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9.6 Resource Goal - Content

Responsible Owner: Patient Care icon Work Group NormativeSecurity Category: Patient Compartments: Group, Patient

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.

Note to Balloters: Key changes made since FHIR 6.0.0-ballot4:

  • Non-Compatible Changes
    • FHIR-53981 icon: Rename statusReason to lifecycleStatusReason, rename statusDate to achievementStatusDate, and change sequence of elements
  • Compatible, Substantive Changes
    • FHIR-55326 icon: Add unknown code to Goal.lifecycleStatus value set
  • Non-Substantive Changes
    • FHIR-53828 icon: Added a note for awareness of the resource-pertainsToGoal extension

9.6.1 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.

9.6.2 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."

9.6.3 References to this Resource

9.6.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal N DomainResource Describes the intended objective(s) for a patient, group, or organizational care

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier External Ids for this goal

... lifecycleStatus ?!Σ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown
Binding: Goal Lifecycle Status (Required)
... lifecycleStatusReason 0..* CodeableConcept Reason for current lifecycle status
Binding: Goal Status Reason (Example)

... achievementStatusDate Σ 0..1 date When goal achievement status took effect
... category Σ 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc
Binding: Goal Category (Example)

... continuous 0..1 boolean After meeting the goal, ongoing activity is needed to sustain the goal objective
... priority Σ 0..1 CodeableConcept high-priority | medium-priority | low-priority
Binding: Goal Priority (Preferred)
... description Σ 1..1 CodeableConcept Code or text describing goal
Binding: Goal Description (Example)
... subject Σ 1..1 Reference(Patient | Group | Organization) Who this goal is intended for
... start[x] Σ 0..1 When goal pursuit begins
Binding: Goal Start Event (Example)
.... startDate date
.... startCodeableConcept CodeableConcept
... acceptance 0..* BackboneElement Individual acceptance of goal

.... participant 1..1 Reference(Patient | Practitioner | RelatedPerson | PractitionerRole | CareTeam | Organization | Group) Individual or organization whose acceptance is reflected
.... status 0..1 code agree | disagree | pending
Binding: Goal acceptance status value set (Required)
.... priority 0..1 CodeableConcept Priority of goal for individual
Binding: Goal Priority (Example)
... target C 0..* BackboneElement Target outcome for the goal
+ Rule: Goal.target.measure is required if Goal.target.detail is populated

.... measure ΣC 0..1 CodeableConcept The parameter whose value is being tracked
Binding: LOINC Codes (Example)
.... detail[x] ΣC 0..1 The target value to be achieved
..... detailQuantity Quantity
..... detailRange Range
..... detailCodeableConcept CodeableConcept
..... detailString string
..... detailBoolean boolean
..... detailInteger integer
..... detailRatio Ratio
.... due[x] Σ 0..1 Reach goal on or before
..... dueDate date
..... dueDuration Duration
... recorder Σ 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Group) Who recorded the goal
... source Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | CareTeam | Group) Who's responsible for creating Goal?
... addresses 0..* Reference(Condition | Observation | MedicationStatement | MedicationRequest | NutritionOrder | ServiceRequest | RiskAssessment | Procedure | NutritionIntake) Issues addressed by this goal

