STU3 Candidate

This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

9.5 Resource Goal - Content

Patient Care Work GroupMaturity Level: 1Compartments: Patient

Describes the intended objective(s) for a patient, group or organization care, for example, weight loss, restoring an activity of daily living, obtaining herd immunity via immunization, meeting a process improvement objective, etc.

9.5.1 Scope and Usage

A Goal in health care services delivery is generally an expressed desired health state to be achieved by a subject of care (or family/group) over a period or at a specific point of time. This desired target health state may be achieved as a result of health care intervention(s) or resulting from natural recovery over time. For example:

  • A goal of a plan for a condition such as a diabetes might specify desired outcome(s) (e.g. HgbA1c level =<5.6% in 3 months) as a result of interventions such as medication therapy, nutritional management and/or increase physical activity.
  • A goal of a procedure might be to meet the intended objective of the procedure (e.g. wet-dry-dressing changes twice a day; goal: wound healed completely in 2 weeks) or to prevent an unintended complication (e.g. repositioning a patient every two hours: goal to maintain skin integrity)

Goals may address the prevention of illness, cure or mitigation of a condition, prolongation of life, or mitigation of pain and discomfort.

When dealing with groups, goals may also reflect health state, such as a reduction of addiction behaviors. However, they may also reflect population health objectives such as education, screening, etc.

Organizational goals are typically not health state specific but may instead identify measurement targets such as infection control, cost management, patient satisfaction, etc.

9.5.2 Boundaries and Relationships

Goals are typically established in the context of a CarePlan. However, goals may also be directly referenced by request-type resources (e.g. MedicationRequest or ReferralRequest) by using an extension.

A goal represents a specific goal instance for a particular patient, group, etc. It is not intended to be used to define types of potential goals as part of an order set or protocol definition. Protocol definitions and order sets are supported through PlanDefinition. The Goal resource is intended to be used once an order set is instantiated or assigned to a patient, which is when the potential goals become the actual goals, if not changed or deleted.

Goals are often evaluated using Observations.

This resource is referenced by careplan

9.5.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Goal DomainResourceDescribes the intended objective(s) for a patient, group or organization
... identifier 0..*IdentifierExternal Ids for this goal
... status ?!Σ1..1codeproposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error
GoalStatus (Required)
... category Σ0..*CodeableConceptE.g. Treatment, dietary, behavioral, etc.
GoalCategory (Example)
... priority Σ0..1CodeableConcepthigh | medium |low
GoalPriority (Preferred)
... description Σ1..1CodeableConceptCode or text describing goal
... subject Σ0..1Reference(Patient | Group | Organization)Who this goal is intended for
... start[x] Σ0..1When goal pursuit begins
GoalStartEvent (Example)
.... startDatedate
.... startCodeableConceptCodeableConcept
... target[x] Σ0..1Reach goal on or before
.... targetDatedate
.... targetDurationDuration
... statusDate Σ0..1dateWhen goal status took effect
... statusReason 0..*CodeableConceptReason for current status
GoalStatusReason (Example)
... expressedBy Σ0..1Reference(Patient | Practitioner | RelatedPerson)Who's responsible for creating Goal?
... addresses 0..*Reference(Condition | Observation | MedicationStatement | NutritionRequest | ProcedureRequest | RiskAssessment)Issues addressed by this goal
... note 0..*AnnotationComments about the goal
... outcome 0..*BackboneElementWhat result was achieved regarding the goal?
.... result[x] 0..1Code or observation that resulted from goal
..... resultCodeableConceptCodeableConcept
..... resultReferenceReference(Observation)

doco Documentation for this format

UML Diagram (Legend)

