Tech + Health

11.18.13

How the Government Can Avoid Another HealthCare.gov Debacle

HealthCare.gov is an embarrassment, but government-created tech is not hopeless. Here’s how the system can improve.

Given the deluge of headlines about the failure of HealthCare.gov, it would be easy to fall prey to the belief that federal government simply can’t get technology right anymore. How is it that a nation that once put a man on the moon and split the atom couldn’t build a functioning website? The disconnect between the failures of the public sector and the wonders of Silicon Valley—as expressed in self-driving cars, 3-D printing, and software that anticipates what you want to read, buy, or watch—is jarring. In 2013, a dysfunctional website really can affect public trust in government.

While government IT fails more often than it should, not all efforts are rotten apples. One of the best stories in federal technology today can be found at the Consumer Financial Protection Bureau (CFPB), which has earned praise from The Washington Post, Bloomberg View, and The New York Times for getting government technology right.

The agency started strong, launching a clean, beautiful website, consumerfinance.gov, in February 2011 and starting to crowdsource fraud reports online. That summer, the CFPB used online feedback to redesign the mortgage disclosure form. In June 2012, the agency launched a complaint database. A year later, the release of that data stimulated banks to improve response times and respond to customer complaints. In October 2013, the agency launched an open source tool to explore regulations online. In November 2013, the CFPB began to solicit online feedback on consumer debt collection practices.

How has the CFPB been able to deliver dozens of IT projects, and do so using modern design principles and web standards?

To begin with, it started with a distinct advantage: starting fresh. Starting a new federal agency in Washington gave its creators the opportunity to build, buy, and deploy technology differently, based on a bold vision. That gave the CFPB tremendous agility, to use cloud computing and adopt a federal government-leading open source policy that supported development on Git and release of software into the public domain on Github.

Second, despite the political pressures it faced from members of Congress and industry, the CFPB was able to attract tech talent from the private sector, as well as from elsewhere in the federal governement, to work at the “startup agency.” It was able to add a fellowship program in January 2013. While human resources was still a huge challenge for hiring tech staff, given the market for data science, design, and modern web development skills, as the first members of the tech team related to me in multiple interviews, the CFPB still managed to do it. (Retaining chief information officers has proved harder.)

Finally, the leadership in the agency understood that using technology well was vital to the achieving the mission of the agency. If CFPB staff were able to make a business case for applying the talents of the developers and “quants” they’d hired, they were able to get internal resources applied quickly to building something. The difference in time and outcomes between using in-house data scientists and coders and putting out a request for proposals to the contracting community is significant, as is having technologists in-house who can monitor and govern the contracts that the agency signed.

Unfortunately, other federal agencies don’t enjoy those conditions. Though states are not saddled with quite the same weight of federal regulations on procurement or human resources, government IT debacles are endemic across the country. There are green shoots, however, where strong political leadership and technologists in government have led to better outcomes for public sector technology.

A “geek squad” of New York City has saved lives and taxpayer dollars by applying predictive data analytics. The city also partnered with the FCC and mobile companies so that mobile alerts were in the palms of citizens when Hurricane Sandy bore down.

Boston’s Office of “New Urban Mechanics” combined mobile, text, and online technology to build a 21st-century platform for constituent services. The city’s public works department cut Boston’s car fleet in half through the adoption of the same car-sharing technology that enables Zipcar’s customers to pay by the hour.

As Elise Hu reported for NPR, there are other places where government IT procurement works, from Philadelphia to Kansas City to, yes, the CFPB.

The problem is that these are exceptions, not the norm, in a public sector that spends more than $140 billion annually on information technology across the United States. Unfortunately, all of that spending is not resulting in great outcomes. According to data from the Standish Group, the rate of government IT failures is jarringly high: 41.4 percent of the 3,555 projects from 2003 to 2012 that had labor costs of at least $10 million were failures.

Examples of poor software built for state governments by corporate giants such as Deloitte are drawing newfound attention to the vulnerability of states to the same management and procurement failures that bedeviled the HealthCare.gov project. Massachusetts created a special commission to investigate procurements. Other states may well follow, as legislators confront angry constituents wondering why their public sector e-services are so far behind private sector offerings and yet cost so much.