... note 0..* Annotation Comments about the goal


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Goal (DomainResource)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 serveridentifier : Identifier [0..*]The state of the goal throughout its lifecycle (this element modifies the meaning of other elements)lifecycleStatus : code [1..1] « null (Strength=Required)GoalLifecycleStatus! »Captures the reason for the current lifecycle statuslifecycleStatusReason : CodeableConcept [0..*] « null (Strength=Example)GoalStatusReason?? »Describes the progression, or lack thereof, towards the goal against the targetachievementStatus : CodeableConcept [0..1] « null (Strength=Preferred)GoalAchievementStatus? »Identifies when the current achievement status took effect. I.e. When achieved, when improving, etcachievementStatusDate : date [0..1]Indicates a category the goal falls withincategory : CodeableConcept [0..*] « null (Strength=Example)GoalCategory?? »After meeting the goal, ongoing activity is needed to sustain the goal objectivecontinuous : boolean [0..1]Identifies the mutually agreed level of importance associated with reaching/sustaining the goalpriority : CodeableConcept [0..1] « null (Strength=Preferred)GoalPriority? »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"description : CodeableConcept [1..1] « null (Strength=Example)GoalDescription?? »Identifies the patient, group or organization for whom the goal is being establishedsubject : Reference [1..1] « Patient|Group|Organization »The date or event after which the goal should begin being pursuedstart[x] : DataType [0..1] « date|CodeableConcept; null (Strength=Example)GoalStartEvent?? »Individual who recorded the record and takes responsibility for its contentrecorder : Reference [0..1] « Practitioner|PractitionerRole|Patient| RelatedPerson|Group »Indicates whose goal this is - patient goal, practitioner goal, etcsource : Reference [0..1] « Patient|Practitioner|PractitionerRole| RelatedPerson|CareTeam|Group »The identified conditions and other resources that provide the context for why the goal existsaddresses : Reference [0..*] « Condition|Observation| MedicationStatement|MedicationRequest|NutritionOrder| ServiceRequest|RiskAssessment|Procedure|NutritionIntake »Any comments related to the goalnote : Annotation [0..*]AcceptanceThe person ororganization whose acceptance/priority is being reflectedparticipant : Reference [1..1] « Patient|Practitioner|RelatedPerson| PractitionerRole|CareTeam|Organization|Group »Indicates whether the specified individual has accepted the goal or notstatus : code [0..1] « null (Strength=Required)GoalAcceptStatus! »Indicates the relative priority assigned to the goal by the stakeholderpriority : CodeableConcept [0..1] « null (Strength=Example)GoalPriority?? »TargetThe parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c levelmeasure : CodeableConcept [0..1] « null (Strength=Example)LOINCCodes?? » « This element has or is affected by some invariantsC »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, Nodetail[x] : DataType [0..1] « Quantity|Range|CodeableConcept|string| boolean|integer|Ratio » « This element has or is affected by some invariantsC »Indicates either the date or the duration after start by which the goal should be metdue[x] : DataType [0..1] « date|Duration »Information about the acceptance and relative priority assigned to the goal by the patient, practitioners and other stakeholdersacceptance[0..*]Indicates what should be done by whentarget[0..*]

XML Template

<Goal xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this goal --></identifier>
 <lifecycleStatus value="[code]"/><!-- 1..1 proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown -->
 <lifecycleStatusReason><!-- 0..* CodeableConcept Reason for current lifecycle status --></lifecycleStatusReason>
 <achievementStatus><!-- 0..1 CodeableConcept in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable --></achievementStatus>
 <achievementStatusDate value="[date]"/><!-- 0..1 When goal achievement status took effect -->
 <category><!-- 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc --></category>
 <continuous value="[boolean]"/><!-- 0..1 After meeting the goal, ongoing activity is needed to sustain the goal objective -->
 <priority><!-- 0..1 CodeableConcept high-priority | medium-priority | low-priority --></priority>
 <description><!-- 1..1 CodeableConcept Code or text describing goal --></description>
 <subject><!-- 1..1 Reference(Group|Organization|Patient) Who this goal is intended for --></subject>
 <start[x]><!-- 0..1 date|CodeableConcept When goal pursuit begins --></start[x]>
 <acceptance>  <!-- 0..* Individual acceptance of goal -->
  <participant><!-- 1..1 Reference(CareTeam|Group|Organization|Patient|
    Practitioner|PractitionerRole|RelatedPerson) Individual or organization whose acceptance is reflected --></participant>
  <status value="[code]"/><!-- 0..1 agree | disagree | pending -->
  <priority><!-- 0..1 CodeableConcept Priority of goal for individual --></priority>
 </acceptance>
 <target>  <!-- 0..* Target outcome for the goal -->
  <measure><!-- I 0..1 CodeableConcept The parameter whose value is being tracked --></measure>
  <detail[x]><!-- I 0..1 Quantity|Range|CodeableConcept|string|boolean|integer|
    Ratio The target value to be achieved --></detail[x]>
  <due[x]><!-- 0..1 date|Duration Reach goal on or before --></due[x]>
 </target>
 <recorder><!-- 0..1 Reference(Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who recorded the goal --></recorder>
 <source><!-- 0..1 Reference(CareTeam|Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who's responsible for creating Goal? --></source>
 <addresses><!-- 0..* Reference(Condition|MedicationRequest|MedicationStatement|
   NutritionIntake|NutritionOrder|Observation|Procedure|RiskAssessment|
   ServiceRequest) Issues addressed by this goal --></addresses>
 <note><!-- 0..* Annotation Comments about the goal --></note>
</Goal>