Goal (DomainResource)This records identifiers associated with this care plan that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)identifier : Identifier [0..*]Indicates whether the goal has been reached and is still considered relevant (this element modifies the meaning of other elements)status : code [1..1] « Indicates whether the goal has been met and is still being targeted (Strength=Required)GoalStatus! »Indicates a category the goal falls withincategory : CodeableConcept [0..*] « Codes for grouping and sorting goals (Strength=Example)GoalCategory?? »Identifies the mutually agreed level of importance associated with reaching/sustaining the goalpriority : CodeableConcept [0..1] « The level of importance associated with a goal (Strength=Preferred)GoalPriority? »Code and/or human-readable description of a specific desired objective of caredescription : CodeableConcept [1..1]Identifies the patient, group or organization for whom the goal is being establishedsubject : Reference [0..1] « Patient|Group|Organization »The date or event after which the goal should begin being pursuedstart[x] : Type [0..1] « date|CodeableConcept; Codes describing events that can trigger the initiation of a goal (Strength=Example)GoalStartEvent?? »Indicates either the date or the duration after start by which the goal should be mettarget[x] : Type [0..1] « date|Duration »Identifies when the current status. I.e. When initially created, when achieved, when cancelled, etcstatusDate : date [0..1]Captures the reason for the current statusstatusReason : CodeableConcept [0..*] « Codes to identify the reason for a goal's current status (Strength=Example)GoalStatusReason?? »Indicates whose goal this is - patient goal, practitioner goal, etcexpressedBy : Reference [0..1] « Patient|Practitioner|RelatedPerson »The identified conditions and other health record elements that are intended to be addressed by the goaladdresses : Reference [0..*] « Condition|Observation| MedicationStatement|NutritionRequest|ProcedureRequest| RiskAssessment »Any comments related to the goalnote : Annotation [0..*]OutcomeDetails of what's changed (or not changed)result[x] : Type [0..1] « CodeableConcept|Reference(Observation) »Identifies the change (or lack of change) at the point where the goal was deemed to be cancelled or achievedoutcome[0..*]

XML Template

<Goal xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this goal --></identifier>
 <status value="[code]"/><!-- 1..1 proposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error -->
 <category><!-- 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc. --></category>
 <priority><!-- 0..1 CodeableConcept high | medium |low --></priority>
 <description><!-- 1..1 CodeableConcept Code or text describing goal --></description>
 <subject><!-- 0..1 Reference(Patient|Group|Organization) Who this goal is intended for --></subject>
 <start[x]><!-- 0..1 date|CodeableConcept When goal pursuit begins --></start[x]>
 <target[x]><!-- 0..1 date|Duration Reach goal on or before --></target[x]>
 <statusDate value="[date]"/><!-- 0..1 When goal status took effect -->
 <statusReason><!-- 0..* CodeableConcept Reason for current status --></statusReason>
 <expressedBy><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson) Who's responsible for creating Goal? --></expressedBy>
 <addresses><!-- 0..* Reference(Condition|Observation|MedicationStatement|
   NutritionRequest|ProcedureRequest|RiskAssessment) Issues addressed by this goal --></addresses>
 <note><!-- 0..* Annotation Comments about the goal --></note>
 <outcome>  <!-- 0..* What result was achieved regarding the goal? -->
  <result[x]><!-- 0..1 CodeableConcept|Reference(Observation) Code or observation that resulted from goal --></result[x]>
 </outcome>
</Goal>

