Episode 63: How to Use Tech to Improve Processes and Reduce Burnout with Julie Cothren, D.Ph.

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Transcript: How to Use Technology to Improve Processes & Reduce Burnout

Amanda Brummitt: We Infuse podcast, episode number 63. Welcome to the We Infuse podcast. My name is Amanda Brummett. In every episode, we give you a seat at the table as we talk to Infusion Center owners, operators, and experts so you can get the insight you need to run a thriving practice. In this episode, we talk with Dr. Julie Cothran, Senior Director Clinical Services of McKesson. Julie is going to tell us about McKesson and We Infuse’s new integration program. which streamlines insurance eligibility, scheduling, nursing notes, and even orders integration. Well, Julie, thank you so much for being here with us today. We really appreciate you. We know how busy you are, and probably especially this time of year, so thank you for taking time for us. Thank you for inviting me. Yeah. I would love to start with you sharing with our listeners, a little bit about your background and how you got into the infusion industry and specifically McKesson.

Julie Cothren: Sure. Well, to start with my background, we have to go back about four decades, as a 15 year old when I decided to start working at an independent pharmacy in my hometown. it was, Great experience. We didn’t have the soda counter. we didn’t have the soda fountain, but we had all the other typical small town independent pharmacies had, even though I wasn’t allowed at 15 back behind the counter there, count pills or anything like that. I typically wrapped gifts, sold cigarettes and greeting cards, but it still gave me a lot of farm. A 15 year old sold cigarettes. That was, back in the day, Yeah, the thought that a pharmacy would sell cigarettes at all today was like, oh my goodness. But yeah, I did. but I cultivated a love, of pharmacy in general. I loved the Working with the people and I loved as the patients came in just seeing those relationships between the pharmacist and the people. So, when time came around for me to decide what to do in college, I was like, that was a no brainer. I was going to pharmacy school. So I did that. And then when I graduated in the early 90s, there were two roads available. At least I thought there were only two roads available to a graduating pharmacist at that time. And it was the hospital road or the retail road. I chose the retail road, which I stayed on for actually several years. started, then I got married, started having children, Two sons and did a little part time retail in there while they were very small. And then when my youngest son, started preschool, I decided it was time to ramp my career back up. So, I started looking for other things outside of retail and landed in a large cancer center. here in Memphis, started working there as a pharmacist, loved that. I had not been in oncology. when I was in pharmacist school, there weren’t even, but probably a handful of oncology drugs. So, this was really exciting to start learning, this whole space. And so, after I worked there, a little while, I ended up. to the role of, director of pharmacy operations. We had nine different sites. So, I oversaw all of the, non infusion sites, the, all of the pharmacy operations for those, and that was just a great experience. Then about eight years ago, decided to change over and start working for McKesson. I had been a McKesson customer. I loved McKesson, loved the people that I worked with and, had the opportunity to not only work remote, but then also to work with, national accounts and, keep learning. So I changed over to McKesson about eight years ago. started as a regional director of clinical services, and then now, I’m currently the national director of clinical services, so I manage a, team of pharmacists, that support physician owned community practices as well as infusion centers. We’re typically only in the specialty space, so, we work mainly with oncologists, rheumatologists. Gastroenterologist, neurologist, all the specialties, as well as the AICs, the endocrine infusion centers, and other infusion centers. So, really enjoying it. I love my, position.

Amanda Brummitt: What an incredible career. And I love that your, early, early, early career job inspired the next 40 years. That’s incredible.

Julie Cothren: I did. I’ve never looked back. I really, I love being a pharmacist, always have. And I’m just thankful that I’ve had the opportunity to, advance down a different career path not that I loved retail when I was in it, but I love, I’ve loved the different steps along the way and learning infusion as well.

Amanda Brummitt: Yeah. That’s fantastic. Well, Julie, with all of that expertise, what would you say is your main area of expertise? And then what do you want our Weanfuse listeners to learn from you today?

