Episode 10: Interview with Infusion Nursing Veteran Judy Back

Dylan McCabe: WeInfuse podcast episode, number 10, welcome to the WeInfuse podcast. My name is Dylan McCabe. And each week we give you a behind the scenes look at the infusion practice because we talk with infusion practices all over the US and we interview people in the infusion industry, whether nurses, providers, consultants, business, people, and everything in between, so that we can give you tips, tactics and a roadmap to streamline and simplify your own practice. We like to say, we take the confusion out of infusion, and I’m excited about this interview because it’s with Judy Back and she’s on our client success team here at WeInfuse. But Judy has been in the infusion space since the mid-80s, she’s been an infusion nurse. She has been in medical device sales. She has been involved in doctor’s offices, hospitals. She’s been involved in nurses’ education for years. She really is an expert when it comes to how to streamline the infusion practice, how to really focus on patients, how to make everything patient centric, because you and I both know that it’s really easy to make this all about the numbers and the concerns and the practice, but Judy just does a great job of bringing it back to what it’s really all about, and that is taking the best care possible of the patient. Getting patient access for these incredible life-changing therapies that are made possible through infusion so let’s jump right in with the interview with Judy here we go. All right, welcome again. And like I mentioned, we have a special guest on today and her name is Judy Back. And, Judy, thank you for being on the show today.

Judy Back: Thank you for having me Dylan.

Dylan McCabe: And the cool thing about Judy is she has been involved in the infusion practice since the eighties. She’s got a lot of experience. She’s had different experience in different medical contexts, all over the US from medical devices to infusion therapy from nursing homes to doctor’s offices, to hospitals she’s really seen a lot. And so it’s really neat to have her, and she’s also on the WeInfuse team, which is really exciting. So Judy, before we jump into my kind of standard list of questions I guess, just share some highlights about your background and what led to this point.

Judy Back: Okay. Well, in 1985, I graduated with my bachelors of nursing at UTA and started just doing general nursing, mainly in emergency rooms. And then I learned real quickly that I love Ivy therapy and I wanted to get better at it. And so my preceptor, I said, how can I learn to really do a good job? And she said do it just make it happen. And so she said, okay, well, if you want to do that, then you’re going to start all the Ivies today in the emergency room. Well kind of scared me a little bit. And I said, well, what if I miss? And she said, well, just do it over again. You’ll get it. And after about three weeks, I thought I was an expert.

Dylan McCabe: Oh, wow.

Judy Back: But it is true. The more you do it, the better you get. And it’s one of those like ride your bicycle and you’ll get it. And then I just progressed from working in hospitals and supervisory positions. And I was always the one they came to, and then I needed an IV because I just never had trouble. I guess it was a gift from God. I always pray before I start one, Oh God, please help me. Cause I don’t want to hurt the person. But so, fast forward to 2001, I went to work for a man by the name of Robert Norris at his home health company in Arlington, as his infusion director. He wanted to start an infusion program during that tenure or that little bit of time there, I kind of had an idea that a friend of mine in Abilene was doing. And I said Mr. Norris, would you like to hear about this opportunity? And because he’s quite an entrepreneur, he said, yea can you come over to my office right now? I want to hear about it. So in all of that, by December of that year, we had formed a company called innovative infusions. And that was a management company that went into our doctor’s offices and started there. I started in the infusion center for them. It was early on when biologics just began to come out. And, so at that time we were also doing antibiotics. So that meant I had to have nurses around the clock or seven days a week, because how can you take an order from a doctor for seven days of Rocephin and not stay open on Saturdays and Sunday? So we had to open. So we had quite a crew and it was our very first one was in Cedar Hill, Texas. And then it grew from there to Arlington and then from there to North Richland Hills. And before it, we just had a bunch of infusion centers that we were managing all over Texas. And so, and they were extremely successful, some more than others. But the one thing that we had a problem with is we were doing everything on paper, everything from the nurse’s notes to keeping up with our inventory, to keeping up with the billing that we were doing in our office actually did the billing for that for the physicians. So everything was on paper. Our nurses did all the authorizations, the verifications, at first, and they had a hard time keeping up with it. And, at the time, our, what is currently now, our CEO of WeInfuse worked for us, Bryan Johnson. And I said, Bryan, you’re a computer guy, build us something that will take all this trouble out of my head and keep up with this better. Because we were sometimes losing track and, I had a nurse one time that had stuffed $20,000 worth of Remicade in the back of a refrigerator and didn’t rotate it and it had expired. And so what a tragedy and from that WeInfuse was born over time, because we knew we had to have a way to keep up with things. And so, I love working for WeInfuse because I know that the customer’s best interest is at their heart. That’s why we want to see the customer and be successful. And how can you be successful if you don’t have a program that really works and WeInfuse works, and it’s getting better and better every day they add something new to it. So I’m proud to say that I can impart my knowledge to the infusion centers that we go into. And my job is to go out on the implementation team and teach and get them going so, fast forward that far, I mean, that’s where we are today.