JSON Template

{doco
  "resourceType" : "Goal",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this goal
  "status" : "<code>", // R!  proposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error
  "category" : [{ CodeableConcept }], // E.g. Treatment, dietary, behavioral, etc.
  "priority" : { CodeableConcept }, // high | medium |low
  "description" : { CodeableConcept }, // R!  Code or text describing goal
  "subject" : { Reference(Patient|Group|Organization) }, // Who this goal is intended for
  // start[x]: When goal pursuit begins. One of these 2:
  "startDate" : "<date>",
  "startCodeableConcept" : { CodeableConcept },
  // target[x]: Reach goal on or before. One of these 2:
  "targetDate" : "<date>",
  "targetDuration" : { Duration },
  "statusDate" : "<date>", // When goal status took effect
  "statusReason" : [{ CodeableConcept }], // Reason for current status
  "expressedBy" : { Reference(Patient|Practitioner|RelatedPerson) }, // Who's responsible for creating Goal?
  "addresses" : [{ Reference(Condition|Observation|MedicationStatement|
   NutritionRequest|ProcedureRequest|RiskAssessment) }], // Issues addressed by this goal
  "note" : [{ Annotation }], // Comments about the goal
  "outcome" : [{ // What result was achieved regarding the goal?
    // result[x]: Code or observation that resulted from goal. One of these 2:
    "resultCodeableConcept" : { CodeableConcept }
    "resultReference" : { Reference(Observation) }
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Goal;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Goal.identifier [ Identifier ], ... ; # 0..* External Ids for this goal
  fhir:Goal.status [ code ]; # 1..1 proposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error
  fhir:Goal.category [ CodeableConcept ], ... ; # 0..* E.g. Treatment, dietary, behavioral, etc.
  fhir:Goal.priority [ CodeableConcept ]; # 0..1 high | medium |low
  fhir:Goal.description [ CodeableConcept ]; # 1..1 Code or text describing goal
  fhir:Goal.subject [ Reference(Patient|Group|Organization) ]; # 0..1 Who this goal is intended for
  # Goal.start[x] : 0..1 When goal pursuit begins. One of these 2
    fhir:Goal.startDate [ date ]
    fhir:Goal.startCodeableConcept [ CodeableConcept ]
  # Goal.target[x] : 0..1 Reach goal on or before. One of these 2
    fhir:Goal.targetDate [ date ]
    fhir:Goal.targetDuration [ Duration ]
  fhir:Goal.statusDate [ date ]; # 0..1 When goal status took effect
  fhir:Goal.statusReason [ CodeableConcept ], ... ; # 0..* Reason for current status
  fhir:Goal.expressedBy [ Reference(Patient|Practitioner|RelatedPerson) ]; # 0..1 Who's responsible for creating Goal?
  fhir:Goal.addresses [ Reference(Condition|Observation|MedicationStatement|NutritionRequest|ProcedureRequest|
  RiskAssessment) ], ... ; # 0..* Issues addressed by this goal
  fhir:Goal.note [ Annotation ], ... ; # 0..* Comments about the goal
  fhir:Goal.outcome [ # 0..* What result was achieved regarding the goal?
    # Goal.outcome.result[x] : 0..1 Code or observation that resulted from goal. One of these 2
      fhir:Goal.outcome.resultCodeableConcept [ CodeableConcept ]
      fhir:Goal.outcome.resultReference [ Reference(Observation) ]
  ], ...;
]

Changes since DSTU2

Goal
Goal.description Type changed from string to CodeableConcept
Goal.target[x] Remove Quantity{http://hl7.org/fhir/StructureDefinition/Duration}, Add Duration
Goal.statusReason Max Cardinality changed from 1 to *
Goal.expressedBy added Element
Goal.addresses Remove Reference(NutritionOrder), Add Reference(NutritionRequest)
Goal.author deleted

See the Full Difference for further information

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Goal DomainResourceDescribes the intended objective(s) for a patient, group or organization
... identifier 0..*IdentifierExternal Ids for this goal
... status ?!Σ1..1codeproposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error
GoalStatus (Required)
... category Σ0..*CodeableConceptE.g. Treatment, dietary, behavioral, etc.
GoalCategory (Example)
... priority Σ0..1CodeableConcepthigh | medium |low
GoalPriority (Preferred)
... description Σ1..1CodeableConceptCode or text describing goal
... subject Σ0..1Reference(Patient | Group | Organization)Who this goal is intended for
... start[x] Σ0..1When goal pursuit begins
GoalStartEvent (Example)
.... startDatedate
.... startCodeableConceptCodeableConcept
... target[x] Σ0..1Reach goal on or before
.... targetDatedate
.... targetDurationDuration
... statusDate Σ0..1dateWhen goal status took effect
... statusReason 0..*CodeableConceptReason for current status
GoalStatusReason (Example)
... expressedBy Σ0..1Reference(Patient | Practitioner | RelatedPerson)Who's responsible for creating Goal?
... addresses 0..*Reference(Condition | Observation | MedicationStatement | NutritionRequest | ProcedureRequest | RiskAssessment)Issues addressed by this goal
... note 0..*AnnotationComments about the goal
... outcome 0..*BackboneElementWhat result was achieved regarding the goal?
.... result[x] 0..1Code or observation that resulted from goal
..... resultCodeableConceptCodeableConcept
..... resultReferenceReference(Observation)

doco Documentation for this format

UML Diagram (Legend)

