Healthcare // Policy & Regulation
Commentary
12/9/2013
03:40 PM
John Engates
John Engates
Commentary
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Rackspace CTO's Prescription For HealthCare.gov

Rackspace CTO John Engates offers a prescription for HealthCare.gov's complete recovery and continued health.

When HealthCare.gov launched in October, it was plagued with problems. It was slow. It crashed. Most importantly, the user experience was just plain bad.

But many of the site's main problems weren't necessarily technical. HealthCare.gov suffered from a severe lack of transparency, accountability, and oversight. There was no single owner -- no centralized management.

Late last month, I was invited to the White House and to the HealthCare.gov operations center to get an inside look at the work being done to fix the site. It seems a number of the initial problems are being fixed. One major first step toward righting the ship was implementing a tech surge. The government brought in some outsiders to work on the site and put all the contractors under a single roof. There is finally a single point of accountability.

[ Want more on HealthCare.gov? Read our Obamacare Tech Saga: Special Report. ]

During my visit, I went behind the scenes and saw how new life is being injected into the ailing healthcare exchange site. I met the vendors and contractors. I saw the hardware and software upgrades. I heard about the bug fixes. I saw where the bottlenecks were dislodged so traffic could flow. I saw firsthand the monitoring upgrades, the optimization overhauls, and the database updates.

Since then, one question I've been frequently asked is: Does HealthCare.gov need to be torn down and rebuilt from scratch? I don't think so. Like most modern websites, it is built in a modular fashion. It's not one big, monolithic code base. Modules can be updated, modified, and upgraded as needed. And through the use of APIs and web services, these modules can be tied together to create a seamless experience. It's not all that different from assembling an airplane. The wings, the fuselage, the electronics, and the engine are built in different locations, but they all come together and fit. But you can't build the wrong engine, try to bolt it on, and expect it to work. It's the same principle with HealthCare.gov. Unfortunately, that's what happened in this case. The different contractors built modules that couldn't be pulled together. In the end, it didn't fly. The tech surge is fixing that.

It is, however, still necessary for HealthCare.gov to bring aboard specialists to run the site in the long term. It will require the expertise of a team experienced at managing websites at massive scale. A number of disparate contractors are doing the work, but there needs to be a full-time, clearly defined team in charge of the site's day-to-day operation to replace the ad hoc team that came as part of the tech surge. A single group must oversee software and code updates and hardware upgrades, plan for changes, and maintain the architecture. Updates must be made frequently and proactively, not as just-in-time fixes in reaction to traffic swells. Think of it like a major e-commerce site that starts planning for Black Friday on Jan. 1. HealthCare.gov must start prepping for the next major deadline months in advance to avoid another major fumble.

One thing's for certain: For HealthCare.gov to succeed, it must be laser focused on the customer experience. When it launched, it was a bad experience. Aside from the crashes and latency, the workflow was all wrong. The first thing users encountered was an Apply Now button. Now they're prompted to compare plans before applying. HealthCare.gov should take a page from online tax preparation software. Greet users with a checklist of what they'll need. Offer them the ability to browse and then input their data, sign up, and check out. It's a lengthy, time-intensive process, and users must input a lot of data. Laying things out from the start and offering a clear step-by-step path to completion will help customers through the experience.

The site must also be elastic and nimble. It has to scale to handle peak loads. Some users have reported trying to apply only to be told to come back later. That's a terrible experience. The site should be able to accommodate people when they have the time. It's estimated that the retooled HealthCare.gov has been able to handle 1 million users in a day. That's great progress, but it also raises questions. Did all those people make it through the process? If not, where did they drop off? Where did they stall out? When did they abandon their session? All this information will be helpful in understanding and improving the customer experience.

This can be achieved with tools such as monitoring, analytics, and auto-scaling, so the site managers can know what's happening when, and the site can adjust itself on the fly to add capacity to accommodate a crunch of users. It's really no different from a sophisticated e-commerce site that has seasonal spikes and lulls but must remain available when those spikes hit.

Overall, I feel HealthCare.gov is on the right track. There is nothing fundamentally wrong with the site or the technology. The team in charge of improving the site now has a clear mission and purpose, and there is an increased level of intensity and accountability -- none of which was there before. The bar has been raised. A few common-sense updates, an experienced team of experts leading the charge, and a heavy focus on the customer experience can push it to success.

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WKash
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WKash,
User Rank: Author
12/9/2013 | 7:01:05 PM
First Hand View
Thanks for sharing your story.  It's been so easy for so many to pile on the criticism -- even on those who had nothing to do with the site, but nevertheless rolled up their sleeves to try help get things back on track, like Federal CTO Todd Park and Federal CIO Steven VanRoekel both of whom the government is lucky to have working for the administration. No question, they could be earning a whole lot more and enduring a whole lot less heartburn in the private sector.  They and others actually deserve more thanks than they're likely to get for stepping in here.
cbabcock
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cbabcock,
User Rank: Strategist
12/9/2013 | 11:24:55 PM
Don't mess with the consumer's money or health care
There are two things that service providers of any sort should never mess with, when it comes to the consumer. One is getting the accuracy of the intended transaction. The other is health care coverage. Somehow, HealthCare.gov got both wrong at the same time. The elected officials and contractors who are responsible have no one else to blame, despite some of the off-the-wall criticism of Obamacare. I'm glad that John Engates can see all its faults and come away with the confidence that it will be fixed. An effective site will start the process of establishing a major, national service of the same rank as Medicare and Social Security. Its roll out may one day be  little more than a quickly forgotten nightmare, except for all the studies that use it to point out how not to do a major online service launch.  
David F. Carr
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David F. Carr,
User Rank: Author
12/10/2013 | 9:23:01 AM
Reuters on the private-sector shame of HealthCare.gov
Reuters offers this analysis:

Healthcare.gov: Private shame, public blame - Nicholas Wapshott http://reut.rs/1iRM9HX

Obamacare may be a government-run enterprise, but the profound errors in building the site were overwhelmingly due to the incompetence of the private sector.

This is not just an example of a public enterprise failing, but the government investing too much faith in the efficiency of the private company that failed to build and deliver an operating site in good time. In the interest of political point scoring, private sector inadequacies are being passed off as inherent faults of the public sector.

The Department of Health and Human Services was in the position familiar to any hapless client when faced with buying software or devising a website. Public servants provided a specification to established web designers, only to find themselves adrift on a sea of incomprehensible technical jargon, mendacity, foolhardiness and obfuscation.

Tweeks_
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Tweeks_,
User Rank: Apprentice
12/10/2013 | 2:08:44 PM
Re: Reuters on the private-sector shame of HealthCare.gov
Is this true?

http://www.alexmarchant.com/blog/2013/10/22/healthcare-dot-gov-lines-of-code-comparison.html

 

Seems as impossibly managable (as in, bloated) as the legistlation itself.

Tweeks
Research: Healthcare IT Priorities
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