JSON Template

{doco
  "resourceType" : "Goal",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this goal
  "lifecycleStatus" : "<code>", // R!  proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown
  "lifecycleStatusReason" : [{ CodeableConcept }], // Reason for current lifecycle status
  "achievementStatus" : { CodeableConcept }, // in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
  "achievementStatusDate" : "<date>", // When goal achievement status took effect
  "category" : [{ CodeableConcept }], // E.g. Treatment, dietary, behavioral, etc
  "continuous" : <boolean>, // After meeting the goal, ongoing activity is needed to sustain the goal objective
  "priority" : { CodeableConcept }, // high-priority | medium-priority | low-priority
  "description" : { CodeableConcept }, // R!  Code or text describing goal
  "subject" : { Reference(Group|Organization|Patient) }, // R!  Who this goal is intended for
  // start[x]: When goal pursuit begins. One of these 2:
  "startDate" : "<date>",
  "startCodeableConcept" : { CodeableConcept },
  "acceptance" : [{ // Individual acceptance of goal
    "participant" : { Reference(CareTeam|Group|Organization|Patient|
    Practitioner|PractitionerRole|RelatedPerson) }, // R!  Individual or organization whose acceptance is reflected
    "status" : "<code>", // agree | disagree | pending
    "priority" : { CodeableConcept } // Priority of goal for individual
  }],
  "target" : [{ // Target outcome for the goal
    "measure" : { CodeableConcept }, // I The parameter whose value is being tracked
    // detail[x]: The target value to be achieved. One of these 7:
    "detailQuantity" : { Quantity },
    "detailRange" : { Range },
    "detailCodeableConcept" : { CodeableConcept },
    "detailString" : "<string>",
    "detailBoolean" : <boolean>,
    "detailInteger" : <integer>,
    "detailRatio" : { Ratio },
    // due[x]: Reach goal on or before. One of these 2:
    "dueDate" : "<date>",
    "dueDuration" : { Duration }
  }],
  "recorder" : { Reference(Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who recorded the goal
  "source" : { Reference(CareTeam|Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who's responsible for creating Goal?
  "addresses" : [{ Reference(Condition|MedicationRequest|MedicationStatement|
   NutritionIntake|NutritionOrder|Observation|Procedure|RiskAssessment|
   ServiceRequest) }], // Issues addressed by this goal
  "note" : [{ Annotation }] // Comments about the goal
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Goal;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External Ids for this goal
  fhir:lifecycleStatus [ code ] ; # 1..1 proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown
  fhir:lifecycleStatusReason  ( [ CodeableConcept ] ... ) ; # 0..* Reason for current lifecycle status
  fhir:achievementStatus [ CodeableConcept ] ; # 0..1 in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
  fhir:achievementStatusDate [ date ] ; # 0..1 When goal achievement status took effect
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* E.g. Treatment, dietary, behavioral, etc
  fhir:continuous [ boolean ] ; # 0..1 After meeting the goal, ongoing activity is needed to sustain the goal objective
  fhir:priority [ CodeableConcept ] ; # 0..1 high-priority | medium-priority | low-priority
  fhir:description [ CodeableConcept ] ; # 1..1 Code or text describing goal
  fhir:subject [ Reference(Group|Organization|Patient) ] ; # 1..1 Who this goal is intended for
  # start[x] : 0..1 When goal pursuit begins. One of these 2
    fhir:start [  a fhir:Date ; date ]
    fhir:start [  a fhir:CodeableConcept ; CodeableConcept ]
  fhir:acceptance ( [ # 0..* Individual acceptance of goal
    fhir:participant [ Reference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 1..1 Individual or organization whose acceptance is reflected
    fhir:status [ code ] ; # 0..1 agree | disagree | pending
    fhir:priority [ CodeableConcept ] ; # 0..1 Priority of goal for individual
  ] ... ) ;
  fhir:target ( [ # 0..* Target outcome for the goal
    fhir:measure [ CodeableConcept ] ; # 0..1 I The parameter whose value is being tracked
    # detail[x] : 0..1 I The target value to be achieved. One of these 7
      fhir:detail [  a fhir:Quantity ; Quantity ]
      fhir:detail [  a fhir:Range ; Range ]
      fhir:detail [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:detail [  a fhir:String ; string ]
      fhir:detail [  a fhir:Boolean ; boolean ]
      fhir:detail [  a fhir:Integer ; integer ]
      fhir:detail [  a fhir:Ratio ; Ratio ]
    # due[x] : 0..1 Reach goal on or before. One of these 2
      fhir:due [  a fhir:Date ; date ]
      fhir:due [  a fhir:Duration ; Duration ]
  ] ... ) ;
  fhir:recorder [ Reference(Group|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who recorded the goal
  fhir:source [ Reference(CareTeam|Group|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who's responsible for creating Goal?
  fhir:addresses  ( [ Reference(Condition|MedicationRequest|MedicationStatement|NutritionIntake|NutritionOrder|
  Observation|Procedure|RiskAssessment|ServiceRequest) ] ... ) ; # 0..* Issues addressed by this goal
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments about the goal
]