Julie Cothren: Amanda, that’s hard to pinpoint, to say what’s our, my main area of expertise. as I said, I do have a team now, that I lead and our team wears a lot of different hats. we’re clinical subject matter experts, we typically support our GPO and sales teams. lately we’ve been working with oncology practices, with regulatory support. I don’t know if you’re familiar with USP 797, USP 800, that both of those just went live, the beginning of November. So we’ve done a lot of work with oncology practices around, that regulatory support. We focus, as you can imagine, we focus a lot on clinical education. but I do think that the true strength and differentiation of our team is that we’ve all come out of practices. So, we all have first hand knowledge and experience of working in a practice or an infusion center as a pharmacist. So, because of that, I would say a lot of our focus ends up being on operational support and improvement. just as an example, I’m sure everyone at this point is familiar with biosimilars. if you’re not familiar with biosimilars, I’m not sure where you’ve been for the last five years. But, when biosimilars first came out, there was a hesitancy, in some To use them, physicians weren’t as sure, if, they truly were going to be, give the same clinical results. Of course, we know, based on their approval, that they are expected to be highly similar and to give the same clinical results, as the reference products. But we did have some hesitancy, we saw some hesitancy, and so we actually participated biosummer master class, to help educate practices. We started with the foundation in science. Behind the biosimilars, just to help physicians have that Comfort level with using the products and then we cover topics like operational readiness and payer strategy so even though the drugs are approved based on that high similarity after the reference product and the expectation that they do provide the same clinical outcome. they’re not generic, so you can’t just treat them as generic. They have to be handled differently. operationally, they have to be handled differently. So it was important that we had real robust education and that our clinics understood that needed to expand throughout the clinic or infusion center from how they needed to be built. these Products have unique cue codes. They’re not built with the same codes that reference drugs are, are, built with. And, all the way through to, reconsidering your patients. do you need to let your patients know, Hey, now we’re going to use this new drug called Biosilmer. You have to educate the patients as well and make sure that they’re comfortable, in the product. So, so your comfort then typically will translate into comfort for the patient.

Amanda Brummitt: Yeah, for sure. I can see how that’s a huge strength for your team. Lengthy

Julie Cothren: answer for one area of expertise, right?

Amanda Brummitt: No, I think, that’s a great answer. A great answer.

Julie Cothren: I was going to say, you also asked what’s one thing that y’all wanted we in Feedlessness to learn, from that area of expertise. And so, I know we’ll talk more about this as we go on, but I think it’s important, For everyone to understand that small improvements in efficiency and operations can lead to overall improvements in safety and quality of care as well as to worker satisfaction.

Amanda Brummitt: Absolutely, especially in the infusion industry, those micro, changes and things that happen can have such a huge impact on the patient outcome. So I love that. Yeah, I

Julie Cothren: can give you one other example of that if don’t mind, but recently, a practice that asked us to do some process review, they had a couple of near misses. With the mixing errors, actually almost, getting into the patient did it thankfully, but then they also did end up wasting some drugs. they had some drugs that was mixed incorrectly end up having to waste. And so, one of my team members and I went in, walk through what their processes were. We looked at how they were, doing everything. And we saw that, they had the processes in place. They had the SOPs written. They knew what was supposed to be. Followed but they weren’t following those processes and why were they not following the processes? Well, the second check the person that was supposed to be going in to do the second check That required that they garb up, every time something was mixed they had to put on the gown This was chemo, right? They had to put on the gown they had to put on the gloves get them a few covers I’d put on my air cover to go into the mixing room, which is a laborious process and so They were skipping over that step when they were busy or distracted. And so we connected them with an outside vendor, that has a verification system where they could use an iPad. So now they can just take pictures there in the hood, send those back out. The pharmacist doesn’t have to garb up anymore. That verification can take place outside of the room. So not only is it safer, but it also in the long run will end up saving money by preventing that drug life. So even though it sounds like, hey, we’re paying on the front end for this system in the long run, it will end up helping them.

