gGastro GIQuIC User Guide
Contents
Registration 2
System Setup 3
Locations: 3
Providers: 3
Time markers: 3
Procedure Overview: 3
Indications: 3
Polyps: 4
Complications/Limitations: 4
Discharge Instructions: 4
Documenting the Procedure for GIQuIC Reporting 5
Data Requirements 6
Patient information 6
Procedure information: 7
Reporting 13
GIQuIC Exception Report: 13
Generating GIQuIC File: 14
Generating a Revised GIQuIC File: 15
Registration
When a practice elects to participate in the GIQuIC program, the gGastro application must be enabled for GIQuIC by gMed. Once enabled, the system is able to “learn” information about colonoscopy procedures, which is used to populate data files. The data files are generated by the practice on a regular basis (weekly, bi-weekly or however else determined by the practice) and submitted to Outcome, which is the company administering the GIQuIC program.
Outcome will provide the client with access to their websites for data file submission. Clients should contact Outcome directly to obtain the necessary web address, credentials, and instructions.
NOTE: Payment for participation in GIQuIC should be made to GIQuIC, not to gMed.
Contacts:
Information about GIQuIC registration
Director of Education, ACG: Laurie Parker:
Support
Project Lead, Outcome Sciences: Joe Brower:
System Setup
In order for the client to use GIQuIC, the Implementation Coordinator will need to ensure the following configurations have been enabled on the client’s gGastro application.
Locations:
Each location in configurations must be updated to indicate:
o GIQuIC Facility ID (issued by Outcome) – this is a required entry
o Teaching status (optional)
o Type of Facility (optional)
Providers:
o Each Provider must have an NPI entered in Identifications (Most existing clients will probably have this setup already).
Time markers:
The following time markers must be configured for Colonoscopy and EGD/Colonoscopy procedures:
o Scope Inserted
o Cecum Reached
o Scope Withdrawn
Procedure Overview:
Procedure Overview must have the following segments include:
o “Informed Consent”
o “Prior Colon Surgery”
o “Quality of Prep”
Indications:
Indications must contain specific wording, exactly as shown:
o Evaluation of barium enema or other imaging study of an abnormality that is likely to be clinically significant, such as filling a defect or stricture
o Evaluation of unexplained GI bleeding
o Unexplained iron deficiency anemia
o Screening for colonic neoplasia
o Surveillance due to prior colonic neoplasia
o Inflammatory bowel disease of the intestine if more precise diagnosis or determination of the extent/severity of activity of disease will influence immediate/future management
o Clinically significant diarrhea of unexplained origin
o Intraoperative identification of a lesion not apparent at surgery
o Treatment of bleeding from such lesions as vascular malformation, ulceration, neoplasia & polypectomy site
o Foreign body removal
o Excision of colonic polyp
o Decompression of acute nontoxic megacolon or sigmoid volvulus
o Balloon dilation of stenotic lesions
o Palliative treatment of stenosing or bleeding neoplasms
o Marking a neoplasm for localization
Polyps:
Polyps removed or retrieved must be documented in a specific manner
o In order for the polyp to properly count in reporting, the user must make sure to enter an actual number/digit, and not text. (5, not “five”).
o Only integers in the Number field
o Finding must be configured with Type = polyp
o Result of an intervention must be populated with specific wording:
§ completely removed
§ partially removed
§ completely retrieved
Complications/Limitations:
Complications/Limitations must contain specific wording, or No Complication check box must be selected when appropriate:
o No Complications – use check box
o bowel perforation
o bleeding
o ED visit
o hospital admission
o sedation related
o death
Discharge Instructions:
Discharge Instructions must contain specific types of instructions. The detailed wording is up to the client. There are two ways to accomplish this:
1. Have the instructions coded onto the Discharge Instructions template, so they automatically appear every time.
2. Create an order macro that would include all of these instructions and choose this every time.
o Diet restrictions
o Usual medications resumed
o Return to activities
o Potential delayed complications
o Contact number for medical emergency
o Patient given instructions relative to resumption of anticoagulant therapy
Documenting the Procedure for GIQuIC Reporting
When documenting the Colonoscopy or EGD/Colonoscopy procedure, follow the next steps to ensure that all of the necessary data is entered and available for reporting:
1. Review patient demographics (can be performed by staff at intake)
2. Select indications from the GIQuIC folder when applicable. If patient indications are not available in that folder, you can document them from the other folders.