Changes from R5 to R6

Goal
Goal.lifecycleStatus
  • Remove codes active, on-hold, completed
  • Add code unknown
Goal.lifecycleStatusReason
  • Added Element
Goal.achievementStatusDate
  • Added Element
Goal.acceptance
  • Added Element
Goal.acceptance.participant
  • Added Mandatory Element
Goal.acceptance.status
  • Added Element
Goal.acceptance.priority
  • Added Element
Goal.recorder
  • Added Element
Goal.source
  • Type Reference: Added Target Type Group
Goal.addresses
  • Type Reference: Added Target Type NutritionIntake
Goal.statusDate
  • Deleted
Goal.statusReason
  • Deleted
Goal.outcome
  • Deleted

Changes from R4 and R4B to R6

Goal
Goal.lifecycleStatus
  • Remove codes active, on-hold, completed
  • Add code unknown
Goal.lifecycleStatusReason
  • Added Element
Goal.achievementStatusDate
  • Added Element
Goal.continuous
  • Added Element
Goal.acceptance
  • Added Element
Goal.acceptance.participant
  • Added Mandatory Element
Goal.acceptance.status
  • Added Element
Goal.acceptance.priority
  • Added Element
Goal.recorder
  • Added Element
Goal.source
  • Renamed from expressedBy to source
  • Type Reference: Added Target Types CareTeam, Group
Goal.addresses
  • Type Reference: Added Target Types MedicationRequest, Procedure, NutritionIntake
Goal.statusDate
  • Deleted
Goal.statusReason
  • Deleted
Goal.outcomeCode
  • Deleted
Goal.outcomeReference
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal N DomainResource Describes the intended objective(s) for a patient, group, or organizational care

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier External Ids for this goal

... lifecycleStatus ?!Σ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown
Binding: Goal Lifecycle Status (Required)
... lifecycleStatusReason 0..* CodeableConcept Reason for current lifecycle status
Binding: Goal Status Reason (Example)

... achievementStatusDate Σ 0..1 date When goal achievement status took effect
... category Σ 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc
Binding: Goal Category (Example)

