributor, without them having to create them directly and repeatedly. There is no need for each provider or provider organization to employ sta-tistical programming or epidemiolog-ical scientists. Such services can be an important part of the benefits of being part of the T-HRB which ensue from its Triad Dataspace core functionality, that is inherited by every user.

T-HRB depositors will be in com-pliance with population health

management aspects of the related ACA and Meaningful Use require-ments related to population health management.

In a HRB using a database technology, multivariable scaling and other data mining pre-requisite operations are required before records can be com-pared. The Triad Dataspace™ universal representation will allow quality orga-nizations to more quickly and economi-cally “discover” new quality measures.

Causality determination is not as simple and is much more computer-intensive when data is captured in conventional database structures.

HIEs Are FalteringThe lack of widespread success by HIEs has left the country with a major electronic data aggregation and inte-gration problem in spite of the “stan-dards” like HL7, DICOM, RxNorm, LOINC, Reed and other codes and standards created to simplify the data aggregation problem. The more that standards are used, the more that new quality measures are obscured – since the standard field set may omit data items that cause distinctions for new quality measures.

Moreover, a patient Encounter Summary is one snapshot of a con-tinuing process of life and disease. Encounter data needs to be modeled as a process description of an evolving dynamic system (life or disease), not constrained by a static, pre-determined and incomplete database schema of a single event captured and expressed in multiple data types.

Emergence of Health Record Banks (HRBs)We see the creation of a new entity – a Health Record Bank (HRB), as a means to achieve security, privacy, use of data accountability, reduced costs, and an entirely new, HRB sustainable business model for the exchange and use of PHI data. HRBs are vehicles for re-aligning shareholder incentives and provide a commercial channel for var-ious entities to offer services to other entities that belong to HRBs.

In MSP’s opinion, the distinction between an HIE and an HRB is

whether it retains conventional data-base and interface engines, has no data compression, and no new analytic tools. Such systems that call themselves an HRB are simply misnomers created for marketing purposes. There are many products that label themselves HRBs springing up already.

The success of HRBs clearly depend upon creating a Business Model that can include all bank data depositors (providers, labs, and all bank service providers (who offer their services) such as quality organizations, phar-maceutical companies, public health agencies, CDC, researchers and others.

Connecting people who want and have agreed to be connected requires a very sophisticated data permissions structure, and MSPs current patents and proprietary intellectual property achieve that level of permissions man-agement sophistication.

In order for HRBs to actually be dif-ferent from and better than HIEs, we have to abandon obsolete data-base technologies that have been the foundation of HIEs, and move on to Healthcare Record Banks (HRBs) built upon Triad Dataspace™ technologies, or be willing to sacrifice one or more of the desirable characteristics that dif-ferentiate HIEs from HRBs. If you are facing implementation of popula-tion health management functions, and don’t want to reinvent a solution based on an old technology, consider moving to a better information representation model, such as a Triad Dataspace™.

Each HRB needs to be “fit” to the needs of the organizations it serves, but a working solution can be crafted in less than 18 months from the time licensing agreements are initially executed. In its simplest, non-buffered form, it is a downloadable software application that is installed on any networked computer.

We invite inquiries from Group Practices, IDNs, ACOs, Public Health, Quality Organizations, health-care device and analytics compa-nies and others. Learn more about Triad Dataspace™ information rep-resentation technology at www.TriadDataspace.com. �


William A. Yasnoff, MD, PhD Managing Partner [email protected]

June 2, 2014 Letter of Recommendation for Triad Dataspace™

As both a physician and PhD computer scientist, I am pleased to have the opportunity to write in support of the widespread use Triad Dataspace™, a new and different approach to automated data storage and retrieval. Its substantial and important advantages over conventional data storage software, including lossless compression, secure encryption, and automatic pattern discovery, make it especially attractive for health and medical applications.

Triad Dataspace™ replaces typical object-‐oriented, relational, entity-‐relational, associative, Hadoop and other conventional storage approaches with a novel, self-‐adaptive information structure called a ‘dataspace.’ A Triad Dataspace™ is an unstructured mathematical storage ‘space’ with no a-‐priori schema, which builds its own information structure as data is presented to it and stored. All record fields are normalized and expressed in a topological (universal) representation, which is a double-‐blind encryption of the original information. The resulting information structure has novel properties. Besides autonomous structure discovery and double-‐blind encryption, it allows near-‐real time query and data lookup even as the amount of stored data becomes huge. It is extremely secure and requires far less storage space than commercial databases, and can enforce access control permissions at the individual data item level with complete audit trails of all access. The properties of Triad Dataspace™ make it an excellent fit for any large health or medical dataset, including Population Health, HIEs, ACOs, Health Record Banks, and cloud-‐based EHRs. More details about Triad Dataspace™ technology are available at www.triaddataspace.com.

My understanding is that Medical Strategic Planning (MSP) is the first company to bring the Triad Dataspace™ system, developed for use by the intelligence community, into commercial healthcare markets. Since the deployment costs quoted by MSP are 50-‐75% less (on a per exabyte basis) than other database technologies now in widespread use, it is a potential game changer for healthcare applications.

Having been responsible for the work at the U.S. Department of Health and Human Services that led to the President’s creation of the Office of the National Coordinator for Health Information Technology in 2004, my consulting practice includes a variety of public and private sector organizations facing very difficult informatics challenges. I now strongly recommend that my clients with large-‐scale healthcare applications (either new or ongoing) seriously consider utilizing Triad Dataspace™ to reduce costs and increase the capabilities and effectiveness of their systems.

Please note that my recommendation is not based on any affiliation with or financial arrangement with MSP, and I very rarely write letters such as this. However, in this case, my independent evaluation is that Triad Dataspace™ represents superior technology with tremendous potential to improve and expand the effective and economical use of large-‐scale health and medical databases. Sincerely,

William A. Yasnoff, MD, PhD, FACMI

N H i i

ADVISORS

NHII Advisors 1854 Clarendon Blvd. Arlington, VA 22201

703/527-5678



• Introduction

• Supercomputing Vs. Dataspaces™

• Conclusion

A Brief Conceptual Comparison of the MPT Blue Cheetah Platform and Triad™By Kenneth Happel, CTO/COO Medical Strategic Planning

This is a short comparison of the mas-sively parallel architecture within Massively Parallel Technology’s (MPT) Blue Cheetah environment and MSP’s Triad™ content inclusive addressing. We believe that MPT has developed a very powerful virtual supercomputer environment that will allow the remote use of their capabili-ties to solve problems by brute force increases in processing power, which become accessible to their clients. It is certainly one way of approaching many problems that transcend normal computer resources. The MPT novelty is making supercomputer resources available on a time-shared basis for computing client-created applica-tions, which MPT provides a toolset to accomplish as its business model.

By contrast, Triad™ is completely dif-ferent approach, and the hallmark of a new generation of solutions that don’t use brute force, massively-par-allel approaches to solving hard or computer-intense problems. Indeed, Triad allows users to do with desktop computers, some types of problems that previously could only be solved by massively-parallel or other super-computer approaches. Instead of requiring massive processing power, Triad™ provides a constant means of expressing data in a form that doesn’t need supercomputing power to begin with. The Triad approach is differenti-ated from all others (including MPT) by the fact that the desired answers are not computed results, but the reduc-tion of computational results to rela-tional structures in analytical models. That is its great advantage, which allows it to solve difficult problems

without resorting to supercomputer methods.

Triad™ models are not the result of data structure simulations requiring innumerable computational iterations on a supercomputer, but the analysis of information and knowledge struc-ture interactions themselves. This is an inherent ability of Triad™ systems that is not inherent to, nor specifi-cally addressable by, supercomputing directly, or through time sharing them using MPT’s business model. Many client-side applications, such as image analysis, camouflage penetration, and other applications where access to a remote supercomputer would be impossible, or create a single point of failure for a life-critical process, such as in most actual healthcare applica-tions. Triad™ processing in ASIC or FPGA silicon overcomes such limita-tions. Triad™ in silicon would be small enough to be embedded in many bio-logical sensors that run autonomously without network access, from battery power sources.

IntroductionMPT patents 7730121 B2 and 6857004 B1 were used as a basis for the comparison. Patent 7730121 describes the Howard Cascade and its methods and systems and patent 6857004 describes the MPT plat-form as service business model and how it monetizes the architecture described in the previously mentioned patent 7730121. The third aspect of the MPT offering is an extensive and formal programing environment that provides access to a library of


functions some provided by MPT and some developed by other users of the MPT environment.

The first patent describes the Howard Cluster. It is a type of state chain thread that removes the necessity that interim data states in a parallel pro-cessing environment are communi-cated to and evaluated by a master process that manages the computa-tional flow of a given group of process objects, the slaves, during execution.

The overhead of master-slave archi-tectures is well known and a large number of solutions to address or mitigate it, have evolved over time. Some earlier solutions involved large hardware architectures where paral-lelism is enforced by the architecture itself. Grid computing’s evolution was to create a massive processing cluster with a loose or asynchronous organization.

The Howard cluster is an advance because it provides a low-level computational organization that is agnostic to the underlying cluster pro-cessing environment and hardware. It uses well defined code formalisms to determine process interaction and define an optimized parallel pro-cessing thread structure for the exe-cution of the software algorithms in applications implemented in it. This is achieved by a formal computation of the data flows between process objects and the assignment of pro-cess order to each node process at the point of code execution. The reduc-tion in process management costs cause a significant savings in the time of execution within any processing environment implementation.

The creation of MPT’s supercom-puter grid as a service is packaged by the use of a formal and standard-ized programing environment that reduces the utilization of the Howard Cluster environment in third party code to the inclusion of a code library (like “.dll” files in Windows) and the requirement that the code be devel-oped in the MPT programming envi-ronment. The result is that imple-mented third-party application code

locks in MPT’s sale of supercomputer horsepower by CPU occupation time.

Supercomputing vs. DataspacesMPT is in the business of selling supercomputing by time slice. To make its advantage in computing opti-mization function properly for third-party software applications, they offer a formalized software development environment that both insures the architectural integrity of the software developed and the implementation optimization with respect to its execu-tion. In short, they build a cloud data center with a cluster of computers connected by TCP/IP. One computer acts as a communications controller and another as a gateway into the clustered computer environment.

Incoming processing requests are directed to the controller that man-ages the processing session. The data supplied with the request is prepro-cessed into formats and chunks that meet the requirements of the pro-cessing thread’s structure within the Howard Cluster software. The software itself is an implementa-tion of one or more code elements that are stored in a library on every processing cluster. These library ele-ments may be provided by MPT or by third parties that monetize their software modules by adding them to the MPT processing library that pays for the time-slices using that code. By specifying the library elements to be executed on each processing machine and the order that the processing machines have in the data flow a vir-tual massively parallel supercomputer is created with a connection structure and code elements optimized for that code architecture.

The assumption behind the whole previous description is that the real issue in solving problems in certain information domains is obtaining very large processing bandwidths.

Such domains include the com-puter simulation and games indus-tries where the calculation of repeti-tive algorithmic iterations results in visualizations or frames of game

graphics. In these applications, the classic problem solutions are greatly enhanced by the kinds of techniques offered by MDT.

