type: resource-definitionsresource: Goal

Goal Definitions

Goal

Describes the intended objective(s) for a patient, group, or organizational care

Definition: Describes the intended objective(s) for a patient, group, or organizational care. Examples include a patient's weight loss, restoration of an activity of daily living for a patient, obtaining herd immunity via immunization for a group, meeting a process improvement objective for an organization, etc.

Comments: Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

Cardinality: 0..*

Mappings: v2=GOL.1; rim=.outboundRelationship[typeCode<=OBJ].; w5=clinical.careprovision

Goal.identifier

External Ids for this goal

Definition: Business identifiers assigned to this goal by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

Comments: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Requirements: Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers.

Cardinality: 0..*

Type: Identifier

Mappings: w5=FiveWs.identifier; rim=.id

Goal.lifecycleStatus

Definition: The state of the goal throughout its lifecycle.

Comments: This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid.

Requirements: Allows knowing whether goal needs to be further tracked.

Cardinality: 1..1

Type: code

Binding: required:goal-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: w5=FiveWs.status; v2=GOL-18-goal life cycle status; rim=.statusCode in-progress = active (classCode = OBJ) cancelled = aborted

Goal.achievementStatus

Definition: Describes the progression, or lack thereof, towards the goal against the target.

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:goal-achievement

Summary: true

Mappings: rim=.statusCode achieved = complete sustaining = active

Goal.category

E.g. Treatment, dietary, behavioral, etc

Definition: Indicates a category the goal falls within.

Requirements: Allows goals to be filtered and sorted.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:goal-category

Summary: true

Mappings: w5=FiveWs.class

Goal.continuous

After meeting the goal, ongoing activity is needed to sustain the goal objective

Definition: After meeting the goal, ongoing activity is needed to sustain the goal objective.

Comments: For example, getting a yellow fever vaccination for a planned trip is a goal that is designed to be completed (continuous = false). A goal to sustain HbA1c levels would not be a one-time goal (continuous = true).

Requirements: Allows for a system to programmatically update achievementStatus upon finding evidence the goal has been met.

Cardinality: 0..1

Type: boolean

Goal.priority

high-priority | medium-priority | low-priority

Definition: Identifies the mutually agreed level of importance associated with reaching/sustaining the goal.

Comments: Extensions are available to track priorities as established by each participant (i.e. Priority from the patient's perspective, different practitioners' perspectives, family member's perspectives)

The ordinal extension on Coding can be used to convey a numerically comparable ranking to priority. (Keep in mind that different coding systems may use a "low value=important".

Requirements: Used for sorting and presenting goals.

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:goal-priority

Summary: true

Mappings: w5=FiveWs.grade; rim=.priorityCode

Goal.description

Code or text describing goal

Definition: Human-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding".

Comments: If no code is available, use CodeableConcept.text.

Requirements: Without a description of what's trying to be achieved, element has no purpose.

Cardinality: 1..1

Type: CodeableConcept

Binding: example:goal-description

Summary: true

Mappings: w5=FiveWs.what[x]; v2=GOL-3.2-goal ID.text; rim=.text

Goal.subject

Who this goal is intended for

Definition: Identifies the patient, group or organization for whom the goal is being established.

Requirements: Subject is optional to support annonymized reporting.

Cardinality: 1..1

Type: Reference(Patient, Group, Organization)

Summary: true

Mappings: w5=FiveWs.subject; v2=PID-3-patient ID list; rim=.participation[typeCode=PAT].role[classCode=PAT]

Goal.start[x]

When goal pursuit begins

Definition: The date or event after which the goal should begin being pursued.

Requirements: Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery.

Cardinality: 0..1

Type: date, CodeableConcept

Binding: example:goal-start-event

Summary: true

Mappings: w5=FiveWs.planned

Goal.acceptance

Individual acceptance of goal

Definition: Information about the acceptance and relative priority assigned to the goal by the patient, practitioners and other stakeholders.

Cardinality: 0..*

Type: BackboneElement

Goal.acceptance.participant

Individual or organization whose acceptance is reflected

Definition: The person ororganization whose acceptance/priority is being reflected.

Comments: Using Group is only allowed when the group represents a family or a household and should not represent groups of Practitioners.

