Goal
Introduction
Scope and Usage
A Goal in health care services delivery is generally an expressed desired health state to be achieved by a subject of care (or family/group) over a period or at a specific point of time. This desired target health state may be achieved as a result of health care intervention(s) or resulting from natural recovery over time. For example:
- A goal of a plan for a condition such as a diabetes might specify desired outcome(s) (e.g. HgbA1c level =<5.6% in 3 months) as a result of interventions such as medication therapy, nutritional management and/or increased physical activity.
- A goal of a procedure might be to meet the intended objective of the procedure (e.g. wet-dry-dressing changes twice a day; goal: wound healed completely in 2 weeks) or to prevent an unintended complication (e.g. repositioning a patient every two hours: goal to maintain skin integrity)
Goals may address the prevention of illness, cure or mitigation of a condition, prolongation of life, or mitigation of pain and discomfort.
When dealing with groups, goals may also reflect health state, such as a reduction of addiction behaviors. However, they may also reflect population health objectives such as education, screening, etc.
Organizational goals are typically not health state specific but may instead identify measurement targets such as infection control, cost management, patient satisfaction, etc.
Boundaries and Relationships
Goals are typically established in the context of a CarePlan. However, goals may also be directly referenced by request-type resources (e.g. MedicationRequest or ServiceRequest) by using an extension.
A goal represents a specific goal instance for a particular patient, group, etc. It is not intended to be used to define types of potential goals as part of an order set or protocol definition. Protocol definitions and order sets are supported through PlanDefinition. The Goal resource is intended to be used once an order set is instantiated or assigned to a patient, which is when the potential goals become the actual goals, if not changed or deleted.
Goals are often evaluated using Observations.
Goal does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive or a request resource with the intent = directive. Legal Advance Directives may specify clinical goals that can be represented as a Goal resource as well. Informally, advance directives could be represented as a Goal resource regardless of whether it was included in the legal Consent, such as "I want to die at home."
Background and Context
Provides additional detail on exactly how the resource is to be used
StructureDefinition
Elements (Simplified)
- Goal [0..*]: - Describes the intended objective(s) for a patient, group, or organizational care
- Goal.identifier [0..*]: Identifier External Ids for this goal
- Goal.lifecycleStatus [1..1]: code required:goal-status proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
- Goal.achievementStatus [0..1]: CodeableConcept preferred:goal-achievement in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
- Goal.category [0..*]: CodeableConcept example:goal-category E.g. Treatment, dietary, behavioral, etc
- Goal.continuous [0..1]: boolean After meeting the goal, ongoing activity is needed to sustain the goal objective
- Goal.priority [0..1]: CodeableConcept preferred:goal-priority high-priority | medium-priority | low-priority
- Goal.description [1..1]: CodeableConcept example:goal-description Code or text describing goal
- Goal.subject [1..1]: [Reference(Patient](/Reference(Patient), Group, Organization)) Who this goal is intended for
- Goal.start[x] [0..1]: date, CodeableConcept example:goal-start-event When goal pursuit begins
- Goal.acceptance [0..*]: BackboneElement Individual acceptance of goal
- Goal.acceptance.participant [1..1]: [Reference(Patient](/Reference(Patient), Practitioner, RelatedPerson, PractitionerRole, CareTeam, Organization, Group)) Individual or organization whose acceptance is reflected
- Goal.acceptance.status [0..1]: code required:goal-accept-status agree | disagree | pending
- Goal.acceptance.priority [0..1]: CodeableConcept example:goal-priority Priority of goal for individual
- Goal.target [0..*]: BackboneElement Target outcome for the goal
- Goal.target.measure [0..1]: CodeableConcept example:observation-codes The parameter whose value is being tracked
- Goal.target.detail[x] [0..1]: Quantity, Range, CodeableConcept, string, boolean, integer, Ratio The target value to be achieved
- Goal.target.due[x] [0..1]: date, Duration Reach goal on or before
- Goal.statusDate [0..1]: date When goal achievment status took effect
- Goal.statusReason [0..*]: CodeableConcept example:goal-status-reason Reason for current lifecycle status
- Goal.recorder [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Patient, RelatedPerson, Group)) Who recorded the goal
- Goal.source [0..1]: [Reference(Patient](/Reference(Patient), Practitioner, PractitionerRole, RelatedPerson, CareTeam, Group)) Who's responsible for creating Goal?
- Goal.addresses [0..*]: [Reference(Condition](/Reference(Condition), Observation, MedicationStatement, MedicationRequest, NutritionOrder, ServiceRequest, RiskAssessment, Procedure, NutritionIntake)) Issues addressed by this goal
- Goal.note [0..*]: Annotation Comments about the goal
Mappings
- Goal Mappings — 28 mapping entries
Implementation Guide
implementationguide-Goal-core.xml
<?xml version="1.0" encoding="UTF-8"?>
<ImplementationGuide xmlns="http://hl7.org/fhir">
<id value="Goal-core"/>
<name value="FHIRCoreGoalProfile"/>
<title value="FHIR Core Goal Profile"/>
<status value="draft"/>
<date value="2014-12-07T00:00:00.000"/>
<publisher value="Health Level Seven, Inc. - FHIR WG"/>
<description value="This profile holds core Goal extensions"/>
</ImplementationGuide>
Resource Packs
list-Goal-packs.xml
<?xml version="1.0" encoding="UTF-8"?>
<List xmlns="http://hl7.org/fhir">
<id value="Goal-packs"/>
<status value="current"/>
<mode value="working"/>
<entry>
<item>
<reference value="ImplementationGuide/Goal-core"/>
</item>
</entry>
</List>
Search Parameters
- achievement-status — token — in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable —
Goal.achievementStatus - category — token — E.g. Treatment, dietary, behavioral, etc. —
Goal.category - description — token — Code or text describing goal —
Goal.description - identifier — token — External Ids for this goal —
Goal.identifier - lifecycle-status — token — proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected —
Goal.lifecycleStatus - patient — reference — Who this goal is intended for —
Goal.subject.where(resolve() is Patient) - start-date — date — When goal pursuit begins —
(Goal.start.ofType(date)) - subject — reference — Who this goal is intended for —
Goal.subject - target-date — date — Reach goal on or before —
(Goal.target.due.ofType(date)) - addresses — reference — Issues addressed by this goal —
Goal.addresses - target-measure — token — The parameter whose value is being tracked —
Goal.target.measure
Examples
- example — goal-example — Goal of Weight Loss
- goal-example — goal-example
- goal-example-stop-smoking — goal-example-stop-smoking
- goal-examples-header — goal-examples-header
- stop-smoking — goal-example-stop-smoking — Goal to Stop Smoking
Mapping Exceptions
goal-fivews-mapping-exceptions.xml
Unmapped Elements
- FiveWs.actor — Unknown
- FiveWs.cause — Unknown
- FiveWs.version — Unknown
- FiveWs.witness — Unknown
- FiveWs.where — Unknown
- FiveWs.context — Unknown
- FiveWs.init — Unknown
- FiveWs.who — Unknown