3. Document HPI and Physical exam
4. Document ASA class
5. Label the images from the Image capture screen. Make sure to use the configured user list or the GI Sites map to avoid typos.
6. Document findings. Make sure to follow the guidance below on how to document polyps and polypectomy/biopsy procedures.
7. Create specimen labels if necessary.
8. Document the scope introduced, cecum reached and scope withdrawn time markers.
9. Document Procedure Overview. Make sure to record Informed consent, Quality of Prep, and Prior Colon Surgeries (when applicable).
10. Document Limitations/Complications from the GIQuIC folder if applicable. If none, make sure to select the checkbox. If the Limitation/Complication is not present in the GIQuIC folder, you can document it from other folders or free text.
11. At the end of procedure documentation, make sure to select Tools/GIQuIC form from the toolbar and document ALL the fields on the form. Specifically pay attention to H&P, Colonoscopy type, Risk Assessment, Pathology Tissue obtained and Follow Up Interval for next colonoscopy (if known at time of procedure documentation).
12. At the end of the procedure, make sure to print out the Discharge Instructions to provide to the patient.
13. If pathology was obtained during the procedure, upon the receipt of the Pathology result, it is vital to return to the GIQuIC form to document/update the Follow Up Interval for next colonoscopy. It can be easily accessed directly from the Pathology result task, on the toolbar:
Data Requirements
When generating a GIQuIC data file:
· The system gathers data from a colonoscopy procedure, and from the colonoscopy portion of an EGD-colonoscopy.
· The data for each service must be supplemented using the GIQuIC questionnaire, which is accessed from the tools menu of a procedure.
· Certain fields are required. If required fields are not populated, the service for the patient will not be included in the file.
· Required fields are shown in bold below
· Fields that are not required will be included in the data file if they are populated
Patient information
The following patient information is available in patient demographics and patient profile. Some of it is usually obtained in the Practice Management/Billing system and comes over into gGastro via interface, some of it is documented in gGastro (such as race, height, weight, etc.)
o Pt Type
· If left blank, this will default to outpatient
· GIQuIC only recognizes “inpatient” or “outpatient”
o Date of Birth
o Gender – Male or Female
o Zip code
o Pt Race
· "African-American" or "Black or African American"
· "White/Caucasian"
· "Hispanic/Latino" or "Hispanic or Latino"
· "Native American" or "American Indian or Alaska Native”
· "Asian" or “Native Hawaiian or Other Pacific Islander” are mapped to GIQuIC value of “Asian Pacific”
· Any other value will be sent to GIQuIC as “Unknown”
· If race is blank in gGastro, the patient/service will not be sent
o Height
o Weight
Procedure information:
When documenting a Colonoscopy or an EGD-Colonoscopy, make sure that the following areas are documented. It is very important to document the required fields, as well as to fill out the GIQuIC form at the end of procedure documentation.
*Required fields in bold
o Type
· Currently gGastro supports procedure types Colonoscopy or EGD-Colonoscopy for the GIQuIC program.
o Date
· This is the date the service is performed
o HPI and PE documented
· The system will determine if HPI and PE are populated for the service
· Make sure to document the HPI and Physical Exam sections in the procedure note.
o Informed consent
· Make sure to document the informed consent on the Procedure Overview. A default value can be set up via Configurations.
· The system will determine if the Informed Consent segment of the Procedure Overview is populated for the service
o ASA class
· Document the ASA class on every procedure.