Cardinality: 1..1

Type: Reference(Patient, Practitioner, RelatedPerson, PractitionerRole, CareTeam, Organization, Group)

Goal.acceptance.status

agree | disagree | pending

Definition: Indicates whether the specified individual has accepted the goal or not.

Cardinality: 0..1

Type: code

Binding: required:goal-accept-status

Goal.acceptance.priority

Priority of goal for individual

Definition: Indicates the relative priority assigned to the goal by the stakeholder.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:goal-priority

Goal.target

Target outcome for the goal

Definition: Indicates what should be done by when.

Comments: When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met.

Requirements: Allows the progress of the goal to be monitored against an observation or due date. Target is 0..* to support Observations with multiple components, such as blood pressure goals with both a systolic and diastolic target.

Cardinality: 0..*

Type: BackboneElement

Constraints: gol-1 | error | Goal.target.measure is required if Goal.target.detail is populated | (detail.exists() and measure.exists()) or detail.exists().not()

Goal.target.measure

The parameter whose value is being tracked

Definition: The parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.

Conditions: gol-1

Cardinality: 0..1

Type: CodeableConcept

Binding: example:observation-codes

Summary: true

Goal.target.detail[x]

The target value to be achieved

Definition: The target value of the focus to be achieved to signify the fulfillment of the goal, e.g. 150 pounds, 7.0%. Either the high or low or both values of the range can be specified. When a low value is missing, it indicates that the goal is achieved at any focus value at or below the high value. Similarly, if the high value is missing, it indicates that the goal is achieved at any focus value at or above the low value. A CodeableConcept target value could be Positive, Negative, Abnormal, Normal, Present, Absent, Yes, No.

Comments: A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Goal.target.measure defines a coded value.

Conditions: gol-1

Cardinality: 0..1

Type: Quantity, Range, CodeableConcept, string, boolean, integer, Ratio

Summary: true

Goal.target.due[x]

Reach goal on or before

Definition: Indicates either the date or the duration after start by which the goal should be met.

Requirements: Identifies when the goal should be evaluated.

Cardinality: 0..1

Type: date, Duration

Summary: true

Mappings: w5=FiveWs.done[x]

Goal.statusDate

When goal achievment status took effect

Definition: Identifies when the current achievement status took effect. I.e. When achieved, when improving, etc.

Comments: To see the date for past statuses, query history.

Cardinality: 0..1

Type: date

Summary: true

Mappings: w5=FiveWs.recorded

Goal.statusReason

Reason for current lifecycle status

Definition: Captures the reason for the current lifecycle status.

Comments: This will typically be captured for statuses such as rejected, on-hold or cancelled, but could be present for others.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:goal-status-reason

Goal.recorder

Who recorded the goal

Definition: Individual who recorded the record and takes responsibility for its content.

Comments: Because the recorder takes responsibility for accurately recording information in the record, the recorder is the most recent author. The recorder might or might not be the source who established the goal. Using Group is only allowed when the group represents a family or a household and should not represent groups of Practitioners.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, Patient, RelatedPerson, Group)

Summary: true

Mappings: w5=FiveWs.author; rim=.participation[typeCode=AUT].role

Goal.source

Who's responsible for creating Goal?

Definition: Indicates whose goal this is - patient goal, practitioner goal, etc.

Comments: This is the individual or team responsible for establishing the goal, not necessarily who recorded it. Using Group is only allowed when the group represents a family or a household and should not represent groups of Practitioners.

Cardinality: 0..1

Type: Reference(Patient, Practitioner, PractitionerRole, RelatedPerson, CareTeam, Group)

Summary: true

Mappings: w5=FiveWs.source

Goal.addresses

Issues addressed by this goal

Definition: The identified conditions and other resources that provide the context for why the goal exists.

Requirements: Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable.

Cardinality: 0..*

Type: Reference(Condition, Observation, MedicationStatement, MedicationRequest, NutritionOrder, ServiceRequest, RiskAssessment, Procedure, NutritionIntake)

Mappings: w5=FiveWs.why[x]; rim=.outboundRelationship[typeCode=SUBJ].target[classCode=CONC]

Goal.note

Comments about the goal

Definition: Any comments related to the goal.

Comments: May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.

Requirements: There's a need to capture information about the goal that doesn't actually describe the goal.

Cardinality: 0..*

Type: Annotation

Mappings: v2=GOL-16-goal evaluation + NTE?; rim=.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value