Since my original impression that the debut of the Healthcare.gov web site was a technological disaster, I’ve contended that the website could be created for much cheaper, and be much easier to use than the mess that was delivered.
There finally seems to be progress in this direction according to today’s New York Times article, HealthCare.gov Is Given an Overhaul. I was quoted by Robert Pear:
“Instead of being user-friendly, the original website was user-hostile”
Basics of Data Entry Systems
We at FMS have created countless database systems where data entry played an important role. Unlike fancy graphics filled systems that look nice, data entry systems must be designed with a focus on ease-of-use by the end-user to enter, review, and update their information. If there are many questions and complex relationships, users need to be able to see as much of that on one screen as possible. If multiple screens are required, being able to move back and forth between screens without losing data and having changes in one screen reflected on others is critical for an efficient and intuitive user experience.
Data Entry Systems Should Target Users with Large Screens
For complex tasks such as writing a paper or working on a large spreadsheet, computers remain the preferred platform for getting work done where people can have one or multiple large screens. Serious data entry applications should target that user.
Mobile Apps Have a Role, but Not for Serious Data Entry
While mobile applications have a place, it’s not appropriate for complicated data entry since one question per screen is very inefficient. Not being able to see previous entries and pressing Next and Back for each question drives users crazy. The original designers of the Healthcare.gov web site designed it as if it were a simple, consumer mobile app meant to be filled out with a few finger clicks. They were either paid by the screen or just clueless about what a business data entry system requires.
Initial Request for Information Should be Anonymous
The purpose of the public facing Healthcare.gov website should be focused on helping prospects with the buying process. People need to quickly browse the health insurance options that are available to them in their state and cost estimates. The initial data entry should be the minimal anonymous information necessary to produce those results such as gender, age, zip code, family size, etc. Nothing personal such as names, social security numbers, email address, etc.
Automating a Paper Form
Only after customers have made a decision to buy should they be required (and expect) to provide more detailed information. This application feature is the core of the public facing Healthcare.gov website and is simply the automation of a 12 page paper form. It shouldn’t be that difficult.
We at FMS have automated paper forms for decades. Recently, we did this for a series of paper documents at the National Archives. The cost of doing this was in the tens of thousands of dollars, not the hundred of millions that Healthcare.gov cost.
Separating Data Entry from Complex Validation
A high volume, data entry system like Healthcare.gov should be designed to collect the user’s information as quickly as possible without trying to validate everything with other government systems in real-time. The cross-validation of information against IRS, HHS, Homeland Security, and other databases should happen in a background process that can withstand slowdowns or down times of dependent systems. This separates the complexity and risk of linking multiple systems together, manages the load on the other systems, and lets the user get done quicker. If a problem is detected later, an email can be sent to the user to fix the mistake or invalidate their application. Regardless, none of that needs to happen while the user is entering their data. After all, it’s not as if they were going to get insurance immediately upon pressing Submit.
It remains shocking to me that it cost taxpayers hundreds of millions of dollars initially for the broken Healthcare.gov site, and hundreds of millions dollars afterwards to the same contractors to fix it. The procurement process and incentives are completely inverted for creating and delivering quality software. It’s outright theft, but no one seems to be held responsible for it, and lots of people profiting mightily from it.
Conclusion: Data Entry Systems Aren’t Difficult If You Know What You’re Doing
I’ve contended that we at FMS could have created the public facing Healthcare.gov site for $1 million. Some people scoff at that, but in our world and that of our customers, $1 million still goes a long ways. We created an international humanitarian relief logistics system for the United Nations for half that amount, and it supports full language localization as it’s deployed in 80+ countries. Healthcare.gov didn’t even support Spanish when it debuted, and that was one of its original requirements.
Creating a good data entry system is not rocket science. This is not something that needs to be done in Silicon Valley. What’s needed is a team who’ve done it before and know what they’re doing. Creating this type of solution requires a solid database foundation, understanding the user needs, creating an intuitive user experience, and building it so that it’s maintainable over time. It’s not something that can be created by people on their first paid programming job, but it’s not a rare skill. I’m proud that my development team at FMS have been with me for decades and continue to deliver systems that just work.