MCC eCare Plan Implementation Guide, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-mcc/ and changes regularly. See the Directory of published versions

MCC Goal Value Sets

There are no additional value sets developed for the MCC Goal Profile beyond the vocabulary bindings as defined in the US Core Goal Profile that the MCC Goal profile is derived from, and the SDOH Goals value set defined by the Gravity project. The US Core Goal profile Goal.description and the Goal.target.measure are extensible bindings or example bindings respectively. Extensible bindings mean if there is no applicable concept in value set (based on human review), an alternate concept (either system/code pair, or text) may be used instead. Example bindings are just suggestions.

In today’s systems, goals are most often captured as free text, and sometimes high-level terms/codes such as LOINC 97842-9 Achievement of therapeutic goals by discharge, or re-using an observable lab code within a goal context, such as LOINC (41995-2) Hemoglobin A1c [Mass/volume] in Blood, and specifying a target measure or detail value of less than 5.7% and a due date. Nursing Care Plan specific EHR modules may take advantage of specific nursing terminology terms that can also often be found in SNOMED CT such as 1144884009 Improvement in level of integrity of skin (finding) * or *703941003 Improved exercise tolerance (finding)

Most of the value sets defined in the MCC libraries, in the context of the MCC Goal profile, could represent goals. For example, the Laboratory Result Value Sets may be used in the MCC Goal Profile as discussed above, and the Symptom Value Sets, may be used in the MCC Goal profiles with an encoded target measure or detail of SNOMED CT 1250004 Decreased (qualifier value).

Table Key

• Value Set Name and Link: All of these value sets are housed in the NLM Value Set Authority Center (VSAC). The value set name is a link to the value set. You must have an NLM/UMLS account to access. There is no charge for an account. Note: the first time you click on the value set name link in a given session, there my be a delay in loading and you will need to sign in once loaded.
• Value Set Clinical Focus: The Value Set Clinical Focus is the same as the clinical focus as written in VSAC which is a free text statement describing the general context of the concepts in the set.
• OID: The Object Identifier (OID) of the set. OIDs of value sets are unique, whereas the names may not be. If accessing the value set outside of this table link, it is safest to perform that search with the OID
• Profile Element: The Profile element asserts the location within the profile the value set term SHALL be used.

MCC Value Sets Use and Validation The value sets in the MCC Value Set Library pages are not bound within any profile. As a result “automatic” validation (confirmation) that a code sent in an instance is a member of that value set will not occurr. Validation support can be added in implmentation. These Symptom Value Sets may be used for several different purposes and no clinically appropriate use is precluded:

• Querying for patients that have experienced particular symptoms
• Within Quality Measures or for research using Clinical Quality Language (CQL) (for example)
• For display within applications
• Terminology validation support

Accessing Value Sets using FHIR Value Set Resource

• To fetch the FHIR ValueSet resource (in other words, the value set definition) use:
• GET https://cts.nlm.nih.gov/fhir/ValueSet/[VSAC OID]
• To fetch the FHIR ValueSet resource expansion use the FHIR $expand operation:
• GET https://cts.nlm.nih.gov/fhir/ValueSet/[VSAC OID]/$expand

For more information refer to the FHIR Terminology Service for VSAC Resources

Comments are welcome as to whether specific goal value sets should be developed for use in the context of a Multiple Chronic Condition Care Plan and the likelihood of being able to successfully query for encoded goals.