Healthcare // Leadership
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11/21/2013
08:00 AM
Paige Francis
Paige Francis
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Thanks Obama! Technology Should Not Be An Afterthought

The HealthCare.gov debacle offers valuable lessons.

It is the era of the meme -- typically a frothy little sound byte, often embedded in an image, that's lacking in basis but has an abundance of snark. These memes are mimicked and shared across social media en masse. Currently the theme seems to be "Thanks, Obama" and blaming our president for all the ills that pain the nation and the world.

A LinkedIn post titled "CEO Lessons from Obamacare" caught my eye and provided great insight from someone in a top leadership position about the Affordable Care Act website debacle the world is watching. Pimco CEO Mohamed El-Erian writes:

Such a botched outcome comes as a surprise for all, and especially given the expectations of both supporters and foes of the initiative. Like the CEO, they had assumed that someone had paid careful attention to the technical implementation details.

Boom. Let's dissect this. This is a major advancement, a major project, a major initiative/game changer/improvement, that's reliant on technology, yet is it possible that technology was not brought in on the discussion when the initiative was but a mere twinkle in a random eye? Are citizens truly unaware that this is certainly not an uncommon occurrence in any industry?

I once worked for an institution where the leader tried to bully (for lack of a better term) the technology department into making a for-certain-bad strategic decision by dismissing our fervent concerns with a laughter-rich, incredulous "Come on. It's not like software development is rocket science."

No, in most cases, software development is not actual rocket science (except, of course, where the software is meant to power rockets). However, one could make the argument that software development is more complex than rocket science. Blogger Raghav K makes the case: "I think rocket science is easy when compared to the software development activity. Most of the time the parameters required to build a rocket remain constant."

I get it. And for the most part, I agree. The landscape of technology is consistently changing. Breach attempts continue to increase, and the challenges never level off when they don't even taper off. Technology improves efficiency, increases service, eliminates hours-of-operation barriers, and provides the ultimate convenience, but these features do not occur automagically. They require full knowledge of historical context of service, current process, and the desired outcome, as well as an abundance of time. You need time to vet with experts, peers, and even Dr. Google. You need time for methodology development, programming and system needs, budget, timelines, testing, training, testing, reconfiguration, testing, implementation, feedback, and did I mention testing?

So when I say, "Thanks, Obama," I actually mean -- well, a sincere thank you. Amid the stress of the ACA online rollout, I think the technology community has learned a deeper respect for some things.

  • The impact of technology: Have you ever battled a string of Christmas lights? It just takes one tiny downed bulb to keep the other hundred bulbs in the string from working. Imagine trying to find that bulb in thousands upon thousands of lines of code. Now imagine that strand of Christmas lights represents your email provider, your Internet connection, or your online healthcare environment.
  • The value of learning from mistakes: It's early yet, but a few things can be gained immediately from this technology faux pas. Will this president and anyone in his surrounding area ever not have a technology representative at the table for discussions again? Is our nation's supply of bandwidth enough to support an entire nation trying to access a system at once? Individuals appear to be (gasp) blaming the humans and not just the technology.
  • Technology happens: I've been saying this for years. Technology typcially happens at the worst possible time with the largest possible impact. The tinfoil hat side of me often thinks, "Maybe this AI isn't artificial anymore," because this beast called technology seems to sense when downtime will deliver the biggest bang for the buck. Then my educated side pops in and realizes that there is no good time for downtime. Any downtime, glitch, or failed initiative occurs during the worst possible time because we rely on technology 100% of the time.

Technology needs a seat at the table. It doesn't need to be fancy or to the immediate right of the CEO. It simply needs to have a place setting and maybe some bread for starters. If your technology leader needs to brush up on table manners or etiquette to integrate better, it's worth the investment to mold that leader into the active participant you need. A big-picture technology representative will not always tell you what you want to hear. We can't simply parrot our leader's words, but we will bring a realistic, doable path to a solution to the project every single time, and we will ensure a comparably seamless introduction to the user base, small to large.

