Quality Control

10 HealthCare.gov bugs you might have missed

bug alert

When HealthCare.gov launched Oct. 1, a team of IT personnel were standing by to deal with bug reports coming from contractors, insurance issuers and heavy users of the site, including the army of "navigators" enlisted to help people enroll.

The meeting notes from the Center for Consumer Information and Insurance Oversight (CCIIO), as provided by the House Oversight and Government Reform Committee, give a running tally of how problems with the site were reported and of early efforts to fix the bugs. Press reports about the 175-page packet of notes spanning Oct. 1 to Oct. 29 focused on the tiny proportion of users who were able to complete applications. But the notes offer an inside look at how a government team tracks information and assigns bug fixes in the midst of a deeply troubled public-facing site launch.

The CCIIO war room was just one of a number of groups sending reports to the Critical Incident Response Team that communicated directly with Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services, and CMS Chief Operating Officer Michelle Snyder.

Here are some of the more interesting reports from the notes:

1. Serco, the contractor in charge of processing paper applications, wasn't able to log in to the site on the launch date. There was also confusion about whether a downloadable application form was supposed to be linked from the site. Once Serco employees were able to reliably access the system, they discovered discrepancies between the paper forms and the online database.

2. The help desk in charge of dealing with identity confirmation issues, run by Experian, was reporting 4-hour to 5-hour waits on opening day. Apparently, users were confused or discouraged because Experian was advertising its credit reporting products on telephone hold recordings.

3. As late as Oct. 17, internal staffers at CMS were not clear on the right way to write bug reports. From the war room notes: "Action Item: Tony to send out more information about emailing defects and getting them in the queue." It's not clear, but it seems probable that "Tony" is Tony Trenkle, whose resignation as CIO of CMS was made public Nov. 6.

4. Three-fourths of the data hub calls to the Department of Veterans Affairs database indicated that the applicant was deceased. War room notes suggest this could represent possible attempts at fraud. It was later learned that Veteran Health Administration data verification wasn't working properly. A fix was put in place by Oct. 21.

5. The CIO shop at CMS – the Office of Information Services – eliminated some of the avenues for insurance issuers to report problems, ask questions and learn about known problems with HealthCare.gov. The war room notes indicate that the move "could [affect] CCIIO's issuer interactions moving forward this week."

6. CCIIO was relying on news accounts of problems with enrollment forms, called 834s in the insurance industry. Their internal dashboard provided only daily numbers and couldn't track the cumulative number of 834s submitted to insurance carriers.

7. On opening day, CCIIO didn't know if the system was over capacity or if the identity management system was broken.

8. The data hub that confirms eligibility and the federally facilitated exchanges were not communicating properly with an accurate tally of unique applicants.

9. An initial effort to create an IT troubleshooting group called for a joint effort of OIS and CCIIO. "OIS calls out the issues and CCIIO identifies the implications." The notes indicate that "many people involved in this group have a history of success in trouble-shooting technical issues during their Part D work." This could be a reference to deputy CIO Henry Chao, who was involved in the launch of Medicare Part D, the prescription drug benefit.

10. Some of the IT complaints that came in from navigators were routed back to navigators.

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Reader comments

Fri, Nov 8, 2013 JOHN_MN Minneapolis

They should have just contracted with QVC to develop this system. QVC could have sold hundreds of policies per day, compared to the maximum design capacity (as reported in the news) of only 1,100 per day! That's just nuts, I think I've run servers / databases under my desk that supported more users / transactions then that!

Fri, Nov 8, 2013

“2. The help desk in charge of dealing with identity confirmation issues, run by Experian, was reporting 4-hour to 5-hour waits on opening day. Apparently, users were confused or discouraged because Experian was advertising its credit reporting products on telephone hold recordings.”
Using the customer interface as a commodity interface, I’m shocked. But that ain’t the half of it! While this may seem like a non sequitur it really isn’t. In our efforts to measure all human economic activity, (redundant?), we’ve created a culture of commodity. A culture where everything gets accounted for and monetized, so if something doesn’t pay right away, than why bother? Moreover, every disruption, slowdown, or outage, natural or manmade, becomes an efficiency metric, (or inefficiency). The time we spend away from our, jobs, the consumer market, and when at leisure is view as an adverse input into our economy. If we are not creating wealth or spending money, we are wasting calories. This plays into a culture of instant gratification. No wonder our spending on basic research is falling behind the rest of the world’s. Be careful what you measure, because it gets managed.

Fri, Nov 8, 2013

I'm noticing a trend here: "Serco, the contractor in charge of processing paper applications..." "The help desk in charge of dealing with identity confirmation issues, run by Experian..." And of course CMS is itself a contractor. I miss the days when the government was allowed to employ its own programmers and wasn't forced to use outside contractors by congressmembers wanting big-money contracts for their campaign contributors .

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