... continuous 0..1 boolean After meeting the goal, ongoing activity is needed to sustain the goal objective
... priority Σ 0..1 CodeableConcept high-priority | medium-priority | low-priority
Binding: Goal Priority (Preferred)
... description Σ 1..1 CodeableConcept Code or text describing goal
Binding: Goal Description (Example)
... subject Σ 1..1 Reference(Patient | Group | Organization) Who this goal is intended for
... start[x] Σ 0..1 When goal pursuit begins
Binding: Goal Start Event (Example)
.... startDate date
.... startCodeableConcept CodeableConcept
... acceptance 0..* BackboneElement Individual acceptance of goal

.... participant 1..1 Reference(Patient | Practitioner | RelatedPerson | PractitionerRole | CareTeam | Organization | Group) Individual or organization whose acceptance is reflected
.... status 0..1 code agree | disagree | pending
Binding: Goal acceptance status value set (Required)
.... priority 0..1 CodeableConcept Priority of goal for individual
Binding: Goal Priority (Example)
... target C 0..* BackboneElement Target outcome for the goal
+ Rule: Goal.target.measure is required if Goal.target.detail is populated

.... measure ΣC 0..1 CodeableConcept The parameter whose value is being tracked
Binding: LOINC Codes (Example)
.... detail[x] ΣC 0..1 The target value to be achieved
..... detailQuantity Quantity
..... detailRange Range
..... detailCodeableConcept CodeableConcept
..... detailString string
..... detailBoolean boolean
..... detailInteger integer
..... detailRatio Ratio
.... due[x] Σ 0..1 Reach goal on or before
..... dueDate date
..... dueDuration Duration
... recorder Σ 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Group) Who recorded the goal
... source Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | CareTeam | Group) Who's responsible for creating Goal?
... addresses 0..* Reference(Condition | Observation | MedicationStatement | MedicationRequest | NutritionOrder | ServiceRequest | RiskAssessment | Procedure | NutritionIntake) Issues addressed by this goal

... note 0..* Annotation Comments about the goal


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Goal (DomainResource)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 serveridentifier : Identifier [0..*]The state of the goal throughout its lifecycle (this element modifies the meaning of other elements)lifecycleStatus : code [1..1] « null (Strength=Required)GoalLifecycleStatus! »Captures the reason for the current lifecycle statuslifecycleStatusReason : CodeableConcept [0..*] « null (Strength=Example)GoalStatusReason?? »Describes the progression, or lack thereof, towards the goal against the targetachievementStatus : CodeableConcept [0..1] « null (Strength=Preferred)GoalAchievementStatus? »Identifies when the current achievement status took effect. I.e. When achieved, when improving, etcachievementStatusDate : date [0..1]Indicates a category the goal falls withincategory : CodeableConcept [0..*] « null (Strength=Example)GoalCategory?? »After meeting the goal, ongoing activity is needed to sustain the goal objectivecontinuous : boolean [0..1]Identifies the mutually agreed level of importance associated with reaching/sustaining the goalpriority : CodeableConcept [0..1] « null (Strength=Preferred)GoalPriority? »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"description : CodeableConcept [1..1] « null (Strength=Example)GoalDescription?? »Identifies the patient, group or organization for whom the goal is being establishedsubject : Reference [1..1] « Patient|Group|Organization »The date or event after which the goal should begin being pursuedstart[x] : DataType [0..1] « date|CodeableConcept; null (Strength=Example)GoalStartEvent?? »Individual who recorded the record and takes responsibility for its contentrecorder : Reference [0..1] « Practitioner|PractitionerRole|Patient| RelatedPerson|Group »Indicates whose goal this is - patient goal, practitioner goal, etcsource : Reference [0..1] « Patient|Practitioner|PractitionerRole| RelatedPerson|CareTeam|Group »The identified conditions and other resources that provide the context for why the goal existsaddresses : Reference [0..*] « Condition|Observation| MedicationStatement|MedicationRequest|NutritionOrder| ServiceRequest|RiskAssessment|Procedure|NutritionIntake »Any comments related to the goalnote : Annotation [0..*]AcceptanceThe person ororganization whose acceptance/priority is being reflectedparticipant : Reference [1..1] « Patient|Practitioner|RelatedPerson| PractitionerRole|CareTeam|Organization|Group »Indicates whether the specified individual has accepted the goal or notstatus : code [0..1] « null (Strength=Required)GoalAcceptStatus! »Indicates the relative priority assigned to the goal by the stakeholderpriority : CodeableConcept [0..1] « null (Strength=Example)GoalPriority?? »TargetThe parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c levelmeasure : CodeableConcept [0..1] « null (Strength=Example)LOINCCodes?? » « This element has or is affected by some invariantsC »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, Nodetail[x] : DataType [0..1] « Quantity|Range|CodeableConcept|string| boolean|integer|Ratio » « This element has or is affected by some invariantsC »Indicates either the date or the duration after start by which the goal should be metdue[x] : DataType [0..1] « date|Duration »Information about the acceptance and relative priority assigned to the goal by the patient, practitioners and other stakeholdersacceptance[0..*]Indicates what should be done by whentarget[0..*]

