QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreGoal

Defining URL: | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-goal
Version: | 4.1.0
Name: | QICoreGoal
Status: | Draft as of 8/22/18
Definition: | Profile of Goal for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
Publisher: | http://www.hl7.org/Special/committees/cqi/index.cfm
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-goal

Usage

See the patterns page for implementation and usage patterns.

### Examples

Weight Loss Example

### Formal Views of Profile Content

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

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from USCoreGoalProfile

Summary

Mandatory: 1 element (2 nested mandatory elements)
Must-Support: 8 elements

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICorePractitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICoreRelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)
- QICoreCondition (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition)
- QICoreObservation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation)
- QICoreMedicationStatement (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationstatement)
- QICoreServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/StructureDefinition/goal-reasonRejected

This structure is derived from USCoreGoalProfile

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
id |  | 0..1 | string | Logical id of this artifact
goal-reasonRejected |  | 0..1 | CodeableConcept | The reason the goal was not accepted URL: http://hl7.org/fhir/StructureDefinition/goal-reasonRejected Binding: Reasons for rejecting goal codes (example): The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support the goal process, in particular the process and reasons for rejecting a goal. This value set is provided as a suggestive example.
lifecycleStatus | S | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
achievementStatus | S | 0..1 | CodeableConcept | in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
category | S | 0..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc.
description | S | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (preferred): This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
subject | S | 1..1 | Reference(QICorePatient) | Who this goal is intended for
start[x] |  | 0..1 | date | When goal pursuit begins
target | S | 0..* | BackboneElement | Target outcome for the goal
measure |  | 1..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (preferred): LOINC codes
detail[x] |  | 1..1 | Quantity, Range, CodeableConcept, string, boolean, integer, Ratio | The target value to be achieved
due[x] |  | 0..1 | date | Reach goal on or before
statusDate | S | 0..1 | date | When goal status took effect
expressedBy |  | 0..1 | Reference(QICorePatient | QICorePractitioner | QICoreRelatedPerson) | Who's responsible for creating Goal?
addresses | S | 0..* | Reference(QICoreCondition | QICoreObservation | QICoreMedicationStatement | NutritionOrder | QICoreServiceRequest | RiskAssessment) | Issues addressed by this goal
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
id | Σ | 0..1 | string | 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) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
goal-reasonRejected |  | 0..1 | CodeableConcept | The reason the goal was not accepted URL: http://hl7.org/fhir/StructureDefinition/goal-reasonRejected
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 | S 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 | S 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: SNOMEDCTClinicalFindings (preferred): This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
subject | S Σ | 1..1 | Reference(QICorePatient) | Who this goal is intended for
start[x] | Σ | 0..1 | date | When goal pursuit begins
target | S I | 0..* | BackboneElement | Target outcome for the goal
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 I | 1..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (preferred): LOINC codes
detail[x] | Σ I | 1..1 |  | The target value to be achieved Binding: (unbound) (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 |
Slices for due[x] | Σ | 0..1 | date | Reach goal on or before Slice: Unordered, Closed by type:$this
due[x]:dueDate | S Σ | 0..1 | date | Reach goal on or before
statusDate | S Σ | 0..1 | date | When goal status took effect
statusReason |  | 0..1 | string | Reason for current status
expressedBy | Σ | 0..1 | Reference(QICorePatient | QICorePractitioner | QICoreRelatedPerson) | Who's responsible for creating Goal?
addresses | S | 0..* | Reference(QICoreCondition | QICoreObservation | QICoreMedicationStatement | NutritionOrder | QICoreServiceRequest | 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

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
lifecycleStatus | ?!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.
description | Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (preferred): This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
subject | Σ | 1..1 | Reference(QICorePatient) | Who this goal is intended for
target | I | 0..* | BackboneElement | Target outcome for the goal
due[x]:dueDate | Σ | 0..1 | date | Reach goal on or before
statusDate | Σ | 0..1 | date | When goal status took effect
addresses |  | 0..* | Reference(QICoreCondition | QICoreObservation | QICoreMedicationStatement | NutritionOrder | QICoreServiceRequest | RiskAssessment) | Issues addressed by this goal
Documentation for this format

