Category Archives: United Kingdom

Lawmakers release proposed draft to codify US CTO role, create U.S. Digital Government Office (DGO)

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After months of discussion regarding how the government can avoid another healthcare.gov debacle, legislative proposals are starting to emerge in Washington. Last year, FITARA gathered steam before running into a legislative impasse. Today, a new draft bill introduced for discussion in the United House of Representatives proposes specific reforms that substantially parallel those made by the United Kingdom after a similar technology debacle in its National Health Service.

The draft bill is embedded below.

The subtext for the ‘Reforming Federal Procurement of Information Technology Act’ (RFP-IT), is the newfound awareness in Congress and the nation at large driven by the issues with Healthcare.gov that something is profoundly amiss in the way that the federal government buys, builds and maintains technology.

“Studies show that 94 percent of major government IT projects between 2003 and 2012 came in over budget, behind schedule, or failed completely, said Representative Anna G. Eshoo (D-CA), ranking member of the House Communications and Technology Subcommittee, and co-sponsor of RFP-IT, in a statement. “In an $80 billion sector of our federal government’s budget, this is an absolutely unacceptable waste of taxpayer dollars. Furthermore, thousands of pages of procurement regulations discourage small innovative businesses from even attempting to navigate the rules. Our draft bill puts proven best practices to work by instituting a White House office of IT procurement and gives all American innovators a fair shake at competing for valuable federal IT contracts by lowering the burden of entry.”

Specifically, RFP-IT would:

  • Make the position of the U.S. chief technology officer and Presidential Innovation Fellows program permanent
  • Create a U.S. Digital Government Office (DGO) that would not only govern the country’s mammoth federal information technology project portfolio more effectively but actively build and maintain aspects of it
  • Increase the size of a contract for IT services allowable under the Small Business Act from $100,000 to $500,000
  • Create a U.S. DGO fund supported by 5% of the fees collected by executive agencies for various types of contracts

“In the 21st century, effective governance is inextricably linked with how well government leverages technology to serve its citizens,” said Representative Gerry Connolly (D-VA), ranking member of the House Oversight and Government Reform Subcommittee, and co-sponsor of RFP-IT, in a statement. “Despite incremental improvements in federal IT management over the years, the bottom line is that large-scale federal IT program failures continue to waste taxpayers’ dollars, while jeopardizing our Nation’s ability to carry out fundamental constitutional responsibilities, from conducting a census to securing our borders. Our RFP-IT discussion draft recognizes that transforming how the federal government procures critical IT assets will likely require bolstering ongoing efforts to comprehensively strengthen general federal IT management practices with targeted enhancements that promote innovative and bold procurement strategies from the White House on down.”

The legislative proposal earned qualified praise from Clay Johnson, former Presidential Innovation Fellow and CEO of the Department for Better Technology, whose advocacy for reforming government IT procurement and fixing the issues behind Healthcare.gov seemed to be on every cable news channel and editorial page last fall and winter.

“This, I think, really works well alongside FITARA, which calls for increased agency CIO authority,” wrote Johnson. “What will hopefully end up happening if both bills pass, is that good talent can get inside of government, and agencies that perform well can operate independently, and agencies that don’t can be pulled back in and reformed, while still having operational continuity (meaning: while that reform is happening, IT projects can still be done well, and run by the DGO).”

In 2014, digital government supports open government. What’s unclear is whether this proposal from two Democratic lawmakers can gain a Republican co-sponsor in the GOP-controlled legislative body or if a federal IT reform-minded Senator like Mr. Carper or Mr. Booker will take it up in the Senate.

This is singular bill isn’t a panacea, however, Johnson emphasized, pointing to the need to fix SAM.gov, the error-prone website for contractors to register with the federal government, and reforms to registration for “set-aside” business.

“We’re not sure how Congress writes a ‘stop throwing errors when a user clicks submit on sam.gov’ law,” wrote Johnson. “That’s going to take hearings, and most likely, a digital government office to fix. And we think this is a bill that complements Issa’s FITARA. Since this bill is at the discussion draft stage, perhaps soon we’ll see some Republicans jump on board.

UPDATE:
 On July 30, RFP-IT was officially introduced. (Full text of the bill, via Rep. Eshoo’s office): “The Reforming Federal Procurement of Information Technology (RFP-IT) Act, introduced by Rep. Anna G. Eshoo (D-Calif.), Ranking Member of the Communications and Technology Subcommittee, Rep. Gerry Connolly (D-Va.), Ranking Member of the Oversight and Government Reform Subcommittee, Rep. Richard Hanna (R-N.Y.), Chairman of the Small Business Subcommittee on Contracting and Workforce, and Rep. Eric Swalwell (D-Calif.), Ranking Member of the Committee on Science, Space and Technology’s Energy Subcommittee, and Rep. Suzan DelBene (D-Wash.)”

