The US governments healthcare portal is under emergency care, afflicted by ailments that have sickened many government IT health systems worldwide.
Two weeks after it opened, users still struggle to gain access and sign up for insurance under the terms of the Affordable Care Act, President Barack Obama's signature legislation.
Financial, technical and managerial missteps caused the crisis, and fixing the $400 million system could take up to two months, the New York Times wrote on Sunday.
The causes for the fiasco are varied and include unfeasible deadlines, scalability issues and bickering politicians.
However, the US isn't alone; the problems and their causes are common around the world as many governments struggle to make e-health a reality, according to Charlotte Davies, lead analyst at Ovums Healthcare Life Sciences team.
"The portal has suffered from the usual lack of infrastructure to process all the requests. That is not a unique problem," she said.
In general, the success of e-healthcare initiatives in the public sector largely depend on political consensus, lack of which has impacted the US project.
One of the criticisms levelled at the Obama administration is that deadlines have been too tight. That usually stems from politicians who think they have a very limited window to accomplish what they want, according to Davies.
In the Britain, the implementation of the Universal Credit welfare reform project, by the Department for Work and Pensions, was recently criticised for similar reasons.
"The Departments plans for Universal Credit were driven by an ambitious timescale, and this led to the adoption of a systems development approach new to the Department," said Amyas Morse, head of the U.K. National Audit Office, in a statement.
Other common problems are bad architectures; lack of user involvement; and procuring systems that are too rigid, according to Davies. All three issues could have impacted the US portal.
Beyond government agencies and the consultants they hire, the software industry also is to blame.
"Traditional vendors who have sold bespoke software packages have tended to market and sell proprietary systems that require a lot of customisation and aren't very flexible," Davies said.
Often a lack competence combined with this complexity creates a "perfect storm," according to Davies.
Despite the shaky start, Davies thinks the US federal government is on the right track.
"President Obama making healthcare accessible and widening the pool for insurance for people on low incomes is essentially the only way forward if they want to reduce the overall burden of health care costs in the long term," Davies said.
The plan in the US is still for coverage to begin on Jan. 1 and then to close open enrollment on March 3.
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