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12/4/2013
08:06 AM
David F Carr
David F Carr
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How Would You Fix HealthCare.gov?

The Obamacare website launch was an embarrassment. Whether it's truly "fixed" is questionable. What actions would you take, IT pros, and what lessons have you learned?

The HealthCare.gov website, the IT centerpiece for implementing Obamacare, is said to be "fixed" now -- although there are still plenty of reports of site access problems and deeper glitches in the software.

Ever since the glitch-ridden launch of the site on October 1, IT experts of all stripes have been weighing in with their thoughts on what went wrong and why. InformationWeek last week conducted a series of interviews with experts in which we asked for a more prescriptive analysis: How do you recover from an IT disaster on the scale of HealthCare.gov?

I recap some of the common themes (and differences of opinion) below, but we'd also like your point of view. Have you ever been involved in a technology turnaround on a big, important project that failed at launch? Did you see that initial failure coming? What are the most successful strategies you've seen for reorganizing for success?

It's hard not to revert to the "blame game" -- pointing out what should have been done in the first place but wasn't -- and there's plenty more to say about that. But put yourself in the shoes of Jeffrey Zients, the man drafted to get the HealthCare.gov project on track. Would you have deployed additional manpower in a "tech surge?" Would you have shut the site down while making repairs? Would you have outsourced more (or fewer) functions? And when you report back to President Obama, which specific recommendations would you make about federal government procurement reform or IT project management strategies? How would you make those changes stick, so that the next president, Republican or Democrat, will be able to make big e-government promises and keep them?

[Read our complete coverage of the HealthCare.gov launch here.]

This exercise shouldn't be about what you think of the Affordable Care Act, a.k.a. Obamacare. Although the two issues have become intertwined, the performance of the website and the wisdom of the law are two different things.

Whether you're cheering for the success or demise of Obamacare, the facts are the facts, and the fact is this technology implementation undercut the policy implementation. I think the president and his top advisers made far too many assumptions about how easy it would be to launch a consumer-friendly insurance shopping website. They failed to comprehend how much bigger a job it is than fielding, say, a campaign website.

Martin Abbott and Michael Fisher, a couple of scalability consultants and authors we interviewed, said the government's mistakes weren't so different from the ones they've seen many private companies make when they misjudge the needed scalability and capacity of their Web systems. The one big difference they see is the partisan environment surrounding the project, where those trying to salvage HealthCare.gov and the programs it represents are competing for attention with those who want them to fail.

Here are a few key questions surrounding the HealthCare.gov failure:

Should it have been shut down?
One of the things that didn't happen but should have, according to one camp, was to shut down the website while it was being fixed, on the premise that it was launched prematurely and clearly wasn't ready. We've heard this line of thinking from computer security experts, both in interviews and Congressional testimony. The overall performance of the website doesn't inspire confidence in its security, and there's also evidence that warnings of security flaws were ignored during the site's construction.

The implication is that the Obama administration failed to shut down the site for "political reasons," because it would have meant admitting defeat and delaying implementation of the law.

Richard Spires, a former Department of Homeland Security CIO, said he would have recommended shutting down the site for repairs -- politics aside. "It takes a lot of energy to run the site," Spires said, and that energy needed to be diverted into fixing functionality and testing performance.

Abbott and Fisher disagree, saying the best way to fix an underperforming website is to make incremental changes and test them against real-world traffic, not against simulated load tests. Even security problems are better solved with a methodical approach rather than a panicked shutdown, they said.

Also, one of the original sins of the Healthcare.gov implementers was that they sent it live in a big bang, trying to bring the site up to full capacity in one day rather than having some sort of beta period or soft launch to gradually build capacity and test functionality. If the site were taken offline and relaunched, that approach would amount to a second big bang -- and, likely, big problems, Abbott and Fisher said.

Bryce Williams, the founder of Extend Health and now managing director of exchanges for Towers Watson, agreed that no going concern -- inside government or outside -- would willingly shut down its primary website. A business would be even more likely to keep an underperforming site operating while working to improve it.

What would you do? Shut it down, or not? Why?