Here’s the quick summary of revised RFP-IT Act:

1) It would officially establish a Digital Government Office within the White House Office of Management and Budget (OMB), with the U.S. CIO at its head as a Senate-confirmed presidential appointee, reporting to the head of the OMB, shifting from “electronic government” to “digital government.”
2) It would codify the Presidential Innovation Fellows program.
3) It would expand competition for federal IT contracting under a simplified process that would ease the regulatory and compliance burden upon smaller companies bidding, bumping the threshold for information tech projects up to $500,000.
4) Establish a digital service pilot program
5) Direct the General Services Administrator to conduct an in-depth analysis of IT Schedule 70.
6) Direct the Comptroller General of the United States to produce three reports to Congress within 2 years of the law passing, on 1) the effectiveness of the 18F program of the General Services Administration, 2) IT Schedule 70, and 3) “challenges and barriers to entry for small business technology firms.”

When digital government supports open government

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As I looked back at the annual Open Government Partnership Summit in London, I was struck by how much technology continues to dominate discussion, particularly when many of the issues that confront people and governments around the world are political or systemic, and thus resistant to simply “fixes.”

Given that so many of the new country commitments for the partnership either involve improving the use of technology or are enabled by technology, it’s tempting to frame the release of government data and other digital efforts as efforts that will primarily serve elites, not the poor, and to warn of the encroachment of commercial interests in that delivery.

The years ahead will be messy, full of anger, violence, ignorance and the worst of human nature, expressed in political conflicts and entrenched institutions and industries fighting against a rising tide of populism and industrial disruption fueled by an explosion of connection technologies.

Near the end of 2013, the majority of humanity is living through the consequences of wars, natural disasters, disease, food shortages or inequality in access to resources. On many days, access to healthy food, electricity and clean water are critical needs. Access to information, however, has rapidly become critical in this new millennium.

That such information will be delivered through the Internet and mobile devices is clearly one of the megatrends of this decade. Similarly, access to one another through those same devices, mediated by social media and video, is shifting how we all can understand, document and experience the world.

While 56% of American adults now own a smartphone, the rest of the world hasn’t hasn’t caught up yet. That’s changing quickly, however, as the cost of mobile hardware continues to drop. There have now been over 1 billion Android activations worldwide. As cheaper smartphones and tablets become available, and more wireless Internet access rolls out through ISPs, mesh networks and perhaps even Google blimps, the pressure to provide digital services will only increase.

Why all the hullabaloo? Isn’t this just “e-government redux,” with phones? It would also be a gross mistake to view digital government as simply rebranding or scaling the existing approaches to buying, building and maintaining government IT.

Unfortunately, the bad news here is that government technology around the world is dominated by regulations, tangled hiring practices and procurement policies that get in the way of building important software, along with politics and poor management. The good news is that the example of the United Kingdom’s new Government Digital Services team shows a potential way forward for building a digital core for 21st century government online.

Adopting a digital government strategy is not the same as moving to a system of government more open and accountable to the people, as a comparison of the democratic accountability in countries as diverse as Singapore, Denmark, Iran and Brazil demonstrate.

Given that technology can and will underpin many efforts to reduce corruption, improve accountability and empower citizen activism and public engagement, dismissing the importance of public-private partnerships or digital government initiatives as inherently “ephemeral” would be a mistake in this young century.

In depth: news and analysis about the troubles behind Healthcare.gov

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Over the past 27 days, as I’ve steadily shared analysis and links on what went wrong in the botched re(launch) of Healthcare.gov on Twitter, Facebook and Google+, I’ve also been talking in more depth about what went wrong on various media outlets, including:

Last week, the Obama administration announced a plan to fix the issues with the software behind HealthCare.gov, including putting QSSI in charge of as the “general contractor” and prioritizing fixing errors in 834 file data first, with the goal of have the system functioning end-to-end by November 30.

The teams of Presidential Innovation Fellows and “A List” contractors in the “tech surge” to fix the software have a tough challenge ahead of them. According to reporting from The New York Times and The Washington Post,  Healthcare.gov wasn’t tested as a complete system until the last week of September, when it crashed with only a few hundred users.

