US Core Implementation Guide
8.0.0-ballot - Ballot United States of America flag

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core Goal Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal Version: 8.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreGoalProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.28

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Goal Profile inherits from the FHIR Goal resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Goal resource to record, search, and fetch Goal information associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Goal Must Have:

  1. a status
  2. description of the goal
  3. a patient

Each Goal Must Support:

  1. start date*
  2. target date(s)*

*see guidance below

Profile Specific Implementation Guidance:

  • *Although both Goal.startDate and Goal.target.dueDate are marked as Must Support, the server system is not required to support both, but SHALL support at least one of these elements. The client application SHALL support both elements.
  • Free text goals can be used in Goal.description.text when a concept isn't available or a legacy goal is not mapped to a LOINC or SNOMED concept.
  • See the Screening and Assessments guidance page for more information when exchanging Social Determinants of Health (SDOH) Goals

Usage:

Changes since version 7.0.0:

  • No changes
  • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    This structure is derived from Goal

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization
    ... lifecycleStatus S 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
    Binding: GoalLifecycleStatus (required)
    ... description S 1..1 CodeableConcept Code or text describing goal
    Binding: US Core Goal Codes (extensible): Value set to describe the Goal

    ... subject S 1..1 Reference(US Core Patient Profile S | Group | Organization) Who this goal is intended for
    ... start[x] S 0..1 When goal pursuit begins
    .... startDate date S
    .... startCodeableConcept CodeableConcept
    ... target S 0..* BackboneElement Target outcome for the goal
    .... due[x] S 0..1 Reach goal on or before
    ..... dueDate date S
    ..... dueDuration Duration

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Goal.lifecycleStatusrequiredGoalLifecycleStatus
    http://hl7.org/fhir/ValueSet/goal-status
    from the FHIR Standard
    Goal.descriptionextensibleUSCoreGoalCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description
    from this IG
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... lifecycleStatus ?!SΣ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
    Binding: GoalLifecycleStatus (required)
    ... description SΣ 1..1 CodeableConcept Code or text describing goal
    Binding: US Core Goal Codes (extensible): Value set to describe the Goal

    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who this goal is intended for
    ... start[x] SΣ 0..1 When goal pursuit begins
    Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.

    .... startDate date
    ... target SC 0..* BackboneElement Target outcome for the goal
    gol-1: Goal.target.measure is required if Goal.target.detail is populated
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... due[x] SΣ 0..1 Reach goal on or before
    ..... dueDate date

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Goal.lifecycleStatusrequiredGoalLifecycleStatus
    http://hl7.org/fhir/ValueSet/goal-status
    from the FHIR Standard
    Goal.descriptionextensibleUSCoreGoalCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description
    from this IG
    Goal.start[x]exampleGoalStartEvent
    http://hl7.org/fhir/ValueSet/goal-start-event
    from the FHIR Standard
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier 0..* Identifier External Ids for this goal
    ... lifecycleStatus ?!SΣ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
    Binding: GoalLifecycleStatus (required)
    ... achievementStatus Σ 0..1 CodeableConcept in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
    Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.

    ... category Σ 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc.
    Binding: GoalCategory (example): Codes for grouping and sorting goals.


    ... priority Σ 0..1 CodeableConcept high-priority | medium-priority | low-priority
    Binding: GoalPriority (preferred): The level of importance associated with a goal.

    ... description SΣ 1..1 CodeableConcept Code or text describing goal
    Binding: US Core Goal Codes (extensible): Value set to describe the Goal

    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group | Organization) Who this goal is intended for
    ... start[x] SΣ 0..1 When goal pursuit begins
    Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.

    .... startDate date S
    .... startCodeableConcept CodeableConcept
    ... target SC 0..* BackboneElement Target outcome for the goal
    gol-1: Goal.target.measure is required if Goal.target.detail is populated
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... measure ΣC 0..1 CodeableConcept The parameter whose value is being tracked
    Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.

    .... detail[x] ΣC 0..1 The target value to be achieved
    Binding Description (No ValueSet): (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.