Dylan McCabe: That’s so neat. And I love it. And for those listening, if, if you didn’t pick up on that, Robert Norris is actually Reese Norris’s dad. So the founders of WeInfuse Reese Norris and Brian Johnson, obviously Judy Back, who’s sitting across from me now in our studio, had a large role to play in the birth of this business idea and, and Robert Norris also did as well. And so this has all been quite a story and quite a progression of events as the company has really evolved over time. And it’s neat to hear your background and also obviously your heart for customer success. And so your role today, you really own our, what do we call our customer success team? Isn’t that what we call it?

Judy Back: Client success

Dylan McCabe: Client success Okay. And so your role, tell our listeners a little bit about your role. What happens when somebody signs up with WeInfuse? What role do you play in that?

Judy Back: Well, I’m on the implementation team also. So Nick is one of our client success engineers and he and I together go in and I asked the customer a lot of questions first about their practice and how they currently are utilizing their infusion center. And then we build, WeInfuse around that to help them come up with a better solution for keeping up with their infusion center. So it starts with this questions. Then we go into training, we have some, very good video, training videos that we ask them to look at. And then we do, either in person or webinar training, for them to get started with wind views. And it, texts a little bit of time there’s a lot to it. So we try to focus on whoever’s going to do what job and really make sure that they understand that they’re rolling within WeInfuse there. Sometimes it’s nothing but the nurse and we teach the nurse everything. Sometimes they have a front office that takes care of some of the, the beginning parts of it. So if they’ve already used an EMR sometimes, it’s a little bit hard to wean them off, on to what we do. But we try to not get it. WeInfuse is really simple. It’s not complex. And, in fact, I just left an implementation where the nurse showed me. She said, we’re so glad to have WeInfuse because what we had before is so confusing and you’ve got to go so many places for so many things. And she said, WeInfuse just has it right here. So I was really glad that we were able to help, but change is not easy. And so that’s one of my jobs is to make change as seamless and as painless as we can.

Dylan McCabe: So let’s talk about that for a minute because one of the questions I like to ask is what is your main area of expertise? And it’s pretty clear that yours is training coming into a practice, asking a lot of questions to figure out where their challenges are. Their pain points are where there’s gaps in the process, and then being, being a part of that solution. So what’s one big thing you would want our listeners to know from your area of expertise, because you’ve seen a lot of different infusion practices, big and small, successful, and unsuccessful? What’s one big lesson you would want our listeners to learn from what you’ve seen as you’ve gone into these practices.

Judy Back: Well, for sure that the training is extremely important. And sometimes it’s hard for me as a knowledgeable infusion nurse to go in and see gaps in their infusion and keep my mouth shut. That’s hard for me, but I try to impart my knowledge on them and give them ideas that can make them successful. And so education is probably the biggest thing. I never wanted to be a teacher in an elementary school or a high school. I just didn’t think I could do that. But when I became a nurse, I realized nursing is all about education. It’s all about imparting your knowledge that you’ve gained over time to the new person. Whether that new person is older are, if they’re just new to, actually infusion. And I see some things that I would change if I had my way in some of the practices, but, just imparting the knowledge that might help them become successful, is exciting. And, and I think that’s probably my mo. is, is education.

Dylan McCabe: That’s so good. Yeah. And like you said, it’s, it’s hard to go into a practice knowing what and having seen so much in most of these practices, they lived in their own small world of how they do things. And I went to a big practice in Pennsylvania this week and we met for two and a half hours and went through how they did everything from intake to their benefits investigation process, to their scheduling, to their charting, to their inventory management. And at the end of it all they said. So, you talked to a lot of practices every week. How do we stack up? And I had to respond and say, listen I’m not here to throw stones at anybody. I’m not here to make anybody look bad, but here’s where there’s some parts of your process that are broken. They’re really broken. And you guys are flirting with disaster in a couple of areas. And I say that to help you, we want to, our goal that WeInfuse is to be much more than a software company. We want to come alongside you and to help, help you simplify, help you streamline, help you maximize your process. So you can take care of patients really well, but so you can also be successful as a business. And that’s what we have to do. And you kind of have to do a dance. You have to be smooth about it and smart about it and caring about it because you don’t want somebody to feel bad when they’ve worked really hard to develop a process that they’ve worked on maybe for months or even years. And then you come in and say, you missed a few major details over here.