Despite the issues revealed by this limited testing, government officials signed off on it launching anyway, and thus was born a historic government IT debacle whose epic proportions may still expand further.

Should the White House have delayed?

“When faced with go live pressures, I tell my staff the following:

‘If you go live months late when you’re ready, no one will ever remember. If you go live on time, when you’re not ready, no one will ever forget.”-Dr. John Halamka, CIO Beth Israel Deaconness Hospital

In retrospect, the administration might have been better served by not launching on October 1st, something that was within HHS Secretary Kathleen Sebelius’ legal purview. After all, would the federal government launch a battleship that had a broken engine, faulty wiring or non-functional weapons systems into an ongoing fight? This software wasn’t simply “buggy” at launch — It was broken. These weren’t “glitches” caused by traffic, although the surge of traffic did expose where the system didn’t work quickly. Now that a reported 90% of users are able to register, other issues on the backend that are just beginning to become clear, from subsidy calculation to enrollment data to insurers reporting issues with what they are receiving to serious concerns about system security.

Based upon what we know about troubles at Healthcare.gov, it appears that people from the industry that were brought in to test the Healthcare.gov system a month ago urged CMS not to go live. It also appears that inside the agency who saw what was going on warned leadership months in advance that the system hadn’t been tested end-to-end. Anyone building enterprise software should have the code locked down in the final month and stopped introducing new features 3-6 months prior. Instead, it appears new requirements kept coming in and development continued to the end. The result is online now. (Or offline, as the case may be.)

On September 30, President Obama could have gone before the American people and said that the software was clearly not ready, explained why and told Americans that his administration wouldn’t push it live until they knew the system would work. HHS could have published a downloadable PDF of an application that could be mailed in and a phone number on the front page, added more capacity to the call centers and paper processing. It’s notable that three weeks later, that’s pretty much what President Obama said they have done.

The failed launch isn’t just about “optics,” politics or the policy of the Affordable Care Act itself, which is a far greater shift in how people in the United States browse, buy, compare and consume health insurance and services. A working system represents the faith and trust of the American people in the ability of government. This is something Jennifer Pahlka has said that resonates: how government builds websites and software matters, given the expectations that people now have for technology. The administration has handed the opponents of the law an enormous club to bash them with now — and they’ll deserve every bit of hard criticism they get, given this failure to execute on a signature governance initiative.

Articles worth reading on Healthcare.gov and potential reforms

  • Whenever I see Fred Trotter, I’m reminded that he’s forgotten more about open source software and healthcare IT than I’m ever likely to learn. Last week, he talked with Ezra Klein about the issues with Healthcare.gov
  • Ezra Klein also talked  to Clay Johnson about the lessons of Healthcare.gov (hint: procurement, project management and insourcing)
  • Tough reporting on failures in e-government is critical to improving those services for all, but particularly for the poor.
  • A post by Development Seed founder Eric Gunderson on the open source front-end for Healthcare.gov: “It’s called Jekyll, and it works.”
  • Rusty Foster on Healthcare.gov: it could have been worse. This failure to (re)launch just happened under vastly more political scrutiny and deadlines set by Congress. The FBI’s Sentinel program, by contrast, had massive issues — but you didn’t see the Speaker of the House tweeting out bug reports or cable news pundits opining about issues. The same is true of many other huge software projects.
  • A must-read op-ed by former Obama campaign CTO Harper Reed and Blue State Digital co-founder and former Presidential Innovation Fellow Clay Johnson on what ails government IT, adding much-needed context to what ailed Healthcare.gov
  • A Mother Jones interview that asked whether Reed and other former campaign staff could fix Healthcare.gov. (Spoiler: No.)
  • If not those folks, then how should the administration fix Healthcare.gov? In the larger sense, either the federal government will reform how it buys, builds and maintains software, through a combination of reforming procurement with modular contracting, bringing more technologists into government, and adopting open source and agile development processes …or this will just keep happening. The problems go much deeper that a “website.”
  • Ezra Klein pulled all of these pieces together in a feature on the “broken promise of better government through technology” at the end of the month. (He may have been heard in the Oval Office, given that the president has said he reads him.) Speaking at an “Organizing for America” event on November 4th, President Obama acknowledged the problem. “…I, personally, have been frustrated with the problems around the website on health care,” he said, “And it’s inexcusable, and there are a whole range of things that we’re going to need to do once we get this fixed – to talk about federal procurement when it comes to IT and how that’s organized…”
  • The issues behind Healthcare.gov cannot only be ascribed to procurement or human resources, as Amy Goldstein and Juliet Eilperin reported in the Washington Post: insularity and political sensitivity were a central factor behind the launch..