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David F. Carr
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David F. Carr,
User Rank: Author
11/21/2013 | 10:02:15 AM
So if you ran the zoo?
If you were in charge of repairing the damage and getting Healthcare.gov working up to spec, where would you start?
FairfieldCIO
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FairfieldCIO,
User Rank: Apprentice
11/21/2013 | 10:30:16 AM
Re: So if you ran the zoo?
It's difficult to say having no knowledge behind the scenes of the history, what got us to today, etc.

If I were called in to respond to the current state of the project, first off we'd need a pretty comprehensive roundtable of all involved, project documentation, etc. including the root issue, who's assisting, where are we. Identifying the issue should be followed by an immediate introduction to the stakeholders (i.e., the world?) with a 'we are here, present, to help, repair, complete' delivered with a dose of transparency into the issue - taking ownership, accountability, and detaching our US president from the 'project leader' spotlight. Obama is not responsible for the fact the website doesn't function as planned. Now, who is working on this? I read an article a few weeks ago [http://allthingsd.com/20131031/oracle-google-and-red-hat-engineers-ride-to-the-rescue-of-health-care-site/] about heavy-hitters stepping up to assist, where are we? It seems like no one wants to step in and officially take the reins, my guess is, because it appears to be a fairly thankless and highly public project. A technology professional needs to OWN this, take charge.

Needless to say, we are nowhere near the finger-pointing phase, all attention needs to be on identifying the issue, making the nation aware of the issue(s) and putting together an attainable roadmap to solution. The time to reflect on what could have been done better is much farther down the road.
Alex Kane Rudansky
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Alex Kane Rudansky,
User Rank: Author
11/21/2013 | 2:13:38 PM
Re: So if you ran the zoo?
Couldn't agree more with "A technology professional needs to OWN this, take charge." I don't understand why the responsiblity and subsequent finger pointing was put on Obama and Sebelius. Where were the tech people? Why didn't a technology leader step up,  take responsibility, and point the project in a new direction earlier? That would've solved some headaches.
WKash
IW Pick
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WKash,
User Rank: Author
11/21/2013 | 6:43:02 PM
Re: So if you ran the zoo?
Some good points here.  I'd add: What often gets lost in the finger pointing, even when the technology folks are at the table, is the extent to which contractors say "trust us, we can deliver what you've asked for" knowing full well that 1) the requirements are never 100% clear and 2) that given the political, budgetary, and scheduling forces at work, even the best business owner-contractor arrangements are forced to make compromises that inevitably lead to unexpected glitches.

 
Expert-007
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Expert-007,
User Rank: Apprentice
11/23/2013 | 5:08:13 PM
Where to start?
As I commented on that LinkedIn discussion, where to start?  Hundreds of millions of dollars to create what should have cost $1M or less, 3.5 years but it was rushed out at the last minute with no end-to-end testing, 55 contractors (many apparently political cronies), all the security of a chunk of Swiss cheese, lousy ergonomics, and of course it can't handle more than a handful of people (if that).  I wouldn't enter information into that mess if you paid me that $1M.

Actually, it's such a horrible counterexample, breaking every well-known rule of how to do a Web site, that I don't think there are any lessons for IT.  But there are lessons for all of us as citizens; it's just a shame we apparently didn't learn those lessons from past failures of government bureaucracies to handle complex issues.

I heard that a few nerds put together a serviceable Web site in 3 days for a few hundred dollars, just to show that it can be done.
Sadie!
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Sadie!,
User Rank: Strategist
11/27/2013 | 11:06:15 AM
Re: Where to start?
I agree with most of your points, except the last note needs an asterix.  The site they built didn't connect to IRS, DHS, and various state exchanges and authorities - so it's a bit unfair to compare.  In addition, I visited the site on the day they announced it and it was down from too much traffic.
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