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Why the Healthcare.gov Site Failed

In the Time Magazine March 10 2014 edition there is an article on how the Affordable Health Care Act’s Healthcare.gov site was fixed.

When the healthcare.gov site was launched in October 2013, a mere hundred or so users caused the site to crash.

Typical of government led initiatives, the different sections responsible did not work in unison and there was no clearly identifiable person in charge of the site. Different parts did not know what was going on, so each assumed all was well and progressing forward. The Centers for Medicare and Medicaid (CMS) spent over $300 million on building a website that did not work. Their tech people forgot simple things like creating a cache, where most frequently accessed information is stored in a layer above the database. In that way queries could proceed quickly and not tie up the entire site – this is done in commercial sites.

The White House was forced to hire properly skilled tech folks from companies like Google to revamp the health care website. The newly hired consultants found that the original government designed site “hadn’t been designed to work right…that any single thing that slowed down would slow everything down.” Many of these troubleshooters fixed the site at a fraction of their usual pay. The lesson is that rich government contracts are awarded to incompetent cronies or to the lowest bidder. Since this is not a meritocracy, it’s unlikely that contracts would go to the most qualified at the onset. The good news for the government is that others can be hired later to do repairs.

Since originally there was no leader of healthcare.gov, we will never find out who was responsible for this mess and why so much money was wasted in the first place.

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More Stupid Hospital Documentation Rules

Today I was notified by Medical Records at my hospital that one of my OR/surgery reports was incomplete. I had done hemorrhoid surgery on a patient 6 weeks ago. Someone in the medical records department flagged a deficiency in my OR note. I had left out the “drain” section – whether a drain was used or not. For my lay readers, you need to know that while drains can be used in abdominal surgery, I have never used one for hemorrhoid surgery in 27 years. In fact I can’t think of any colorectal surgeon ever using a drain for hemorrhoidectomy. In any case I was in violation as the hospital Medical Record Procedure Committee stated that Drain recording is a requirement and has to be addressed in the Operative report. I was directed to Rules and Regulations page 14. Was the documentation of drains a ‘requirement’ of the committee because of government regulatory agency rules or did the committee feel that drains should be used in hemorrhoidectomy? I doubt anyone sitting on this committee knows anything about anal surgery, so it’s likely a misinterpretation or misapplication of a badly written regulation. If this documentation of drains is required, then this should be mentioned in all surgery despite clinical relevance or common sense. Taking this to a ridiculous end in my hospital, drain use should be documented for anal fissure surgery, removal of rectal foreign body and colonoscopy performed in the OR in spite of logic that drains are never used in these procedures. It is thoughtless mindless enforcement of such ‘rules’ and regulations which lead to more and more doctors leaving medicine in frustration.