XML Template

<Goal xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this goal --></identifier>
 <lifecycleStatus value="[code]"/><!-- 1..1 proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown -->
 <lifecycleStatusReason><!-- 0..* CodeableConcept Reason for current lifecycle status --></lifecycleStatusReason>
 <achievementStatus><!-- 0..1 CodeableConcept in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable --></achievementStatus>
 <achievementStatusDate value="[date]"/><!-- 0..1 When goal achievement status took effect -->
 <category><!-- 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc --></category>
 <continuous value="[boolean]"/><!-- 0..1 After meeting the goal, ongoing activity is needed to sustain the goal objective -->
 <priority><!-- 0..1 CodeableConcept high-priority | medium-priority | low-priority --></priority>
 <description><!-- 1..1 CodeableConcept Code or text describing goal --></description>
 <subject><!-- 1..1 Reference(Group|Organization|Patient) Who this goal is intended for --></subject>
 <start[x]><!-- 0..1 date|CodeableConcept When goal pursuit begins --></start[x]>
 <acceptance>  <!-- 0..* Individual acceptance of goal -->
  <participant><!-- 1..1 Reference(CareTeam|Group|Organization|Patient|
    Practitioner|PractitionerRole|RelatedPerson) Individual or organization whose acceptance is reflected --></participant>
  <status value="[code]"/><!-- 0..1 agree | disagree | pending -->
  <priority><!-- 0..1 CodeableConcept Priority of goal for individual --></priority>
 </acceptance>
 <target>  <!-- 0..* Target outcome for the goal -->
  <measure><!-- I 0..1 CodeableConcept The parameter whose value is being tracked --></measure>
  <detail[x]><!-- I 0..1 Quantity|Range|CodeableConcept|string|boolean|integer|
    Ratio The target value to be achieved --></detail[x]>
  <due[x]><!-- 0..1 date|Duration Reach goal on or before --></due[x]>
 </target>
 <recorder><!-- 0..1 Reference(Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who recorded the goal --></recorder>
 <source><!-- 0..1 Reference(CareTeam|Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who's responsible for creating Goal? --></source>
 <addresses><!-- 0..* Reference(Condition|MedicationRequest|MedicationStatement|
   NutritionIntake|NutritionOrder|Observation|Procedure|RiskAssessment|
   ServiceRequest) Issues addressed by this goal --></addresses>
 <note><!-- 0..* Annotation Comments about the goal --></note>
</Goal>

