In Oregon, the Affordable Care Act became the Oracle Full Employment Act -- meaning it employs Oracle software in every nook of the architecture and relies on Oracle consultants to implement it with minimal oversight, according to a federal assessment of the state's dysfunctional health insurance exchange.
While the federal HealthCare.gov website and many state-based insurance exchanges stumbled at launch in October, and some state sites are still struggling, only Oregon is still without a website where consumers can shop for and enroll in plans. The deadline for open enrollment is March 31, after which consumers who do not have insurance could be subject to penalties. Oregon residents have been forced to apply on paper or go through insurance agents and other intermediaries to get coverage. The only Web applications delivered so far have been for those intermediaries -- and even they have been plagued with errors.
As reported by The Oregonian newspaper, even as Oregon's Congressional representatives and senators from both parties are calling for a federal investigation, one was completed on Feb. 27 at the request of the Centers for Medicare and Medicaid, which gave the state $305 million in grants for the project. The review was conducted by the MITRE Corporation, a federally funded research and development center that provides technical assistance to many government agencies, through the CMS Alliance to Modernize Healthcare. A spokesperson for Cover Oregon, the organization managing the exchange, told The Oregonian that the report's findings are not news and are already being addressed. Oracle declined to comment.
[Does Obamacare jeopardize the security of patients' health data? Read Obamacare Vs. Patient Data Security: Ponemon Research.]
Under a recently announced transition agreement, Oregon paid Oracle $43.5 million it has been withholding for poor performance, enough to get cooperation on transitioning the project to another consulting firm, yet to be named. The state withheld another $25.5 million and reserved its right to litigate and try to recover any or all of the $160 million Oracle has been paid or claims it is still owed, according to The Oregonian.
Extricating the state from dependency on Oracle won't be easy. One of the audit's primary findings was that the system architecture was overloaded with Oracle software. In an abbreviation-packed critique of Cover Oregon (CO) and Oracle Consulting Services (OCS), the report places ultimate blame on CO for failing to have adequate contracting processes in place but also faults Oracle for poor performance and transparency, meaning that the company failed to provide information needed to remedy issues with website and contract performance.
"The CO solution stack is comprised of almost every single component/product in the Oracle product portfolio. While there are other State Based Marketplaces utilizing elements of the Oracle product portfolio, CO has, without doubt, the most complex mix," the federal report read. One of the reasons the Cover Oregon Web applications have been so unstable, according to the report, has been "the management of the many sessions created by Siebel, Oracle Real Application Clusters (RAC), Service Oriented Architecture (SOA) and Web Center that consume a significant amount of CPU and memory." Servers regularly ran out of memory and needed to be rebooted.
Getting the system working is likely to require a significant reexamination -- and simplification -- of the system architecture, according to the report.
While the report focuses on Cover Oregon, one reason for some of this disorganization in the early phases of the project may have been the division of labor between that agency and the Oregon Health Authority, which provided IT project management particularly in the early phases of the planning. An Oracle marketing case study called "Architects of Reform," published in 2012, celebrated the project as a triumph of Enterprise Architecture, a holistic approach to mapping out enterprise systems and the relationships between them. The original plan was to make the Cover Oregon website and back end systems part of a broader redesign of the state's health and welfare systems around a complete suite of Oracle Software.
Even as the state relied on Oracle to put all the pieces together, the CMS report found OCS "lacking in resources with expertise in Oracle Configuration Management (OCM), which has contributed to the delays experienced at the outset of the CO implementation."
The Cover Oregon project is highly dependent on Oracle consultants, "many of whom do not have extensive knowledge and experience in a formal software development life cycle," according to the report. "The lack of any formal SDLC has had a significant contribution to the root cause of the delay in the delivery of the CO solution," it continued.
Cover Oregon has had little visibility into the configuration of the system. "While OCS does utilize SVN for code management, there is no formal tool in place for system build configuration management. Without this insight into the environments, CO faces challenges in being able to manage their own system and/or bringing other vendors on board if a future decision to terminate the OCS contract is made," read the report. In particular, any release featuring changes to Siebel pose problems because, according to the report, Siebel has no code branching (revision control) capabilities. "If there are any problems with a build installation, the system cannot be restored to the previous state in an efficient manner. Rather, the Siebel environment has to be re-built and deployed to the previous version which, in its own right, has not been seen to operate in a consistent manner."
Meanwhile, Cover Oregon's weak contract administration and monitoring has resulted in ongoing confusion and misunderstanding about what OCS was expected to deliver, the authors found, citing the example of performance testing. The state is dependent on OCS for schedules, fixes, and releases, yet "it appears that CO does not have any leverage in their contract to make OCS accountable for missing key deliverables."
Project management, meanwhile, has been spotty, with no overarching dedicated project manager. Even though the project team professes to be following an agile methodology, the federal critique found it should be following a more disciplined approach under the leadership of an experienced scrum master.
Other findings include:
The state was already working on a transition plan when the CMS report was published, and the authors said they "highly recommended" the state seek out a "more appropriate" technology partner or partners. To help explore alternatives, Oregon hired to Deloitte, which worked on some of the more successful health insurance exchange projects in Connecticut, Kentucky, Rhode Island, and Washington -- states that have tended to keep their system architecture relatively simple and their ambitions modest.
With so much rework needing to be done, the report notes Cover Oregon "is burning their funding rapidly with the addition of staff hired to assist with the manual processes and has not planned anything beyond the full individual launch Release 1.1." With state officials saying that finding additional money will be "financially challenging," the report adds, "CMS is committed to working with States to ensure that individuals get health insurance coverage which may include additional funding for IT development."
But if that money comes, federal officials want to make sure it is better spent.
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