This structure is derived from USCoreGoalProfile

Summary

Mandatory: 1 element (2 nested mandatory elements)
Must-Support: 8 elements

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICorePractitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICoreRelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)
- QICoreCondition (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition)
- QICoreObservation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation)
- QICoreMedicationStatement (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationstatement)
- QICoreServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/StructureDefinition/goal-reasonRejected

Differential View

This structure is derived from USCoreGoalProfile

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
id |  | 0..1 | string | Logical id of this artifact
goal-reasonRejected |  | 0..1 | CodeableConcept | The reason the goal was not accepted URL: http://hl7.org/fhir/StructureDefinition/goal-reasonRejected Binding: Reasons for rejecting goal codes (example): The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support the goal process, in particular the process and reasons for rejecting a goal. This value set is provided as a suggestive example.
lifecycleStatus | S | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
achievementStatus | S | 0..1 | CodeableConcept | in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
category | S | 0..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc.
description | S | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (preferred): This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
subject | S | 1..1 | Reference(QICorePatient) | Who this goal is intended for
start[x] |  | 0..1 | date | When goal pursuit begins
target | S | 0..* | BackboneElement | Target outcome for the goal
measure |  | 1..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (preferred): LOINC codes
detail[x] |  | 1..1 | Quantity, Range, CodeableConcept, string, boolean, integer, Ratio | The target value to be achieved
due[x] |  | 0..1 | date | Reach goal on or before
statusDate | S | 0..1 | date | When goal status took effect
expressedBy |  | 0..1 | Reference(QICorePatient | QICorePractitioner | QICoreRelatedPerson) | Who's responsible for creating Goal?
addresses | S | 0..* | Reference(QICoreCondition | QICoreObservation | QICoreMedicationStatement | NutritionOrder | QICoreServiceRequest | RiskAssessment) | Issues addressed by this goal
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | USCoreGoalProfile | Describes the intended objective(s) for a patient, group or organization
id | Σ | 0..1 | string | 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) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
goal-reasonRejected |  | 0..1 | CodeableConcept | The reason the goal was not accepted URL: http://hl7.org/fhir/StructureDefinition/goal-reasonRejected
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 | S 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 | S 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: SNOMEDCTClinicalFindings (preferred): This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
subject | S Σ | 1..1 | Reference(QICorePatient) | Who this goal is intended for
start[x] | Σ | 0..1 | date | When goal pursuit begins
target | S I | 0..* | BackboneElement | Target outcome for the goal
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 I | 1..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (preferred): LOINC codes
detail[x] | Σ I | 1..1 |  | The target value to be achieved Binding: (unbound) (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 |
Slices for due[x] | Σ | 0..1 | date | Reach goal on or before Slice: Unordered, Closed by type:$this
due[x]:dueDate | S Σ | 0..1 | date | Reach goal on or before
statusDate | S Σ | 0..1 | date | When goal status took effect
statusReason |  | 0..1 | string | Reason for current status
expressedBy | Σ | 0..1 | Reference(QICorePatient | QICorePractitioner | QICoreRelatedPerson) | Who's responsible for creating Goal?
addresses | S | 0..* | Reference(QICoreCondition | QICoreObservation | QICoreMedicationStatement | NutritionOrder | QICoreServiceRequest | 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

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet
Goal.language | preferred | CommonLanguages Max Binding: AllLanguages
Goal.lifecycleStatus | required | GoalLifecycleStatus
Goal.achievementStatus | preferred | GoalAchievementStatus
Goal.category | example | GoalCategory
Goal.priority | preferred | GoalPriority
Goal.description | preferred | SNOMEDCTClinicalFindings
Goal.target.measure | preferred | LOINCCodes
Goal.target.detail[x] | example |
Goal.outcomeCode | example | SNOMEDCTClinicalFindings

#### Constraints

Id | Grade | Path | Details | Requirements
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 | Goal.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Goal.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Goal.extension:reasonRejected | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Goal.extension:reasonRejected | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Goal.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Goal.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Goal.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.lifecycleStatus | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.achievementStatus | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.priority | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.subject | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.start[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.target | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
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() |
ele-1 | error | Goal.target.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Goal.target.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Goal.target.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Goal.target.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Goal.target.measure | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.target.detail[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.target.due[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.target.due[x]:dueDate | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.statusDate | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.statusReason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.expressedBy | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.addresses | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.note | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.outcomeCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Goal.outcomeReference | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |