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Economy
More on the Obamacare IT nightmare
2013-03-27
Posted because a number of our readers have experience in this area, which will affect all of us who are Americans, not to mention our ability to fight the War on Terror.
In response to my blogpost on how setting up the information technology for Obamacare is an "impossible endeavor," Reader John Capron of Modena, New York, whose LinkedIn profile shows 35 years of IT experience, has given me permission to quote the following, which I pass along without further comment:

"Wow, what can go wrong here? Let me assess this based on my years of experience in this industry. The federal government is going to build 50 exchanges, using a data hub that doesn't exist physically and in fact, the design hasn't been solidified, and must be accessible to a variety of data processing technologies that range from archaic to old.

Each of the 50 states have different eligibility rules, and with a significant number of states opting out, the federal government now has to learn the intricacies of each state's Medicaid eligibility models which then scale to different applicability rules for different members of a given family.

The thousands of pages of bureaucratic rules that will drive requirements haven't been completed yet, and those requirements are needed to drive design not only for the application programs, but for the entire processing architecture. The issue of network, processor, and storage performance has to be decided, modeled and tested.

To complicate matters, the convoluted federal procurement rules for hardware and software have to be adhered to, which require mixing different hardware brands, software packages and service providers. Add to this compliance analysis to validate and revalidate trusted sources of data. All legal requirements at the local, state, and federal level have to be met by the design.

And last but not least, staffing up for customer support which requires hiring, training on applications not yet designed and real world tested, the creation of support documentation, building or retrofitting facilities for these folks, setting up backup sites for the required redundancies, plus hardening the sites for natural disaster power failures.

Additionally, the people hired must meet the Equal Opportunity criteria, and all GUIs must be handicapped usable, as well as the facilities themselves. I could be here all evening defining additional work to be done. Oh, did I mention this will be done by next year. Now I know why this has never been attempted. We are a country made up of 50 separate and distinct states, with all their own rules of governing, and to make things more unworkable are all the federal rules that have to be adhered to. I think we the people are going to be safe for quite awhile here."
Thoughts?
He's understating the problems...
Posted by:trailing wife

#24  Obamacare was conceived and scheduled in a manner oblivious to previous Healthcare IT law, namely HIPPA. Seems like it always takes two lawyers and a BAA (Business Associate Agreement) and several months just to let one company share medical data with another company. How this is going to be ironed out, made workable, etc. in the next 9 months, so information flows freely among all the new players is beyond me. I honestly don't even think the lawyers will be done this year ... let alone the engineers that have to make it work. Healthcare IT already moves slow. Now it will be moving slow as usual, with some paranoid on top given questions about what everyone is up to, and the final gift of a deadline to get it done.

That is going to work out well. Popcorn!
Posted by: Beau   2013-03-27 23:25  

#23  I see a common understanding of the REAL purpose of Obamacare in regards to politicians these excerpts of comments on this thread...

"get very rich on tax dollars" - "nobody gets a system"

"they can get some of the boodle."

"contributions to the right party will help in landing those extremely lucrative contracts"

"fraud will be huge"

"This version of gov't theft targets everyone!"

and when things go start going crazy for all the people who are under Obamacare (that is everyone but 100 Senators and 400+ in the House of "Representatives", the Justice Department and IRS will make a pony show of the contractors but the contractors will strangely not be prosecuted as they file bankruptcy. And the beat goes on, unless it is stopped.


Posted by: George Clunk4883   2013-03-27 22:25  

#22  30 years in IT myself...must be the magic number. my stint in healthcare was frightening enough at the state level...it will be billions spent and nobody gets a system but the consultant companies (Deliotte, PWC etc) get very rich on tax dollars
Posted by: Warthog   2013-03-27 22:11  

#21  Merge obamacare with the post office. It will save the post office and bring back house visits. Just put an ambulance light on the postal jeeps and America is good to go.

FOWARD to the DEtroitification of America!
Posted by: Airandee   2013-03-27 19:27  

#20  those programs have to consider this as well.
Posted by: Beavis   2013-03-27 19:12  

#19  To err is human,
To forgive, Divine,
to really screw things up requires a computer,
But to achieve complete and total chaos and destruction you need a government.
Posted by: CrazyFool   2013-03-27 17:33  

#18  In the 1980s the company I was working for bid on a project to supply the VA Hospitals with a computerized Patient Management system. We had successfully installed our system in many private hospitals.

After answering the original Request for Proposal and numerous revised RFPs we along with other reputable companies pulled out of the bidding. It was hopeless and nothing came of it.

In the meantime the VA had purchased a boatload of brand new DEC Mini Computers to run the their Patient Management systems that never came. They were all stored in a warehouse in Chicago and as I understand it they were eventually sold as surplus for pennies on the dollar.
Posted by: GolfBravoUSMC   2013-03-27 16:45  

#17  Like other Government IT projects this is going to be estimated in 1-2 billion - and actually cost several-tens-of-billions and at the end there will be nothing to show for it except fat consultants and *very* rich spouses of Senators.