    Based on interviews with more than two dozen current and former administration officials and outsiders who worked alongside them, the project was hampered by the White House’s political sensitivity to Republican hatred of the law — sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition. Inside the Department of Health and Human Services’ Centers for Medicare and Medicaid, the main agency responsible for the exchanges, there was no single administrator whose full-time job was to manage the project. Republicans also made clear they would block funding, while some outside IT companies that were hired to build the Web site, HealthCare.gov, performed poorly.

  • What could be done next? Congress might look across the Atlantic Ocean for an example. After one massive IT failure too many, at the National Health Service the United Kingdom created and empowered a Government Digital Services team. UK Executive Director of Digital Mike Bracken urged U.S. to adopt a digital core.”
  • In the video below, Clay Johnson goes deep on what went wrong with Healthcare.gov and suggests ways to fix it.

  • Can the White House and Congress take on the powerful entrenched providers in Washington & do the same? I’m not optimistic, unfortunately, given the campaign contributions and lobbying prowess of those entities, but it’s not an impossible prospect. I’ll write more about it in the future.

Does privatizing government services require FOIA reform to sustain open government?

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I read an editorial on “open government” in the United Kingdom by Nick Cohen today, in which he argues that Prime Minister David Cameron is taking “Britain from daylight into darkness. Cohen connects privatization to the rise of corporate secrecy … Continue reading →

United Kingdom looks to put 50 million health records online and increase patient data rights

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This Monday, Minister of Parliament Jeremy Hunt, the United Kingdom’s Secretary of State for Health, delivered a keynote address at the fourth annual Health Datapolooza in Washington, DC. In a rhetorical turn that would be anathema for any national conservative politician on this side of the Atlantic, Hunt commended the United States for taking steps towards providing universal health insurance to its people.

Hunt outlined three major elements in a strategy to improve health care in the UK: 1) applying data more effectively 2) improving transactional capabilities and 3) putting patients in the “driver’s seat” of their own health care. He pointed to several initiatives that support that strategy, from extending electronic health records to 50 million people to sequencing the genomes of 100,000 people and developing telemedicine capabilities for 3 million patients. Given the focus of the datapalooza, however, perhaps his most interesting statement came with respect to personal data ownership:

After the keynote, I interviewed Secretary Hunt and Tim Kelsey, the first national director for patients and information in the National Health Service. Our discussion, lightly edited, follows.

What substantive steps has the UK taken to actually putting health data in the hands of patients?

Hunt: Basically, I have given an instruction that everyone should be able to access their own health record online before the next general election, which means that I will be accountable for delivering that promise. There’s no wiggle room for me. That’s a big change, and it’s also a big change for the system because, basically, it means that every hospital and every general practitioner has to get used to the idea that the data they write about patients will be able to be accessed by patients. It’s a small but very significant first step.

There’s sometimes a disconnect between what politicians direct and what systems actually do. What’s happening with the UK’s long-delayed EHR system?

Hunt: I’ve given a pretty accountable timeframe for this: May 2015. I’ll be facing a general election campaign then. If we don’t deliver, then my head’s going to be on the block. I think it is a valid question, because of course once you set these objectives, then you start to look underneath it. One of the questions that we have to ask ourselves is how many have actually used this. We want everyone to be able to use this, but in practice, if the way they use it is they’re going to have to go into their GP, they’ve got to sign a consent form, there’s some complex procedure, then actually it’s not going to change people’s lives. The next question is about take-up, and that’s what we’re exploring at the moment.

Are there any aspects of the U.S. healthcare system that you think might be worth adopting and bringing back to the U.K.? Or vice versa?

Well, it’s quite interesting. We just had a really good meeting with [US CTO] Todd Park. I don’t think the differences are so great. I mean, on one level, yes, hospitals here are private or charitable, so they can’t be mandated by the government to do anything. And yet, they’ve succeeded in getting 80% of them to adopt EHRs through setting a standard and a certain amount of financial incentive. We can tell our hospitals to do things, but actually, as you said earlier, that’s not the same as them actually doing it.

I think in the end, in both countries, what you have to do is make it so that it’s in the hospitals’ own interest. In our case, the way that we’re doing that is trying to demonstrate that sensibly embracing the technology agenda has a massive effect on reducing mortality rates and improving clinical outcomes. By publishing all of the data about those outcomes, we’re creating competition between hospitals. That, I hope, will drive this agenda.

