In the course of the past year we have been contacted by numerous countries, agencies and states about very large scale implementations of our Advantage and WebVista systems. It got us to thinking about just what the top limit would, turns out there really isn’t one. This executive summary gives a very limited introduction to such a system and we would love to have feedback on it. We are actively working on a much more detailed look at particulars of such a system that touches on privacy implications, additional benefits for federal agencies and public health, and practical aspects of real national interoperability. The technology used to scale a system like this is already widely available and proven on even larger scales, we envision a system here with just under 2 million users, facebook alone has close to 800 million. Using the open source touchstones of pound, linux, apache, mysql, php and memcached (LAMMPP) a system of any size is cost effective. We need to put healthcare spending in perspective or we are never going to be able to resolve the problems plaguing it.