A Glimpse Of The Federal Health Information Technology Initiative Challenges
Few can take issue with the advantages such a system could offer, but even fewer can realistically expect that this initiative will succeed where previous ones have not. The daunting challenges were brought into sharp focus on a recent visit to a comparable Federal system.
I accompanied someone to a Social Security Administration (SSA) office, the first time I’d ever been in one. The visit was illuminating on a number of levels, but perhaps the most was in recognizing the sheer, massive scale and scope of the production systems that the SSA uses. We were there for a good part of the morning, mainly waiting, and it occurred to me that the Health Information Technology Initiative could well benefit from the SSA’s operational experience.
One of the notable observations was the amazing lack of paper that was being used. However it may be stored and managed, the massive amount of data is embodied in electronic form, much more so than most large insurance or financial offices that I’ve seen. And it makes sense: There aren’t enough trees for the paper that would be needed, or file cabinets to store it, or concrete to make the floors on which those file cabinets stood, or steel to make the rebar.
This particular SSA office is in a very nice, horsey-set area, where most of the cars are Lexus’ and MBs and BMWs and the like. The building was part of a nice upscale office campus in keeping with the area, but entering the office’s public spaces was somewhat akin to going to East Berlin before The Wall came down. I half expected to see something out the movie Brazil, with open frame computers and five inch CRTs with magnifying glasses in front. But the workstations had seventeen inch LCD monitors and were current, as were the networks and, presumably, everything else related to IT infrastructure.
It all runs, and has been for some time. Not just at that local office, but probably everywhere, as databases in Washington DC and Virginia and myriad other places were being queried for us and everyone else at that office and all the other offices around the country. With a ‘database’ as enormous as the SSA’s is, doing a complete snapshot backup must be physically impossible: Data will change while a disk platter moves less than a millimeter or a charge is deposited on a solid state memory device somewhere, and concurrency of data for real time redundancy poses some interesting issues in physics that are on the border of philosophy.
It also occurred to me that changing such a system is close to impossible, for many of the same reasons as doing a complete data backup. The risk of breaking something is extremely high. So changes that increase operational efficiencies have to be done in very small increments at a very slow pace, which must be amazingly frustrating to the SSA staff as they have to continue using procedures that they know can be streamlined in light of experience, but cannot speedily improve due to the limits of technology.
All in all, the SSA’s management of information technology is impressive, and anyone else who has to contend with massively huge information systems would do well to study it.
© Copyright 2009 Chuck Brooks for FutureWare SCG
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