HealthCare.gov: Time To Take A Deep Breath

Posted on | October 16, 2013 | Comments Off on HealthCare.gov: Time To Take A Deep Breath

Mike Magee

I experienced my first beta installation of a health information system in 1987 at Baystate Medical Center in Springfield, MA. It was my first hospital administration job and an eye opener. The company was Technicon, an IT firm that began in 1965 as a cooperative effort between Lockheed and El Camino Hospital out of California, a leader in the field at the time.

We had significant in-house talent thanks to the recruiting efforts ofMike Daly, the first class CEO of the Health System. Rich Rydell was our head of HIT and Chair of the Board of HIMSS (Healthcare Information and Management Systems Society). Bill Bria, a critical care pulmonologist and our clinical lead, would go on to head up the program at the University of Michigan Health System for 16 years.

The planning was detailed, intensive, and thoroughly prospective. It lasted for the better part of two years. All stakeholders were laboriously involved. But when the key was turned on, there were multiple unexplained glitches, continued – mostly passive – resistance by the medical staff, and within one month a list of our 300 requested changes by the staff which had to be prioritized and took another 18 months of programming and reeducation to address.

Note that this was not a public site, but rather an in-house professional site. Resistance was passive, not active. No Supreme Court cases. No wild rhetoric, or threats of shutting down the medical center. No demonstrations on the front lawn. Still it was messy, complex and challenging. That was the reality.

Since then, I’ve been involved in many IT launches – in hospitals, medical schools, consumer sites and companies, large and small. All were messy and all were challenging, not just because of the technology, or the cultural shift, or the fears of human beings, but mostly because the systems were disrupters of the status-quo.

Enter the US Health Delivery System – the largest assembly of disparate, disconnected, inefficient and highly variable services ever knit together by any human population. This is a system where everyone in power felt they could stay in power if the system remained disconnected and broken. This is a system largely left behind by the consumer revolution, the information technology revolution, and the professional education revolution. This is, and has been, the “Queen Mother” of all status-quo’s.

If this seems hyperbolic, let me offer as Exhibit I the organized and systematic effort that we have witnessed over the past year to destroy what is essentially a health insurance reform bill – one that would expand coverage, equity, justice, rationality and efficiency. Let me offer as Exhibit II the active (not passive) attempt to discredit, complicate, and cripple the national information system that is the critical structural underpinning for the successful implementation of the Affordable Care Act.

If you are wedded to the historic dis-integrated status quo of US health care delivery, it is logical and predictable that you would strike at the pressure point where recruitment, data analysis and operational efficiencies reside. How would you cripple it?

First by ensuring non-cooperative IT programming in the states you control. Second, by distracting focus on implementation at it’s most critical point with bogus legal and legislative attacks. And finally, as a last gasp, as people of good will work 24/7 to bring functionality to a new and incredibly complex, consumer facing endeavor, repeat over and over “I told you so. I told you so.”

This is not to excuse the problems that are evident in HealthCare.gov. Experts say it’s about 70% of the way there. 30% to go. It attempts to finally integrate our currently wildly and purposefully complex hetero-system. In fact when you push the “apply” button on HealthCare.gov, you are sending data down 92 different pathways simultaneously before a customized response comes back to you. In the backroom, Homeland Security, the IRS, the Social Security, the Defense Department and many others are weighing in on your application – verifying data, ensuring efficiency and preventing fraud.

It’s been a rocky two weeks because it’s not easy using virtual connectivity to repair what has been deliberately broken over decades and decades. It would be messy under the best circumstances – and I think by now most Americans viewing the performance of Congress would admit, “These are not the best circumstances.”

And yet here we are. And as was the case at Baystate 25 years ago, we have too much invested and are too far along to get weak kneed now. We’re all in.

So we’re going to fix this platform, HealthCare.gov. We’re going to cover and connect and improve health delivery in the United States. It will take awhile. And we’ll take the advice of experts during the fix. In particular, here are three steps to watch to ensure ultimate success:

1. “Do continuous testing. Test through the development cycle. Test the first day, and test everyday.”

2. “Test across environments. Make sure you’re testing the back end and the front end together, and not separately. A lot of the problems occur at the connection points – the cartilage to the bone, so to speak.”

3. “Make sure you do load testing all the time. It doesn’t have to be millions of users. A lot of problems will occur with 100 users on a site. You just have to do some sort of load testing and you have to do it consistently.”

Luckily, leaders in HIT don’t give up easy. Rich Rydell is currently the CEO of the Association of Medical Directors of Information Systems. Bill Bria is the Chief Medical Information Officer for the Shriner’s 22 hospital system. So say after me, “It is not easy. It is not pretty. But it will be done!”

For Health Commentary, I’m Mike Magee