JSON Template

{doco
  "resourceType" : "Goal",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this goal
  "lifecycleStatus" : "<code>", // R!  proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown
  "lifecycleStatusReason" : [{ CodeableConcept }], // Reason for current lifecycle status
  "achievementStatus" : { CodeableConcept }, // in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
  "achievementStatusDate" : "<date>", // When goal achievement status took effect
  "category" : [{ CodeableConcept }], // E.g. Treatment, dietary, behavioral, etc
  "continuous" : <boolean>, // After meeting the goal, ongoing activity is needed to sustain the goal objective
  "priority" : { CodeableConcept }, // high-priority | medium-priority | low-priority
  "description" : { CodeableConcept }, // R!  Code or text describing goal
  "subject" : { Reference(Group|Organization|Patient) }, // R!  Who this goal is intended for
  // start[x]: When goal pursuit begins. One of these 2:
  "startDate" : "<date>",
  "startCodeableConcept" : { CodeableConcept },
  "acceptance" : [{ // Individual acceptance of goal
    "participant" : { Reference(CareTeam|Group|Organization|Patient|
    Practitioner|PractitionerRole|RelatedPerson) }, // R!  Individual or organization whose acceptance is reflected
    "status" : "<code>", // agree | disagree | pending
    "priority" : { CodeableConcept } // Priority of goal for individual
  }],
  "target" : [{ // Target outcome for the goal
    "measure" : { CodeableConcept }, // I The parameter whose value is being tracked
    // detail[x]: The target value to be achieved. One of these 7:
    "detailQuantity" : { Quantity },
    "detailRange" : { Range },
    "detailCodeableConcept" : { CodeableConcept },
    "detailString" : "<string>",
    "detailBoolean" : <boolean>,
    "detailInteger" : <integer>,
    "detailRatio" : { Ratio },
    // due[x]: Reach goal on or before. One of these 2:
    "dueDate" : "<date>",
    "dueDuration" : { Duration }
  }],
  "recorder" : { Reference(Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who recorded the goal
  "source" : { Reference(CareTeam|Group|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who's responsible for creating Goal?
  "addresses" : [{ Reference(Condition|MedicationRequest|MedicationStatement|
   NutritionIntake|NutritionOrder|Observation|Procedure|RiskAssessment|
   ServiceRequest) }], // Issues addressed by this goal
  "note" : [{ Annotation }] // Comments about the goal
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Goal;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External Ids for this goal
  fhir:lifecycleStatus [ code ] ; # 1..1 proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected | unknown
  fhir:lifecycleStatusReason  ( [ CodeableConcept ] ... ) ; # 0..* Reason for current lifecycle status
  fhir:achievementStatus [ CodeableConcept ] ; # 0..1 in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
  fhir:achievementStatusDate [ date ] ; # 0..1 When goal achievement status took effect
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* E.g. Treatment, dietary, behavioral, etc
  fhir:continuous [ boolean ] ; # 0..1 After meeting the goal, ongoing activity is needed to sustain the goal objective
  fhir:priority [ CodeableConcept ] ; # 0..1 high-priority | medium-priority | low-priority
  fhir:description [ CodeableConcept ] ; # 1..1 Code or text describing goal
  fhir:subject [ Reference(Group|Organization|Patient) ] ; # 1..1 Who this goal is intended for
  # start[x] : 0..1 When goal pursuit begins. One of these 2
    fhir:start [  a fhir:Date ; date ]
    fhir:start [  a fhir:CodeableConcept ; CodeableConcept ]
  fhir:acceptance ( [ # 0..* Individual acceptance of goal
    fhir:participant [ Reference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 1..1 Individual or organization whose acceptance is reflected
    fhir:status [ code ] ; # 0..1 agree | disagree | pending
    fhir:priority [ CodeableConcept ] ; # 0..1 Priority of goal for individual
  ] ... ) ;
  fhir:target ( [ # 0..* Target outcome for the goal
    fhir:measure [ CodeableConcept ] ; # 0..1 I The parameter whose value is being tracked
    # detail[x] : 0..1 I The target value to be achieved. One of these 7
      fhir:detail [  a fhir:Quantity ; Quantity ]
      fhir:detail [  a fhir:Range ; Range ]
      fhir:detail [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:detail [  a fhir:String ; string ]
      fhir:detail [  a fhir:Boolean ; boolean ]
      fhir:detail [  a fhir:Integer ; integer ]
      fhir:detail [  a fhir:Ratio ; Ratio ]
    # due[x] : 0..1 Reach goal on or before. One of these 2
      fhir:due [  a fhir:Date ; date ]
      fhir:due [  a fhir:Duration ; Duration ]
  ] ... ) ;
  fhir:recorder [ Reference(Group|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who recorded the goal
  fhir:source [ Reference(CareTeam|Group|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who's responsible for creating Goal?
  fhir:addresses  ( [ Reference(Condition|MedicationRequest|MedicationStatement|NutritionIntake|NutritionOrder|
  Observation|Procedure|RiskAssessment|ServiceRequest) ] ... ) ; # 0..* Issues addressed by this goal
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments about the goal
]

