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Good IT System, Vague Implementation Strategy a Challenge for One CIO

The Nevada Cancer Institute had the money to build a world-class facility. But equipping it with leading-edge technology required more than just dollars when a new CIO discovered the lack of an implementation plan.

The Nevada Cancer Institute learns it takes more than a dream budget to build a world-class medical center.

When Richard Faircloth became the CIO at the Nevada Cancer Institute, it seemed like he had hit the jackpot:

He would be in charge of IT at a brand-new, state-of-the-art medical facility financed by big-time casino money. As is often the case in Las Vegas, however, the reality turned out to be quite different from the dream.

The institute was building a glitzy new facility on the edge of the desert, but for all its cutting-edge technology, there was no good plan to make it all work together. Some of the high-tech gear turned out to be impractical. In exam rooms, outlets were on the wrong walls. The mission-critical core electronic medical record (EMR) system needed serious adjustments. All in all, the road to world class turned out to be surprisingly bumpy.

"There was no plan on how to get everything magically running," Faircloth says.

"IT," adds Phillip J. Manno, the chief of clinical oncology at the institute, "has been as stressed as you can get."

Faircloth was the institute's second CIO before the new facility even opened. He joined the institute in April 2005 after the first CIO returned to the casino industry. Faircloth says he inherited a good IT system but only a vague implementation strategy -- and a six-month deadline, which ultimately came down to a four-week race to the finish to complete the data center build-out.

"I was given a four-week window from the time we were given the keys to the time we were seeing patients," says Faircloth. "But the plan to get this up and running wasn't there. They kind of knew what they were buying, but not how they would put it together. The vendors were told, 'Configure wherever you want, and hopefully it will all work.'"

Vendor Management

So, Faircloth devised his own plan: He found a vacant data center in town to rent, where vendors could work on configuring the gear before the move to the new facility. There was no time to order equipment racks, but Las Vegas has no shortage of banquet tables, so the installers spread out their networking gear like a high-tech buffet.

"I had to get them all in the same room working together," Faircloth says. "I had EMC, Cisco and Dell in different corners. The vendors were stepping on each other's toes."

Faircloth soon discovered that getting vendors to work together was one of his biggest headaches -- a change from the casino business, where vendors enjoy lucrative business for years to come and bend over backward to be helpful. "When you do a deal with a casino, they want to hold your hand until you're 100% supported," Faircloth says.

At the institute, Faircloth was dealing with half a dozen major vendors. One provider that he won't name installed the gear and left before the CIO could blink.

"How do you turn this thing on?" Faircloth wondered. "They left an 800 number. That's not acceptable."

Faircloth found himself on the phone with the CEO of at least one supplier. The installer who flew home wound up flying back to Las Vegas a couple of days later.

"Vendors were mad at me," Faircloth says. "I want implementers. At first these guys just wanted to install and leave; they couldn't hit McCarran Airport fast enough. They didn't go through IT training and the users' side. [I said],'You can't leave until we're up and running and we can support this.'"

Then, one Friday in September 2005, the Nevada Cancer Institute closed its small clinic in Las Vegas and spent the weekend moving into the new facility. On Monday the new building greeted its first patients. There was even a fireworks show.

"We put in some more hours than we thought we might," Faircloth says. "You just manage your problems until you're up and running. It's the third or fourth data center I've put together or moved in my career. No one thought we could do it in two weeks."

A Don't-Say-No Policy

Walk into the lobby of the Nevada Cancer Institute, where a colorful blown-glass chandelier by artist Dale Chihuly hangs dramatically, and the receptionist will offer you bottled water. Room temperature or chilled? she asks.

"Hospitality is key," Faircloth says. "We're not a normal hospital. We put the guest -- the patient -- on a pedestal. Everything here is designed to make them feel like a king or queen."

Faircloth walks into a large, sunny room. Floor-to-ceiling windows flood the area in light, while a panorama of the Las Vegas Strip unfolds in the distance.

"We gave them the nicest views," he says.

Patients recline in comfortable chairs watching cable TV on private screens with headphones while an IV dispenses treatment. Off to the side, other patients work on laptops in small private offices while receiving their medicine.

This is the infusion room at the institute, where patients undergo chemotherapy. Some spend eight hours a day for a week here.

"We try to make it as comfortable as possible," says Susan Caramico, nurse manager of clinical oncology.

That seems to be the whole philosophy of the institute. There's a library where patients can check out books. A meditation room with falling water and faux candles. A gift shop that sells wigs and "Cancer sucks" T-shirts. Even the research labs have expansive views of the crimson-colored crags of Red Rock Canyon to the west.

"You can tell it's a Nevada facility," Faircloth says. "You don't say no here; anything is possible. I seldom run into obstacles; it's always, 'Let's find a way to do it.'"

In 2002, Heather Hay Murren founded the nonprofit Nevada Cancer Institute. She was the lead consumer products analyst at Merrill Lynch when she volunteered at a Las Vegas medical clinic and was shocked to discover that the fastest-growing city in the country had no decent cancer treatment center.