However, the fundamental nature of both computing and supercom-puting remain unchanged by MDT technology. While MPT provides a strong innovation in the marketing and development of virtual hard-ware services, MDT does not change the classic view that programs oper-ating on computers are seen as state machines where data is processed from one state to another.

In this classic (MPT) approach: the program is constant, the operating system organization is constant and the choice of algorithms used are dependent on the data types involved but are otherwise constant. It is the data that changes. Data at one point in the process may be completely dif-ferent than the same data at another point which is why they have included a patented manner of remembering crash/restart points.

Unaddressed Issue: The fundamental problems of cloud application secu-rity and cloud storage costs remain unchanged. Even the replacement of the master/slave is based upon the pre-estimation of the processing order and the ability to divide a process into parallelizable subparts. The informa-tion domain and the actual data pro-cessing models are unaffected. So are the elements at the network and hard-ware levels.

The Triad™ Dataspace approach: The difference with Triad™ dataspace technology is that instead of making the data processing environment vir-tual and optimized by invoking an optimized scheduling system in order to make a well behaved and opti-mized process,

Dataspaces™ make the data content itself organize the processing flow without what is normally called “data processing” because the data flow and the processing flow are the same.


That is, the fact of communication is the process. The address is the answer. The flows between addresses are not sequenced by software because each address element is asynchronous and self-invoking.

It’s the Content Inclusive Addresses™ that makes the difference. There is only one datatype. As a result there are no differences in code algorithms based upon difference in datatypes. Operations are at the bit stream level and can be performed “on the fly” during switching, without needing CPU type data processing computers at all.

The issues and cost of data storage and security are completely changed. Triad™ interfaces with third-party applications; and hardware do not require the use of a proprietary soft-ware development environments or code thread preprocessing. This is in stark contrast to MDT’s requirement of preprocess analysis of the software and development inside of a propri-etary environment to standardize the processing code so it can be run in parallel.

The states of a Triad™ “program” are addresses and not processed data states. In Triad™ information is not characterized by its data type nor as behavior states within the data type.

In Triad™ information is character-ized by process dynamics. Processing energy is entropic, it reduces as the process grows in scope.

All common structures “fall to sleep”, anomalies invoke new relational expressions denoted by a changes in address. At any given moment, increasing the dimensionality of data shortens the search times for instances of it. All data structures, within the scope of the data presented, can be evaluated bitwise, numerically and with algebraic completeness and clo-sure. Behavioral patterns are detected by the descriptive elements that are invoked by the content address struc-ture itself. These descriptive elements allow the prediction of changes and non-linear evolution of dynamic

systems by small computing environ-ments, which has important implica-tions in open-knowledge domains like healthcare for Population Health Management and Predictive Analytics.

ConclusionTriad’s was created to make super-computing environments unneces-sary for massive data set analysis. In many areas of information analysis, it has been successful. Areas such as image analysis, dynamic systems mod-eling and raw content searching the requirement of supercomputing plat-forms has been reduced or eliminated.

Both technologies have their place, and both are synergetic. In the domains of cinematography within the film industry, the two approaches together could revolutionize the completion of the huge repository of incomplete films. For example, MDT could revolutionize the computer graphics, visualization and animation industry by placing the horsepower to create scenes in the hands of anyone at a reasonable price.

Triad™ solves problems that formerly required grids, supercomputers and pipe processors, by allowing them to execute on small, low-powered por-table real-time platforms or directly in silicon chips – that supercom-puters cannot be practically applied to. Examples demonstrated with aca-demic review boards include single windows computer solutions to:

• Predicting the next trade of a day-trader based upon the behavior of the current trading session,

• Fixing genome DNA sequencing snips, and

• Finding random noise patterns from one source inside random noise fields created by other sources, and others.

The use of Triad’s universal (double-blind encrypted) data representation solves transmission and datacenter security issues that cannot be other-wise solved.

The ability to provide an item-level audit trail of all state changes cre-ated by access (or attempted access) to stored content (as recommended by the Department of Health and Human Services), and to provide that audit trail to every data content con-tributor, can’t be duplicated by time-shared supercomputer models.

Finally, the ability to implement and synchronize Triad™ on both the client side (in silicon) and server side as a cloud-based Dataspace™, cannot be cost-effectively duplicated by MTP or other supercomputer approaches.

Any client considering a network-of-network solution to a multi-tiered information aggregation and fusion challenge, needs to clearly understand the potential and limitations of the two approaches, including the cost, security and implications of the failure of some part of the network during abnormal events, emergencies or incidents of national significance, to avoid the situation where at a critical time, when data is crucial to human survival or mission-critical application execution, the very design of the net-work-of-networks solution depending upon a remote supercomputer, makes it fail and become unavailable. �

Editor’s Note: Various White Papers are available at the www.triaddataspace.com website for readers interested in learning about this new and breakthrough technology.


Obamacare: Dishonest, Reckless, Inept & Very Government Invasive!An editorial by Arthur Gasch - Publisher

Obamacrats who think they need to control American’s lives and health-care are killing people and dam-aging the U.S. economy, delaying the recovery and setting up the next reces-sion. If you want to understand the future under Obamacare, look no far-ther than the VA hospital mess today. Secret waiting list while veterans die – no accountability, only excuses and bonuses for irresponsible bureaucrats and evidence destroyed by govern-ment employees.

Obama learns what’s wrong from the new media - again. Good management and accountability no where to be found. The government controls the entire VA system, and has for years.1 The system has problems and has been ignored for years. The results are sad and typical of government. People who defended our country are dying

1 The Bush administration pointed out to Obama there was a problem, and he spent six years ignoring it!

for lack of healthcare. Dozens so far, that we know about due to Obama secrecy and incompetence. How many more? Again, no one is accountable, but Obama says he is, “mad as hell!” Mad that his management incompe-tence has again surfaced publicly. With Obama the presidency is all vacations, fund raising events, and late night talk show publicity opportunities to propa-gate known false information. Obama is missing in action during terrorist attacks, and exhibits lack of knowledge about everything.

Meanwhi le under Obamacare , Democrats deny anything is amiss and label anyone who reports oth-erwise as a liar or a racist or both. They deny Obamacare is hurting and killing people. This article pres-ents three stories of real people who have been injured, contrary to the Senate Majority Leader, Mr. Harry Reid’s ridiculous assertions that all


• Business Weighs In

• Recession Will Be Industry-Wide

• Please Keep Helping

• Renewed Recession on the Horizon

• Tax Increases & National Debt

• Folks Harry Reid Labels as “Liars”

• The Obamacare Tax

• Liberal-Biased News Media Promotes Administration Propaganda & Lies

• Jessica Sanford - Suddenly the Liar!

• Negative Impact Is Wide Spread

• Michele, One of Reid’s “Fictitious” Persons

• Watergate Seems Like a Prank!

• Double Standard, Oops, No Standards

• Were FAR Policies Followed?

• Faulty Healthcare Statistics

• Gross Lack of Accountability

• Government Mandates Dependency & Poverty - Shelly’s Story

• Adding Insult to Injury

• “Obamacare” Wait, No it has to be Medicaid – A Nightmare Story!

• Obamacare Catch-22

• Another trick for Food Stamps/Welfare Assistance – Enter the L&S Agency

• Breaking Faith With Medicare Donors

• Obama Fails Elementary Math

• Mr. Obama, Quit Playing Let’s Pretend

• Repentance


negative stories regarding Obamacare are lies. We reveal how Obamacare is adversely affecting the U.S. economy, which showed essentially no growth in Q1 2014. Here is the data published April 30, 2014.

America’s economic growth rate collapsed in the first quarter to a stunningly slow annual-ized rate of 0.1 percent...the sharp downshift also raises questions about important segments of the economy, notably housing & healthcare. In this chilled business investment, exports dropped and inventories climbed at a slower pace. Consumer spending rose more than forecast, propelled by the biggest gain in services in 14 years. Forecasters generally had expected a slow quarter, but one more on the order of a one percent growth rate – not one-tenth that pace.

The lack of growth wasn’t good or even expected news. It shows that Obama anti-business policies are having an adverse effect on the economy.

Business Weighs InIf there was ever a “darling” of the Obama Administration in business, it was Jeffery Immelt of GE, who Obama invited to Washington to advise him. Obama also bailed out GE’s financial division to the tune of $138 billion in November 2011.2 Now 30 months later, Mr. Immelt is speaking out about damage that Obamacare is doing to American businesses.

At this year’s GE shareholder meeting in Chicago, Immelt declared, “I think that there’s still a lot of uncertainty in health care and we’ll just have to see that over time.” The company’s chairman on Wednesday warned that, “uncertainty in the health care field will persist for much longer.” Their most recent financial results showed a rise in profits, but a cut in medical business revenues, attributed to companies and hospi-tals holding back on purchases of GE equipment out of concern over how badly Obamacare will hit their profit margins. A week later General Electric blamed Obamacare for hurting its med-ical business. Immelt’s comments came in response to a question from Justin

2 See http://politicalvelcraft.org/2011/09/21/general-electric-the-worst-bailout-in-the-world-fox-forum-foxnewscom/

Danhof, Director of the National Center for Public Policy Research’s Free Enterprise Project. The conserva-tive think tank released a statement and audio recording on the Q&A.

“Obamacare’s devastation is so far-reaching that it’s now having a tangible, real-world negative af-fect on one of the world’s largest and most diversified companies,” Danhof said.

“Obamacare’s devastation is so far-reaching that it’s now having a tangible, real-world negative af-

“Obamacare’s devastation is so far-reaching that it’s now having a tangible, real-world negative af-fect on one of the world’s largest and most diversified companies,” fect on one of the world’s largest and most diversified companies,”

Reuters reported that GE Chief Financial Officer Jeff Bornstein attrib-uted the spending cuts to a “massive structural change” in the U.S. health care market caused by Obamacare. “I expect that softness to persist into the second quarter,” Bornstein told Reuters. “As CEO, Mr. Immelt has vast health care experi-ence, yet even he cannot predict what the future of the Affordable Care Act (ACA) will do to the country or his company,” wrote Paul Bedard, the Washington Examiner’s “Washington Secrets” columnist. (Contact Paul at [email protected]).

Immelt Confirms What MSP Forecast Immelt confirmed in the real market place exactly what MSP has been pre-dicting/reporting since 2013, and re-ported in the last two issues of this newsletter. MSP market research clear-ly shows why it is happening! It’s dead simple, if you understand that medical devices markets are saturated markets.

All new healthcare device sales are replacement of existing units currently installed in healthcare fa-cilities; slowing down that replace-ment cycle immediately shrinks the market size, and that ripples through the entire supplier chain resulting in reduction in production and loss of jobs.

All new healthcare device sales are replacement of existing units currently installed in healthcare fa-

All new healthcare device sales are replacement of existing units currently installed in healthcare fa-

the market size, and that ripples through the entire supplier chain resulting in reduction in production

This is exactly what hospitals must do in response to Obamacare and that will accelerate as more hospitals are forced to replace formerly profitable

(privately-insured) patients with unprofitable Obamacare patients.

The ripple effect of the ACA, how-ever, is larger than the sum of its parts, according to Gerald Hickson, Vanderbilt’s Vice President for Quality Safety and Risk Prevention. “The one thing health reform has done is it has changed the way we’re thinking,” he said. “That’s where change begins, and it has begun.”

