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● Viewpoint The Source for Healthcare Information Systems Solutions www.healthmgttech.com

An IT blunder or a lack of

T GROUP PUBLISHER

Kristine Russell krussell@healthmgttech.com

communication? By Matt Peacock | Publisher

he recent HealthCare.gov IT blunder that is facing our nation spurs huge questions about information infrastructures in the healthcare arena. While people’s opinions vary on whether or not the Aff ordable Care Act is going to help or hurt us, most of us are

wondering how, in this day and age, did the back end of this venture fall apart? After all, it’s just information that needs to be processed. News coverage of this debacle has found that the issues stem from its original design, calling it political incompetence and unawareness of actual website traffi c volume. And can we mention why a non-American programming company was hired? Are these really the problems, though, or are they byproducts of something larger? T e Healthcare Insurance Marketplace system was built by 55 contractors, utilizing 112 diff erent computer systems, and received 14.6 million unique visits in the fi rst 10 days. T e Washington Post recently published an article that explained their take on why the system broke and further speculated that it will not be up and running by the end of November. T e Wall Street Journal reported that the cost of the exchange site was more than the development cost of the orginal iPhone. T e process to access and sign up for coverage entails information exchange

through eight steps. First, users create an account, followed by a registration step that collects personal data. T e third step verifi es the user’s data while he or she waits for further instruction. After an applicant’s identity is verifi ed, the system obtains proof of eligibility and the applicant can shop for a plan. After a plan is selected, the data is translated into a format insurance companies can accept. Finally, the system notifi es the applicant of enrollment. During this entire process, information is handed off from one database to another. T is process peaked my curiosity, and I began to wonder how in the world

did a government program work before computers and large-scale networks? Social Security began to organize in 1936. T e Social Security Board did not have fi eld offi ces, so it contracted the U.S. Postal Service to help. Sound fa- miliar? At the time, 45,000 post offi ces were in operation, and 1,074 of them were designated as typing centers. On November 16,1936, employers began to complete an SS-4 form. Employees completed an SS-5 form, which was the basis for assigning SS numbers. T e forms made their way back to the Social Security headquarters in Baltimore, MD, where all master fi les were kept. Once at HQ, the cards went through a nine-step process that created a master record. T e birth of Social Security had its obstacles too. Technically, no social security cards should have been issued before November 24, 1936, but post offi ces didn’t follow their instructions and there were reports that some cards were given out before this date. T e fi rst person offi cially issued a SS number was John David Sweeny, Jr. (SS# 055-09-0001) on December 1, 1936. If you think about large undertakings like Social Security and the Aff ord-

able Care Act, it is interesting to note that many of the problems stem from a lack of communication. Today, in-person communication is limited and problems arise from databases not communicating properly. In 1936, the entire system relied on communication from actual humans – and it was all done without computers.

Communication is a vital component of anything we try to accomplish.

Stepping back from the micro details of any problem exposes that we, as society, don’t communicate well.

4 December 2013 HEALTH MANAGEMENT TECHNOLOGY PUBLISHER Matt Peacock mpeacock@healthmgttech.com

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