At the same time, we need to change public awareness. This is the big challenge – this sense that you can actually be in charge of your own health is just, surprisingly, absent in large numbers of people. There’s a very strong sense that lots of people have that “health is something that’s done to me” by NHS.

In the U.S has released data on the disparities in pricing for hospital procedures and comparisons of hospital quality — but you still need to go to places that take your health insurance. In the NHS, is that as much of an issue?

Hunt: That’s a really good question to ask because, in the U.K, for virtually any procedure, you have the right to have it done in any hospital in the country — and yet, very few people avail themselves of that right. So, by publishing surgical survival rates, we’re hoping to create pressure, where people actually say “I’m going to have this heart operation, and I’m not going to go to my local hospital, I’m going to go to this one a bit farther away that has higher success rates.” At the moment, people don’t actually do that; they tend to go where they’re recommended to. That’s where this information revolution can take hold.

What is the most unexpected thing that has happened since the U.K. began releasing more open data about health?

Tim Kelsey: I don’t know if this is unexpected or not, but the most startling thing is that we’ve moved from having one of the worst heart surgery survival rates in Europe to being the best. Heart surgery is the only speciality where we’ve published comparative data by heart surgeons across the whole country.

Do you think that’s an accident?

Tim Kelsey: No, I don’t think it’s an accident at all. Within that data, if you look at what has actually happened, the assumption of the geniuses who actually pioneered the program was that the gap between the best surgeons and the worst surgeons would narrow, because the weaker surgeons would raise their game. That didn’t happen. What happened was that the best surgeons got even better, and the underperforming surgeons also raised their game. The truth is that they want to be the winner, and open data has had a massive impact in driving outcomes and standards.

What are the most important principles or substantive steps that you’re applying at the NHS to mitigate risks or harms from privacy breaches?

Hunt: We have to carry the public with us. We have a very strong free press, as you do, and we’re very proud of that. If they believe that people’s data is going to be used to infringe their privacy, then public confidence in the huge revolution that the dataaplooza is all about will be shaken and lack a massive impact. I think that there’s a very simple way that you maintain public confidence, which is by making it absolutely clear that you own that data. You can choose, if you don’t want that data to be used, in even in an anonymized form, you can say I’m not going to share my data. I think once you do that, you create a discipline in the system to make sure that the anonymization of data is credible, because people can withdraw their consent if they don’t believe it.

Also, you put people in the driver’s seat, because I think people’s motives are different. You and I, as young and hopefully healthful individuals, we’re thinking about privacy. If somebody’s got terrible cancer, he’s actually thinking, ‘well, I would really like my data to be used for the benefit of humanity.’ They’re actually very, very happy to have their data shared. They have a different set of concerns.

I don’t think you’ll have any trouble, for example, getting 100,000 people to consent to have their genome sequenced. These will be people who have cancer, and once you have cancer, you think, ‘what can I do to help future generations conquer cancer?’ The mentality changes. We have to maintain people’s confidence.

I think the best analogy, though, is banking. Perhaps the second thing people care about most after their health is their money, and the banks have been able to maintain people’s confidence. They’re actually doing banking online, so that you can access your bank account from any PC, anywhere in the world. It’s something you can do with confidence. They’ve done that because they’ve thought through the procedures.

In the U.S., you’re entitled to access a free copy of your credit report once a year. Consumers, however, still don’t have access to their own data across much of the private sector. Will the British government support “rights to data for its citizens?”

Hunt:: We are hoping to preempt the worry about that by instructing the NHS that everyone has a right of veto over the use of their own data. You own your own medical record. If you don’t want that shared, then that’s your decision, and you’re able to do that. If we didn’t do that, I think the courts might make us do that.

Kelsey: Just to clarify that point: The Data Protection Act, which is effectively a European piece of legislation, says that people have the right to object to data being shared, in any context, private sector or health or otherwise, or to opt out. We’ve said, because of the rights priority we’re giving to patients as the de facto owner of the data, which is different from the American situation so far.

We’re setting a global standard here, which will be interesting experiment for the rest of the world to watch, that people will have the right to say “I don’t want my data shared” — and people will respect that. Now, at the moment that is not a legal right, that is a de facto right that will be expected. It may well be that we’ll need to simply write down a law that this is an individual’s data and rights flow from that. At the moment, there’s no law that gives an individual patient the right to their own data nor to opt out out of its sharing.