Vanderbilt does not have shareholders monitoring its spending, but it must keep a close eye on costs. In September, Vanderbilt notified state and federal government officials that the medical center will cut more than 1,000 jobs by the end of the year to prepare for eco-nomic uncertainties, some of which are due to health care reform (Obamacare).

Jim Lott -- Executive Vice President of the Hospital Association of Southern California -- said, “...We are forecasting for hospital closures because of the changes brought about by the implementation of Obamacare... About 40 hospitals in the state could close over the next five to 10 years, which would repre-sent nearly 10% of hospitals statewide.” (Los Angeles Times, 4/3)

MSP believes that estimate of hos-pital closures is too low. Hospitals that remain over the next 3 years will have fewer employees and/or lower-cost employees (those practicing close to the limits of their licenses), since if they suffer the expected 25-35% reduction in real income and simultaneously treat more patients without redesigning their systems, each employee would need to be paid 40% less.

If you reduce the revenues of healthcare that represents 18% of the economy by 6 to 8% every year for 4 years, you are forcing a reduction of about 1.4% of GDP over the entire economy,3 whose Q1-2014 growth was 0.1 percent (essentially nothing).

Recession Will Be Industry-WideThe downturn Mr. Immelt is com-plaining about won’t just impact GE. It

3 Read more: http://www.businessin-sider.com/what-will-change-with-obamacare-2013-10#ixzz306oiivLE


will impact Philips, Draeger, Spacelabs, Mindray, Nihon Kohden, Covidien, Boston Scientific, PhysioControl, Zoll and the entire rest of the medical device industry going forward for several years, or permanently after the Obamacare “employer mandate” takes effect.

The longer Obamacare is pursued, the more damage will be done and the greater the job loss will be.




Federal under-reimbursement of actual costs has an impact - it causes recession when private insurance (that is profitable to providers) is cancelled and replaced with below-cost reim-bursement o f Medica id and Obamacare policies. If one believes government figures, over 7.1 million Obamacare policies were issued by April 1, 2014 and at least 4.2 million were substitutions of a profitable rela-tionship with a hospital, for an unprof-itable one. When the “employer man-date” kicks in, that number will rise to something like 111 million (of 143 million total) who are employed at firms affected by the “Employer Mandate” (again delayed to take effect in 2016). These are all Americans who Obama promised that their insurance would not be touched.

The President assures America, “Obamacare is working!” Appar-ently, it’s all part of Obama and Ezekiel Emmanuel’s drive for “in-come equality,” healthcare ration-ing and wealth redistribution.

The President assures America, “Obamacare is working!” Appar-ently, it’s all part of Obama and

The President assures America, “Obamacare is working!” Appar-ently, it’s all part of Obama and Ezekiel Emmanuel’s drive for “in-come equality,” healthcare ration-Ezekiel Emmanuel’s drive for “in-come equality,” healthcare ration-ing and wealth redistribution.

Cascade Into Recession As hospitals struggle to reduce expenses brought on by their intentional under-reim-bursement under Obamacare and de-lay the replacement of aging technol-ogies, their technology suppliers will downsize their production, laying off many production and support work-ers, switching some remaining em-ployees from full-time to part-time sta-tus in response. Spare parts costs will also increase. Determining the size of this downturn requires real data, which MSP has thanks to our readers.

Please keep HelpingThis is why the annual MSP survey is so crucial; we need to understand how the capital equipment replace-ment cycles are changing in order to accurately forecast the shrinkage in the total market size. People’s jobs are related to the actual market size, which our surveys capture. Participating hos-pitals are welcome to our summary conclusions at no charge and a free subscription to this newsletter for par-ticipating. So when the MSP survey team calls, please spend 5-8 minutes to help us understand the market impact at your hospital. Thanks!

Understanding the medical device market is something that Washington bureaucrats have seemingly over-looked because their healthcare poli-cies have created tsunamis for the Healthcare sector. The next U.S. reces-sion will be in large part, a creation of the Democratic Party’s Obamacare healthcare policies, and the blank check they have given Obama to create 11,588,500 words on new taxes and healthcare regulations!

A ten percent unemployment cre-ated in healthcare is a two percent downturn in employment across the entire nation.

A ten percent unemployment cre-ated in healthcare is a two percent A ten percent unemployment cre-ated in healthcare is a two percent downturn in employment across the

A ten percent unemployment cre-ated in healthcare is a two percent downturn in employment across the

A ten percent unemployment cre-ated in healthcare is a two percent downturn in employment across the

Renewed Recession on the HorizonThe new, Democratic recession that Obama’s healthcare policy is creating in healthcare in 2014 will spread to the entire rest of the U.S. economy by 2016, unless voters sweep democrats out of office and those who are elected rescind Obamacare immediately, and make other policy changes to reverse the negative impact on hospitals and their technology suppliers. Otherwise, policy momentum will cause a national recession by 2017 (regardless of which party candidate is elected President in 2016). The Employer mandate is a poison pill for the U.S. economy.

Obamacare is not a sustainable business model without massive additional tax increases.

Obamacare is not a sustainable business model without massive Obamacare is not a sustainable business model without massive additional tax increases.

Obamacare is not a sustainable business model without massive additional tax increases.

Tax Increases & National DebtTax increases have already been mas-sive. Average increases in health-care costs have averaged 5.4 percent before Obamacare. In 2013 alone the Manhattan Institute reported health-care insurance premiums increased by 41 percent on average, and are slated to increase again in this fall when the 2015 policy costs are announced by the insurance industry. In one indi-vidual‘s case reported in this issue, the premium increase was 78 percent in 2014!

Payments on the national debt were $415.7 billion in 2013, which apart from expenditures on national defense, makes it the second largest (non-social security) expenditure in the nation -- and that is at current interest rates.

Since I began writing this article, the national debt has increased by $16.8 billion dollars! Before you see the finished copy of this newsletter, the national debt will have increased by $288 billion dollars!

When the U.S. enters another reces-sion, its credit worthiness will be ques-tioned internationally. If U.S. credit-worthiness drops further, interest rates will increase, escalating payments on the national debt in absolute dollars. It is not inconceivable that interest on today’s national debt could sky rocket to over $750 billion per year (or more) under such circumstances.

The next recession will see hyper-inflation from the deficit spending of the last 6 Obamacare years, which will has increased the nation’s debt from $10.6 trillion to $17.5 trillion. At the current rate, by 2016 when Obama leaves office, national debt will exceed $20 trillion dollars – an 89% increase during Obama’s administration. Bush increased the debt by 32% or $3.39 trillion during his two terms. Obama will have increased it by almost three times that amount! Yet no one inside the Beltway is listening to the outcry from the average American.

Instead Harry Reid “Ridicules” all the negative stories about Obamacare as


lies, simply fantasies invented by oppo-nents of the Obama Administration. Reid claims does an about face and claims that he never said that, even though the links to his taped remarks are listed in this newsletter.

This Obamacare Catch-22 was created because policy makers ap-parently don’t understand the U.S. economy or Business 101.

This Obamacare Catch-22 was created because policy makers ap-parently don’t understand the U.S.

This Obamacare Catch-22 was created because policy makers ap-parently don’t understand the U.S. created because policy makers ap-parently don’t understand the U.S. created because policy makers ap-parently don’t understand the U.S. economy or Business 101.

Obama labels his opponents as rac-ists, a refrain picked up by Elijah Cummings, Oprah Winfrey and Al Sharpton. This is the character of the radical left-wing Democratic leader-ship in Washington, and the American people are tolerating it. Amazing!

Folks Harry Reid Labels as “Liars”The Tea Party website4 recently reported on a man named David who lives in Florida. David’s company was one of the 92% that were antici-pating changes to its employee-based plans as catalogued by the Heritage Foundation. Here is a synopsis of David’s story.

David’s Healthcare Tax Increased By 78% from $600 to $1,069 Per Month Under Obamacare for Less Coverage and mandated, unneeded benefits.

David’s Healthcare Tax Increased By 78% from $600 to $1,069 Per Month Under Obamacare

David’s Healthcare Tax Increased By 78% from $600 to $1,069 Per Month Under Obamacare Per Month Under Obamacare for Less Coverage and mandated, Per Month Under Obamacare for Less Coverage and mandated,

“I previously had insurance offered by my employer. Last year, I paid about $600 a month for a policy with a super high deduct-ible. Nothing was covered until the deductible was met, but I was grateful to have it. Our insurance broker for my employer contacted us to let us know that when the Affordable Care Act goes into effect that my premium would go up by 78%,” stated David.

Bracing for an exorbitant increase in costs, David never anticipated what was to follow. “The premium [for my policy] only increased by 37%, but it no longer covered my wife. She had to go and get her own single policy. That’s another $585 a

4 http://www.teapartypatriots.org/all-issues/news/8-hospitals-is-enough-losing-access-while-paying-more/

month,” he explained. “In addition, eight hospitals have been removed from our network of reimbursed care.”

David had to pay $484 a month for his own policy, but had to purchase an additional plan for his wife, bringing their total premium costs to $1,069 – an increase by 78% from their original coverage.

David had to pay $484 a month for his own policy, but had to purchase an additional plan for his wife,

David had to pay $484 a month for his own policy, but had to purchase an additional plan for his wife, bringing their total premium costs to $1,069 – an increase by 78% bringing their total premium costs to $1,069 – an increase by 78% from their original coverage.

The Obamacare TaxIn considering this case we need to remember what the U.S. Supreme Court ruled, “Obamacare Health insurance is a TAX,” which is the only reason it was ruled constitutional. So in effect, to keep healthcare at all, David has been hit with a 78 percent increase in his TAXES!

How many businesses in the country could survive if their tax bill was sud-denly raised by 78 percent? Well, David was in the middle class before the radical social re-engineers in the Obama administration decided he would be better off losing his current insurance and having no choice but to accept their new insurance that covers less and costs a lot more. So, is David now better off? Did Obama keep his promise, or did he simply deceive everyone?

David’s home value is less than 6 years ago, his wage increases less than cost of living increases, and healthcare taxes increased by 78% for less coverage with higher out-of-pocket expenses. Obama sums that up by saying, “Obamacare is working - let’s move on!”

David’s home value is less than 6 years ago, his wage increases less than cost of living increases, and

David’s home value is less than 6 years ago, his wage increases less than cost of living increases, and

of-pocket expenses. Obama sums that up by saying, “Obamacare is of-pocket expenses. Obama sums that up by saying, “Obamacare is working - let’s move on!”

Liberal-Biased News Media Promotes Administration Propaganda & LiesObama declares David is doing just fine, he is rapidly moving towards “income equality”; and the liberal-biased media that includes NBC (owned by GE and RCA), CBS (controlled by Sumner Redstone through National Amusements, its parent) and ABC

(Disney), all agree with Obama that, “Obamacare’s working.”

The only failure greater than the failure of President Obama, is the failure of the liberal-biased media that passes itself off as “main-stream and unbiased.”