Judy Back: Well, and Dylan, you know that one of the things that we all have to remember is the number one thing we’re looking out for is the patient. As a nurse, that’s preached into our head in our education processes becoming a nurse, it doesn’t matter when it all comes down to the end result, it’s the patient that we’re looking out for, not our business. Although we do have to really be careful about it, because if we’re not careful with that, we’ll, we won’t be there for the patient. But we have to remember that the ultimate goal is to get that patient, the treatment that they need and deserve and have been prescribed for them correctly and all. And WeInfuse does a great job of keeping up with what number one the insurance company has allowed them to do and keeping up with dates because dates are important. If WeInfuse too early, we might not get paid. And we don’t want that. We want, that was one of our pain points in innovative infusion is sometimes we got those dates mixed up. We saw the patient, nurses are notorious. Very, if you got them in the chair, we’re going to infuse them. We’re going to stick them and we’re going to give them the medicine. So we don’t let them get that far with WeInfuse. We just don’t let them even get on the schedule unless the date is correct. And so, to me, that is so exciting to know that we’ve got that, we’ve, we’re taking that issue and wrapping up in a little package in WeInfuse and preventing that. Now, sometimes people get frustrated because, well, I want to put them on the schedule, but look at your date. You don’t want to put him on the schedule. You might really think you want to put them on the schedule, but you really don’t until you’ve got an authorization to say you can,

Dylan McCabe: Right? You don’t want to schedule them even a day early before that authorization approval, then

Judy Back: absolutely not.

Dylan McCabe: Well, let’s, let’s switch gears with all that you’ve seen in the infusion practices and the experience that you’ve had, what’s a consistent challenge that you see these practices deal with on a, on a weekly basis. Cause you’ve seen a lot of different infusion practices. What’s one pain point that tends to stick out the most?

Judy Back: Probably those authorization dates and inventory. Inventory is a huge thing in the infusion world. Of course, we all know that the very best way financially to get ahead is to buy and bill, but doctors are scared to buy and bill, because they’ve been bitten by buying too much, not enough, the patient gets there and you don’t have their drug there because somebody forgot to order it or it is not taken care of correctly. And it ends up expiring before you use it. And inventory’s expensive, especially today in today’s world with the biologics. So you gotta be really careful. So with WeInfuse, that’s all taken care of, literally, the system tells you exactly what vial to pick up and use that day. And when we first start teaching that sometimes nurses go, well, that’s ridiculous. I’m just going to go get the vial I want. No, you’re going to get the vial that has the right lot and right expiration that WeInfuse, told you to get, because that’s what’s going to rotate your drugs and keep them from expiring. So that is a big thing. Knowing what you have in inventory, how many dollars you have there. And our system allows you to see that the exact dollar figure that’s pretty sobering sometimes/. When you think you might have $200,000 sitting in your refrigerator. And so it does help you to sober up, so to speak in your knowledge of, yes, I do have that much in there. Then WeInfuse doesn’t want you to buy what you don’t need. So if you, if the system will tell you, yes, you need five vials of Remicade for and through the next week are five vials of whatever. And it does that by having the patient on the schedule and the system knows exactly how many vials that patient’s going to get. So you don’t overbuy, but you make sure you have enough. And so of course, buying and billing, and then we have another section which is specialty pharmacy. So if your insurance company says, yes, you must buy it through Alliance or CVS, then we have a way to keep up with that. So when it does come into the infusion center, it’s documented as that patient’s drug for that particular, infusion time.