There will *never* be a final, agreed upon design of even the most basic elements. Everyone will want their little piece of the pie made in *their* district or state so that they can get some of the boodle.
Posted by: CrazyFool   2013-03-27 15:53  

#16  ObamaCare IT Support:

"Hole don I got's to AX Somebody"
Posted by: GolfBravoUSMC   2013-03-27 15:44  

#15  I cannot even imagine where you will start with this.
Posted by: newc   2013-03-27 15:11  

#14  Yeah, but I think some vendors are gonna get very, very wealthy from this. And it's a good bet that contributions to the right party will help in landing those extremely lucrative contracts. And if you happen to work for one of those vendors you'll have a job for the rest of your life, or at least as long as you can live with yourself for doing it, whichever comes first.
Posted by: Ebbang Uluque6305   2013-03-27 12:28  

#13  No reason it can't be both GB.
Posted by: CrazyFool   2013-03-27 10:31  

#12  Try this link
Posted by: Besoeker   2013-03-27 10:28  

#11  Good to get some inside perspective. Thanks GB. Here's one for you Devil Dogs.

Chesty
Posted by: Besoeker   2013-03-27 10:07  

#10  I've been in the Healthcare IT business for 43 years and have not seen the guvmint perform Medicare reimbursement. They have farmed it out to regional contractors such as Blue Shield and Palmetto GBA. In our jurisdiction we still use dial-up modems to connect to Palmetto for Medicare billing or we have to go through a third party to sort of connect through the internet.

Here's a example of a relatively small change:

In the recent past Physicians had a group of ID numbers for Insurance billing, Medicare, Medicaid, Blue Cross etc. A great idea was to just issue a single ID (NPI - National Provider Identification) for each Healthcare provider. The transition took years and was a mess. I had clients taking second mortgages on their houses to make payroll because their Medicare reimbursement was held up for months.

This is going to be really ugly. Before it's over Hogan's Goat is going to look like precision machinery. I can see two possible scenarios; reimbursement for ObamaCare patients will be held up or they will have to cut corners and the opportunity for fraud will be huge.

If I were a Physician I wouldn't go near a ObamaCare patient unless I considered it charity.
Posted by: GolfBravoUSMC   2013-03-27 10:00  

#9  I think what you cynics are missing is the vast amount of intellectual firepower that has accumulated, sort of like lint, in the upper ranks of the federal government. Put Barbara Boxer, Patty Murray and Sheila Jackson Lee in a room for a couple of hours and they'll knock this problem right out. ("Is there an app for this I can get on my iphone?")
Posted by: Matt   2013-03-27 09:04  

#8  You guys still don't get it, I'm surprised.
There is only ONE form, for all 50 states, that is really important here.
And you can get it from the IRS.
That's it and that's all, insurance for the proles is a messy side business. It's the tax/penalty that they will need to get up and running first, expect considerable lag time with the nuts and bolts.
Posted by: bigjim-CA   2013-03-27 08:46  

#7  I work in fed IT; even if it were doable, it would take much longer than anticipated. But since it's not doable, it will fail - first it will be delayed, eventually abandoned. What replaces it is the question...
Posted by: Spot   2013-03-27 08:35  

#6  Yes, the single payer scheme is the obvious intended outcome. The implied goal of single payer can be found in the 25,000 unread pages of the original legislation.

The on-going banking theft in Cyprus targets the larger investor. This version of gov't theft targets everyone!
Posted by: Besoeker   2013-03-27 08:14  

#5  35+ years IT experience. This is going to be an Epic ClusterF*ck - by design.

As someone in the article commented: This is designed to fail - and bring down the IT industry with it so that there is no alternative but to go to single payor.
Posted by: CrazyFool   2013-03-27 08:01  

#4  Additionally, the people hired must meet the Equal Opportunity criteria

A bug, not feature.
Posted by: Besoeker   2013-03-27 07:32  

#3  30+ years in the software business. Consulted at everything from local to federal gov't as well as medium to mega sized businesses.

All of the preceding is exactly correct and still misses one thing.

Laws change.

This abomination will change early and often. Each change will require full on testing. The life cycle of development will be overwhelmed by the life cycle of the laws constantly moving target.
Posted by: AlanC   2013-03-27 07:25  

#2  He's spot on. And I know of what he speaks - almost 30 years IT experience and I currently work for a state government agency and am involved in designing, implementing, and maintaining databases and applications responsible for transmitting data to various local, state, federal, and international agencies in a number of different systems, all of which need to communicate flawlessly with a required up-time of better than 99%.

This is a morass of hundreds of different systems that have grown up over the past 40 years and are finally approaching what they want to do in a year with this thing.

The communications protocols, security protocols, interagency agreements, audit logs, audit process, auditor training, certifications, training documentation, maintenance agreements, etc are going to be a nightmare.

It took a year for our state to get 3 agencies to agree to submit one form of protected data - and a very, very minimal sub-set of that data, in fact. A YEAR. Just for the agreements.

Not. Going. To. Happen.

Orion

Posted by: Orion   2013-03-27 02:07  

#1  The rule of thumb is, if you double the size of a system, you half the chances of it being succesfully delivered. The Mythical Man Month explained this is because, as the number of people increases linearly, the amount of communication required increases exponentially.

Sounds like the chances of it being delivered are vanishingly small.
Posted by: phil_b   2013-03-27 02:04  

00:00