Thursday, October 17, 2013
National Health IT Projects Seems To Be Too Hard For Almost Everyone! Witness The Current Mess in The US.
The US has - as of October 1, 2013 - implemented a major change in in its health system. Termed the Affordable Care Act (ACA) - or Obamacare - it has been causing vast political ructions. Underlying the ACA are what are called Health Insurance Exchanges which permit the user to find subsidised health care cover (insurance) if they are eligible. This is said to move some 30 million people into the insured population - but of course it is not cheap - hence US Conservatives hate it and US Democrats love it! As I type we now have a good part of the US Government shut down as the Conservatives try to block a law that has passed, been approved by the Supreme Court, seen Obama re-elected and has now started - go figure how that works.
The implementation of these HIX’s has been pretty messy. The website is www.healthcare.gov. Here is some of the commentary.
Problems with the federal government’s new health-care Web site have attracted legions of armchair analysts who speak of its problems with “virtualization” and “load testing.” Yet increasingly, they are saying the root cause is not simply a matter of flawed computer code but rather the government’s habit of buying outdated, costly and buggy technology.
The U.S. government spends more than $80 billion a year for information-technology services, yet the resulting systems typically take years to build and often are cumbersome when they launch. While the error messages, long waits and other problems with www.healthcare.gov have been spotlighted by the high-profile nature of its launch and unexpectedly heavy demands on the system, such glitches are common, say those who argue for a nimbler procurement system.
They say most government agencies have a shortage of technical staff and long have outsourced most jobs to big contractors that, while skilled in navigating a byzantine procurement system, are not on the cutting edge of developing user-friendly Web sites.
These companies also sometimes fail to communicate effectively with each other as a major project moves ahead. Dozens of private firms had a role in developing the online insurance exchanges at the core of the health-care program and its Web site, working on contracts that collectively were worth hundreds of millions of dollars, according to a Government Accountability Office report in June.
The result has been particularly stark when compared with the slick, powerful computer systems built for Barack Obama’s presidential campaigns, which in 2008 harnessed the emerging power of social networking and in 2012 relied on aggressive data-mining efforts to identify and turn out voters. For those, the campaign recruited motivated young programmers, often from tech start-ups.
“The wizards from the campaign have no desire to contract with the federal government because it’s a pain in the butt,” said Clay Johnson, a veteran technologist for Democratic campaigns who pushes for procurement reform through his whimsically named start-up, the Department of Better Technology. “Is it possible to be good? Is it possible to do right by the taxpayer in this space? I’m not sure that it is.”
He is one of many Obama supporters hoping to help fix the Web site by drawing on the collective wisdom of software developers, a mostly left-leaning group that have been analyzing healthcare.gov and sharing their thoughts in e-mails, blog posts and exchanges on Reddit.
Among their conclusions: Requiring all users to sign in before surfing choked the system, as did insufficient server capacity. They also noted that the Web site stalls if a single step in the process — such as verifying a user’s identity — is not quickly completed.
Industry officials note that new software often is buggy, even when it is produced by respected tech firms such as Apple and Google. It’s one reason that private companies prefer gradual launches and long periods of testing before starting major marketing pushes. Although it is possible to conduct “load testing” on a site in hopes of determining how it will respond to heavy demand, there is no substitute for the crush of traffic experienced by a popular system on its official launch date.
Despite warnings of looming problems from the GAO and others, federal officials expressed surprise when the Web site failed almost immediately, with millions of people receiving puzzling, frustrating error messages.
Federal officials have blamed the problems mainly on site usage far beyond what was anticipated, with more than 8 million people trying to use healthcare.gov in the first three days after the site was fully activated on Oct. 1.
Lots more here:
Another set of interesting comments are here:
by Sean Gallagher - Oct 11 2013, 1:15am AUSEST
The rocky launch of the Department of Health and Human Services' HealthCare.gov is the most visible evidence at the moment of how hard it is for the federal government to execute major technology projects. But the troubled "Obamacare" IT system—which uses systems that aren't connected in any way to the federal IT infrastructure—is just the tip of the iceberg when it comes to the government's IT problems.
Despite efforts to make government IT systems more modern and efficient, many agencies are stuck in a technology time warp that affects how projects like the healthcare exchange portal are built. Long procurement cycles for even minor government technology projects, the slow speed of approval to operate new technologies, and the vast installed base of systems that government IT managers have to deal with all contribute to the glacial adoption of new technology. With the faces at the top of agency IT organizations changing every few years, each bringing some marquee project to burnish their résumés, it can take a decade to effect changes that last.
That inertia shows on agency networks. The government lags far behind current technology outside the islands of modernization created by high-profile projects. In 2012, according to documents obtained by MuckRock, the Drug Enforcement Agency's standard server platform was still Windows Server 2003.
Magnifying the problem is the government's decades-long increase in dependency on contractors to provide even the most basic technical capabilities. While the Obama administration has talked of insourcing more IT work, it has been mostly talk, and agencies' internal IT management and procurement workforce has continued to get older and smaller.
Over 50 percent of the federal workforce is over 48 years old—and nearly a quarter is within five years of retirement age. And the move to reliance on contractors for much of IT has drained the government of a younger generation of internal IT talent that might have a fresher eye toward what works in IT.
But even the most fresh and creative minds might go numb at the scale, scope, and structure forced on government IT projects by the way the government buys and builds things in accordance with "the FAR"—Federal Acquisition Regulations. If it isn't a "program of record," government culture dictates, it seems it's not worth doing.
Lots more here:
The second article especially tells it like it is. Little retained skill in government, lots of contractors, political deadlines, older technology, serious cost constraints, wrong metrics and so it goes.
Remind you of anything here is OZ - and I am not talking about the NBN!
Posted by Dr David More MB PhD FACHI at Thursday, October 17, 2013