The only failure greater than the failure of President Obama, is the failure of the liberal-biased media

The only failure greater than the failure of President Obama, is the failure of the liberal-biased media failure of the liberal-biased media that passes itself off as “main-failure of the liberal-biased media that passes itself off as “main-

Now that Judicial Watch has sur-faced the non-redacted, readable “smoking gun” memo on Benghazi, one asks, where were Woodward and Bernstein, or their younger liberal disciples? Totally missing in action! Totally willing to publish Jay Carney’s propaganda hook, line and sinker. They didn’t file the FOIA lawsuit that surfaced the truth - why not? The Democrats are still considering how to stonewall the investigation, which reveals a lot about how widespread and deep the corruption and decep-tion goes inside the Beltway.

It has become clear who the above-listed media is speaking for. Why not, a $138 billion dollar bailouts is a lot of money and a lot of political IOU’s to the Obama administration. Show up at the Press Conference, and Jay will tell you what to write, whether or not it’s true. Help make Obama seem com-petent or look good, don’t report that actual facts.

The mainstream media has become simply the propaganda arm of the Obama administration. Investigative reporting is dying. Printing facts makes one a target of federal wiretaps, NSA surveillance, and abuse by IRS and other agencies. Fox News executives paid a dear price for their candor.

Obama tells America he is the cham-pion of the middle class, who is moving toward “income equality”. That’s Orwellian-speak for, “the former middle class is taxed into poverty and becoming more dependent upon the govern-ment for handouts,” forget moving on up to the East side.


Jessica Sanford - Suddenly the Liar!In the last issue of Industry Alert™ we published an extensive expose on the adverse impact Obamacare had on Jessica Sanford, someone who the President himself proclaimed with great charismatic fervor on national TV, was “helped by Obamacare”. But when all the facts came out and the dust settled, it was simply another inten-tional deception by Obama, another liberal Washington Democrat public lie, passed off as “good” news about Obamacare by the biased liberal media, without bothering to check the facts!

Sanford, who lives in Washington State, was NOT able to obtain the inexpensive healthcare she was quoted because the state insurance exchange was incompetently designed, and twice misquoted her a premium which later had to be increased - ultimately becoming so expensive it was unaf-fordable. The final premium was over twice what was originally quoted and higher than she could afford, so Jessica remained uninsured. Her story must be a lie according to Harry Reid. Maybe Reid would say, well, she’s no worse off than before.

Negative Impact Is Wide SpreadIn fact, one does not have to do reams of original research to find many examples of people who were dis-appointed by the false pretenses of Obamacare, all you have to do is be alive and listen to people around you at a party, restaurant, wedding, or wherever they gather. There are just so many nice people that are being hurt by Obamacare, that the propa-ganda from DC is sickening and an disgusting and the media silence is deafening.

Many folks have been thrust against their wills into tragic situations of losing healthcare coverage by the insensitive policies of the “I-know-what’s-best-for-you, trust me, I’ll fix everything” Obama liberal democrats lead by Reid, Pelosi and others -- who remarkably are still perpetuating false-hoods about Obamacare’s successes. It’s the BIG LIE from the aliens who

work inside the DC beltway. In con-trast to such deceptions, here are some factual cases of real people who have graciously granted us permission to reprint their stories.

Michele, One of Reid’s “Fictitious” PersonsAt my grandson’s recent birthday party a good friend of my daughter’s whom I will call Michele, a women who is working three jobs to make ends meet (rather than being on welfare) told me her experience when she tried to sign up for Obamacare in March, 2014. Mind you, this was four months after the still-broken www.healthcare.gov site was pronounced “fixed” by Barack Obama and the same Washington lib-eral Democrats who have just pro-nounced Obamacare was a “huge success by signing up nine million people.”

Well, Michele was unsuccessful, because having spent 35 minutes one day entering all her personal infor-mation, she realized she didn’t have the full amount for the first payment due at the end of that sign-up ses-sion. Three days later when she got paid and had the money to pay for her policy, she was unable to access any of her previously entered information on the site. Neither she, her “navigator” or anyone else able to access her infor-mation. The poor design of the site prevented her from being able to pay, or even sign up again.

The design of the $500M healthcare.gov website is so sophisticated that Michele could not re-enter her informa-tion on healthcare.gov either, because she had only one e-mail address, which the site that couldn’t provide her access to her own information, could tell her was already in use and could not be reused. Comparing that to the ease-of-use of Amazon is ridiculous.

Apparently, Michele’s troubles were her fault for not immedi-ately being able to pay the shock-ingly high premiums for the new, “improved, less expensive” policy offered by Obamacare. Who would expect that a client might actually have to return to a website, and needs to be

able to sign in again? Also her fault was not having a second e-mail address so she could re-enter all her information again and pay for her policy in one ses-sion. She missed the deadline, and is NOT insured in 2014.

Michele had to use the healthcare.gov site in DC because NJ opted out of building its own exchange. Other states who didn’t are now reporting then need to start over, after another $474 Billion has been wasted on their sites, some of which also don’t work. Nevada has abandon theirs.

The Feds have spent $3.9 billion on state healthcare exchanges, in addition to what the states have spent. Fourteen states and DC did their own. Oregon spent $303M, Maryland $65.4 million and it failed. Put on a per-enrollee basis, Hawaii spent $23.9 million per enrollee. At the other end of the spectrum, Vermont spent $4.4K, and NY only $1.1K and CA about $1K per enrollee. When it’s added up, $474 million plus the feds $3.9 billion! Result?

Healthcare.gov is “all fixed,” but simply still doesn’t work right!Healthcare.gov is “all fixed,” but Healthcare.gov is “all fixed,” but simply still doesn’t work right!Healthcare.gov is “all fixed,” but simply still doesn’t work right!

A statement that could have been written by Lewis Carroll. It’s typical of much that Obama “fixes,” including the VA hospitals nationwide.

Apparently, it takes someone with more patience and intelligence (than a para-legal) and at least two e-mail addresses to register one day and then login two days later at www.healthcare.gov to pay for a policy, something that even with the assistance of unvetted government navigators, Michele couldn’t do.

How do people without any e-mail addresses sign up? But healthcare.gov is fixed, and it’s now secure, because Barack Obama and Harry Reid have declared it is. Remember, “Everything is working now, according to plan. It just isn’t really working,” Obama is mad as hell and will be getting to the bottom of it. Right!


While Democrats are certain that things are working well, they can’t tell us how many Americans whose records now exist on the insecure government web-site, actually paid for their coverage and are receiving insurance coverage that they are actu-ally able to use at some hospital that actu-ally accepts it. Some say 90 percent, others cite different figures.

I bet however that Amazon.com knows many paying customers it has, and that they spent no where near $500M to develop their web-site and commerce engine.

I bet however that Amazon.com knows many paying customers it has, and that they spent no where

I bet however that Amazon.com knows many paying customers it has, and that they spent no where has, and that they spent no where near $500M to develop their web-site and commerce engine.

“We don’t have the data yet,” according to Jay Carney. Is he a liar, or is the Obama administration simply that incompetent?

Omission, distortion, outright lies, the hallmark of the Obama administration. Those dissatisfied are “racists”, whether they are black or white. Some are tar-geted by the IRS, OSHA, the FBI and the Bureau of Tobacco and Firearms for harassment. See that story in the blue inset sidebar in this issue. But there is nothing wrong in this admin-istration and no constitutional viola-tions here, “everything is working just fine.” It’s the Bush administration, our racist voters and domestic terrorists who are at fault - we’re the source of all Obama’s problems. I have to give the liberal media some credit, if it were not for them, Obama would not know about the VA hospital mess, because he monitors what is happening in his administration by what the media reports. Those Cabinet meeting appar-ently don’t advise him of anything. Thank God for the media.

Watergate Seems Like a Prank!What Obama is doing with impunity in Washington makes Watergate pale by comparison; unless you are part of the celebrated liberal media pundit Bob Woodward, who dismisses it all because, “Obama intended to do the right thing.” The Obama-Nixon compari-sons have been extensive enough that Obama himself was asked about them

on Thursday. Joe Scarborough asked Bob Woodward what he thought of the panoply of scandals currently facing the Obama administration. “Well it’s a big mess, obviously,” he said. “I know there have been these comparisons to Watergate. I would say not yet, Joe. You’ve made the point which I think is absolutely correct that you’ve got to investigate all of these things.” Some minutes later, though, he raised the issue of Benghazi.

“If you read through all these E-mails, you see that everyone in the government is saying, ‘Oh, let’s not tell the public that terrorists were involved, people connected to al Qaeda. Let’s not tell the public that there were warnings,’” he said. “And I have to go back 40 years to Watergate when Nixon put out his edited tran-scripts to the conversations, and he personally went through them and said, ‘Oh, let’s not tell this, let’s not show this.’ I would not dismiss Benghazi. It’s a very serious issue.”

What a reversal for Mr. Woodward, who back in November 2013, dis-missed Benghazi, saying it did not rate very high on his list of Watergate-like prob-lems, and dismissed Obamacare lies on healthcare with the remark that they were OK, because Obama meant well. What a double standard liberal media has! Frankly, it isn’t all OK simply because it’s democrat liberals that sub-vert the U.S. Constitution, that selec-tively enforces laws passed by Congress, compile enemies list and then coop Federal agencies like IRS and FBI to harass folks who point out their illegal acts and broken promises.

Under Eric Holder, the DOJ has time to investigate Gov. Christy for the Bridgegate “scandal,” but no interest in investigating the IRS abuses, or Benghazi attacks or the Fast and Furious sales of guns to Mexican Drug Lords, used later to kill U.S. border patrol agents, or the criminal negli-gence at the VA hospitals around the country or any violations of FAR regu-lations on the government healthcare.gov procurements. DOJ lawyers are simply too busy investigating poten-tial political rivals for the 2016 elec-tions. Obama, Holder, and Reid remain figures above the law, unaccountable people, who repeatedly lie about what-ever they are doing and who it adversely

affects. Yet the administration official who edited the Benghazi talking points exclaims, “I can’t remember the details, Dude - Benghazi was three years ago!” No wonder people don’t respect Obama or his administration, they are arrogant and show disrespect for everyone.

Would David agree? Would Michele, who is without healthcare insurance? Would millions more just like her. Would Catherine Engelbrecht agree? Fortunately, they still get to vote, although without organizations like Engelbrecht’s ‘True the Vote’, even the dead can have a voice in politics and will all vote democratic -- after all, they did in the last elections in several states.

Double Standard, Oops, No StandardsPerhaps it’s time to recover federal funds back from the myriad of gov-ernment contractors that have botched the healthcare.gov website and ripped off American voters? Perhaps it’s time to disqualify them from future govern-ment contracts? That could start with CGI Group, Accenture, whose political action committee donated $157,445 to the Obama campaign5, according to the Sunlight Foundation, a nonpar-tisan watchdog group that tracks money in politics. It could continue with: Development Seed, QSSI/Optum, and Equifax. Where is the recovery from these firms? What accountability is there to their botched work?

Perhaps Harry Reid should introduce a bill in Congress to take back the expended funds or create a panel to investigate whether there was appro-priate competitive procurement under the Federal Acquisition Regulations (FARs) to select CGI or Accenture and various subcontractors in the first place, or whether there were procure-ment irregularities, or these vendors considered to be “single source” sup-pliers. I am sure the House would sup-port it and take up the same issues, but don’t expect Reid to hold anyone accountable, nor to uncover if FARs were complied with, because that

5 http://www.theblaze.com/stories/2014/03/06/healthcare-gov-contractor-with-troubled-back-ground-has-long-history-with-obama/


becomes a criminal matter, and in Obama’s case, an impeachable offense if he was aware of it. If he wasn’t checking with Sebelius on the imple-mentation of his signature piece of legislation, one is led to ask, “WHY NOT?” Apparently because it hasn’t been broken as another scandal by the new media yet.

Were FAR Policies Followed?No one has yet been accountable for the $500 million dollar website that sort of works, and is sort of easy to use, and sort of secure but can’t actu-ally report who signed up for the products offered there and actually paid. At the very least gross incom-petence is the hallmark of the Obama healthcare.gov website and the DHHS employees who were sort of respon-sible to oversee it.

Harry Reid can investigate $1 mil-lion of disputed grazing by his domestic terrorist cattle ranchers in his state but not look into the $974,000,000 of incompetence at www.healthcare.gov and 15 derivative state (and DC) healthcare exchanges? Which would be a better use of tax-payer dollars, looking into traffic pat-terns in NJ and prosecuting cattle ranchers whose stock grazes on unused government land, or investigating healthcare.gov cost overruns, incom-petence and possibly FAR contracting violations? Of course, traffic jams and cattle ranchers!

Faulty Healthcare StatisticsHow many more Michele’s are there out there? What about that, “easy as shop-ping at Amazon” promise from Obama? Apparently, another exaggeration, untruth, ridiculous statement – what’s one more? Who is counting anymore. As Obama’s lies goes, “ease of use” is a small one. Who expects anything the government has us do to be simple to use? Look at income tax, how simple is that. Time for a flat tax and no IRS? Would any American really miss the IRS? Would there be complaints, “I just need to have the IRS back, I can’t live without

the IRS?” I don’t think so. Time for a flat tax and no IRS.

The Propaganda Chief Will Spin It Who would have imagined that faced with a 78% increase in premiums could be spun by Jay Carney and Obama, as a “less expensive policy?” Who de-signs a website that once you sign in, you can’t sign in again two days lat-er? The Obama administration seems to have in Michele’s case at least. But Obama pronounced it’s “all fixed” three months earlier so that ends the discussion for the liberal media. It’s declared fixed!

Michele has no idea why the site worked that way in her case. Nei-ther do I, but it did. Are having such problems (still) in late March, 2014 excusable? Not when the President claimed they were fixed in January!

Michele has no idea why the site worked that way in her case. Nei-ther do I, but it did. Are having such

Michele has no idea why the site worked that way in her case. Nei-ther do I, but it did. Are having such problems (still) in late March, 2014 excusable? Not when the President claimed they were fixed in January!

problems (still) in late March, 2014 excusable? Not when the President claimed they were fixed in January!

That is yet another case of Obama mis-speaking either out of ignorance or in order to save face and cover up the incompetency of the people doing the site. In either case it makes him seem ridiculous.

Harry Reid is quite silent about Obama’s broken promise that the web-site is/was fixed – with good reason. None of the other “solemn prom-ises” Obama has made have proved true. [“If you have insurance, you can keep your insurance,” or the promise that, “Purchasing healthcare on healthcare.gov will be as easy as buying something on Amazon.com,” or “premiums will go down,” or the “website is secure, nine million people got healthcare insurance.”] All were misrepre-sentations, lies, distortions or whatever label you use depending upon the reason you associate for the difference between the promise and the out-come. President Obama has certainly earned his repeat, “Four Pinocchio” titles. Apparently breach-of-contract only applies to commercial CEOs, not to U.S. Presidents!

Gross Lack of AccountabilityTo date no radical Democrat has made themselves accountable for any of the

outrageous things that have happened or they have done. Think back – name a case where they have. In every case I look at, when they do take “respon-sibility,” they do absolutely nothing. Nothing has been done about Fast and Furious, unanswered congres-sional subpoenas, botched website expenditures, IRS targeting, multi-agency attacks against those asking for accountability (e.g. “True the Vote” founder Catherine Engelbrecht) - instead of taking the blame, these are just additional situations in which there is feigned accountability – but which turns out to be more decep-tions, cover-ups or whatever label you put on it – disappointing people even more. It seems to be a pattern in Obama’s political career.

Senate Voting Record “In the brief time Obama served in the Senate, from Jan. 2005 to Oct. 2008, Obama missed 314 of 1,300 roll call votes, which is 24.2%. This is worse than the me-dian of 2.2% among the lifetime records of senators serving in Oct. 2008.”6

As President, he was apparently absent from the “Situation Room” during the Benghazi attacks, during key status meeting about the website readiness, and so on.

When questioned about where he was, no answers have been pro-vided, even by Jay Carney. It simply remains an unanswered question. Apparently Hillary could reach him by phone however. So nothing much has changed.

Government Mandates Dependency & Poverty - Shelly’s StoryWhile at the 2014 HIMSS in Orlando, during the opening reception, I had occasion to meet a women who works for a major technology company on the east coast. When she discovered that I was a reporter/publisher she told me of her sister, I will call her Shelly. Shelly lives in Michigan. This is her story, mostly in her own words, reprinted with her permission. Shelly was among the 4.2 million other 6 https://www.govtrack.us/congress/members/

barack_obama/400629


Americans promised by Obama that they could keep their plans, but whose plans were instead involuntarily can-celled – contrary to Obama’s promise.

My name is ‘Shelly’. I am a college graduate with a Clinical Psychology degree, who is one of the fast-growing numbers of people that have had their health care plan cancelled, thanks to the new “Affordable” Care Act. I have a daughter with “multiple special needs”, primarily Down’s syndrome and Autism, which requires full-time care. I live under our government’s declared poverty income level in order to keep my daughter’s Medicaid and assistance, as I can’t survive without it. Now, thanks to Obamacare, I have lost my prior health insurance – and am being forced to consider Welfare as my only healthcare option.

I am a single mom, following strug-gles with a special-needs child that led to divorce. I have full custody of my daughter with the challenge of balancing bills, life, and my daugh-ter’s needs, daily. Previously, I had a job at a hospital making a respectable income, but Medicaid rules mandated that I made too much income. They took away health coverage and assis-tance for my daughter. Without the assistance, even with decent income, I could not afford day care, health care, and other basic assistance my daughter required. Therefore, due to this and other challenges in working full time and raising a special needs child, I had to quit my full time job to keep within the income level Medicaid required to keep assistance my daughter needed.

Most people probably don’t realize that when you have a child with spe-cial needs, you get grouped in with welfare recipients and are required to meet those standards of income to receive Social Security Disability (Michigan’s State SSI). This means if you make over approximately $1,570 a month ($18,840 / year) your SSI benefits including the child’s health care and day care assistance is cut off. Essentially, this forces and compels one to make below poverty income levels to keep their SSI benefits and assistance.

The program is structured to force one to not work to their potential, and live in a state of struggle, poverty and humiliation. A child with special needs requires a constant high level of financial support to cover special care workers/providers, medical needs, dental needs, medications, educational and stimulation tools, 24 hour supervi-sion, and so on. The expense of day care, alone, ranges from $1,920 to $2,400 a month. This doesn’t include normal life expenses of mortgage, food, clothing, gas, auto, insurances, phone, and utilities. Keep in mind the state expects one to live and cover all expenses at a level of $1,570 a month. This seems impossible.

If families with special needs children would not be grouped into the welfare program, and could obtain assistance with health care, day care and home assistance for the special needs child separately (or on a realistic tiered level to income), it would allow a family or single parent to work, contribute to society, pay bills, have self respect, and be able to give their children adequate care while relieving stress and reducing government program financial output.

Government should be rewarding and promoting independence for those who can work, offering basic assistance to supplement the child’s needs (adequate healthcare and day care assistance). Let me work and earn wages to have a life worth of living with pride, while “helping” me to ensure my daughter is properly cared for, so that she has some quality of life. Without some level of assistance, it is virtually impossible for the average person to make enough to balance special needs costs.

Adding Insult to Injury(Shelly liked her healthcare plan – Obamacare cancelled it!)

Prior to Obamacare (ARA), I was covered by a limited low income county-level Health Care plan, while working part time. Adding in insult to humility, it was involuntarily cancelled because it did not meet Obamacare law health insurance standards. Prior

to Obamacare, my limited County Health Care policy was acceptable and working for me and my daughter. The policy had a $5 co-pay for an office visit and medications, a $10 co-pay for specialist visits, with no hospital services coverage. Nonetheless, it was adequate for me and my needs.

In January of 2014, Shelly was informed that her health insurance policy was being cancelled, as the policy did not comply with Obamacare provisions effective March 31st, at the deadline of the Obamacare enrollment period. Less than 30 days after the initial noti-fication, she was informed that all poli-cies would be cancelled February 28th. (Shelly speculates this resulted because of less-than-expected Obamacare sign-ups, and to get people whose policies were cancelling to sign up for Obamacare, sooner, in order to get the numbers up - Editor). What an underhanded way, and gesture of “good will”, by playing games with Obamacare enrollments to force increased enrollee numbers. Remember, that these are plans created for low income people. In the end, the only option is to go on Medicaid.

“Obamacare” Wait, No it has to be Medicaid – A Nightmare Story! After I found out I was losing my health insurance, I called the health exchange four times. Initially they would not talk to me unless I gave them all of my personal informa-tion – even though all I wanted was basic cost information. (What other product requires you to submit personal infor-mation to find out what it costs? Certainly not Google or Amazon.com! - Editor) Finally, after arguing back and forth, I provided them my income and basic information.

The representatives stated to me that, because of my income level (at 15K), I would only qualify for Medicaid. I wasn’t eligible for Obamacare or credits to get into the state health exchange. I asked if I could get infor-mation on other insurance options, and was told that I would not eligible to get into any exchange.


I tried finding other options. I called BCBS directly and spoke to one of their exchange specialist. He veri-fied that I had no other options at my income level except Medicaid. I couldn’t even pay the exchange amount out of pocket, or sign up for a policy. He stated the Obamacare Law would not allow him to sign me up for any other policy except Medicaid.

When Obama was campaigning, I don’t remember the mentioning that private policies would be cancelled, or that we couldn’t keep our doctors, or that Medicaid would be the only option available for low income earners. Do you? You either sign up for Medicaid or go without insurance – no longer a legal option in our country.

Obamacare Catch-22I was told that, in order to get into the exchange, I would have to inflate my income “LIE”. However, if I inflated my income I would then lose my assistance for my daughter. It was, and is, a NO WIN situation. Thanks Mr. Obama, your plan is forcing low income families to sign up for Medicaid under the deception that it is health-care “assistance”. It isn’t. It is “welfare”, and it needs to be called what it truly is. Welfare taxes all Americans and is destroying our American values and founding principles.

After making the decision to not sign up for Medicaid, I started to panic that I would have no healthcare. What if my daughter or I got sick or hurt? I decided to inquire further about Medicaid. I was told that if I signed up for Medicaid, I would be giving the State of Michigan the right to recover ALL expenses they I may incur. They could take my assets, including a small whole life insurance policy I have had in place for my daughter’s future care. It was also indicated to me that the state would even be able to take my child support if I signed up for Medicaid. Though not a large amount of money, I use to help toward my daughter’s needs.

With these options, how did or do I have any choice? There is no choice for low income people. Our lives are being forced put under government control. I either lie about my income and lose my daughters healthcare and day care assistance, or go on welfare (Medicaid) and sink deeper into the government control, and give away my daughter’s future and child support. It is very scary to not have any health coverage since I have a chronic issue with skin melanoma. I have no other viable healthcare option – since I do not want welfare.

What is not being realized, is that President Obama is hurting the very people he is claiming to help. His ARA law is forcing them to take gov-ernment assistance to make a depen-dent country. I believe this plays in to Obama’s dream of creating a nanny state that is government controlled – we lose our rights!

Another trick for Food Stamps/Welfare Assistance – Enter the L&S AgencyIn late 2013 I had an OB/GYN health issue that required surgery. Knowing the cost would be a concern, I dis-cussed options with my doctor. She told me that the hospital had a grant program I could apply for that assists low income people. I applied for the grant and was happy to hear back that I had been approved at 100%, due to my income level. I had my surgery in November 2013, and was relieved when I didn’t have to stress over coming up with a deductible.

In early 2014 I started receiving daily calls from an agency called L&S. I did not know who they were. The same agency started calling my emergency contact, which was my other daugh-ter’s cell phone, telling her that I needed to contact them right away – claiming it was urgent.

I contacted the L&S Agency. A lady said she needed to gather more information from me regarding my Hospital “grant”. I answered her questions, of which took about 45

minutes. When we were done she said, “Congratulations it looks like you qualify for assistance.” I was con-fused. I asked, “What assistance? I thought my surgery grant was already approved!” She continued to tell me that if I got all my documentation together they would send a car over to pick me up and take me to get a bridge card (Michigan’s Food Stamp program) and other assistance. Why?

I told her I had no interest in food stamps, or other assistance. She kept pushing to have a car come get me to go get signed up. After some time she got very snotty with me, and indi-cated that if I refused to cooperate the Hospital would make my entire sur-gery bill due immediately. She asked, “Do you have the money to pay for your surgery bill in full?” I asked if she was threatening me, and she said that I must cooperate and sign up for Medicaid in order to keep the grant. She kept saying I don’t have to do any-thing, and that she would represent me and get my Medicaid and assis-tance processed, quickly. I refused and ended the call. To my frustration I continued to receive daily calls, I mailed and faxed them a letter stating I did not give them permission to rep-resent me, and to stop calling.

Following this encounter, I contacted the Hospital Grant Department. They stated they hired the L&S Agency to recover cost from low income people by signing them up for Medicaid because Medicaid will pay for the costs. I asked her if she was aware of the tactics being used. She asked me why I wouldn’t want assistance. I could continue the nightmare story regarding calls and conversations. In the end, after months of dealing with this, I finally reached a point where I indicated I would get a lawyer involved for harassment if they didn’t stop trying to make me take food stamps and welfare and the calls finally stopped. The sad part is that I am sure there are many out there that are falling for the tactics being used of its “assistance owed”. And, once they get in to the system and sign off their


assets, they are stuck and on a path of government dependency.

My hope in sharing my story is for – republicans, independents and Americans – to stand up and fight to repeal Obamacare, which is degrading our level of healthcare at a cost we cannot afford. Obamacare is forcing low income people to let government gain more control over their lives. I encourage citizens to stand against the ACA Healthcare Reform, as a person who is now locked in to poverty because of our government that claimed to want to help. Americans do you really want that? Focus on the broken parts and mend those aspects. Our stories are real Mr. Reed and Ms. Pelosi…

Has Obama done Shelly any great service, by passing legislation that cancels her existing insurance and forcing her to accept Medicaid, putting all of her future support arranged for her special needs daughter at risk?

Has Obama done Shelly any great service, by passing legislation that cancels her existing insurance and

Has Obama done Shelly any great service, by passing legislation that cancels her existing insurance and

putting all of her future support arranged for her special needs

[Harry Reid subsequently declares he never made these remarks, but the audio tape of his remarks are at the link provided below. – Editor] Reid isn’t even truthful about what he has said that is captured on video tape.

No wonder many Americans are dis-gusted with Democrats in Congress and don’t have faith in what they are doing. No one likes to be continu-ally misled and lied to by their leaders who promise one thing and do just the opposite. How stupid do politicians think Americans are?

This sort of national leadership is toxic, disgraceful and causes a lack of respect for the Presidency and the Congress. It is no wonder that busi-ness leaders have no idea what to plan for and are reluctant to hire. Hospitals aren’t spending, they are cutting staff and holding back on capital expenses, because they do know they will be getting less revenues/patient under Obamacare. The questions are only how many profitable patients will be

taken away, when and how much less will they receive?

Once a hospital closes, it takes a lot of funding to open a new one. According to AHA statistics, in 1984 there were 6,872 hospital. In 2008, when Obama took office, there were 5,815 hospitals, now there are 5,723. We have lost 92 hospitals in six years, and that will now accelerate. Now, as demand is increasing, and capacity is rapidly shrinking, the inevitable result will be increased wait time.

Obamacare excludes about 38% of hospitals in NH from even participating in the program. That’s insane. We believe that 1/3rd of the nation’s hospitals at risk during the next 6 years.

Obamacare is doing the same thing with doctors, driving them out of the system at a time when that there is increased demand for services.

We now see how well that works at the VA hospitals, that the government total controls and incompetently mismanages. We see how sensitive government bureaucrats are as American veterans dies because of their inefficiency and cover ups. How bureaucrats are willing to falsify waiting lists to justify receiving bonuses for efficient management. This underscores the total lack of ethics in government, and is a primary reason that Americans should not turn over control of healthcare to the government.

Breaking Faith With Medicare DonorsObamacare diverts money from Medicare to fund itself. Those retiring have paid into Medicare for decades so they would have money for their healthcare, not to fund his left-wing social experiments. It wasn’t a volun-tary system. They couldn’t keep the money and invest it to earn a return on their own. It was a tax. Now what it was supposed to pay for is being diverted for other purposes. America has become the place where govern-ment steals from you, disenfranchises you, spies on you, and threatens you

if you speak up about it. It’s disgusting and I believe it’s criminal!

I don’t like it, nor do the majority of Americans. Most people don’t like to be made poor, lied to and overtaxed – the moral common denominator of the Obama administration and politicians from both parties who are made themselves unaccountable to no one except big corporations and special interests that finance their political contributors. Americans, in their dazed complacency have elected looney-tune extremists who tell us that cattlemen are domestic terrorists, while our Eric Holder at DOJ releases real murders, rapists and other felons who are illegal aliens from America’s prisons.7 For their victims, being assaulted, murdered and raped is more terrorizing than having cattle peacefully grazing on public lands; but what does Harry Reid focus on?

Obama Fails Elementary MathGovernment figures report there were 47 million in America with health insurance in 2006 before Obamacare. Those in the U.S. illegally don’t need health insurance (they quickly learn to show up at Emergency Rooms, get the care they need and let the taxpayers pay the bill). Of these 47 million, the government said it would pro-vide insurance for 32 million under Obamacare, who had no insurance. But in typical Obama double-speak that was at best highly misleading and ultimately completely untrue.

As documented in our last issue, since 2009 when Obamacare was passed, (but before it took affect in 2013), there were 29 million workers who lost private health insurance because their employers cancelled insurance as a fringe benefit that was too expensive

7 A Immigration Studies report found that in 2013, U.S. Immigration and Customs Enforcement, released 36,007 criminal aliens who had com-mitted 87,818 crimes, back onto the streets. This included 9,187 convicted of drug infractions, 426 convicted of sexual assaults, 303 who were kidnap-pers, 193 who had committed murder, 1,317 who were guilty of domestic violence, and 1,075 who committed aggravated assault. 32 of these folks had multiple felony convictions - according to Whistle blower. See http://www.wnd.com/2014/05/release-of-36000-criminal-illegals-impeachable-offense/ . Also reported by the New American, USA Today and others.


to maintain. There seems to be no data on how many of these folks were rein-sured by some means (e.g. as a depen-dent on a spouse’s policy) or if they remained uninsured. The government isn’t saying either. It’s never men-tioned. In 2013, Obamacare cancelled private insurance of at least 4.2 million more Americans, including myself, our employees, Shelly, David, without our knowledge or consent. So where are we now that Obamacare has taken effect?

Let’s see, 47M + 29M + 4.2M = 80.2 million uninsured, of which 33.2 million were disenfranchised by Obamacare. If we believe Obama’s numbers, which independent fact checkers dispute, that a total of 7.1M8

signed up by the end of enrollment in April 2014. That means we have 80.2M - 7.1M = 73.1M without insur-ance in 2014. That’s a net increase of 26.1 million MORE who are now UNINSURED (a 55 percent increase) due to Obamacare. This is what Obama says, “is working and he is proud of.” It’s classics of Obamanomics, the new math of the radical left democrat party. Most rational person perceives that as a step backwards no matter what Jay Carney, Harry ridiculous, and Nancy Pelosi say about it.

You can’t count Medicaid enroll-ments in this, because some folks were eligible for Medicaid BEFORE Obamacare was passed, and just couldn’t afford to sign up (like Shelly) because they didn’t want to hand over the few remaining assets they have to the government to be a part of it. Obamacare didn’t help these people, it made many of their situations worse. The stories speak for themselves. Who is lying speaks for itself, Obama, Reid, Pelosi, the Pinocchio trio of the radical left-wing Democrat party.

So why do American voters continue to elect candidates of such ques-tionable character to Congress? That’s on voters, we get exactly what we elect!

So why do American voters continue to elect candidates of such ques-tionable character to Congress?

So why do American voters continue to elect candidates of such ques-tionable character to Congress? tionable character to Congress? That’s on voters, we get exactly tionable character to Congress? That’s on voters, we get exactly

8 The Washington Post refutes that number as just another misrepresentation (giving Obamacare yet another Four Pinocchio’s award for dishonesty)

When we elect liars, we get lies and deception. When we elect incompe-tent people, we can expect scandals and cover-ups. Being a President is no place for on-the-job military, business management and ethics training.

Mr. Obama, Quit Playing Let’s PretendIt’s time to quit playing let’s pretend. Let’s pretend employment is down and everyone is working. Let’s pre-tend that al Qaeda is on the run but ignore Benghazi. Let’s pretend the administration is transparent and open - but officials don’t honor subpoenas or take the 5th Amendment. Let’s pre-tend that the Constitution is actually being respected and government has not over-stepped itself, and ignore the DOJ filing suit against Arizona who actually tries to enforce federal border laws. Let’s pretend that we run the debt up indefinitely without an eco-nomic meltdown that has permanent impact on America. Let’s pretend that we can placate radical Islam, while this administration watches them develop nuclear weapons. Let’s pretend that cattle ranchers are domestic terror-ists. Let’s pretend that if let out illegal immigrants who are felons, rather than deport them, our streets will be safer. Let’s pretend that its OK for American Veterans to die because the VA is ineptly managed, and the General who manages it should not be held accountable. Let’s pretend that 56 million babies aborted is OK. Let pretend taxing everyone to support abortion is ethically acceptable. Let’s pretend that massive tax increases will result in more take home pay and the strengthening of what’s left of the middle class. Let’s pretend that two part-time jobs that each pay poorly, is better for workers and their fami-lies than one full-time job that actu-ally pays well. Let’s pretend that we can build America on a foundation of lies and the shifting sands of ever escalating debt, and it won’t collapse. Let’s pretend that we can vanquish God from America, but that He will leave his provision, protection and blessing behind when he leaves. Let’s pretend this all has a good outcome

– or let’s finally wake up this “magic thinking” to what we are doing to our-selves and our nation, and make a long overdue change in direction before it all crashes and burns.

As in the movie “War Games,” this [Let’s Pretend Game] is a strange game... the only way to win is not to play it!

Obamacare is a failure, that was based numerous intentional deceptions and breaches of faith with Americans. Obama intentionally promised one thing (insurance for the uninsured) but had in mind something entirely different (government-controlled healthcare for all). Not satisfied with the incompetence of government-run VA healthcare, the plan was to achieve “healthcare equality” (which meant poor access to care for all Americans) and to raise taxes. Both objectives have been achieved - are we better off?

Obamacare has damaged 32.2 million Americans that previously had health private insurance coverage, increased the total number of Americans without health insurance, delayed access to care, and made it more, not less expen-sive. Jeffery Immelt says it’s causing a downturn in the U.S. economy. If the “Employer Mandate” ever takes effect, watch for the collapse of the health-care system or a massive downturn in healthcare quality and delays in accessing healthcare.

Jay Carney and Obama claim every-thing is going according to plan, Obamacare has proven to be a success, and democrats should run in the 2014 elections on that success. Isn’t that amazing!

Under Obamacare, having a heart attack becomes a financially devastating event for millions of Americans due to lack of access to care at the nearest hospital.

Under Obamacare, having a heart attack becomes a financially devastating event for millions of

Under Obamacare, having a heart attack becomes a financially devastating event for millions of devastating event for millions of Americans due to lack of access to devastating event for millions of Americans due to lack of access to

hospital.

In some states like NH, 35% of hos-pitals are excluded from the plan altogether, making access to care for patients in those locations much


more challenging and expensive; and making emergency services, such as for a heart attack, covered at only 60% after meeting a $5,000 deductible.

In what areas has the Obama admin-istration been a success? The middle class is shrinking, the total number of Americans not working has increased, household income continues to fall, hospitals are closing, doctors are bailing out of the system, the Medicare trust funds are being diverted, care to the elderly is becoming harder to access, the economy is being crashed, the national debt is growing out of sight and American’s who stand against voter fraud are being attacked by their elected officials, and it’s all according to the plans of radical social re-engi-neers like Barack Obama and Ezekiel Emanuel who tell us, “everything is good.”

The stories reported here are true. Those adversely affected have a right to live without fear of being targeted by their government because of what they believe or say. We will continue to print the truth. If liberty and freedom mean anything in America these mat-ters deserve public scrutiny. We have domestic terrorists, but they aren’t cattle ranchers. There are “gate” scandals, but it isn’t “bridgegate.” Try Benghazi-gate, or IRS-gate or VA-gate.

Not all domestic terrorists look like unshaven revolutionaries. Some are clean shaven, well-educated, well-dressed, charismatic politicians who hold high offices today.

Not all domestic terrorists look like unshaven revolutionaries. Some are clean shaven, well-educated, well-

Not all domestic terrorists look like unshaven revolutionaries. Some are clean shaven, well-educated, well-clean shaven, well-educated, well-dressed, charismatic politicians who hold high offices today.

RepentanceRepentance means regretting actions taken against God’s laws. If you don’t believe in God’s laws, then there is the law of the jungle for you - the weak are the fair game and victims of the rich and powerful. Obamacare is the Law of the Jungle, atheists and agnos-tics should love it, even if it kills them or denies them care.

Repentance is turning back to God’s moral values, inviting Him back into our national life, honoring Him, and

acknowledging that the reason He gave us the 10 Commandments was because following them leads to a better out-come than violating them does.

God gave us a free will to violate his principles but that has consequences, and for those who deny God. We are now seeing the first fruits of those consequences. They are evil, but the liberal media and black congressmen, call them good, commend those who are leading American down this trou-bled road to disaster and proclaiming anyone opposing them as “racists.”

We are free to keep doing that and free to suffer the increasing conse-quences by ignoring what our Creator told us would work well, keep us safe and protected and in a loving relation-ship with him and with each other. Obamacrats espouse doing just that, blindly continue on our current path. How is that path working for you and your family?

I picked the word “repentance” inten-tionally because I think that America is engaged in a spiritual war, as much as in a political or military one, and that it is being lost because of what we have become as a society where ethical and moral values are swept aside by politicians who brag openly that “they can do whatever they want!”

The trends I track suggest we are caught in a downward spiral that will undermine and sweep away the middle class. The very rich don’t care – they feel their great riches will protect and insulate them. Yet, I wonder if wealth will make a difference during a pan-demic of MERS virus or MRSA bac-teria, or as the other incurable diseases emerge. No matter how much money one has, you can’t buy a drug to cure a disease if the drug doesn’t exist.

The responsibility for the direction of America rests entirely on its middle class. Regardless of one’s spiritual beliefs, we need to encourage policies which grow the middle class, not drive it into poverty. This administration has failed miserably. Either voters will change it, or they will reap the con-sequences of this Toad’s Wild Ride,

folly. It’s up to voters. Consider the direction we are headed, decide who is telling the truth and then vote your heart. That will show us who we are. �


AIRSTRIP BUyS WIRELESS HEART MONITOR

Mar 28, 2014 -- AirStrip buys technology from Sense4Baby, a wireless fetal/maternal monitoring system to perform non-stress testing for high-risk pregnancies, has been acquired by AirStrip, says James Aldridge, Web Editor- for the San Antonio Business Journal. San Antonio-based AirStrip licensed the associated technology from the Gary and Mary West Health Institute.

Sense4Baby already received clearances from the Food and Drug Administration and the European Union to market the device in clinical settings. The acquisition will allow women to undergo non-stress testings to monitor fetal and maternal heart rate and contraction patterns using non-invasive sensors. The device can be used at doctors’ offices, clinics and ambulances.

AirStrip plans to pursue FDA clearance for home-based monitoring. AirStrip will integrate Sense4Baby’s tech-nology with its AirStrip ONE mobile platform. This will allow doctors and other health care professionals to view the heart beats of expecting mothers and unborn children remotely via a smartphone or a tablet.

CDC: FIRST CASE OF MERS INFECTION TRANSMITTED INSIDE THE UNITED STATES

Atlanta (CNN) -- The first case of Middle East Respiratory Syndrome believed to be transmitted within the United States has been identified in an Illinois man who was infected and is no longer sick, a doctor with the Centers for Disease Control and Prevention said Saturday.

The unidentified Illinois man had “extended face-to-face con-tact” during a 40-minute business meeting with an Indiana man who was diagnosed with MERS after traveling from Saudi Arabia, Dr. David Swerdlow told reporters during a telephone briefing.

“We think that this patient was likely infected with MERS. But techni-cally he doesn’t count as an official case of MERS,” he said.

The case does not meet the World Health Organization definition of an active case, which requires evidence of a live virus, according to Swerdlow. The case was discov-ered as part of an investigation by U.S. health officials to track people who came in close contact with the Indiana man, who became the first person diagnosed with MERS in the United States. He was diagnosed with the virus on May 2.

MERS, first found in the Arabian Peninsula in 2012, is a coronavirus -- the same group of viruses as the common cold. It attacks the respiratory system.

Symptoms, which include fever and a cough, are severe and can lead to pneumonia and kidney failure. Gastrointestinal symptoms such as diarrhea have also

been seen, according to the WHO. There is no vaccine or special treatment, and it can be fatal in up to one-third of cases, Dr. Anne Schuchat, assistant surgeon general for the U.S. Public Health Service told CNN recently.

To date, there have been more than 570 confirmed cases of MERS, including 171 deaths, according to the World Health Organization. The number of countries with confirmed cases expanded to 18, with a case in the Netherlands, according to the WHO.

Many of the cases are in Saudi Arabia and the United Arab Emirates.

No one knows exactly how the virus originated, but evi-dence implicating camels is emerging. In a recently pub-lished study in mBio, researchers said they isolated live MERS virus from two single-humped camels, known as dromedaries. They found multiple substrains in the camel viruses, including one that perfectly matches a substrain isolated from a human patient.

The Illinois case was discovered as part of an investigation by U.S. health officials who tracked the movements and contacts of the Indiana man, who was an American health care provider who had been working in Saudi Arabia and was on a planned visit to Indiana to see his family.

He traveled April 24 from Riyadh to London, then to Chicago, and took a bus to Indiana, officials said.

In Indiana he began experiencing shortness of breath, coughing, and fever on April 27, the Indiana State Department of Health has said.

He was admitted to Community Hospital in Munster, Indiana, on April 28, the same day he visited the emer-gency department there, the health department said. The man was released from the hospital last week.

Health officials tested 53 health care workers, six family member and an additional business associate.

The MERS virus appears to have presented differently in the Illinois man, who reported only mild-like cold symptoms.

“There is a broader spectrum of MERS than first thought... you can have no symptoms,” Swerdlow said.

There are no travel restrictions to the Arabian Peninsula; however, the CDC suggests that people who visit there monitor their health and watch for any flu-like symptoms. If you do feel unwell after such a trip, be sure to tell your doctor about your travel.

From: ht tp : //w w w.cnn .com/2014/05/17/hea lt h /mers-case-u-s-/

Vendor Short Takes


CLASS I AND II FDA RECALLS

MSP has picked up the MedWatch reports for selected Class I and Class II recalls. We will begin reprinting them as a service to our BME readers as space permits in our next issue. CLASS II RECALLS

ERT ExPANDS SUITE OF ECOA OFFERINGS

PHILADELPHIA – June 16, 2014 –– ERT, a global solution provider for high-quality patient safety and effi-cacy endpoint data collection, announced an expansion to its comprehensive suite of electronic Clinical Outcome Assessment (eCOA) data collection solutions for use in clinical trials. With this expansion, clinical trial sponsors can improve trial efficiencies while reliably collecting important eCOA data via patients’ personal Apple® (iOS) or Android™ phones and tablets.

An extension of ERT’s flagship DIARYpro® solution, the Bring Your Own Device (BYOD) option is based on over 25 years of scientifically and regulatory-proven COA data collection experience. This native mobile application enables trial sponsors to acquire high-quality eCOA data while eliminating the cost and time associated with pur-chasing, shipping, and managing a global fleet of dedicated eCOA devices. In addition, ERT’s BYOD solution ensures that assessments are presented consistently across different device types and screen resolutions.

Unlike other mobile applications that run within web browsers and require a live internet connection, ERT’s BYOD solution allows fully-offline operation for when data must be entered during strict time windows, regardless of internet connectivity. Further, on-device reminders to begin or continue assessments are not dependent on any external email or text server, and these notifications blend naturally into smartphone users’ daily lives, enhancing compliance.

