Friday, December 6, 2013

From Nuclear Warfare To Healthcare, Part 2: Thawing Cold War Leads To A Career Change

This was originally posted at www.healthsystemcio.com.

[Below is the latest in a blog series in which Dale Sanders explores the “combination of fate, luck, planning and preparation that rolls together and creates a career.” Click here for Part 1.]

In the mid and late 1980s, we (members of the US Air Force Strategic Air Command battle staff) were seeing evidence in national intelligence reports that the Soviet Union’s Strategic Rocket Forces were having difficulty maintaining their nuclear weapons systems in fully-capable status. What we didn’t fully appreciate at the time was the root cause — the Soviet logistics supply chain was failing because the inefficiencies of the totalitarian-communist political-economic model were crumbling.
My team and I supported the first Reagan-Gorbachev summit in Geneva, providing a secure, nuclear EMP-protected voice conferencing system via satellite from President Reagan’s location in Geneva to the Pentagon’s National Military Command Center, NORAD, and the SAC Command Post. This nuclear survivable voice conferencing system — named Early Pentagon Connectivity (EPC) — was a direct request from Reagan. He did not fully trust the Soviets, even the congenial Gorbachev, and was deeply concerned that, while in Geneva, the Soviets might be tempted to launch a limited nuclear “bolt out of the blue” attack on the US.
The electromagnetic pulse (EMP) that accompanies a nuclear detonation tends to destroy the fragile electronics of solid-state computer and communications systems. For this reason, the US has spent hundreds of billions of dollars retrofitting and reengineering around EMP. One of the more concerning US military scenarios is the “nuclear hostage” scenario in which a limited, surprise nuclear attack from an enemy generates a large EMP, destroying the ability for the President and National Command Authorities to communicate with US forces, and thus enabling the attacker to hold the US hostage and emit further destruction.
It sounds like a bizarrely unlikely scenario, but for the better part of 50 years, the likelihood was not so low. Reagan, who was born and raised in a period of world history that was characterized by wars and near-crippling surprise attacks, was particularly concerned about this scenario.
Our tiger team of 12 worked for three months, seven days a week, 14 hours a day to finish EPC before the Summit. A satellite-based, secure, EMP-protected voice conferencing system had never before been designed or attempted. We weren’t sure it could be done, but we tried and managed to succeed. (The Secretary of Defense wrote each of us a personal thank you note.)
At the Summit, there was no hint of Reagan’s premeditated sense of paranoia. Gorbachev arrived early and unannounced at Reagan’s cottage, catching Reagan somewhat unprepared. It didn’t matter; the informality led to humor. The warmth that Reagan extended to Gorbachev was immediately returned. With their four-handed handshake combined with a growing understanding that the logistics infrastructure of the Soviet army was rapidly coming apart at the seams, it was clear that the Cold War was all but over, minus a few pen strokes.  By the way, I didn't see this handshake until I saw it on TV, like everyone else.  I was monitoring the summit and the EPC circuit from an airborne command post.
For me, it also became clear that the seriousness and responsibility of US nuclear operations that attracted me to the Air Force were also going to mellow. It was time to make a change.
In 1989, I resigned from active duty in the Air Force (while remaining in the reserves) to work for TRW, a large and well-respected space and defense contractor with whom I had worked extensively, particularly with its optical reconnaissance, signals intelligence, and communications satellites. TRW hired me for my experience as a member of the SAC battle staff and knowledge of the Air Force’s nuclear intercontinental ballistic missiles — Peacekeeper and Minuteman.
At one time, TRW was a major prime contractor for the National Security Agency, the Central Intelligence Agency, and owned the world’s largest consumer credit reporting system, now called Experian. TRW probably managed 80 percent of the world’s information in the 1990s.
While I was in the Air Force, we practiced nuclear warfare regularly — at least daily. The realistic nature of these exercises never lost their intensity. They were always disturbing, always chilling, and always creepy. We had 20 minutes to make decisions in which we discussed casualties in the tens and hundreds of millions lives.
During these exercises, under enormous pressure and time constraints, I saw enormous variability in the diagnosis and reaction to the scenarios. We had incredibly complicated decision support technology for fusing data together into a comprehensive picture of what was happening and to who and where, but we lacked any sophisticated technology for guiding the decision. We were surrounded by computers, technology, and essentially an unlimited budget, but our decision making tool was a five-ring binder called the Presidential Black Book, developed by Secretary of Defense Harold Brown in President Carter’s administration. The Black Book was approximately 100 pages of very simply described scenarios and attack options. We joked under our breath about the senior US decision makers who were predictably prone to choose “MAO 4, no withholds,” (Major Attack Option 4) which meant launching everything we had-- withholding no targets from attack-- military, industrial, or civilian — everything would go.
At TRW, I approached my bosses, Ron Gault and Bob Bloss, with a proposal to develop a computerized decision support tool that would (1) replace the antiquated and oversimplified Black Book with a computer-aided decision support tool that could more quickly analyze intelligence and sensor data, algorithmically diagnose the situation, and suggest response options that were directly traceable to US policy and military strategy, rather than the personal biases of the decision making officers and civilian leadership; (2) reduce the likelihood of reacting to a false-positive attack or failing to react to a false negative attack; and (3) address the completely new profile of potential nuclear enemies in a post-Soviet environment.
It’s worth pausing here to note the patterns in decision making that overlap with healthcare. Assessment, diagnosis, identifying and managing false positives and false negatives, response and treatment, monitoring outcomes, and repeating the cycle as necessary until the desired outcome is achieved.
In this period of Eric Snowden and NSA spying on our allies, some might be surprised to learn that our nuclear weapons software targeting programs also included the option to target our allies that posses nuclear weapons-- even if those weapons are stockpiled US warheads-- in case those foreign nuclear weapons come under the influence of a terrorist group or other unpredictable command.
My bosses at TRW approved the request to investigate the concept for a nuclear warfare decision support system. We approached the Pentagon for their support and funding and received approval. We called the project the Strategic Execution Decision Aid (SEDA). In short, it was a real-time, computerized decision support tool to be used in the pre-attack phase of a nuclear war in which the length of the decision making time frame was anywhere from 4 minutes to 23 minutes, depending on the location, source, type of weapon, and mode of delivery associated with the attack. SEDA was, simply, a real-time enterprise data warehouse, overlaid with very complex profiling and predictive algorithms for the analysis and visualization of data.
While developing the concept of operations and requirements for SEDA, I researched all industries and their use cases for real-time, time critical, life critical, computerized decision support. This research took me to the railway and mass transit industry, nuclear power plants, air traffic control, embedded flight control systems on civilian and military aircraft and finally healthcare. I was supremely confident in my naïve assumption that healthcare, with the efficiency of private sector economic motives, not hampered by the stodgy and ego-driven culture of decision making in the US military, would be my best source of lessons learned and techniques for designing and developing SEDA.  My confidence was misplaced but my curiosity and passion for healthcare decision support were kindled.

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