· The system will determine if ASA class is populated for the service, and report the ASA Class value
o Physician Specialty (not required)
o Insurance Type (not required)
o Sedation Type (not required)
o Sedation Administered By
· Required IF sedation type is moderate, deep or general
o Discharge Instructions
· The system will determine if discharge instructions are printed for the patient for the service
· The discharge instructions must include specific instructions. It is the responsibility of the client to ensure the Discharge Instructions contain the specified instruction set.
· Documentation of an instruction for Anticoagulant Therapy resumption is required.
o Type of colonoscopy
· Document on the GIQuIC questionnaire form
§ Surveillance
§ Diagnostic
§ Colon Cancer Screening
o Year of previous colonoscopy
· The system will determine the latest date of any colonoscopy entry in the patient’s medical history of diagnostic studies, excluding the current service
o Quality of Prep
· The system determines the quality of prep documented, and translates to the required values of “adequate” or “inadequate”. Simply make sure to select the appropriate quality of prep in the Procedure Overview.
o Indications
· Make sure to select the indication from the GIQuIC indications folder configured in your Indications user list.
· The system will determine if at least one indication in the specified set is populated. See configurations section above.
· The system will search for an exact match on specific wording when attempting to populate the data file.
· If there is an entry that is not an exact match, the system will populate the wording in a text string of up to 75 characters.
o Landmarks photographed (cecal intubation rate)
· Make sure to label the procedure images with the sites. To ensure correct spelling, use the GI sites map or user list selections from Image Properties tab.
· The system will determine if landmarks have been photographed by looking for the following specific date in the description of images captured for the service:
§ "ileocecal valve " or "ileo-cecal valve”
§ "appendiceal orifice "
§ "terminal ileum"
· Images must be labelled with at least 1 of the 3 above cecal landmarks. Labelling as “cecum” is not adequate for GIQuIC’s purposes.
· Failure to label images appropriately will not show up on the GIQuIC exception report
o Risk Assessment
· By default, both risk selections are blank. It is ok to leave them blank for the cases where the risk assessment does not apply. The system will automatically include the correct indicator of N/A in the GIQuIC data file.
· If the documentation of the risk assessment applies to the patient’s case, one of the two options has to be selected.
· The system will determine if risk assessment is documented on the GIQuIC Questionnaire form
§ Average
§ High
· In addition, if High risk is selected, users must select any risk assessment options that apply to High Risk procedure.
· Selecting at least one option or documenting “other” is required
o Number of Polyps
· Ensure that all polyps are documented in the procedure note. Try to create an individual entry for each combination of polyp/site/intervention/outcome, so that the system can correctly determine the number of polyps removed or retrieved, and which sites were affected.
· The system will determine if there is documentation in Findings of polyps
· The user should document as:
· Finding has a type = Polyp:
· Number has an integer
· Intervention is Polypectomy
· Result contains
o Completely removed
o Partially removed
o Completely retrieved
· If there are multiple entries of the same Type, intervention, and Result, the system will add together the Number entered for each finding
o Polyp description and size
· The system will determine if there are any Findings matching the above requirements, and if so, look to see if the size “from” field is populated
· The system will determine if there are any Findings matching the above requirements, and if so, look to see if the description field is populated
o Duration to cecum
· In order to report duration to cecum, make sure to document the Time markers. These can be accessed by clicking on the Tools icon on the service toolbar or by accessing the Time Tracker from the Image Capture window:
· The system will determine if “cecum” is documented in Site Reached in the Procedure Overview
o If it is, then the system will determine if there are Time Markers documented, and report minutes by calculating the value of time cecum reached minus time scope inserted
o If only one of the Time Markers is populated or both are blank, the system will report “Time not documented”
o If ”cecum” is NOT documented in Sites Reached in the Procedure Overview, the system will report “Did not reach cecum”
· The system will determine if Hemicolectomy is selected in the Procedure Overview, and report Hemicolectomy
· The system will determine if No Cecum is selected in the Procedure Overview, and report No Cecum