The Real Problem with Healthcare.gov

The biggest story in IT this year is without a doubt, the rollout issues surrounding Healthcare.gov - a.k.a Obamacare. The story is both bizarre and quite familiar at the same time and does represent perhaps the first time that national politics has been so laser-focused on an IT project. Many people who have been introduced into the world of IT through this might think that the saga of Healthcare.gov is unique or somehow unusual - well, it is isn't. By many accounts, more than half or more IT projects fail - this is consistent across government and industry (there have been spectacular failures in both arenas).

As the media circus has picked up steam over the past 2 weeks, we've been treated to a Congressional attempt to hire John McCaffee and Edward Snowden's offer to fix the problem because he knew what it was. We're just waiting on Miley Cyrus to weigh in...

that is, if you can sign on...

The figure associated with the project so far - (approx $170 million) is not in fact that large for a complex IT project. Just last year, the AF Logistics ERP project, ECSS was cancelled after $1.2 billion was spent - no one seemed to notice it (outside of interested circles). The director of Health & Human services has held herself personally accountable in multiple apologies so far for the various problems associated with the site; which seem to include the following:

• An inability to handle the anticipated user traffic (multiple site crashes)
• An inability to generate user logins
• Errors which involve policy termination
• password reset failures
• Failure on the underlying data integration hub
• Multiple page not found related errors
• Various problems surrounding form processing
• Data center crash

There have been any number of armchair quarterback giving simple fix suggestions to the problem - as with most similar situations such advice is generally less than useful. The most common one I've seen relates to the need for the government to use open source coding practices (which it was in fact doing with code up on github). So, let's be clear - for projects like this - there is not now and never will be silver bullet fixes - they are too complex. It's also important not make knee-jerk comparisons to commercial solutions either. I've seen a number a quotes trying to compare Healthcare.gov and Amazon.com; Amazon spent more than a decade perfecting their technologies and likely invested several billions of dollar in it. From news accounts, it seems as though coding for Healthcare.gov only began sometime early this year.  

So what happened? Well, I've only got clues from various articles but several key elements seem to stand out:

1. Somehow, the team seemed to have made a decision regarding who should enroll and when didn't occur until very late in the game (when isn't exactly clear).
2. That enrollment capability seems to be tied to Oracle Identity Management suite - which is a very complicated tool and requires a significant amount of engineering (custom code, performance considerations, etc.).
3. For whatever reason, the development timeline got pushed to the right but the rollout deadlines didn't change. 
4. There seems to be some lack of clarity as to who was the integrator (the prime vendor or government agency).
5. The contract was issued in December of 2011, but requirements were delayed - and requirement changes were being made up through this September. (very common story actually)
6. There were a great number of moving parts - more than 50 contractors. This may also imply an overly complex architecture.
7. It appears that there was an excessive amount of code involved - which begs the question - why wasn't more of this handled with prepackaged (portal) software?
8. The prime vendor didn't seem to have had experience architecting portal solutions with the type of volume that would clearly be associated with Healthcare.gov. 

John McCaffee is not the tech support we need to solve the Healthcare.gov mystery

Unfortunately, given the nature of the problems, it seems as though fixing Healthcare.gov while doable may take longer than is being promised. Sometimes, throwing extra money and attention towards a problem at this stage has the unwanted effect of making things even more complicated. Here are some suggestions though that may help alleviate the current crisis:

1. Eliminate the need to register just to shop for plans.
2. Refine project roles and responsibility immediately - choose / assign a lead integrator.
3. Switch to incremental roll-outs for actual enrollment (e.g. shopping available nationwide by enrollment opens up state by state).
4. Assign tiger teams per critical problem (e.g. one for identity management, one for the data hub, one for performance engineering etc.)
5. Do not oversell the fix timelime; in other words don't promise something you can't deliver - extend the overall compliance timelines in order to give the project time to catch up. 

Copyright 2013, Stephen  Lahanas

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