"The joke was if you needed treatment for cancer," recalls Faircloth, "you were told to go to McCarran Airport."

Murren quit her job and -- with her husband, Jim, who happened to be president of casino giant MGM Mirage -- started raising money for an institute. So far, they've raised $70 million: $40 million in private funds and the rest in a state-backed bond issue.

In 2003 the institute broke ground on land donated by the Howard Hughes Corp. and the Rouse Corp. in the upscale Summerlin district of Las Vegas. Marnell Corrao Associates, which built many of the mega-resorts on the strip such as the Bellagio, designed a four-story, 142,000-square-foot facility to treat patients and conduct research. The project cost some $52 million.

"We're here to cure cancer," Faircloth says.

The Casino Network

When Faircloth was hired as CIO, he had six months to get his IT shop up and running. Most of Faircloth's experience was in the banking, resort and casino sectors. His résumé included stints at the Summa Corp., Golden Nugget Inc. and MGM Grand, where he was involved in opening a 5,000-room hotel and casino, the largest in the world.

Although Faircloth was new to the medical industry, he had lived in Las Vegas since 1968, was familiar with the local IT scene and knew how to get things done in the town.

And the institute's connection to the MGM certainly helped. The hotel donated a pile of networking equipment. "I can call the MGM and say, 'We need help,' and they'll lend us someone," Faircloth says.

Faircloth's first move was to look at the plans he had inherited. From the get-go, the institute wanted to implement an EMR system. The original idea was to use a template developed by another cancer institute, which happened to be an inpatient facility instead of an outpatient clinic.

Dr. Robert Comis, president of the Philadelphia-based Coalition of National Cancer Cooperative Groups, notes that EMR technology is still in the early stages, and some deployments have been painful.

"CIOs are essential," he says. "You need a progressive platform for your own institution and interfacing with other systems. EMR penetration is not huge. People have been talking about EMR my whole career. But in the future, an EMR system will become the hub of a whole variety of spokes of information. All institutions grapple with how much they do on their own or how much they want to adapt to take off the shelf. It's a struggle."

That certainly proved true at the Nevada Cancer Institute. Faircloth inherited an IT staff of four, none of whom were that familiar with the selected EMR vendor, IMPAC Medical Systems Inc. Faircloth immediately hired a project manager as well as systems and network experts, picking ex-IMPAC employees for their domain expertise.

"There's not a lot of EMR out there developed for cancer research," says Dr. Manno. "We were looking for a software program that would warehouse all data on our patients so that it could be mined."

The EMR template then needed months of workflow revamping to adopt it to the way the institute does business. "Not many cancer centers have everything in one building," Faircloth says. "We're one stop. We can turn around labs and MRIs in a couple of hours. We have a different philosophy of patient flow. That took six months to get correct."

The Doctors' Experience

While the institute was being built and the kinks were getting worked out of the EMR system, doctors worked with paper charts at a small clinic in Las Vegas. Then one day, Faircloth flipped a switch and the business went paperless overnight. It wasn't a painless transition.

"Doctors are not computer people; they don't feel they should be doing data entry," Faircloth says. "There were a couple of times we had some uprisings, 'This isn't working, let's go back to paper. I need my charts.' I've kept the focus that everything needs to be electronic. The hub is our EMR system."

Manno recalls the frustration.

"The learning curve was very difficult for a lot of physicians, myself included," he says. "I've been on computers since 1977, but the software program needed to be tweaked. The IT center was being developed with state-of-the art equipment, but the software program that was chosen created difficulties. It was not up to speed to make a totally paperless environment. We've had to make it fit with a great deal of frustration. I'm still not totally happy."

There were other problems as well. The institute went through a couple of dictation software programs before finding one that met its needs: the Dragon product by Nuance Communications Inc., in Burlington, Mass.

The original plan called for doctors to do much of their work on wireless tablet PCs. But the doctors found the screens too small to view spreadsheets or examine images. The battery power didn't last long enough. People kept knocking them off tables.

Eventually Faircloth changed course and put PCs into exam rooms, which required re-wiring the walls.

"If we ever build a building again, we'll be able to do it a little better," says Manno.

The institute has also redrawn the org chart to make IT more central to the business. Faircloth originally reported to the CFO but now works with President and COO Sandra Murdock. And Faircloth has tried to change the way IT deals with its clients.

"They expected IT to do everything: [to] know how these systems work and would be implemented," he says. "Now we're working more closely with the operating departments. Before it was, 'Rich, go out and find out what's the best and get it running tomorrow.' IT can do that, but it should not. You fail more than you succeed when you don't have input for the products. I've been pushing it back at them."

And yet for all the potholes along the way, Faircloth says the institute finally seems to be coasting along.

"I've opened quite a few places," Faircloth says. "I know the steps that need to be done. It comes down to having the right people and a good plan. Now I get more help calls about a bad Internet connection in a hotel across the country than I do about our systems, and that's a good thing."

Michael Ybarra is a contributing writer for Write to him at

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