The Politics Of Technology

Lawmakers must consider the ripple effect of legislation on agencies' IT systems.

Effective information technology systems are essential to the nation's business, from collecting Social Security to providing for national defense. These systems must interconnect, and changes to one spawn changes to many others. As a result, every time Congress passes legislation that has a strong IT component, it creates profound technical and financial risks.

A year ago, the Centers for Medicare and Medicaid Services launched Medicare Part D, mandated by Congress to alleviate the often crippling cost of prescription drugs for the 43 million elderly and disabled Americans eligible for Medicare. But the rollout of the program by any measure was less than stellar.

With promises of a seamless transition, the first few weeks were "pure hell," as one pharmacist put it. Many Medicare beneficiaries discovered they were being overcharged for their drugs, assigned to inappropriate plans, or denied benefits altogether. The situation became so bad that more than 20 state governors had to step in and order temporary payment of drug benefit claims for their senior citizens.

Most new large-scale programs suffer from teething problems in their infancy, but Congress helped turn this one into a root canal-without Novocain. The legislation required upgrades to the IT systems of pharmacists, insurance companies, state governments and CMS alike. Upgrading disparate systems that handle huge volumes of data is difficult enough, but it becomes harder still with a political deadline for implementation looming.

More than a dozen critical IT systems at CMS alone had to be upgraded, a process that typically would take 24 months or longer, according to its administrator, Dr. Mark B. McClellan. CMS had 12 months. The tight deadline left no time to test the Part D enrollment process before going live on Nov. 15, 2005, even though CMS admitted there were at least five areas where the process could go wrong.

Making a bad situation even worse, Congress required 6 million low-income seniors and people with disabilities to switch from Medicaid to Medicare on Jan. 1, 2006. Lawmakers wanted Medicare beneficiaries to have the option of choosing from at least 20 insurance drug plans-the actual number varied by state-resulting in mass confusion. Many beneficiaries had to sift through more than 50 plans-Oregon had 70-to find the one that best met their needs. Even Medicare specialists were confused: Beneficiaries who called the help lines received wrong answers 41 percent of the time.

The confusion meant that many beneficiaries didn't decide on their drug benefit plan until just before the program went into effect. This created a flood of enrollment paperwork, which overwhelmed CMS and the company responsible for processing and verifying eligibility.

Medicare Part D is only the latest case of what happens when Congress passes legislation that is critically dependent on information technology without considering the full impact on the people, processes and technology needed to implement it. Other examples abound.

Many of the problems with IT modernization at the Internal Revenue Service, for instance, can be traced to Congress. Every change to the tax code creates ripple effects on myriad IRS information technology systems. Every piece of tax legislation, which is usually vague and complex, must be interpreted, defined into a process that can be automated, coded, tested and made operational by the next tax season, if not sooner.

At least 84 new tax laws and more than 14,000 changes to the tax code have churned through Congress since 1986. It's no wonder the IRS modernization project has been on the Government Accountability Office's high-risk list since 1995.

It is probably a forlorn hope that Congress can stifle its desire to play systems engineer or software architect in such situations. One way would be to require an IT impact statement, modeled after the Environmental Protection Agency's environmental impact statement, for every major piece of legislation being considered. The statement would provide full and fair discussion of significant effects on information technology, informing decision-makers and the public about alternatives that could avoid or minimize adverse technical, financial or social consequences. It would help Congress recognize realistic IT goals and expectations, rather than ones based on political wishes-no matter how well intended.

The next big thing that is on the congressional IT agenda is electronic health records. President Bush has set a goal for all Americans to have interoperable electronic health records by 2014. Cost estimates for implementing such a system range from $100 billion to $300 billion. But none of the estimates currently takes into account Congress' penchant for software design by legislation. There are nearly 50 pieces of legislation before Congress that affect electronic health records, the passage of any one undoubtedly having major IT design, operation and cost implications.

As officials in the United Kingdom discovered, politically inspired technical decisions on electronic health record implementation are spinning off billions in unexpected costs, putting the entire effort at risk.