doesn’t need a tech surge, it needs better primary care


The Affordable Care Act is off to a rocky start, to say the least.

Attention has been focused on, where those without employer-provided insurance can shop for health plans.  Finger pointing abounds, with the Centers for Medicare & Medicaid Services and contractors blaming each other.

A story in the Wall Street Journal chronicles the debacle:

The contractors said each of their pieces worked more or less as intended, but the website was nearly paralyzed when they were bolted together. The federal agency overseeing the site also took on the job of integrating the many parts of the system—an unusual arrangement for such a complex project.

Testing of the complete package took place in the final two weeks before the launch and revealed problems, contractors said. But they couldn’t name who in the government was responsible for addressing the problems or making key decisions.

It appears that the dozens of contractors were working on the site without a single entity “quarterbacking” the project.

Indeed, White House spokesperson Jay Carney was asked who was supervising the many moving parts.  His response: “This is on us. And that goes from the president on down.”

You mean the president, who didn’t even appear to be aware of the problems of the site before going live?

Let’s think of like the American patient.

First, according to a New England Journal of Medicine study, Medicare patients today see 7 different doctors in a given year: two primary care physicians and five specialists working in four different practices. had dozens of contractors working on it, rather than a single entity building the site.

Second, electronic medical record systems from various care venues often don’t talk to one another.  Consider a typical patient who was recently admitted for congestive heart failure.  He may have separate records on three different systems: one from his primary care doctor, another from the hospital, and yet another from his cardiologist. This is similar to, which has trouble accessing information from separate non-compatible systems like the IRS to determine subsidies and private insurers for health plan data.

And finally, the primary care shortage contributes to many patients being without a “quarterback” to coordinate their care. also lacked a clear, accountable authority figure.

It doesn’t matter when you’re a patient or a website.  If you have too many mismanaged parts — even if they work well in isolation — it breaks down when put together. needs a stronger leader to coordinate its care.  In other words, akin to a primary care doctor.  The much publicized “tech surge” sounds like the government is sending it to see more specialists at leading academic medical centers.

Which is exactly the last thing this patient needs.

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor,, also on FacebookTwitterGoogle+, and LinkedIn.

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