Healthcare // Policy & Regulation
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3/21/2014
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Oregon Health Insurance Exchange Failure: Blame Runs Deep

Postmortem report confirms diagnosis of weak project oversight, unrealistic goals, and poor performance by Oracle.

launch of the website on Oct. 1 would be incomplete, serving only insurance agents and other intermediaries. Even then, they characterized it as a "staged rollout" of a project that was essentially still on track.

One of the key errors identified in the First Data report was a decision Lawson made, and Goldberg approved, not to hire a system integrator. That decision left state employees with the responsibility for making sure all the components of the project would come together correctly. So, although the report does lay some blame on Oracle, it also notes that Oracle was never in the role of system integrator -- only as a provider of software and consulting manpower, billed on a time-and-materials basis rather than with payment tied to concrete deliverables.

"This departs from best practices and put the state in the position of having to pay for work that did not always result in the anticipated deliverables or that required more hours (and higher cost) than planned," the report noted. "It also created an environment where there were no consequences for missing deadlines and no financial incentive for being realistic about delivery dates."

The state selected Oracle technology based on assurances that it could meet 95% of the state's requirements, meaning that only 5% customization would be required. But a May 2013 assessment of how the project was shaping up characterized it as requiring more like 40% custom coding.

First Data asked to interview six members of the Oracle project team, none of whom were made available to investigators. Oracle instead provided an interview with chief corporate architect Edward Screven (accompanied by an attorney), even though Screven was not actively involved in the project until November.

First Data's summary of that meeting does include a defense of Oracle's role in the project, which Screven said suffered from:

  • The lack of well defined, stable requirements
  • The lack of discipline in the change-control process (too many undocumented, ad hoc changes)
  • The absence of a system integrator, which Oracle said was unprecedented for a project this complex
  • The lack of timely test cases, some of which were not provided until mid-October 2013, according to Oracle

However, First Data found that Oracle was one of the parties continually offering assurances, while the project was underway, that the work would be completed on time.

Kitzhaber said the next step is for the state to figure out whether to repair the online exchange or replace it, either by moving to the federal HealthCare.gov exchange or adopting software developed by one of the other states with a more successful exchange. Asked if it was possible the state would scrap all the work Oracle has done to date, he said, "it's a possibility" and reiterated that the state was keeping open "all its legal options" to recover money paid to Oracle or withhold funds it says it is owed.

Despite the lack of an online signup process, Kitzhaber said the state had signed up more than 287,000 people on paper and through other workarounds. "It's important to remember that the website is a means to an end, not an end in and of itself," he said. "Our enrollment figures stand out even among other states that have fully functional websites. The value of our success in this regard should not be overlooked, even as we work to fix what went wrong."

Download Healthcare IT in the Obamacare Era, the InformationWeek Healthcare digital issue on the impact of new laws and regulations. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but IT priorities are also being driven by the shift.

David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio

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WKash
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WKash,
User Rank: Author
3/24/2014 | 10:55:41 PM
Re: Cleaning house at Cover Oregon health insurance exchange
This seems like one of the perils a customer faces when the incumbent tells you "We can do it" and only discovering afterward they couldn't.

 
David F. Carr
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David F. Carr,
User Rank: Author
3/24/2014 | 10:40:37 AM
Re: Cleaning house at Cover Oregon health insurance exchange
The big promise at issue seems to have been that the Oracle stack of technologies would only require 5% customization to serve the state's needs for a health insurance exchange. Perhaps that's why it seemed reasonable to state officials that the state could act as its own system integrator. Whether that was reasonable at any percentage is questionable, but they were trying to figure out how to make the budget work.

With Oracle consultants to customize the Oracle software, what could go wrong?

 
liberalisisasocialdisease
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liberalisisasocialdisease,
User Rank: Apprentice
3/24/2014 | 9:50:59 AM
Re: Cleaning house at Cover Oregon health insurance exchange
predictably Oregon liberals promised the world and once again delivered a pile of &^%$. It isn't by chance Oregon is now #1 in homelessness and the #1 user in food stamps. This gross incompetence goes far beyond Cover Oregon.

 My mother was a pioneer in the field of occupational nursing, and ran the medical department's for Oregon's giants in industry. She was directly responsible for the immediate health care of over 30K oregon blue collar workers when they injured themselves on the job.

 Every time liberals reformed our health care they buried my mother in more paperwork, and added far more dysfunction to the system then the educated idiots claimed to be solving.

