Jennifer Laughlin Mueller, CIO, Watertown Regional Medical Center, Chapter 1

If you ask Jennifer Laughlin Mueller how she achieved her career goals, she’ll tell you that it was through hard work, taking advantage of golden opportunities, and being visible. “You say yes to things you might not know anything about,” says Mueller, who has learned a tremendous amount during her 17 years at Watertown. In this interview, she talks about the major changes her organization faces with a recent affiliation to LifePoint Health — and how her team is already leveraging its resources; how physician engagement has evolved from “arm-twisting” to a true partnership; and her vision for state HIEs. Mueller also shares the advice she’d like to give all young women, the attributes she values most in aspiring leaders, and the conversation with a CEO that was a career-defining moment.

Chapter 1

• About Watertown Regional MC
• Affiliating with LifePoint — “We’re trying to feel our way through the transition.”
• Upgrading to Meditech C/S 5.6.7
• Optimization visits
• Establishing governance structure & processes
• Physician IT advisor as a “liaison”

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We are working to establish a governance process or structure in order to start prioritizing and figuring out where’s the low-hanging fruit, what can we do fairly quickly, and who’s going to do it. That’s a big project.

We’re in the spot now that I would describe it as a bit of chaos, because many providers are utilizing the system in many different ways. We need to get back to what’s the best practice and establish workflows and get back to the elbows of the providers and train and implement a little more consistency.

If you don’t clean up the workflow, it doesn’t really matter what EMR system you have in place, it’s going to be chaotic. I’m hoping that by streamlining and structuring this, we will be able to raise the satisfaction with the system.

As we get new physicians into our community, they would never go back to paper. It has been great seeing that arm-twisting, if you will, is just not necessary anymore.

Gamble:  Hi Jennifer, thank you so much for taking some time to speak with us today.

Mueller:  You’re welcome. I’m glad to be here.

Gamble:  Great. So to give our readers and listeners some information, can you give an overview of Watertown Regional, in terms of where you’re located, number of beds, things like that?

Mueller:  Watertown Regional Medical Center is located in Southeastern Wisconsin. We’re about halfway between Milwaukee and Madison, and about two and a half hours north of Chicago. We are licensed for 95 beds; however, we staff about 55 beds currently at the organization. Just to give you some stats, we have about 1600 admissions, about 19,000 ED visits per year, and 250 births. Most of our volume is really in our clinics. We have 14 clinics spanning most specialties — primary care, ophthalmology, urology, women’s health, orthopedics.  We have a variety of specialties and clinics in our primary and secondary markets. Recently, actually as of September 1, we affiliated with LifePoint Health, and so we’re working through the integration process with their organization as we speak.

Gamble:  So you’re still kind of feeling out how that’s going to work as far as that affiliation?

Mueller:  Yes. Our relationship is brand new, so we’ve had a good time already working with a lot of the folks and incorporating and trying to integrate with them in my role specifically as it relates to IT. I can get into that a little bit later as far as some of the projects we’re working on, but just overall as an organization, we’re just trying feel our way through the transition from a nonprofit organization to a for-profit organization. So we’ve had a little bit of change in the last couple of months.

Gamble:  In terms of the clinical application environment at Watertown, what do you have as your EHR?

Mueller:  Right now we’re on Meditech Client Server 5.6.6 — we’ve been on that since 1998. We are in the process of going to 5.67, which is going to be live on December 15, in our hospital. And our clinics use LSS. LSS is actually now owned by Meditech, so they’re a very, very integrated product, and we’ve been on LSS in our clinics since early 2000s, around 2001 or 2002.

We’ve done really well on their systems. We’re recognized as a stage 6 hospital, and we’ve been recognized as a Most Wired organization for 11 years. We’re participating in Meaningful Use stage 2, year 2, and we were the first in the state to begin working with our state health information exchange, WISHIN. So we’ve had a lot of success on Meditech and LSS.

Gamble:  And as far as going to 5.6.7, is there anything major there or is it really just upgrade?

Mueller:  It is definitely going to give us a few more pieces of functionality. One thing I know physicians have been waiting on are the ability to place future orders, so if there’s a patient coming in for, say, a colonoscopy in two weeks, they can place the order for the colonoscopy today for that procedure in two weeks. Right now, we can do that, but we have some workarounds in place to get that accomplished. Another big one is the ability to electronically prescribe controlled substances. The laws have changed to allow that, and so now the functionality just needs to catch up. So that’ll be another big one.

