QI-Core Implementation Guide
8.0.0-ballot - STU 8 - ballot

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. 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/fhir-qi-core/ and changes regularly. See the Directory of published versions

## Resource Profile: QICore Goal

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-goal | Version: 8.0.0-ballot
Standards status: Trial-use Active as of 2018-08-22 | Maturity Level: 4 | Computable Name: QICoreGoal

Profile of Goal for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

- lifecycleStatus: proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
- subject: (QI) Who this goal is intended for
- description: Code or text describing goal

QI Elements:

- start[x]: (QI) When goal pursuit begins
- target: (QI) Target outcome for the goal

Primary code path: category
(PCPath) This element is the primary code path for this resource CQL Retrieve
Usage

See the patterns page for implementation and usage patterns.

### Examples

Weight Loss Example

Usages:

- Examples for this Profile: Goal/example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | 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 | ?!S Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
description | S Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: US Core Goal Codes (preferred): Value set to describe the Goal
Additional Bindings | Purpose
Social Determinants of Health Goals | Preferred
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who this goal is intended for
start[x] | S Σ | 0..1 |  | (QI) When goal pursuit begins Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date S |
startCodeableConcept |  |  | CodeableConcept |
target | S C | 0..* | BackboneElement | (QI) Target outcome for the goal Constraints: gol-1
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
due[x] | S Σ | 0..1 |  | Reach goal on or before
dueDate |  |  | date S |
dueDuration |  |  | Duration |
expressedBy | S Σ | 0..1 | Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | Who's responsible for creating Goal?
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Goal.lifecycleStatus | Base | required | GoalLifecycleStatus | 📦4.0.1 | FHIR Std.
Goal.description | Base | preferred | US Core Goal Codes | 📦8.0.0 | US Core v8.0
Goal.start[x] | Base | preferred | Goal start event | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Goal | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Goal | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
gol-1 | error | Goal.target | Goal.target.measure is required if Goal.target.detail is populated | `(detail.exists() and measure.exists()) or detail.exists().not()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
subject |  | 1..1 | Reference(QICore Patient) | (QI) Who this goal is intended for
start[x] | Σ | 0..1 |  | (QI) When goal pursuit begins Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date |
startCodeableConcept |  |  | CodeableConcept |
target |  | 0..* | BackboneElement | (QI) Target outcome for the goal
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Goal.start[x] | Base | preferred | Goal start event | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | 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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ | 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 | S Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: US Core Goal Codes (preferred): Value set to describe the Goal
Additional Bindings | Purpose
Social Determinants of Health Goals | Preferred
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who this goal is intended for
start[x] | S Σ | 0..1 |  | (QI) When goal pursuit begins Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date S |
startCodeableConcept |  |  | CodeableConcept |
target | S C | 0..* | BackboneElement | (QI) Target outcome for the goal Constraints: gol-1
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 | Σ C | 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] | Σ C | 0..1 |  | The target value to be achieved Binding Description: (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] | S Σ | 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 | S Σ | 0..1 | Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Goal.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Goal.lifecycleStatus | Base | required | GoalLifecycleStatus | 📦4.0.1 | FHIR Std.
Goal.achievementStatus | Base | preferred | Goal achievement status | 📦4.0.1 | FHIR Std.
Goal.category | Base | example | Goal category | 📦4.0.1 | FHIR Std.
Goal.priority | Base | preferred | Goal priority | 📦4.0.1 | FHIR Std.
Goal.description | Base | preferred | US Core Goal Codes | 📦8.0.0 | US Core v8.0
Goal.start[x] | Base | preferred | Goal start event | 📦4.0.1 | FHIR Std.
Goal.target.measure | Base | example | LOINC Codes | 📦4.0.1 | FHIR Std.
Goal.target.detail[x] | Base | example |  | Not State | Unknown
Goal.outcomeCode | Base | example | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Goal | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Goal | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
gol-1 | error | Goal.target | Goal.target.measure is required if Goal.target.detail is populated | `(detail.exists() and measure.exists()) or detail.exists().not()`

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | 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 | ?!S Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
description | S Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: US Core Goal Codes (preferred): Value set to describe the Goal
Additional Bindings | Purpose
Social Determinants of Health Goals | Preferred
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who this goal is intended for
start[x] | S Σ | 0..1 |  | (QI) When goal pursuit begins Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date S |
startCodeableConcept |  |  | CodeableConcept |
target | S C | 0..* | BackboneElement | (QI) Target outcome for the goal Constraints: gol-1
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
due[x] | S Σ | 0..1 |  | Reach goal on or before
dueDate |  |  | date S |
dueDuration |  |  | Duration |
expressedBy | S Σ | 0..1 | Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | Who's responsible for creating Goal?
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Goal.lifecycleStatus | Base | required | GoalLifecycleStatus | 📦4.0.1 | FHIR Std.
Goal.description | Base | preferred | US Core Goal Codes | 📦8.0.0 | US Core v8.0
Goal.start[x] | Base | preferred | Goal start event | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Goal | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Goal | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
gol-1 | error | Goal.target | Goal.target.measure is required if Goal.target.detail is populated | `(detail.exists() and measure.exists()) or detail.exists().not()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
subject |  | 1..1 | Reference(QICore Patient) | (QI) Who this goal is intended for
start[x] | Σ | 0..1 |  | (QI) When goal pursuit begins Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date |
startCodeableConcept |  |  | CodeableConcept |
target |  | 0..* | BackboneElement | (QI) Target outcome for the goal
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Goal.start[x] | Base | preferred | Goal start event | 📦4.0.1 | FHIR Std.

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | 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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ | 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 | S Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: US Core Goal Codes (preferred): Value set to describe the Goal
Additional Bindings | Purpose
Social Determinants of Health Goals | Preferred
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who this goal is intended for
start[x] | S Σ | 0..1 |  | (QI) When goal pursuit begins Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date S |
startCodeableConcept |  |  | CodeableConcept |
target | S C | 0..* | BackboneElement | (QI) Target outcome for the goal Constraints: gol-1
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 | Σ C | 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] | Σ C | 0..1 |  | The target value to be achieved Binding Description: (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] | S Σ | 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 | S Σ | 0..1 | Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Goal.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Goal.lifecycleStatus | Base | required | GoalLifecycleStatus | 📦4.0.1 | FHIR Std.
Goal.achievementStatus | Base | preferred | Goal achievement status | 📦4.0.1 | FHIR Std.
Goal.category | Base | example | Goal category | 📦4.0.1 | FHIR Std.
Goal.priority | Base | preferred | Goal priority | 📦4.0.1 | FHIR Std.
Goal.description | Base | preferred | US Core Goal Codes | 📦8.0.0 | US Core v8.0
Goal.start[x] | Base | preferred | Goal start event | 📦4.0.1 | FHIR Std.
Goal.target.measure | Base | example | LOINC Codes | 📦4.0.1 | FHIR Std.
Goal.target.detail[x] | Base | example |  | Not State | Unknown
Goal.outcomeCode | Base | example | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Goal | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Goal | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Goal | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
gol-1 | error | Goal.target | Goal.target.measure is required if Goal.target.detail is populated | `(detail.exists() and measure.exists()) or detail.exists().not()`

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)

Maturity: 4

Other representations of profile: CSV, Excel, Schematron