Is this a job for government IT? 
Former Air Force Col. Mark Douglas, who as a military IT leader oversaw some technology turnarounds, acknowledged the limits of the government's capability to build complex systems on its own. "The US government is not the leader in commercial IT, nor should it be," he said. Government employees must focus on the inherently governmental aspects of a program, creating an efficient division of labor with private industry partners.

On the other hand, one of the villains in this story is the government's process for procuring IT services. David Blumenthal, a former director of the Office of the National Coordinator for Health IT, argues that managers most involved in an IT project's requirements often are kept at arm's length from the people who select contractors to deliver on those requirements, making for unnecessary dysfunction.

Extend Health's Williams suggested another way the government could partner with private industry, by letting private insurance brokers (such as his) handle more of the consumer enrollments. Under that scenario, the government would focus on services that only it can provide, like providing an online determination of eligibility for federal subsidies, while private firms would be responsible for providing "a spectacular user experience," something he doesn't see as a government core competency.

What parts would you outsource? What would you keep in government hands? And if services are to be outsourced, how must the contracting process change?

Does a "tech surge" make sense?
Drawing an analogy from military operations in Iraq, the Obama administration decided to address HealthCare.gov’s problems with a "tech surge" of additional manpower, effort, and oversight. The experts we interviewed were ambivalent about the value of such a surge, saying that it's difficult for new people, no matter how talented, to come up to speed on a mature IT project and figure out what needs to be done to fix it. On the other hand, the existing team members may know what needs to be done but aren't empowered to do it.

"On mega, custom-coded IT implementations that trip before the finish line, many organizations want to throw money at the problem in the form of outsider IT SWAT teams. Keep your money," Col. Douglas advised, "unless your program team is literally incapable of fixing the problems." He added that it's "extremely difficult, expensive, and time-consuming to bring in new people to work on custom code."

Abbott and Fisher said project leaders could put additional manpower to good use as long as they focus it on identifying and correcting problems -- the hundreds of bugs the developers have been fixing over the past couple of months.

What do you say? Surge or no surge? Keep the project team or throw the bums out?

Those are some of our key questions. We'd like your answers. Also, what are the questions we forgot to ask?

Follow David F. Carr on Twitter @davidfcarr or Google+. He is the author of Social Collaboration For Dummies (October 2013).

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs. (Free registration required.)

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David F. Carr
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David F. Carr,
User Rank: Author
12/9/2013 | 1:36:00 PM
Re: Its not like this was the first IT Project mankind attempted
@Pmasarik, great commentary, thank you.
dogcat
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dogcat,
User Rank: Guru
12/8/2013 | 10:27:19 PM
It's a political/managerial problem, not technical
While it's true that the private sector have large scale failed IT projects, the cause of private vs public sector (and especially the Federal area) have some significant differences, though some are the same. In the Federal government, high level agency or department heads are often political appointees, who have no or little experience in the agency, or managing large enterpeises at all. In house career Federal employees who might have years of experience and organization domain experience and knowlede are ignored.  It's the patronage, or spoils sytem. Recall in Katrina episode that former President Bush told America that "Brownie was dong a great job."

So, Number 1, incompetence at the highest levels. In the private sector, while this does happen, it is much less frequent. The President and his agency chief clearly were not watching this high profile project.

Secondly, number 2, the Federal government's purchasing and expendiures are not based on the same principles as in the private sector. Federal procurement has an economic stimulus and social function, to support and encourage businesses. The procurement process is moribund in many, but not not all agencies. Large Federal contractors are making $Billions feeding at the Federal trough, while Federal employees are criticized.

Number 3, outsourcing. Given number 2 above, developing and nurturing in house Federal employee skill and competence is actually discouraged, in favor of paying twice as much for contractors, who will pass the buck and maximize their profit. In the private sector, one tries to minimize expense. In the current Federal set up, the contractor's goal is to increase costs.

Col. Mark Douglas' put down on our having a competent government in favor of feeding government contractors because of the 'inherant goverment' kanard is just a bogus red herring used to subvert govenment to become a lackie to coporations. It is not in the constitution. Eisenhower warned about the 'military industrial' complex, which can now be expanded to the 'business industrial' complex, or medical-business complex.

