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  Here is some of the commentary.

Some say health-care site’s problems highlight flawed federal IT policies

By Craig Timberg and Lena H. Sun, E-mail the writers

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are saying the root cause is not simply a matter of flawed computer code but rather the government’s habit of buying outdated, costly and buggy technology.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 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 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 in the first three days after the site was fully activated on Oct. 1.
Lots more here:
Another set of interesting comments are here:

Why US government IT fails so hard, so often

One hint: Windows Server 2003 is still good enough for government work.

by Sean Gallagher - Oct 11 2013, 1:15am AUSEST
The rocky launch of the Department of Health and Human Services' 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!


Anonymous said...


I'm from the Government and I'm here to help...

Trust me!

Bernard Robertson-Dunn said...

From the bottom of the ars technica link:

The bottom line is that federal IT programs' success is measured by things that have nothing to do with how successful they are or by the metrics most of the world uses. While the business world (and Web companies in particular) now monitor user experience and productivity as a metric for IT success, the government keeps throwing out numbers that mask the truth: the only people who would use their systems are the ones that are forced to.

Does this sound familiar?

In words that have been used with respect to the PCEHR:

"The only relevant measures are in terms of health outcomes."

Anonymous said...

Yes, "The only relevant measures are in terms of health outcomes.".

"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!"

Most Australians don't yet comprehend what lies ahead for them if Australia continues to take similar steps as those that led to medical cost induced bankruptcy for Americans.

Millions of Americans without health insurance were either unable to afford the healthcare they needed or were mortgaging/selling their homes to pay for huge medical bills.

The Democrats were and still are the only party in the USA with a conscience trying to plug that gaping hole.

People who have worked hard, struggled to buy a home, dedicated themselves to raising a family - watch it all slip away after a single devastating health event - assets gone, start all over again with medical debts - and it's even worse for those without assets to draw down upon.

Yes, Democrats have good reason to love what they've done and to pat themselves on the back for this achievement because it has been opposed by Conservatives for decades.

Those without compassion and social conscience will always look at the dollar figure because they don't understand, don't want to understand, or simply just don't give a damn.

Anonymous said...

While the left wing view of it does appear compassionate, you have to wonder if government is capable of providing a solution. The issue is that there are so many large companies out there with very well refined skills at extracting public money and delivering very little. I think the insurance industry in the US has driven up prices to the point that healthcare has become unaffordable and adding more government money could just make it worse.

Society needs to deal with these issues, rather than making the 1% richer by printing money and letting government waste it.

In reality its government money that has destroyed eHealth in Australia, even though the intention may have been good.

K said...

Right. I know a number of US folks who are all in favour of full coverage, but think that the ACA is a mess. (kind of reminds me of the pcEHR)

At some stage we all need to have a serious discussion about how to decide how to limit the healthcare we could have because we can't afford it. But everyone keeps mouthing off slogans of one kind or another and kicking the real can down the road.

You can only get away with moving risk around for so long, but it has to live somewhere.

Anonymous said...

”Those without compassion and social conscience will always look at the dollar figure because they don't understand, don't want to understand, or simply just don't give a damn.”

This is a very uninformed and misguided view of US healthcare funding and US healthcare system operation arguments. It also smacks of a very anti-capitalist mentality that mistakes the present global crony-capitalism model, which is completely unjust and immoral and the equally dysfunctional and unjust socialistic systems of economic resource allocation compared with a true free market liberal economic capitalistic system.

For an alternative view that has moral justice and human rights at its core, please absorb the following content:

Why ObamaCare Will Fail: A Reading List

You’ll discover plenty of compassion and social conscience embedded within each and every referenced article!

Anonymous said...

"...a true free market liberal economic capitalistic system."

Unfortunately, perhaps, this is just as large a myth as the fantasy of "perfect communism" in which the barriers of law and state are also absent.

Back on Planet Earth and, in particular the USA, it would be an improvement if the innocent victim of a cinema shooting didn't wake up in hospital to face a $2 million dollar medical bill!

Anonymous said...

Any facts to support these sensational claims?

Careful of your sources as they may well undermine your hyperbole!

While history does contains mythology, the historical record of capitalism's uplift to mankind's standard and quality of living is certainly no myth and very real to the careful observer today.

Anonymous said...

I think this is a good start to understand the current state of western democracy...