Changes from R5 to R6

Goal
Goal.lifecycleStatus
  • Remove codes active, on-hold, completed
  • Add code unknown
Goal.lifecycleStatusReason
  • Added Element
Goal.achievementStatusDate
  • Added Element
Goal.acceptance
  • Added Element
Goal.acceptance.participant
  • Added Mandatory Element
Goal.acceptance.status
  • Added Element
Goal.acceptance.priority
  • Added Element
Goal.recorder
  • Added Element
Goal.source
  • Type Reference: Added Target Type Group
Goal.addresses
  • Type Reference: Added Target Type NutritionIntake
Goal.statusDate
  • Deleted
Goal.statusReason
  • Deleted
Goal.outcome
  • Deleted

Changes from R4 and R4B to R6

Goal
Goal.lifecycleStatus
  • Remove codes active, on-hold, completed
  • Add code unknown
Goal.lifecycleStatusReason
  • Added Element
Goal.achievementStatusDate
  • Added Element
Goal.continuous
  • Added Element
Goal.acceptance
  • Added Element
Goal.acceptance.participant
  • Added Mandatory Element
Goal.acceptance.status
  • Added Element
Goal.acceptance.priority
  • Added Element
Goal.recorder
  • Added Element
Goal.source
  • Renamed from expressedBy to source
  • Type Reference: Added Target Types CareTeam, Group
Goal.addresses
  • Type Reference: Added Target Types MedicationRequest, Procedure, NutritionIntake
Goal.statusDate
  • Deleted
Goal.statusReason
  • Deleted
Goal.outcomeCode
  • Deleted
Goal.outcomeReference
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

9.6.4.1 Terminology Bindings

Path ValueSet Type Documentation
Goal.lifecycleStatus GoalLifecycleStatus Required

Codes that reflect the current state of a goal and whether the goal is still being targeted.
Goal.lifecycleStatusReason GoalStatusReason Example

Codes to identify the reason for current lifecycle status.
Goal.achievementStatus GoalAchievementStatus Preferred

Describes the progression, or lack thereof, towards the goal against the target.
Goal.category GoalCategory Example

Example codes for grouping goals to use for filtering or presentation.
Goal.priority GoalPriority Preferred

Indicates the level of importance associated with reaching or sustaining a goal.
Goal.description GoalDescription Example

Example value set for Goal descriptions.
Goal.start[x] GoalStartEvent Example

Identifies types of events that might trigger the start of a goal.
Goal.acceptance.status GoalAcceptStatus (a valid code from Goal acceptance status code system) Required

Codes that identify whether the goal has been accepted or not.
Goal.acceptance.priority GoalPriority Example

Indicates the level of importance associated with reaching or sustaining a goal.
Goal.target.measure LOINCCodes (a valid code from LOINC icon) Example

This value set includes all LOINC codes

9.6.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img gol-1Rule Goal.targetGoal.target.measure is required if Goal.target.detail is populated(detail.exists() and measure.exists()) or detail.exists().not()

9.6.5 Notes

9.6.5.1 Goal Outcome

The core extension resource-pertainsToGoal icon is used to indicate a resource, such as Observation, is related to either the measurement, achievement, or progress towards the referenced goal.

9.6.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
achievement-status token in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Goal.achievementStatus
addresses reference Issues addressed by this goal Goal.addresses
(Condition, RiskAssessment, MedicationRequest, NutritionOrder, Observation, Procedure, NutritionIntake, MedicationStatement, ServiceRequest)
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 58 Resources
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)
(Patient)		 60 Resources
start-date date When goal pursuit begins (Goal.start.ofType(date))
subject reference Who this goal is intended for Goal.subject
(Group, Organization, Patient)
target-date date Reach goal on or before (Goal.target.due.ofType(date))
target-measure token The parameter whose value is being tracked Goal.target.measure