Critics of governement ought to at least realize why it is so imcompetent, because it profits many by being that way, and thus it is kept cripled to the advantage of some, and loss to others.


What is pathetic about this failure is that it is totally self inflicted by our highest level leaders.

Some folks will be making a lot of money in over budget costs on this fiasco. The question is not techincal, or whether to shut down for repairs or fix in flight, (those questions are moot, and techie questions, but not project mangement questions) but rather how can top government leaders be so incompetent and why have we allowed our governament to be taken over by corporations that have only their own private interests at stake? And how have we allowed our system to reward self serving interests while ignoring the commong good?

It's a total contradiction that a private entity, like a government contractor, with its own profit-seeking-at-all-costs motivation be able to deliver a service for the common good that is not to its own advantage. And, it's not that self interest profit seeking is bad, it's just deluded to expect action contracy to its own charter and interest.

 
dogcat
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dogcat,
User Rank: Guru
12/8/2013 | 10:19:17 PM
Re: Its not like this was the first IT Project mankind attempted
While it's true that the private sector has large scale failed IT projects, the cause of private vs public sector (and especially the Federal area) IT project failures have some significant differences, though some are the same. In the Federal government, high level agency or department heads are often political appointees, who have no or little experience in the agency, or managing large enterpeises at all. It's the patronage, or spoiles sytem. Recall in Katrina episode that former President Bush told America that "Brownie was dong a great job."

So, Number 1, incompetence at the highest levels. In the private sector, whild this does happen, it is much less frequnt.

Secondly, number 2, the Federal government's purchasing and expendiures are not based on the same principles as in the private sector. Federal procurement has an economic stimulus and social function, to support and encourage businesses. The procurement process is moribund in many, but not not all agencies. Large Federal contractors are making $Billions feeding at the Federal trough, while Federal employees are criticized.

 

Number 3, outsourcing. Given number 2 above, developing and nurturing in house Federal employee skill and competence is actually discouraged, in favor of paying twice as much for contractors, who will pass the buck and maximize their profit. In the private sector, one tries to minimize expense. In the current Federal set up, the contractor's goal is to increase costs.

Some folkes will be making a lot of money in over budget costs on this fiasco. The question is not techincal, or whether to shut down for repairs or fix in flight, but rather how can top government leaders be so incompetent? This is just one example.

 
Pmasarik
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Pmasarik,
User Rank: Apprentice
12/7/2013 | 10:34:47 AM
Its not like this was the first IT Project mankind attempted
There is some really great commentary posted on this site most of which hits the nail on the head.
---------------------------------------------------------------
As an Information Management & Technology professional for many years, what runs through my mind is.....WOW. Will wonders never cease?

So here it is, yet another failed IT Project - or maybe call it a project with IT failings - and a very publicized one at that making a horrible situation even worse and now there are millions of opinions to be listened to - and as we all know how useful that is.....NOT   

Its not like this was the first IT Project mankind  attempted


What is inexcusable is the failing to do it right from the beginning. When these things occur, and Phase-VI of the project gets underway - Hunt for the Guilty - it always comes back to the beginning where we find one big messy ball of over-managed-everything by people who should not have been involved to begin with, yet there it is...and a mind-set of 'we've done something like this before.. lets get started...we got a deadline to meet'
 
And to help with the 20/20 hindsight lesson lets see if we can get a peek at 
1). the envisioned end-state diagram/description.
2). the (actual) Project Plan as followed,
3). the published/approved Business Requirements
     document.
4). the published/approved Functional/Non-Functional
     document,
5). the published/approved Technical Design
     Specification
6). the published/approved Test Plan,
7). the published/approved operating environment  
     technical design..... 

and throw in the list of all the meetings held and lastly, the overall count of WHO worked on this project by role....

If this information only partially exists we have the smoking-gun. Sadly, these findings are TYPICAL when IT Projects go down the drain.  But we already know this intuitively - honesty will not be found here - all will be covered up or merely stated as 'oh we did all that....' 

yea, that ought to add up to $600,000,000+ US Dollars 
 
Resonating is the old sage...' there is never enough time and money to do it right the first time, but there is always enough time and money to do it over again.'
 
