Healthcare // Policy & Regulation
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12/3/2013
10:48 AM
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How We'd Fix HealthCare.gov: Scalability Experts Speak

Martin Abbott and Michael Fisher, consultants on building large-scale websites, say one answer to retooling HealthCare.gov is creating "swim lanes" for each state the federal website serves.

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David F. Carr
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David F. Carr,
User Rank: Author
12/3/2013 | 7:16:13 PM
Re: Take it offline?
To be clear, I should say I approached them as scalability experts to talk about scalability -- which was clearly one of the big issues with HealthCare.gov, but the only one. They didn't claim any insider knowledge of the bugs to be fixed with this system, but I still think their analysis of how this falls into a common pattern is useful.

It's easier to dream big dreams about creating a word-beating website than it is to be ready when the world really does come beating down your door.
WKash
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WKash,
User Rank: Author
12/3/2013 | 6:45:14 PM
Program Management
Some good points here about scaling the website. But it's worth noting, streamling web operations is only part of the larger picture, especially in working with CMS, IRS, Social Security and other agency data.

Richard Spires, former DHS CIO, makes the additional point elsewhere in this series about the importance for organizations to understand the need for strong program management capabilities to succeed with big IT projects.   Read more at: http://add.vc/qbp
PatrickD672
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PatrickD672,
User Rank: Apprentice
12/3/2013 | 5:29:28 PM
Re: Take it offline?
As a Project Management professional I do not know the technical fix but I can tell you when project failure occurred - it was right in the startup phase. Inadequate definition of the product followed by lack of effective change control and quality assurance plan.
oneilldon
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oneilldon,
User Rank: Strategist
12/3/2013 | 5:15:49 PM
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 January 15, 2014.
GirishSeshagiri
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GirishSeshagiri,
User Rank: Apprentice
12/3/2013 | 5:12:18 PM
Re: Take it offline?
Abbott and Fisher being scalability experts, make it sound like scalability as the only Helathcare.Gov problem. I am not sure that   deploying poor quality code on different servers would have made the difference as they seem to suggest.

The big problems with Healthcare.Gov are yet to come. What we now have is a patched up barely functioning product. We will be spending more than 80% of the O&M spend (My estimate $60 million per year) for fixing bugs. And a lot of the bugs will be cybersecurity vulnerabilities leading to cyber attacks.
Shane M. O'Neill
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Shane M. O'Neill,
User Rank: Author
12/3/2013 | 4:02:00 PM
How to get back on track?
"The only way to tackle the issues with an underperforming site -- including fundamental issues of site architecture -- is to prioritize them and chip away at them with a disciplined system of issue tracking and management."

This seems to be the most logical approach right now for healthcare.gov, rather than adding more manpower (more chefs in the kitchen). Any other website architects out there been in a similarly hellish position as the healthcare.gov team? How did you turn it around?
David F. Carr
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David F. Carr,
User Rank: Author
12/3/2013 | 11:25:44 AM
Take it offline?
One big point of debate seems to be whether it would have made sense to take the site offline while repairs were under way. Abbott and Fisher make a good case about why it was better to keep it operating. On the other hand, some of the deeper problems with the system beyond scalability and availability may have long-term consequences. The Washington Post is reporting that as many as one third of the enrollments processed contained data errors, meaning that people who enrolled for ensurance may not be signed up for the plan they expected at the price they expected.
Research: Healthcare IT Priorities
Research: Healthcare IT Priorities
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