Amanda Brummitt: Yeah, absolutely. And that’s what process improvement is all about. So as our listeners think about McKesson, you’re a huge organization, just vast scope of everything that you guys do. and you’re fairly unique in the infusion space. Can you share with our listeners a little bit about, what makes you guys unique in the infusion space? Thanks.

Julie Cothren: I don’t want to sound cliché when I say this, but I truly believe that our people are our biggest differentiator. one of McKesson’s focus statements is that we improve care in every setting, one product, one partner, and one patient at a time. And, going back to what I said about my team’s background, and, also because we’re customer facing, we have the unique opportunity to see those day in and day out struggles, and then we can help find solutions for those struggles. McKesson has some great technology solutions that are our own, but then we also partner with outside vendors like we do to expand options for our customers. And then, of course, the big piece. on my side is that our GPO team worked very closely with Biopharma to be able to offer different steady contracts that bring value to our customers.

Amanda Brummitt: Awesome. I love that. So, Julie, you’ve had the opportunity to look at a ton of infusion centers across the country. What would you say is one of the biggest challenges that they face and, if you can give us a specific, maybe behind the scenes look, that would be great.

Julie Cothren: this is probably not something that would, maybe would not immediately come to mind when you think about an indigenous center, but I would have to say burnout among the staff. during the COVID years, I’ve started researching both burnout and compassion fatigue in health care. And I don’t know, how familiar you are with the difference, but, compassion fatigue is a specific type of burnout. And that’s what I saw, when I was in the oncology clinic, I saw that a lot. But it’s an extreme state of tension and preoccupation with the suffering of those that are being helped to the degree that it’s traumatizing for the helper, it’s sometimes referred to as the cost of caring for others in emotional pain. so of course, I saw that a lot in oncology, but burnout is a little bit different because it’s an occupational related thing. syndrome. it’s typically characterized by physical and emotional exhaustion, cynicism and a low sense of professional accomplishment. And then we see that leads to decrease effectiveness at work. it’s typically burnout, typically a response. to work stressors, such as staffing, workload, or inadequate resources. there’s also the perception of a skewed work life balance, that leads to burnout. And then we typically see that leading to symptoms that I mentioned, like the exhaustion, the diminished morale. And then you start seeing the outcomes of the burnout, which can be medication errors, like I mentioned earlier, decreased empathy, and then even the changing of career path, we, Kind of a mass exodus. of nurses, physicians, pharmacists, other health care workers that are getting out of the field, due to burnout. and I think most of the research, I actually just read an article, sorry, I forgot the publication, but just last week, that points to administrative burden. being one of the biggest drivers of burnout in health care workers. And so I think that the we and P McKesson immigration is one solution for leaving some of that administrative burden.

Amanda Brummitt: Wow. That is definitely something we hear across All industries. And I’m glad you mentioned it for infusion, especially since our people are so highly specialized and they’re working with patients that are often really sick. Both that burnout and compassion fatigue are real. and there is such an immense administrative burden, across the spectrum. so that is incredible. Well, I’d love to hear about. Ways you think we can combat that, and, definitely tell us about the WeInfuse McKesson integration for sure.