    ..... detailQuantity Quantity
    ..... detailRange Range
    ..... detailCodeableConcept CodeableConcept
    ..... detailString string
    ..... detailBoolean boolean
    ..... detailInteger integer
    ..... detailRatio Ratio
    .... due[x] SΣ 0..1 Reach goal on or before
    ..... dueDate date S
    ..... dueDuration Duration
    ... statusDate Σ 0..1 date When goal status took effect
    ... statusReason 0..1 string Reason for current status
    ... expressedBy Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Who's responsible for creating Goal?
    ... addresses 0..* Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment) Issues addressed by this goal
    ... note 0..* Annotation Comments about the goal
    ... outcomeCode 0..* CodeableConcept What result was achieved regarding the goal?
    Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".


    ... outcomeReference 0..* Reference(Observation) Observation that resulted from goal

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Goal.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Goal.lifecycleStatusrequiredGoalLifecycleStatus
    http://hl7.org/fhir/ValueSet/goal-status
    from the FHIR Standard
    Goal.achievementStatuspreferredGoalAchievementStatus
    http://hl7.org/fhir/ValueSet/goal-achievement
    from the FHIR Standard
    Goal.categoryexampleGoalCategory
    http://hl7.org/fhir/ValueSet/goal-category
    from the FHIR Standard
    Goal.prioritypreferredGoalPriority
    http://hl7.org/fhir/ValueSet/goal-priority
    from the FHIR Standard
    Goal.descriptionextensibleUSCoreGoalCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description
    from this IG
    Goal.start[x]exampleGoalStartEvent
    http://hl7.org/fhir/ValueSet/goal-start-event
    from the FHIR Standard
    Goal.target.measureexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Goal.target.detail[x]example
    Goal.outcomeCodeexampleSNOMEDCTClinicalFindings
    http://hl7.org/fhir/ValueSet/clinical-findings
    from the FHIR Standard

    This structure is derived from Goal

    Summary

    Must-Support: 6 elements

    Structures

    This structure refers to these other structures:

    Maturity: 3

    Differential View

    This structure is derived from Goal

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization
    ... lifecycleStatus S 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
    Binding: GoalLifecycleStatus (required)
    ... description S 1..1 CodeableConcept Code or text describing goal
    Binding: US Core Goal Codes (extensible): Value set to describe the Goal

    ... subject S 1..1 Reference(US Core Patient Profile S | Group | Organization) Who this goal is intended for
    ... start[x] S 0..1 When goal pursuit begins
    .... startDate date S
    .... startCodeableConcept CodeableConcept
    ... target S 0..* BackboneElement Target outcome for the goal
    .... due[x] S 0..1 Reach goal on or before
    ..... dueDate date S
    ..... dueDuration Duration

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Goal.lifecycleStatusrequiredGoalLifecycleStatus
    http://hl7.org/fhir/ValueSet/goal-status
    from the FHIR Standard
    Goal.descriptionextensibleUSCoreGoalCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description
    from this IG

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... lifecycleStatus ?!SΣ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
    Binding: GoalLifecycleStatus (required)
    ... description SΣ 1..1 CodeableConcept Code or text describing goal
    Binding: US Core Goal Codes (extensible): Value set to describe the Goal

    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who this goal is intended for
    ... start[x] SΣ 0..1 When goal pursuit begins
    Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.

    .... startDate date
    ... target SC 0..* BackboneElement Target outcome for the goal
    gol-1: Goal.target.measure is required if Goal.target.detail is populated
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... due[x] SΣ 0..1 Reach goal on or before
    ..... dueDate date

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Goal.lifecycleStatusrequiredGoalLifecycleStatus
    http://hl7.org/fhir/ValueSet/goal-status
    from the FHIR Standard
    Goal.descriptionextensibleUSCoreGoalCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description
    from this IG
    Goal.start[x]exampleGoalStartEvent
    http://hl7.org/fhir/ValueSet/goal-start-event
    from the FHIR Standard

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier 0..* Identifier External Ids for this goal
    ... lifecycleStatus ?!SΣ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
    Binding: GoalLifecycleStatus (required)
    ... achievementStatus Σ 0..1 CodeableConcept in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
    Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.

    ... category Σ 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc.
    Binding: GoalCategory (example): Codes for grouping and sorting goals.


    ... priority Σ 0..1 CodeableConcept high-priority | medium-priority | low-priority
    Binding: GoalPriority (preferred): The level of importance associated with a goal.