---------------------------------------------------------------
Smart a$$ comments by me? maybe -but its like déjà vu....again  
oneilldon
IW Pick
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oneilldon,
User Rank: Strategist
12/7/2013 | 10:09:25 AM
Affordable Care Act (ACA) Rollout: State of Failure
Video Comment
oneilldon
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oneilldon,
User Rank: Strategist
12/7/2013 | 9:52:34 AM
The Way Forward
Those pretending that the problems being encountered are glitches, kinks, or simply bugs to be fixed and hoping that the problems will simply dissipate with the relaunch need to cease their wishful thinking. It is time to insist on the professional management steps needed to get to the bottom of this and right the ship.    

The following ten steps are called for immediately:

1. Use of ACA website by customers seeking healthcare insurance should be terminated. 

2. Existing customer profile data, personal data, and decision data should be quarantined. 

3. The ACA website requirements foundation and technical architecture should be reviewed, assessed, and audited by a team of experienced industry experts.

4. The management, engineering, and process practices employed on the project should be reviewed, assessed, and audited by a team of experienced industry experts.

5. The accumulated Technical Debt on the project should be reviewed, assessed, and audited by a team of experienced industry experts.

6. A professional team should be charged with assembling factual analytics associated with assurance metrics, compliance metrics, noncompliance metrics, product engineering metrics, project management metrics, and process metrics. 

7. A full scale program review should be conducted to assess requirements, architecture, practices, and metrics. The review team should record its findings and consequences and provide recommendations and rationale for carrying the project forward.

8. A professional team should be charged with assessing Cyber Security vulnerabilities in accordance with the NIST Cyber Framework.

9. A professional team should be charged with assessing privacy and civil liberties vulnerabilities in accordance with the NIST Cyber Framework.

10. The completion date for these activities should be established as December 16, 2013.

 
WKash
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WKash,
User Rank: Author
12/6/2013 | 12:53:37 PM
Re: Does anyone even know what HealthCare.Gov is built on?
An Operations Readiness Review, from Centers of Medicare and Medicaid Services, dated 9/4/13, shows a diagram broadly illustration what's used in the Presentation layer for end users (bulit using Apache RP, and Layer7 SOA gateway, using SAML2 assertion); an application layer that uses Jboss Enterprise Web Server and Jboss SOA.

More at: http://docs.house.gov/meetings/IF/IF14/20130910/101274/HHRG-113-IF14-Wstate-CampbellC-20130910.pdf

 
David F. Carr
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David F. Carr,
User Rank: Author
12/6/2013 | 11:46:05 AM
Re: Does anyone even know what HealthCare.Gov is built on?
We mostly asked about project management strategies. The architectural specifics are hard for anyone outside of the project to know in great detail, although this is an interesting resource:

http://www.civicagency.org/2013/10/learning-from-the-healthcare-gov-infrastructure/
rprescott
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rprescott,
User Rank: Apprentice
12/5/2013 | 10:37:37 PM
unintended consequences
Okay. ..Real quick.  Most of the experienced spectators expected just what they have seen... An amateurish product delivered by a hands-off amateur. His two claims-to-fame are low level legislative "voting present" public sevice and " community organizer" resume entries. He had nothing else, save Ivy league law degrees, and we turned our country over to him. My wife and I are doing our darndest to position our daughter and son to be able to persevere, but a boat-load of our posterity are going to suffer the consequences of the naive. We are praying for them.

 

 
danielcawrey
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danielcawrey,
User Rank: Ninja
12/5/2013 | 1:09:35 PM
Re: Project Management
This is such a complex issue. The project management of this was bad, but is that because of te IT behind it or because of government procurement process?

Then, consider the implications of shutting the site down. Knowing that security issues existed, a business would have likely removed all functionality until the site was fixed. But the Obama administration could not deal with that type of fallout, allowing those of us on the sidelines to continue to debate this debacle. 
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