Dylan McCabe: it’s so good. And I, I really do like showing our inventory system as well and kind of showing it off because it’s so automated and keeps on top of all this. So what’s an example of it? Like, so I’m at a practice I met with a practice recently and they don’t have an inventory management system. They don’t have a spreadsheet and notebook, nothing there, their inventory management system is we order, they say, we, they would say, we order based on who’s coming on the schedule, we look at the schedule and we order exactly those drugs on a weekly basis. And then I said, okay, but how do you account for when you order those vials? And they come in, how do you know exactly which ones came in, how big the vials are, what size in DC law, all that, do you write any of this down? And they said, no, we, we look at it and we compare it against the calendar, what we need. And I said, okay, let me just, so I understand correctly, you’re saying when you get, $50,000, $100,000 worth of vials in your inventory management system is to look at them with your eyes and then look at the calendar with your eyes. And you’re literally not writing a single thing down or putting a single thing. Yep. That’s how we do it. And we’ve never had a problem. And I said, and I told them, you’re flirting disaster, you’re flirting disaster. But their defense was, and it makes sense. We’ve never had an issue with this. And I said, well, you’re going to, and whether it’s three months from now or six months from now, we’re going to be talking about it. And I told them whether you guys use WeInfuse or not. Obviously I think it’s the best system out there, but you guys have to get something, whether it’s an Excel spreadsheet or some way to track all of this, because my mind is thinking somebody could, like, you mentioned, vials could get pushed to the back. Even if you might get an extra vial or you might be missing a vial somebody could steal. I mean, you hate to think that, but somebody could. I mean, you got a $10,000 vial on hand or an $800 vial on hand. And so what do you think could be some things that could go wrong with an inventory management system?

Judy Back: One of the big things is if it’s a weight-based drug, what if you have the exact number of vials you need for that, but you, they come in and they’ve gained 10 pounds from their last infusion. So they require an extra vial and you don’t have it. So our system has a par level that they can establish on drugs that are weight-based drugs. We really recommend a small par level. Doesn’t have to be big, but that you have five or 10 extra vials just in case of that

Dylan McCabe: For those higher volume drugs.

Judy Back: And so, so you’re able to track it like that. So, so you could pick one, an extra vile, if you need to, for that, that patients extra, that they might need,

Dylan McCabe: Then that goes back to your initial thing. So you can take care of that patient that day. It’s a patient focused strategy. That’s good, that’s a good point. Well let’s share another story, with what you’ve experienced so far in the infusion practice, what’s, what’s a big light bulb moment you’ve had, whether it’s about patients or it’s about processes or whatever, just what’s one big thing that kinda guide you on a daily basis in this world.

Judy Back: Well, Dylan it goes back to my initial talking to Mr. Norris when I first started and I had a friend in Abilene, Texas, that was doing this. And, I said, I think, I think we can do this. And I think it’s going to be a huge benefit for patients that don’t need to be in the hospital. And Mr. Norris said I’m one of them. I had an injury to an elbow and it was infected. And the doctor put me in the hospital for seven days on Rocephin. I didn’t need to be in a hospital. All I needed was the Rocephin, but at that time there was no way to get it except go into the hospital. So it was a very painful time for him to just sit there while he was getting his Rocephin. So I said, well, that’s the prime example on how we can help set these practices up with an infusion center and physicians can manage that as, as clinically manage it. Our nurses can give it and the patient gets to sleep in their bed at night. How awesome is that? And so really that was so early, that was before very many biologics were out at all. In fact, I believe Remicade was the very first biologic we ever gave. We were doing a lot of antibiotics and, and making fluids people would be dehydrated. And, we would give them a bag of fluid. And a lot of it was coming from the practice that we were in. The doctor was seeing patients rather than send them to the hospital. He put them in the infusion center. And so our nurses would take care of them, make sure that they were back on their feet and they got to sleep in their bed so talk about a moment and it still exists today where a patient doesn’t have to go in the hospital to get these things. And hospitals don’t want those patients anyway. They really don’t they sometimes think they did, but they’re not great revenue generators. And so, but the patient’s happy they’re right there. They know there’s a physician present at our nurse practitioner. And if they, if something happens, we’ve got a backup. And so it’s, it’s golden. It’s like the best of the best where you can go get your drug and still go home. I have a really good friend that came down with CIDP, which is a neurological disease, and they have to have IVIG. And I was able to talk to her about a physician that I knew that did that literally from having almost a walker, needing a walker to get around from totally no Walker now and going about her business. She and her husband did a lot of traveling now they’re back to traveling because she was able to go into that infusion center every three weeks, get her IVIG and it has turned that disease process around.

Dylan McCabe: That’s awesome.