    ... description SΣ 1..1 CodeableConcept Code or text describing goal
    Binding: US Core Goal Codes (extensible): Value set to describe the Goal

    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group | Organization) Who this goal is intended for
    ... start[x] SΣ 0..1 When goal pursuit begins
    Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.

    .... startDate date S
    .... startCodeableConcept CodeableConcept
    ... target SC 0..* BackboneElement Target outcome for the goal
    gol-1: Goal.target.measure is required if Goal.target.detail is populated
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... measure ΣC 0..1 CodeableConcept The parameter whose value is being tracked
    Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.

    .... detail[x] ΣC 0..1 The target value to be achieved
    Binding Description (No ValueSet): (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.

    ..... detailQuantity Quantity
    ..... detailRange Range
    ..... detailCodeableConcept CodeableConcept
    ..... detailString string
    ..... detailBoolean boolean
    ..... detailInteger integer
    ..... detailRatio Ratio
    .... due[x] SΣ 0..1 Reach goal on or before
    ..... dueDate date S
    ..... dueDuration Duration
    ... statusDate Σ 0..1 date When goal status took effect
    ... statusReason 0..1 string Reason for current status
    ... expressedBy Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Who's responsible for creating Goal?
    ... addresses 0..* Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment) Issues addressed by this goal
    ... note 0..* Annotation Comments about the goal
    ... outcomeCode 0..* CodeableConcept What result was achieved regarding the goal?
    Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".


    ... outcomeReference 0..* Reference(Observation) Observation that resulted from goal

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    Goal.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Goal.lifecycleStatusrequiredGoalLifecycleStatus
    http://hl7.org/fhir/ValueSet/goal-status
    from the FHIR Standard
    Goal.achievementStatuspreferredGoalAchievementStatus
    http://hl7.org/fhir/ValueSet/goal-achievement
    from the FHIR Standard
    Goal.categoryexampleGoalCategory
    http://hl7.org/fhir/ValueSet/goal-category
    from the FHIR Standard
    Goal.prioritypreferredGoalPriority
    http://hl7.org/fhir/ValueSet/goal-priority
    from the FHIR Standard
    Goal.descriptionextensibleUSCoreGoalCodes
    http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description
    from this IG
    Goal.start[x]exampleGoalStartEvent
    http://hl7.org/fhir/ValueSet/goal-start-event
    from the FHIR Standard
    Goal.target.measureexampleLOINCCodes (a valid code from LOINC)
    http://hl7.org/fhir/ValueSet/observation-codes
    from the FHIR Standard
    Goal.target.detail[x]example
    Goal.outcomeCodeexampleSNOMEDCTClinicalFindings
    http://hl7.org/fhir/ValueSet/clinical-findings
    from the FHIR Standard

    This structure is derived from Goal

    Summary

    Must-Support: 6 elements

    Structures

    This structure refers to these other structures:

    Maturity: 3

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:


    Quick Start


    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to goal data SHALL support these US Core SMART Scopes:

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching for all goals for a patient using the patient search parameter:

      GET [base]/Goal?patient={Type/}[id]

      Example:

      1. GET [base]/Goal?patient=1137192

      Implementation Notes: Fetches a bundle of all Goal resources for the specified patient (how to search by reference)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and lifecycle-status search parameters:

      GET [base]/Goal?patient={Type/}[id]&lifecycle-status={system|}[code]

      Example:

      1. GET [base]/Goal?patient=1137192&lifecycle-status=active

      Implementation Notes: Fetches a bundle of all Goal resources for the specified patient and lifecycle-status (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and target-date search parameters:
      • including support for these target-date comparators: gt,lt,ge,le
      • including optional support for AND search on target-date (e.g.target-date=[date]&target-date=[date]]&...)

      GET [base]/Goal?patient={Type/}[id]&target-date={gt|lt|ge|le}[date]{&target-date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Goal?patient=1137192&target-date=ge2015-01-14&target-date=le2019-01-14

      Implementation Notes: Fetches a bundle of all Goal resources for the specified patient and target-date (how to search by reference and how to search by date)

    3. SHOULD support searching using the combination of the patient and description search parameters:

      GET [base]/Goal?patient={Type/}[id]&description={system|}[code]

      Example:

      1. GET [base]/Goal?patient=1137192&description=http://snomed.info/sct|1078229009

      Implementation Notes: Fetches a bundle of all Goal resources for the specified patient and description (how to search by reference and how to search by token)