US Quality Core Implementation Guide
1.0.0-ballot - STU 1 - ballot United States of America flag

US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

Resource Profile: US Quality Core Goal

Official URL: http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-goal Version: 1.0.0-ballot
Standards status: Trial-use Maturity Level: 4 Computable Name: USQualityCoreGoal
Other Identifiers: OID:2.16.840.1.113883.4.642.40.78.42.18

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

USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V2 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V2 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the Must Support section of this guide for more information. These elements are flagged as (USCDI+ Quality) in the formal profile views.

USCDI+ Quality Elements:

Profile element Description USCDI+ Quality Data Element(s)
description Code or text describing goal Goals and Preferences: Patient Goals, Goals and Preferences: SDOH Goals
expressedBy Who's responsible for creating Goal? Provenance: Author

Because this profile is derived directly or indirectly from US Core, systems are also expected to support the Must Support and Additional USCDI requirements specified by the US Core profile this profile inherits from. For more information about those requirements, refer to the US Core Goal Profile. The Formal Views section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal 0..* USCoreGoalProfile(9.0.0) 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)
... subject SΣ 1..1 Reference(US Quality Core Patient) Who this goal is intended for
... start[x] SΣ 0..1 When goal pursuit begins
Binding: GoalStartEvent (preferred): 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
Constraints: gol-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... due[x] SΣ 0..1 Reach goal on or before
..... dueDate date S
..... dueDuration Duration
... expressedBy SΣ 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) (USCDI+ Quality) Who's responsible for creating Goal?

doco 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 📦9.0.0 US Core v9.0
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()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal 0..* USCoreGoalProfile(9.0.0) Describes the intended objective(s) for a patient, group or organization
... description 1..1 CodeableConcept (USCDI+ Quality) Code or text describing goal
... subject 1..1 Reference(US Quality Core Patient) Who this goal is intended for
... start[x] 0..1 date, CodeableConcept When goal pursuit begins
Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.

doco 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.
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal 0..* USCoreGoalProfile(9.0.0) 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
... 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 ?!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 (USCDI+ Quality) Code or text describing goal
Binding: US Core Goal Codes (preferred): Value set to describe the Goal
... subject SΣ 1..1 Reference(US Quality Core Patient) Who this goal is intended for
... start[x] SΣ 0..1 When goal pursuit begins
Binding: GoalStartEvent (preferred): 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
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 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: (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 SΣ 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) (USCDI+ Quality) 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

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 📦9.0.0 US Core v9.0
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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal 0..* USCoreGoalProfile(9.0.0) 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)
... subject SΣ 1..1 Reference(US Quality Core Patient) Who this goal is intended for
... start[x] SΣ 0..1 When goal pursuit begins
Binding: GoalStartEvent (preferred): 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
Constraints: gol-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... due[x] SΣ 0..1 Reach goal on or before
..... dueDate date S
..... dueDuration Duration
... expressedBy SΣ 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) (USCDI+ Quality) Who's responsible for creating Goal?

doco 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 📦9.0.0 US Core v9.0
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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal 0..* USCoreGoalProfile(9.0.0) Describes the intended objective(s) for a patient, group or organization
... description 1..1 CodeableConcept (USCDI+ Quality) Code or text describing goal
... subject 1..1 Reference(US Quality Core Patient) Who this goal is intended for
... start[x] 0..1 date, CodeableConcept When goal pursuit begins
Binding: GoalStartEvent (preferred): Codes describing events that can trigger the initiation of a goal.

doco 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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Goal 0..* USCoreGoalProfile(9.0.0) 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
... 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 ?!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 (USCDI+ Quality) Code or text describing goal
Binding: US Core Goal Codes (preferred): Value set to describe the Goal
... subject SΣ 1..1 Reference(US Quality Core Patient) Who this goal is intended for
... start[x] SΣ 0..1 When goal pursuit begins
Binding: GoalStartEvent (preferred): 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
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 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: (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 SΣ 0..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) (USCDI+ Quality) 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

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 📦9.0.0 US Core v9.0
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()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Element Conformance Indicators by Profile Layer

Badges identify the profile layer where each conformance indicator is first introduced. Indicators introduced in an earlier layer remain applicable in later derived profiles.

Element conformance indicators organized by the profile layer where they are first introduced
Profile element FHIR US Core US Quality Core
lifecycleStatus Mandatory Must Support
description Mandatory Must Support USCDI+ Quality
subject Mandatory Must Support
start[x] Must Support
target Must Support
target.due[x] Must Support
expressedBy Must Support USCDI+ Quality

Cardinality note: “Mandatory” means the element has a minimum cardinality greater than zero. For nested elements, the cardinality indicator applies when the containing element is present.

Mandatory US Quality Core Server Search Parameters

The searches below are the focused set identified by US Quality Core as needed to retrieve USCDI+ Quality data for quality measurement and reporting. See the US Core FHIR RESTful Search API Requirements for detailed information on requirements by search parameter type.

Because this profile derives directly or indirectly from US Core, servers SHALL also support all mandatory searches described in the US Core Server CapabilityStatement requirements for Goal. When possible, this guide reuses mandatory searches from US Core and notes them with the EXISTING US CORE REQUIREMENT flag. While US Quality Core may restate US Core requirements to highlight searches directly relevant to USCDI+ Quality data access, US Core requirements not restated here remain applicable.

See the US Quality Core Server CapabilityStatement for complete requirements for the underlying Goal resource and Search Requirement Selection for how this focused set was selected.

Servers supporting this profile SHALL support the following search parameters and search parameter combinations:

  1. SHALL support searching for all Goal resources for a patient using the patient search parameter. EXISTING US CORE REQUIREMENT

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

    Example:

    GET [base]/Goal?patient=Patient/example

    Implementation Notes: Fetches a bundle of US Quality Core Goal resources matching the specified search criteria. See how to search by reference.

    Rationale for inclusion: Supports patient-scoped retrieval of Goal resources for USCDI+ Quality workflows.