Goal (DomainResource)This records identifiers associated with this care plan that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)identifier : Identifier [0..*]Indicates whether the goal has been reached and is still considered relevant (this element modifies the meaning of other elements)status : code [1..1] « Indicates whether the goal has been met and is still being targeted (Strength=Required)GoalStatus! »Indicates a category the goal falls withincategory : CodeableConcept [0..*] « Codes for grouping and sorting goals (Strength=Example)GoalCategory?? »Identifies the mutually agreed level of importance associated with reaching/sustaining the goalpriority : CodeableConcept [0..1] « The level of importance associated with a goal (Strength=Preferred)GoalPriority? »Code and/or human-readable description of a specific desired objective of caredescription : CodeableConcept [1..1]Identifies the patient, group or organization for whom the goal is being establishedsubject : Reference [0..1] « Patient|Group|Organization »The date or event after which the goal should begin being pursuedstart[x] : Type [0..1] « date|CodeableConcept; Codes describing events that can trigger the initiation of a goal (Strength=Example)GoalStartEvent?? »Indicates either the date or the duration after start by which the goal should be mettarget[x] : Type [0..1] « date|Duration »Identifies when the current status. I.e. When initially created, when achieved, when cancelled, etcstatusDate : date [0..1]Captures the reason for the current statusstatusReason : CodeableConcept [0..*] « Codes to identify the reason for a goal's current status (Strength=Example)GoalStatusReason?? »Indicates whose goal this is - patient goal, practitioner goal, etcexpressedBy : Reference [0..1] « Patient|Practitioner|RelatedPerson »The identified conditions and other health record elements that are intended to be addressed by the goaladdresses : Reference [0..*] « Condition|Observation| MedicationStatement|NutritionRequest|ProcedureRequest| RiskAssessment »Any comments related to the goalnote : Annotation [0..*]OutcomeDetails of what's changed (or not changed)result[x] : Type [0..1] « CodeableConcept|Reference(Observation) »Identifies the change (or lack of change) at the point where the goal was deemed to be cancelled or achievedoutcome[0..*]

XML Template

<Goal xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this goal --></identifier>
 <status value="[code]"/><!-- 1..1 proposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error -->
 <category><!-- 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc. --></category>
 <priority><!-- 0..1 CodeableConcept high | medium |low --></priority>
 <description><!-- 1..1 CodeableConcept Code or text describing goal --></description>
 <subject><!-- 0..1 Reference(Patient|Group|Organization) Who this goal is intended for --></subject>
 <start[x]><!-- 0..1 date|CodeableConcept When goal pursuit begins --></start[x]>
 <target[x]><!-- 0..1 date|Duration Reach goal on or before --></target[x]>
 <statusDate value="[date]"/><!-- 0..1 When goal status took effect -->
 <statusReason><!-- 0..* CodeableConcept Reason for current status --></statusReason>
 <expressedBy><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson) Who's responsible for creating Goal? --></expressedBy>
 <addresses><!-- 0..* Reference(Condition|Observation|MedicationStatement|
   NutritionRequest|ProcedureRequest|RiskAssessment) Issues addressed by this goal --></addresses>
 <note><!-- 0..* Annotation Comments about the goal --></note>
 <outcome>  <!-- 0..* What result was achieved regarding the goal? -->
  <result[x]><!-- 0..1 CodeableConcept|Reference(Observation) Code or observation that resulted from goal --></result[x]>
 </outcome>
</Goal>