 Liberals told us they reformed health care through Obamacare. They lied to push this through. Then when busted in their lies they lied all the more. When Obama rating dropped he had a mia culpa moment, and has now vowed to reform Obamacare. You do not reform a social disease, you kill it before it kills you.
TomM765
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TomM765,
User Rank: Apprentice
3/23/2014 | 2:03:17 PM
Re: Cleaning house at Cover Oregon health insurance exchange
The time limit "feature" cutting off subscribers mentioned here is a sure tip off of the bad (or just plain lack of) design review that only scratches the surface of the problems.  The ultimate driver is the fact that non technical people were in charge, and good *technical* program management from the get-go is a vital element that will doom a complex development effort if it's neglected.  As a Sr. Test engineer of 25 years I saw this in places that really, really should have had their act together and the "tells" were many (no good requirements base defined to ground the product definition, no Engineering Review Boards to govern needed ongoing changes, no technical milestones scheduled to check development and testing progress, etc., etc.).  So it's absolutely no surprise to me that letting folks without any large-scale network centric project experience lead the OR exchange ended up with an unholy mess.  But before you get down on the people involved too badly you have to consider that there are many, many smooth talking consultant firms and product providers out there who wanted in on the ACA cash-cow but were in fact way out the their own league techically with a ACA system.  In the end this is a good example of the blind leading the blind right into a ditch.  
anon0710468466
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anon0710468466,
User Rank: Apprentice
3/22/2014 | 6:28:43 PM
Re: Cleaning house at Cover Oregon health insurance exchange
As a user who was in Mexico at the time this rolled out, I found it a nightmare.  The form you had to fill out was 19 pages and they allowed 1 hour to do it or they dumped your data.  There might have been a way to save it but I could not figure it out.

Internet access in Baja was very limited where we were staying and the only way I could figure out to make it work was to print the forms, fill them out on paper, and then use keyboard short cuts to enter the data.  I was able to enter the data for 2 people in one familiy in about 45 minutes and met their dead line to file.  This was after putting the data in the first time and missing the 1 hour cut off and loosing it all.

I have worked on seveal large IT type software projects and this one seem to be implemented with out thought of what was being required of the user. 


Just to add fuel to the fire, they chose a new free area code number which was 855 for their phone number.  There was no way to dial this from the Telcel network in Mexico because a new work around prefix had not been assigned.

Not one of Oregon's better ideas.

 

 
Somedude8
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Somedude8,
User Rank: Ninja
3/21/2014 | 1:39:26 PM
Re: Ditch It
I think there was considerable over reaction in the case of HealthCare.gov. It could have been built better, and load tested much better, but it seemed workable. At least from an outsider's perspective.

The Oregon site sounds like a different beast entirely. Sounds like questionable decisions all the way at the top of the project, what some would call "Architecture Defects". A serious architecture defect usually renders the code built to that architecture to be straight out useless. Or, even worse, it looks like the code can be wrenched around to suit the new architecture. Then you end up with that laegacy codebase experience, but with your brand new shiny code. Well, not so shiny!

I could be way off, but from what I have read, it sounds like the problems go all the way to the architecture.
RobPreston
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RobPreston,
User Rank: Author
3/21/2014 | 1:11:29 PM
Re: Ditch It
Many were making the same argument for the federal Healthcare.gov: Ditch it and start over. I'm not convinced that would have been the better course of action, though I'm no defender of the "tech surge" that's supposedly putting that Humpty Dumpty back together again.
Somedude8
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Somedude8,
User Rank: Ninja
3/21/2014 | 12:32:28 PM
Ditch It
Have seen several projects that were "nearly finished" where in fact, starting over from scratch would have been much more economical. But this rarely goes over well "Hey all that money you just spent, it was totally wasted because we have to start over. Yup, you lost all that money and time!"

This is often the result of technical decisions being made by people not qualified to make them. 

Am watching one particular slow motion train wreck from the sidelines right now, thankful that I am not involved. Marketing making technical decisions because they have the ear of the CEO. And making bad, terrifyingly bad decisions. When it all goes sideways, and it will go terribly sideways, blame will land on IT.
David F. Carr
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David F. Carr,
User Rank: Author
3/21/2014 | 12:20:44 PM
Cleaning house at Cover Oregon health insurance exchange
Is bringing in a new team the necessary next step?

According to the Oregonian: "Kitzhaber said he also asked the Cover Oregon board to remove Triz DelaRosa, chief operating officer for Cover Oregon, and Aaron Karjala, Cover Oregon's chief information officer."
Research: Healthcare IT Priorities
Research: Healthcare IT Priorities
Meeting regulatory requirements barely inched out managing digital patient data as the top priority for our 363 healthcare provider IT pros.
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