Spoken to any software developers about HealthCare.gov? Everyone that I’ve spoken with, of whatever political persuasion, cringes when the topic comes up. It seems that every conceivable principle of software development was, and is being, violated. In a perverse way it is the ultimate source of compelling illustrations of what not to do. Whether the issues are requirements, design, testing, deployment, or management, HealthCare.gov is replete with anti-patterns. From the oldest lessons captured in The Mythical Man-Month to the latest best practices in website architecture, HeathCare.gov seemingly has gone the opposite direction. Few are surprised and no one is happy — after all, it is taxpayer dollars being spent.
In sifting through the documents, reports, and testimony associated with this fiasco, I came across one item that, to me, crystallized a core problem, a problem which I believe lives in many other projects having nothing to do with the Affordable Care Act or HealthCare.gov. I was, of course, interested in learning which companies were responsible for the website. One of the early and key names to come up was CGI Federal Inc. Another was the “lead” organization: CMS, The Centers for Medicare and Medicaid Services — more about them in a minute.
CGI Federal’s role is an important one, important enough that Cheryl Campbell, a Senior Vice President at CGI Federal and who leads their Health and Compliance Programs Business Unit, provided testimony to Congress on September 10th regarding their work on the Federally-Facilitated Marketplace. In her testimony she said, “At this time, CGI Federal is confident that it will deliver the functionality that CMS has directed to enable qualified individuals to begin enrolling in coverage when the initial enrollment period begins on October 1, 2013.” Given how the rollout turned out, I was particularly struck when I also found a press release on CGI’s website, from one year earlier, that reads, in part, as follows: “CGI Federal… announced today that its Health and Compliance Programs Business Unit (BU) has achieved the Software Engineering Institute’s (SEI) Capability Maturity Model Integration (CMMI) Development Maturity Level 5, the highest rating possible. CGI Federal is the 10th company in the United States to receive the Level 5 rating for CMMI Development, version 1.3, which notes the BU’s success in establishing a culture based on continuous improvement of robust, standardized, and well-defined software development processes. Level 5 is the highest level an organization can attain in the CMMI framework.”
So, a business unit assessed at the “highest rating possible” nonetheless could not realize, a month before HeathCare.gov was supposed to be operational nationwide, that it would not, in fact, “deliver the functionality that CMS has directed.” That, to me, exposes a major problem. This CMMI level 5 organization has apparently allowed their understanding of process to triumph over an appropriate focus on product. But this is an issue that transcends healthcare and the ACA. Given how influential the process assessment ethos has pervaded other organizations across the country it calls into question how many other products either are, or will be, failures while their responsible organizations nonetheless claim process sophistication.
And CMS? Two years before the October 2013 HealthCare.gov rollout, CMS was the subject of a 193-page report produced by the National Research Council of the National Academy of Sciences. “CMS turned to the National Research Council to conduct a consensus study to strategize about how to modernize CMS’s business processes, practices, and information systems effectively to meet today’s and tomorrow’s demands, including how to build in the flexibility to deal effectively with changing requirements.” Despite the report’s numerous substantive and far-reaching recommendations for change, it appears little was acted upon. But at least the report was successfully written.
Here’s hoping your organization focuses on substance, and makes process subservient to product. That’s our focus.
ISR Director, Richard N. Taylor