Julie Cothren: Sure. Sure. So, there are some great features of WeInfuse that improve efficiency. The, one of the things that I love is the real time inference eligibility. this is huge because, When you build something incorrectly on the front end, is it, it’s not only costly, but it’s time consuming to go back and correct those. the, just the fact that you can, that the, healthcare workers can look into the WEMP system and see real time insurance eligibility. Actually can give a real life testimonial to that today my mother is at my 84-year-old sweet 84-year-old mother is supposed to be having back surgery this morning and she was called at about four o’clock yesterday afternoon saying that they had failed to it’s pre-cert done, time for her to have the surgery this morning. So it’s very important. That, practices and clinics and infusion centers stay up to, have, know what that insurance eligibility is, that those pre certs are done, that those prior authorizations have been done, and those, and the medications have been approved. it had, the chair based scheduling, is a huge, plus for the, software as well as the medic specific nursing. And, now that they’re integrated with the RX toolkit, there’s, some great. Clinical education, and notes that the nurses have access to the way into you. But I’m most excited to tell you about the order of integration, that’s between we infuse in the Kessler. So, again, from personal experience, coming out of a practice, one of our, the most laborious manual processes that we did every day, this is something we did every day, was a manual chart review. so we would print the schedule, who’s coming in the next day, who’s on the schedule, who’s scheduled for infusion, and then had to go into each individual patient within the EMR to look and see which specific drugs they were scheduled to receive, and Then we had a piece of typing paper with our 35 50 drugs, written down and we did little tick marks or whatever those are called, so we knew how many vials of what strength to order so that we had enough for the next day or the following day or three days out, whatever we were ordering for. So, It’s super exciting that now practices and infusion centers can benefit from predictive inventory management. So, their orders through WNTs and through this integration, they can quickly be generated and based on scheduling. they also have the option to maintain PAR levels on some drugs if they, if they desire to do that. But they’re able to generate, Predictive ordering info through the specific dates that they choose. So, if if they want to order out for two days, order out for three days, or just order for tomorrow. One thing we see is that due to the high cost of a lot of these specialty biologics, it’s a best practice to limit the amount of inventory sitting on sales. it becomes very costly, if unused drug becomes expensive. So a lot of clinics and infusion centers operate on what we call just in time inventory. So, because McKesson is now part of WeInfuse’s Distributor Connect program, we have that integration that allows customers to submit drug orders directly through WeInfuse instead of having to take extra time to log in to the customer center through the McKesson website. So, less clicks means increased efficiency. Increased efficiency, less burnout. win right?

Amanda Brummitt: Yeah, I love that. what I’m hearing is it’s better for patients because they’re not going to get canceled on the day before their procedure. I’m sorry that happened to your mom. I’m, hearing less work for the team and more integration to where people aren’t hand king things, which tells me we’re going to have less errors, which is always a beautiful thing.

Julie Cothren: That’s right. That’s right. Another, great thing with we infused going back to even medication errors, it. The nurses as they’re pulling out or dispensing, getting the drug ready, pharmacist, whoever is doing that task of getting the, infusion ready for the patient, we infuse tells them exactly quit vials to use, to make, to add that admixture. So that cuts down also on the risk of not only medication errors to the patient, but also, billing errors. Which is what we see more often where the wrong size vial is pulled and used and then the insurance company will kick it back and say, no, you should have used this size and this size together. You build for too much. you’ve got too much waste. So that’s also a nice feature.

Amanda Brummitt: Absolutely. Saving our centers money and hopefully saving patients money too. Absolutely. All right, Julie. Well, that sounds like an amazing integration, that is going to save people money and Help with less work for the staff, which I’m hearing is going to fix burnout for health care. Let’s just say it. That’s right. so you’ve had this lengthy and rich experience in the infusion industry. What would you say has been your biggest lab bulb moment through that?

Julie Cothren: I’m not sure if it’s actually a light bulb moment, but one thing I can say is that I’ve seen, definitely seen growth in infusion practices from year to year. it’s a 100 billion plus infusion therapy market, and it’s going to continue to grow. why is it going to continue to grow? the aging of the American population. We’re seeing a rise in chronic diseases, and we’re also seeing the approval of new and novel treatments. like I said in the beginning of the podcast when I was in pharmacy school, none of these biologics existed. so it’s, that we’ve got so many more treatment options than we, and every year that, that increases. So, and not only that, but many of these treatments for chronic diseases last years, if not for a lifetime. So, we’re going to continue to see, the infusion, growth in infusion practices. And not only that. But we’re also seeing a shift from hospital sites of care to outpatient settings for infusion. So, as I said earlier, my team, we, support community owned, we support the non hospital based infusion centers, and we are definitely seeing shifts. from hospitals, why is that players are seeing the cost effectiveness and shifting the side of care to physician clinics and ambulatory infusion centers. And I think, I would be remiss if I didn’t also point out that it’s better, we have better patient convenience and improved access to therapy. when the patient is shifted to those outpatient settings.