Even if the Obama administration's "tech surge" is able to make Healthcare.gov work for 80% of users by December 1st, thanks to the international publicity about its problems, there's now newfound political attention being paid to buying and building technology differently in the public sector.

In what now feels like a cosmic irony, the version of HealthCare.gov that went live in June was actually an example of technology that was successfully built by the government. The relaunch of HealthCare.gov featured a collaboration between Health and Human Services, private sector designers, and a startup based in the District of Columbia. The result was a fast, lean website based on open standards and largely hosted in Akamai’s content distribution network. The software that went live on October 1 that powered the marketplace was just the opposite: bulky, buggy code on the front-end connected to proprietary software hosted at a data center that couldn't scale to meet the demand of millions of visitors.

While the issues behind HealthCare.gov also include management failures and political fears, it’s clear that something has to change on the technology front as well. Increasingly, the way government technology should work in the 21st century looks like a combination of open data, open standards, open source, cloud computing, and open procurement, where government hires the best talent it can afford and collaborates with members of the private sector when it cannot. While that may seem like a lot of “open,” that somewhat radical prescription is the answer to decades of outsourcing, legalized corruption in procurement, and closed, proprietary systems and data standards that lock agencies into vendor relationships for years to come.

While getting to that vision might seem impossibly daunting, it’s worth noting that the United Kingdom has has made huge strides in making it real. After experiencing its own government IT debacle in the form of a failed National Health Service project that cost billions of pounds, political leaders acted by creating a Government Digital Service (GDS) and hiring Mike Bracken as Executive Director of Digital to run it, and putting him at the table in a cabinet-level position. Today the GDS is being hailed as the best startup in Europe. The singular Web domain and service it created for all of the U.K., GOV.UK, has literally redefined online government platforms.

It’s not clear whether the United States will be able to follow the lead and pace set by the United Kingdom here. A government IT procurement reform bill that passed the House of Representatives as part of the National Defense Authorization Act may pick up momentum in the Senate after the HealthCare.gov debacle, despite the Federal IT Acquisition Reform Act’s $145 million price tag, but it won’t be enough on its own. Congress will need to take steps to make itself smarter about technology policy and investigate waste and cronyism in government IT contracting, much in the same way the Truman Committee took on wartime profiteering in the middle of the 20th century.

The nation’s chief executive seems finally to understand that there’s a fundamental issue. In an interview with NBC News this November, President Obama acknowledged the problem:

“So, part of what I’m gonna be looking at is how do we across the board, across the federal government, leap into the 21st century...Medicaid is still largely done on paper. When we buy IT services generally, it is so bureaucratic and so cumbersome that a whole bunch of it doesn’t work or it ends up being way over cost. And yeah, in some ways, I should have anticipated that just because this was important and I was saying this was my top priority. And I was meeting with folks once a month telling ’em, ‘Make sure this works.’

Understanding that you had some structural problems there—you know, that’s on me. That’s something that I’ve got to—refocus on. And—I actually think that once we get this—this particular website fixed, there are gonna be some lessons learned that we can apply to—the federal government generally.”

If Obama now, finally, fully realizes how much of an issue the broken state of government IT procurement is to federal agencies fulfilling their missions in the 21st century, he’ll use the soft power of the White House to convene the smartest minds from around the country and the hard power of an executive order to create the kernel of a United States Digital Services team built around the DNA of the CFPB: digital by default, open by nature.

The president could direct and empower the United States chief information officer, Steven VanRoekel, to use his statutory authority to accelerate the implementation of the digital government strategy, enforce modular contracting, commodity purchasing and adoption of open standards, and push more aggressively on the use of Portfolio Stat to save taxpayer dollars.

The Office for Personnel Management could help to expand the success of the Presidential Innovation Fellows program across government and get serious about recruiting and retaining tech talent.

The Office of Management and Budget could work with Congress to audit and investigate awards to contractors that appear directly tied to the same kind of revolving door between IT staff at federal agencies and government contractors that parallels members of Congress and lobbying firms.

But if the President and Congress fail to act after bad software hindered the implementation of a signature legislative achievement, expect the issues that led to HealthCare.gov to continue to undermine the mission of every agency for years to come.