Oregon’s ACA Healthcare Website Failed, Too. But The Reason Why Could Spell Direct Primary Care Success.

The state of Oregon has paid software giant Oracle over $100 million to build a healthcare exchange site. Unfortunately, it doesn’t work. And now it appears that Oregon is stuck with Oracle because they can’t hire another firm to finish the job. This is case and point of an old-school IT provider lagging behind the current trends in building massive web operations i.e. the open source approach used on mega-scale websites like Google and Facebook.


Last September, Oracle realized that the site wasn’t going to make the October 1 launch date, so Oregon stopped paying Oracle. The company worked until last week, though, according to Wired, and then pulled 100 contractors from the project. They also demanded $69.5 million for the work they had completed since September. This week, The Oregonian reported that the state settled on paying Oracle $43.9 million of the outstanding bill so that Oracle could resume working on the project.

You might think that Oregon officials would have been happy to see Oracle go, considering their $100 million site is still broken. However, getting the service to work properly will likely depend on Oracle’s contractors. It’s the classic case of corporate job security — where a lousy employee can’t be fired because they “know” something that will cost the organization if they’re let go. So for now, Oregon needs Oracle. But that’s only part of the problem, says Wired, “Oregon, like so many other IT customers over the years, is now locked into a contract with a vendor and has few options other than paying the company more or starting the project over from scratch.”

Some have called Healthcare.gov an unprecedented project. However, there are companies that have approached similar problems. How about Amazon, Google, and Facebook? They have infrastructure in place that supports millions of daily users. And when these companies face problems scaling up to user demand, they don’t go to outdated companies like Oracle. Instead, they turn to the open source community. Even better, when Facebook couldn’t find the open source tools they needed, they built their own, and then gave them back to the online community.

Red Tape Could Also Be Called Broken Government
Actually, government agencies have used open source. Turns out, the original Healthcare.gov interface — i.e., the part that actually worked — was open source. NASA was behind OpenStack, a system for placing Amazon-style clouds within your own data centers. And this is ironic: The National Security Agency, built its own infrastructure to support its massive (and disturbing) surveillance projects using open source software. It even built its own open source database system that was inspired by a Google researcher paper.

But these open-source efforts of the NSA put them in a bind with the Senate oversight committee. They weren’t in trouble for constitutional violations, but for building open source software instead of buying from a company like Oracle.

Clay Johnson, a former White House fellow who also co-founded the company that built President Barack Obama’s campaign website, wrote for the New York Times that the way government agencies buy software is badly broken. We’ve seen this all over the place. Just look at the state of EMR. Companies are raking in tons of cash based on think tank research papers promising major savings, only to find the results lackluster, and the promised saving unfounded.

Wired writes that the buying process is “convoluted,” and that it benefits the entrenched players — ie. the Oracles — who can more wisely navigate the “rules” i.e. the red tape. However, these newer companies are the ones better versed in current tools, technologies, and trends.

So what’s this have to do with direct care? For one, we are that new, young company up against the Oracles of primary care — the patient mills, the EMR sycophants, the prescribe your way to profit mentality that is outdated, and needs to change. We are the ones using today’s technology, and an open-source approach. Just check our direct care EMR software for proof. As opposed to Oracle, who tied up millions by hermetically sealing their knowledge, we offer free consultations on our healthcare model. No joke: email us, text us, call us anytime. We are well aware that in order to overcome the old dogs of healthcare — the megalomaniacal companies and the oppressive government policies — a large number of doctors, patients and even insurers are going to need to freely communicate and collaborate. Only then can we scale up and start providing quality healthcare where and when it’s needed.