JSON Template

{doco
  "resourceType" : "Goal",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this goal
  "status" : "<code>", // R!  proposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error
  "category" : [{ CodeableConcept }], // E.g. Treatment, dietary, behavioral, etc.
  "priority" : { CodeableConcept }, // high | medium |low
  "description" : { CodeableConcept }, // R!  Code or text describing goal
  "subject" : { Reference(Patient|Group|Organization) }, // Who this goal is intended for
  // start[x]: When goal pursuit begins. One of these 2:
  "startDate" : "<date>",
  "startCodeableConcept" : { CodeableConcept },
  // target[x]: Reach goal on or before. One of these 2:
  "targetDate" : "<date>",
  "targetDuration" : { Duration },
  "statusDate" : "<date>", // When goal status took effect
  "statusReason" : [{ CodeableConcept }], // Reason for current status
  "expressedBy" : { Reference(Patient|Practitioner|RelatedPerson) }, // Who's responsible for creating Goal?
  "addresses" : [{ Reference(Condition|Observation|MedicationStatement|
   NutritionRequest|ProcedureRequest|RiskAssessment) }], // Issues addressed by this goal
  "note" : [{ Annotation }], // Comments about the goal
  "outcome" : [{ // What result was achieved regarding the goal?
    // result[x]: Code or observation that resulted from goal. One of these 2:
    "resultCodeableConcept" : { CodeableConcept }
    "resultReference" : { Reference(Observation) }
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Goal;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Goal.identifier [ Identifier ], ... ; # 0..* External Ids for this goal
  fhir:Goal.status [ code ]; # 1..1 proposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-error
  fhir:Goal.category [ CodeableConcept ], ... ; # 0..* E.g. Treatment, dietary, behavioral, etc.
  fhir:Goal.priority [ CodeableConcept ]; # 0..1 high | medium |low
  fhir:Goal.description [ CodeableConcept ]; # 1..1 Code or text describing goal
  fhir:Goal.subject [ Reference(Patient|Group|Organization) ]; # 0..1 Who this goal is intended for
  # Goal.start[x] : 0..1 When goal pursuit begins. One of these 2
    fhir:Goal.startDate [ date ]
    fhir:Goal.startCodeableConcept [ CodeableConcept ]
  # Goal.target[x] : 0..1 Reach goal on or before. One of these 2
    fhir:Goal.targetDate [ date ]
    fhir:Goal.targetDuration [ Duration ]
  fhir:Goal.statusDate [ date ]; # 0..1 When goal status took effect
  fhir:Goal.statusReason [ CodeableConcept ], ... ; # 0..* Reason for current status
  fhir:Goal.expressedBy [ Reference(Patient|Practitioner|RelatedPerson) ]; # 0..1 Who's responsible for creating Goal?
  fhir:Goal.addresses [ Reference(Condition|Observation|MedicationStatement|NutritionRequest|ProcedureRequest|
  RiskAssessment) ], ... ; # 0..* Issues addressed by this goal
  fhir:Goal.note [ Annotation ], ... ; # 0..* Comments about the goal
  fhir:Goal.outcome [ # 0..* What result was achieved regarding the goal?
    # Goal.outcome.result[x] : 0..1 Code or observation that resulted from goal. One of these 2
      fhir:Goal.outcome.resultCodeableConcept [ CodeableConcept ]
      fhir:Goal.outcome.resultReference [ Reference(Observation) ]
  ], ...;
]

Changes since DSTU2

Goal
Goal.description Type changed from string to CodeableConcept
Goal.target[x] Remove Quantity{http://hl7.org/fhir/StructureDefinition/Duration}, Add Duration
Goal.statusReason Max Cardinality changed from 1 to *
Goal.expressedBy added Element
Goal.addresses Remove Reference(NutritionOrder), Add Reference(NutritionRequest)
Goal.author deleted

See the Full Difference for further information

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle), JSON-LD (for RDF as JSON-LD),

9.5.3.1 Terminology Bindings

PathDefinitionTypeReference
Goal.status Indicates whether the goal has been met and is still being targetedRequiredGoalStatus
Goal.category Codes for grouping and sorting goalsExampleGoalCategory
Goal.priority The level of importance associated with a goalPreferredGoalPriority
Goal.description Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.UnknownNo details provided yet
Goal.start[x] Codes describing events that can trigger the initiation of a goalExampleGoalStartEvent
Goal.statusReason Codes to identify the reason for a goal's current statusExampleGoalStatusReason
Goal.outcome.result[x] 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"UnknownNo details provided yet

9.5.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPathsIn Common
categorytokenE.g. Treatment, dietary, behavioral, etc.Goal.category
identifiertokenExternal Ids for this goalGoal.identifier26 Resources
patientreferenceWho this goal is intended forGoal.subject
(Patient)		31 Resources
statustokenproposed | planned | accepted | rejected | in-progress | achieved | sustaining | on-hold | cancelled | on-target | ahead-of-target | behind-target | entered-in-errorGoal.status
subjectreferenceWho this goal is intended forGoal.subject
(Group, Organization, Patient)
targetdatedateReach goal on or beforeGoal.targetDate