Judy Back: It’s the best, it’s just the best. And it’s, and so, but all those things cost money they cost time. They have, you must have expertise. And so having, WeInfuse as a part of all that and helping to manage that process is what re that’s what WeInfuse really does is manages a process from the patient’s, insurance, the patient’s, treatment note, the patient’s inventory, the patient’s schedule. It does all of that and does it really well?

Dylan McCabe: Yea I know it’s nice to come into a practice and just keep thinking of the one I met with most recently, and these nurses turned into project managers with these patients in the infusion practice, because there’s so many moving parts. There’s a process that can take weeks at a time and you have to follow up, check up on details and keep the process going. And, and I get excited knowing that WeInfuse in this, we’re not trying to totally just promote WeInfuse on this podcast, but it’s true. It’s nice to come in there and say, hey, we can simplify a very complex process and enable you to relax a little bit and focus more on the clinical part of why you really got into all this. And that is, that is exciting. So well, there’s so much we could, I mean, we could talk for hours about your experience and all the, all the things that are going on in infusion. What would you say is one kind of last parting piece of advice for our listeners?

Judy Back: Keep on infusing. Don’t give up because you’re making a difference in the patient’s lives. There was a time that I did some work for an oncology device company. And, so I had an opportunity to go into oncology centers and of course that’s where lots of lives are being changed in that. And I think that’s great. but I love this part of it where it’s maybe not quite as intense in the therapy, but yet we know we’re making a difference in patient’s lives from something like my friend has the neurological disease and, and MS is a big one. We have a new drug we’re given for MS. And I’m just a part of all that. And I see it every day and now there’s a new, potentially new Alzheimer’s drug. That’s going to come out. That’s an infusion drug that boy, when that comes out, it’s going to bust it wide open, and infusion centers are going to be a part of that, just like they are with patients that have crones are rheumatoid arthritis or any of those real, autoimmune diseases that biologics can make a huge difference for. It’s exciting to see the progression of the patient. And I get to see that even though my job is to get WeInfuse into these practices, but I get to see that because I’m right there with the patient. So I get to enjoy that. and the nurses always telling me this is a patient that came in and all the, all the history of that patient and how well they’re doing, they share that with me just cause I’m a nurse so that’s exciting for me to be able to see that

Dylan McCabe: That is, I love that keep, keep infusing as Judy’s parting advice. And it is amazing. It’s amazing to see how people’s lives are changed and they get their freedom back. They get their freedom to do the kinds of things they want to do. And it’s so good and so anyway, thank you so much for being on the program, Judy, and, and your experience, and obviously your influence in your heart here at WeInfuse. I love working with you. And so it’s been great to have you on the podcast.

Judy Back: Thank you, Dylan.

Dylan McCabe: All right. That sums up our interview with Judy and I love what she said when I asked her what’s one parting piece of advice, and she said, keep infusing. And I’ve heard wonderful stories about how patients’ lives have been changed through infusion therapy, but you know what? You can’t keep infusing very well. If you don’t have processes in place that streamline the whole benefits investigation process, the scheduling billing, and then the ability for the nurse to chart in a way that’s fast and easy, but also very effective. And that’s what WeInfuse offers. So if you haven’t done so yet, be sure to go to WeInfuse.com and request a demo. If you haven’t seen our software in its full glory, you will be impressed because it really just makes your life easier. It helps to automate some parts of the process, but really it’s just designed to help manage that overall workflow from beginning to end, when it comes to the AIC, the ambulatory infusion center or the provider office that also does infusions or whatever the case may be. If you have an infusion practice you need, WeInfuse. So be sure to check us out. WeInfuse.com, schedule your demo today and see for yourself. I think you’ll be glad you did. If you guys have any questions or you have any major issues that you are challenged by, and you’d like to hear about in future podcasts, be sure to ask us, mention it on our Facebook page, go to Facebook and do a search for WeInfuse inside of Facebook. Be sure to make a comment on our Facebook page. We’d love to interact with you there. And we also have a LinkedIn group, a closed LinkedIn group for people involved in the infusion space. Be sure to search for that group and join the dialogue there as well. Guys, this has been exciting to be with you on this journey. My name is Dylan McCabe, and we will catch you in the next episode.

Guest Speaker: Judy Back, RN, BSN, Clinical Nurse Educator at EQUASHIELD, received her BS as a Registered Nurse from the University of Texas at Arlington in 1985. She has since worked for numerous clinical companies, including as a Nurse Liaison for WeInfuse.