As CIOs we can always be learning about the importance of information technology by watching what other IT organizations are doing. A fantastic opportunity has just shown up in the U.S. As part of the Obamacare overhaul of how healthcare is provided to U.S. citizens, a new web site has been set up to allow every U.S. citizen an opportunity to register for healthcare insurance coverage. All has not gone well and that’s where the real learning for CIOs is happening…
What Was Supposed To Happen
The Department of Health and Human Services is responsible for providing all Americans with the ability to sign up for the new health care system. The new health care law that has gone into effect in the U.S. requires that all citizens carry health care coverage. In order to get this coverage, they have to select from the health care options that are available in the state in which they live. They can do this via an online web site that is either provided by their state or by the federal government.
The government is running the insurance marketplaces in 36 of the 50 states that make up the U.S. This is because the governors of those states opted to not accept federal funding to expand their state’s health care system. Consumers are going to have until mid-December to sign up for policies that start on Jan. 1.
At their front end, the insurance marketplaces are essentially websites that consumers use to compare health plans and enroll in coverage. These websites link to data from other parts of the government, such as the Internal Revenue Service, and from health plans to verify eligibility and deliver subsidies for coverage. The Center for Consumer Information and Insurance Oversight is one of the main offices within Medicare charged with developing the exchanges.
The healthcare exchanges are the cornerstone of the Affordable Care Act, President Obama’s health insurance reform legislation enacted in March 2010. Since the passage of the law, government agencies, contractors and private insurers have been working on the design of the insurance exchanges. But implementation has only begun in earnest within the last 12-18 months. A Government Accountability Office report in June noted that, despite progress, “much remains to be accomplished within a relatively short amount of time.”
What Really Happened And Why
When the rollout occurred, there were glitches. Some of the errors were simple things that should never have occurred like security questions drop down boxes that were empty. However, there were other serious errors such as unavailable servers.
Ultimate responsibility for this very large scale IT system belongs to the Centers for Medicare & Medicaid Services. Tony Trenkle has the CIO job and is the Director of the Office of Information Services (OIS) in the Centers for Medicare and Medicaid Services (CMS). Ultimately, the proper operation of the online insurance marketplaces is Tony’s responsibility.
Experts who have taken a close look at the federal web site and it’s supporting IT infrastructure have come away not being impressed. They report that there are both coding flaws and problems with the architecture of the system. One of the system’s biggest flaws has to do with its ability to verify the identity of a system user. In order to do this it has to work, Homeland Security has to send the citizenship information, IRS sends the income information, Social Security sends the Medicare eligibility information, and from the user’s state you get the Medicaid eligibility. Clearly there are a lot of API’s and other interfaces at work here and it doesn’t look like it was completely tested before being rolled out.
Experts who have examined the government web site are reporting that it appears to have been built on a foundation of sloppy software. Additionally, basic web application design techniques such as caching appear to not have been used. This coupled with web-traffic problems have resulted in the system being usable by only a small number of the roughly 9 million visitors that tried to use it the first day that it was in operation.
What All Of This Means For You
The rollout of the IT systems that were required in order to support the Obamacare health initiative in the United States turned in to a bit of a mess on launch day. The big question is why? The launch date had been known for a long time and you would think that the person in the CIO position would have had plenty of time to get all of the issues worked out.
The reason that the rollout had such big problems were varied. Some of the problems can be traced to the simple fact that the system was clearly not sized properly – too many people tried to use it at the same time. This is a classic IT problem and should never have been an issue because we know how to deal with it. Another issue appears to have been the complexity associated with verifying users. This requires multiple systems to talk to each other on the back end and those interfaces appear to not be working correctly all the time.
Undoubtedly the IT issues with the new U.S. healthcare system will eventually be resolved. Having such a public facing system have issues almost insures that the right people will be working on it. However, if the CIO in charge had been doing his or her job, none of these easy to anticipate issues would have occurred. As CIOs we need to take the time to learn from these mistakes and make sure that they never happen in our shop.
Question For You: Do you think that the rollout should have been delayed to allow for more system testing?
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What We’ll Be Talking About Next Time
I’m hoping that you are not familiar with the U.S. food stamp program. This is a government funded program that provides people who are living below the poverty line with money that can only be spent on food. Clearly it’s a critical program that demonstrates the importance of information technology and the people who are enrolled in it desperately need it. That’s why it’s unacceptable when the IT systems that support the program stop working. Clearly the person who has the CIO job is the one to blame…