Amanda Brummitt: Yeah, absolutely. There’s a time and a place to have an infusion in a hospital, but if I ever need one, I’d like to do it in a comfortable outpatient setting, please. That’s right. So, you’ve shared a lot about your, passion for patients, your passion for practices. What are you most excited about in the industry right now?

Julie Cothren: with the increase of patients that are being funneled into the outpatient space, I think these environments could be more appealing. As a workplace, the nurses, the pharmacist, technology advancements, like those we see which we can help improve those operational efficiency, and decrease burnout, improve clinical outcomes. And I believe that most nurses and pharmacists do that career path if they chose in order to positively impact patient’s lives, and this is the piece of the job that brings meaning and purpose, and improve technology that. That streamlines those administrative tasks will allow the nurses to devote more time and attention to the patient and that’s a win for both the nurse and the patient. So i’m just excited that There are settings like this where health care workers can really use their skills and Be able to treat patients and not just spend all their time on administrative tasks

Amanda Brummitt: That is actually really exciting and how odd that we’re talking about that. It’s exciting that pharmacists and nurses can get back to what they love, taking care of patients. but yeah, we’re, seeing a swing in healthcare where we’re re emphasize, re emphasizing that. So yeah, great answer. All right, Julie, what is one last piece of advice that you would give to the We Infuse listeners?

Julie Cothren: I think I would just probably reiterate what I said earlier in the podcast about those small improvements in efficiency and operations, leading to overall improvements in the safety and quality of care, and then as well as worker satisfaction, since we talked about burnout, I just, I would encourage your listeners to look for those areas where improvements can be made and then start taking those steps to make those improvements. look for that low hanging fruit, start there and, give. start making steps and pray.

Amanda Brummitt: I love that. Julie, I thought I came on here today to talk to you about technology. And what I personally am walking away with is, lots of, warm and fuzzy feelings about, building a team and, those tiny ripple effects that we have. And so I just, I loved the way that you approach infusion and, the way that you’re utilizing technology to truly build a team. Make healthcare better and make the journey better for the patient, the nurse, and the pharmacist. that’s incredible.

Julie Cothren: Well, thank you Amanda for having me on there and, hopefully if nothing else came out, it is my passion, for healthcare, my passion for, my, my, job as a pharmacist and, just knowing, yes, we’re a distributor. But at the end of the day, there’s a patient’s name at the end of that drug, it’s coming out of our distribution center, but it’s somebody’s. it’s somebody’s mother, it’s somebody’s sister, it’s somebody’s aunt, it’s somebody’s best friend, and I, I know, we’ve all got friends and family members that deal with chronic illnesses, or cancer, and so, I think in a roundabout way, when, any, anything that indigenous centers can do, to optimize, to, help health care worker satisfaction in the long run. It does end up helping the patients, right?

Amanda Brummitt: Absolutely. We’re sure. Julie, thank you for your time today and thank you so much for your passion. Thank you. Wow. That was great information from Julie Cawthorne of McKesson about utilizing technology to improve the experience for patients and their caregivers. I just love her passion around small operational efficiencies to positively impact patients, nurses, and pharmacists. Well, if you aren’t already familiar with the WeInfuse software platform and RxToolkit’s web based resources, I encourage you to schedule a test drive and be sure to check out the McKesson integration during that test drive. These tools can save time and money in your practice while making infusions safer for patients and for caregivers. My name is Amanda Bremit, and we’ll catch you in the next episode.

Guest Speakers:

Dr. Julie Cothren, D.Ph, Sr. Director, Clinical Services of McKesson