Gamble:  So I’m sure it’s still a lift, but maybe not a major lift on your end?

Mueller:  Right. Definitely, it’s an upgrade. It’s major, but it’s not as big as we’ve had in the past.

Gamble:  Okay, so I want to get into some of the other priorities on your plate, but first let’s talk a little bit about LifePoint and that integration, and maybe how you see that going.

Mueller:  Well, it might be a little bit too soon to get into that specifically. However, some of the things that we are working on — and they are certainly involved in with us — is recently we had what was called an AIM visit or an optimization visit where we went out to all of our clinics with a group of folks. We were really at the elbows of our providers, watching them and listening to their frustrations. We’ve been trying to give them tips for optimization and things that they’ve seen in other hospitals and clinics in the LifePoint family, and as a result of that visit — they were here for a week — we have really a long list of things that we see that we can improve on.

Right now we are working to establish a governance process or structure in order to start prioritizing and figuring out where’s the low-hanging fruit, what can we do fairly quickly, and who’s going to do it. That’s a big project that’s going to be kicking off here pretty soon. So that’s on our clinic side of things.

On the hospital side, too, because we’ve been using Meditech for so long, we actually really enjoy it and do really well on that side, so I think they were actually able to take some things away from how we do things as best practice.  So that was really good.

Gamble:  It’s interesting about the optimization visits. You said governance is something that needs to be done right away, because I can imagine it’s difficult to prioritize those tasks. How do you plan to address that, and who will be part of that group?

Mueller:  Certainly we’ll include providers. One of the things that helped us with buy-in and rolling out the electronic medical record over the past 10 years-plus was the ability for us and the system to be flexible and to customize it. It was, ‘hey doctor, please use our system. We’ll customize it any way you want.’ Well, after years of that, we’re in the spot now where I would describe it as a bit of chaos, because many providers are utilizing the system in many different ways. We need to get back to what’s the best practice and establish workflows and get back to the elbows of the providers and train and implement a little more consistency, especially because we have an integrated product. If we make a change in the clinic side of things, it affects how it’s viewed in the emergency department, the OR module, the inpatient side, things like that. We have to go back to the beginning, if you will, and work through some of the major workflows and establish best practices.

Gamble:  Right. I would think having that governance in place kind of gives you something to point to when you are kind of inundated with requests, you can point to this and say okay, this is where this is on our list.

Mueller:  Definitely, yes. We have a physician IT advisor, Dr. Steven LeGrow. He has been wonderful. He’s a family physician in Watertown, and he has been a really great liaison between our IT department and our medical staff, so he really helps field complaints. He also is the guy who communicates changes — he puts together these little short vignettes on YouTube on how to place an order and things like that. I envision continuing to use him in that role and helping us to communicate with our medical staff if things change or about the priorities that are established.

Gamble:  Looking back at the evolution that the organization has undergone from an IT standpoint is very interesting, because you have all these lessons learned from over the years, and I would think sometimes it can get a little overwhelming having so many of those lessons learned and trying to figure out just how to tweak the system.

Mueller:  Right. It’s definitely going to be a huge challenge going backwards, if you will, but it has to be done. I think everybody’s feeling it at this point because their frustration level is at the point where, is it the EMR system or is it our processes? If you don’t clean up the workflow, it doesn’t really matter what EMR system you have in place, it’s going to be chaotic. I’m hoping that by streamlining and structuring this, we will be able to raise the satisfaction with the system.

Gamble:  Looking back at the early days of being on that EHR system, have you noticed a pretty significant difference in physician participation levels?

Mueller:  Our medical staff is amazing. They adopted our EMR very quickly. We’ve been utilizing CPOE, for example, since 2005. We’ve been using eMAR and bedside medication verification since then as well. We’ve been paperless since 2009. We don’t even have medical records in a file in our medical record department. We just don’t have any paper. So it has been really fun to work with this medical staff. And now as we get new physicians into our community, they would never go back to paper. It has been great seeing that arm-twisting, if you will, is just not necessary anymore.

Chapter 2