ERT delivers the most widely deployed solutions in central-ized cardiac safety, respiratory services, suicide risk assess-ment and Clinical Outcome Assessments (COAs) – which includes patient, clinician, and observer reported outcomes. By efficiently integrating these solutions through a system built upon a scientific and regulatory foundation, ERT col-lects, analyzes, and delivers safety and efficacy data critical to the approval, labeling, and reimbursement of pharma-ceutical products. ERT is a global organization with head-quarters in Philadelphia, PA and offices throughout the U.S., U.K., Japan, and Germany.

HAzARDOUS CHEMICALS FOUND IN DAy CARE CENTERS

More than half of all young children in the United States attend a day care center or preschool, sometimes spending up to 50 hours a week at these facilities. Their parents should listen up:

A new study, published in the journal Chemosphere, finds these child care centers can host high levels of dangerous, flame-retardant chemicals.

Lead study author Asa Bradman recalls first learning about the dangers of some of these chemicals when he was in high school. “You know, 35 years later, I’m surprised to find these materials in an environment where young children spend a lot of time,” he said. Bradman is associate director of the Center for Environmental Research and Children’s Health at University of California, Berkeley’s School of Public Health.

The study authors evaluated the dust and air of 40 child care centers in California, ranging from in-home day care to private schools to government-funded preschool pro-grams. Bradman and his colleagues surveyed the samples for 18 flame-retardant chemicals, including a family of chemicals known as PBDE’s, some of which are banned by the European Union.

All of the dust samples had flame-retardant chemicals in them. The concentration levels were similar to what pre-vious studies have found in homes, the study authors say. While all the dust samples were found to have traces of the tested compounds, flame-retardant levels in air sam-ples were much lower.

There’s a growing body of scientific evidence linking these chemicals to low birth weights, hormone imbalances and even cancer.

Arlene Blum, director of the Green Science Policy Institute, said the chemicals’ potential impact on the brain and reproductive systems are of particular concern for young children because their systems are still develop-ing. Young children are particularly vulnerable, explained Blum, because they “tend to crawl in the dust and put their hands in their mouths.”

Blum, who was not involved in the study, said these flame-retardant chemicals likely made their way into the dust and air of schools from the foam of couches, furniture and children’s products such as sleeping mats.

Bradman and his colleagues found that schools using upholstered furniture and foam napping mats had the highest concentrations of the chemicals.

“Child care environments aren’t unlike other home and indoor environ-ments,” Bradman explained. “The message here is that child care is not uniquely unsafe for kids. Rather it’s an environment that we haven’t looked at much.”

In a statement, the North American Flame Retardant Alliance said, “Independent research shows that flame retardants play an important role in protecting people from the devastation of fire. This layer of protection is particularly important for vulnerable popula-tions, including the elderly and young children, who are disproportion-ately affected by fires.”


“It’s important to remember that flame retardants, like all chemicals, are subject to review by the EPA and other governmental agencies in the U.S. and around the world.”

Blum said that there is good news in this. While foam companies long used flame retardants to meet safety stan-dards, those standards are changing.

So how can parents tell if their child’s day care’s couch - or even their own furniture at home - has flame retardants in them? Look for a tag that says “CA TB-117,” which indi-cates the product has flame retardant foam in it. A tag with “TB 117-2013” means no flame retardants are included.

INTERMOUNTAIN WILL NOT ATTEST MU THIS yEAR

Intermountain Healthcare cited other priorities and patient safety worries as the reasons it will not achieve EHR mean-ingful use attestation this year. According to officials, the risks of pursuing attestation while transitioning to a Cerner EHR platform exceed the benefits. As a consequence, Intermountain will face financial penalties in 2016, and it will not receive incentive payments for 2014.

MEDTRONIC REVEAL LINQ INSERTABLE CARDIAC MONITOR

Norwalk Hospital has become the first hospital in Fairfield County to implant the Medtronic Reveal LINQ Insertable Cardiac Monitor System in a patient.

Dr. Joseph J. Tiano, electrophysiologist with Cardiology Associates of Fairfield County, implanted four of these devices in patients at Norwalk Hospital recently.

The Reveal LINQ ICM is one-third the size of a AAA bat-tery, making it more than 80 percent smaller than other ICMs. While significantly smaller, the device is part of a powerful system that allows physicians to continuously and wirelessly monitor a patient’s heart for up to three years, with 20 percent more data memory than its larger predeces-sor, Reveal XT.

“This significant technological advancement, with wireless technology, continuously monitors the heart so that we have a reliable snapshot of the patient’s cardiac activity for more prompt and accurate diagnosis,” Tiano said.

In addition to its continuous and wireless monitoring capa-bilities, the system provides remote monitoring through the Carelink Network. Through the Carelink Network, physi-cians can request notifications to alert them if their patients have had cardiac events. The Reveal LINQ ICM is indi-cated for patients who experience symptoms such as dizzi-ness, palpitation, syncope (fainting) and chest pain that may suggest a cardiac arrhythmia, and for patients at increased risk for cardiac arrhythmias.

NURSES’ UNION kNOCkS EHRS HARD

National Nurses United, which bills itself as the largest organization of nurses in the country, is in the midst of a campaign to spotlight the potential risks of patient harm spurred by what the group calls, “an unchecked proliferation of unproven medical technology and sharp erosion of care standards.”

Founded in 2009, the NNU tallies 185,000 members, with members in every state.

The NNU campaign, announced on May 13, includes radio ads from coast to coast, video, social media, legisla-tion, rallies and a call for public action. Its slogan: “When it matters most, insist on a registered nurse.”

In its press statement launching the campaign, the NNU questioned the use of EHRs – and other medical technology.

“Computerized electronic health records systems too often fail, leaving doctors and nurses in the dark without access to medical histories or medical orders,” they said. “The Office of the Inspector General for the Health and Human Services Department has reported widespread flaws in the heavily promoted systems. Telemedicine and robotics marketed as improved care deprive patients of individualized care so essential to the therapeutic process central to healing.

“Bedside computers that diagnose and dictate treatment for patients, based on generic population trends not the health status or care needs of that individual patient, increasingly supplant the professional assess-ment and judgment of experienced nurses and doctors exposing patients to misdiagnosis, mistreatment and life-threatening mistakes.”

“Hospitals and other healthcare industry giants are spending billions of dollars on medical technology sold to the public as the cure for everything from medical errors to cutting costs, but the reality is proving to be far different,” the NNU said in a press statement.

The NNU also pointed to hospital industry profits as being at a record high – some $64.4 billion in 2012, according to American Hospital Association data.

Kaiser Permanente, which is the model for many of the industry trends, just reported first-quarter profits of $1.1 billion, up nearly 44 percent from a year ago, the NNU stated.

A NNU radio ads notes that many of those hospitals are spending their profits and patients’ healthcare dollars “on everything but quality patient care” – on technology, Wall Street investments, buying up other hospitals, while cutting the staff of bedside registered nurses, “the health professionals most critical to your care and safety.”

The NNU also claimed inadequate, unsafe staffing in the nation’s hospitals. Just one example of many, the NNU called attention to a report released May 12 in which Washington, DC, nurses cited 215 incidents of severe understaffing, including life-threatening events, in District hospitals over the past 15 months. RNs in DC and several states are pursuing safe staffing legislation.


“The American healthcare system already lags behind other industrial-ized nations in a wide array of essential health barometers from infant mortality to life expectancy. These changing trends in healthcare threaten to make it worse,” said NNU Co-President Jean Ross, RN, in a statement. “Behind every statistic is a patient and their family, who are exposed to unnecessary suffering and risk as a result of the focus on profits rather than what is best for individual patient need.”

PANASONIC SHOWS HIGH-PERFORMANCE 20” 4k TABLET

HIMSS was the showcase for the first 20-Inch 4K Tablet we have seen, and the display was striking. The 4K visual experience leverages a 20-inch IPS Alpha LCD screen with 3840x2560 pixel display featuring 230 pixels per inch and 15:10 aspect ratio. It is powered by Intel® Core™ i7 vPro™ Processor, NVIDIA® Quadro® GPU to Serve as Mobile CAD, Video Workstation and its portable. The HIMSS showcase ups the ante for portable healthcare dis-plays from HDTV resolution. Marketed as the Toughpad 4K, it will power mobile workstation for professionals in visual-intensive fields such as computer-aided design (CAD) and video editing. It is optimized for the Windows 8.1 Pro operating system, but can be backed down to Windows 7 Professional, for those afraid of Windows 8. (Why would anyone do that?)

Storage & Memory capacity is 256GB SSD,16 GB RAM, or 2GB VRAM.

Connectivity & I/O is also impressive. It offers Mini DisplayPort™, Intel® Centrino® Advanced-N 6235 Wi-Fi 802.11 a/b/g/n, Bluetooth® v4.0 (Class 1), USB 3.0, SDXC card slot, smart card reader, docking connector, Gigabit Ethernet LAN port

The integrated camera was only 5 MegaPixels rear cam-era; 1280 x 720 pixel front camera. That is OK, but not spectacular.

“Professionals in visual-intensive fields such as CAD and non-linear editing have traditionally been stuck working behind a desk away from where decisions are being made, due to a lack of mobile technology on the market with the large, high-quality displays and high-performance processors these users require,” said Kyp Walls, director of product management, Panasonic System Communications Company of North America. “As a lightweight 20-inch tablet PC with beyond Ultra HD resolution and high-performance processing power, the Toughpad 4K performance model enables these workers to get things done in the field that previously were only practical at a desktop workstation, greatly expanding productivity, creativity and efficiency in a number of areas.”

Like other Panasonic solutions, this one is more rugged than most CPUs, surviving 12-inch drops to 26 angles (non-operating) and 30-inch drop to its back (operating). One thing is that you will have to carry a charger with you because battery life is only 2.5 hours. Weight is good how-ever at only 5.6 lbs., 0.49 inch thick. Perhaps Panasonic will

offer a future model with extended battery life even if it weighs a pound or two more.

Like the standard model, the Toughpad 4K performance model offers an optional Panasonic Electronic Touch Pen, a unique new device offering pixel-level precision and a distinctly pen-and-paper-like feel for freehand sketching, annotation or handwriting. The pen uses infrared signals to distinctly read each pixel on the screen and communi-cates with the tablet via Bluetooth®. For natural and highly accurate drawing or handwriting, the pen can be held from various angles and can interpret more than 2,000 levels of pressure. The Toughpad 4K also offers 10-point multi-touch input.

Combined with accessories such as the optional Panasonic desktop cradle and carrying case solution, the device can be used as both a desktop PC and tablet. The cradle easily converts into a titled stand to allow the tablet to be used in drafting table mode, and offers USB 3.0 x3, Ethernet and HDMI-output connectivity. A VESA-compatible mounting adapter plate is also available.

Overall, this was the most innovative hardware device we saw at HIMSS and we recommend it to our healthcare readers who need rugged, high resolution displays.

But be prepared, it’s pricey - with a list prices of$6,999. The previously announced Toughpad 4K standard edition, featuring an Intel® Core™ i5-3437U vPro™ processor with an NVIDIA® GeForce® 745M GPU, is available and lists at $5,999.

Both include a comprehensive 3-year warranty. Sales inqui-ries for Panasonic’s Toughpad family of tablets should be directed to [email protected] or 877-803-8492.

MSP Industry Alert™Medical Strategic Planning, Inc.5 Shelbern DriveLincroft, NJ 07738-1324

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