This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). 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

9.6 Resource Goal - Content

Patient Care

Work Group

Maturity Level: 2

Trial Use

Compartments: 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.

9.6.1 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.

9.6.2 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 ServiceRequest) 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

Structure

Name	Flags	Card.	Type	Description & Constraints
Goal	TU		DomainResource	Describes the intended objective(s) for a patient, group or organization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	External Ids for this goal
status	?!Σ	1..1	code	proposed \| accepted \| planned \| in-progress \| on-target \| ahead-of-target \| behind-target \| sustaining \| achieved \| on-hold \| cancelled \| entered-in-error \| rejected GoalStatus (Required)
category	Σ	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc. GoalCategory (Example)
priority	Σ	0..1	CodeableConcept	high-priority \| medium-priority \| low-priority GoalPriority (Preferred)
description	Σ	1..1	CodeableConcept	Code or text describing goal SNOMED CT Clinical Findings (Example)
subject	Σ	1..1	Reference(Patient \| Group \| Organization)	Who this goal is intended for
start[x]	Σ	0..1		When goal pursuit begins GoalStartEvent (Example)
startDate			date
startCodeableConcept			CodeableConcept
target	I	0..1	BackboneElement	Target outcome for the goal + Goal.target.measure is required if Goal.target.detail is populated
measure	Σ I	0..1	CodeableConcept	The parameter whose value is being tracked LOINC Codes (Example)
detail[x]	Σ I	0..1		The target value to be achieved
detailQuantity			Quantity
detailRange			Range
detailCodeableConcept			CodeableConcept
due[x]	Σ	0..1		Reach goal on or before
dueDate			date
dueDuration			Duration
statusDate	Σ	0..1	date	When goal status took effect
statusReason		0..1	string	Reason for current status
expressedBy	Σ	0..1	Reference(Patient \| Practitioner \| RelatedPerson)	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? SNOMED CT Clinical Findings (Example)
outcomeReference		0..*	Reference(Observation)	Observation that resulted from goal
Documentation for this format

UML Diagram (Legend)

XML Template

<Goal xmlns="http://hl7.org/fhir"> 
 <!-- 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 | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected -->
 <category><!-- 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc. --></category>
 <priority><!-- 0..1 CodeableConcept high-priority | medium-priority | low-priority --></priority>
 <description><!-- 1..1 CodeableConcept Code or text describing goal --></description>
 <subject><!-- 1..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>  <!--  0..1 Target outcome for the goal -->
  <measure><!--  0..1 CodeableConcept The parameter whose value is being tracked --></measure>
  <detail[x]><!--  0..1 Quantity|Range|CodeableConcept The target value to be achieved --></detail[x]>
  <due[x]><!-- 0..1 date|Duration Reach goal on or before --></due[x]>
 </target>
 <statusDate value="[date]"/><!-- 0..1 When goal status took effect -->
 <statusReason value="[string]"/><!-- 0..1 Reason for current status -->
 <expressedBy><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson) Who's responsible for creating Goal? --></expressedBy>
 <addresses><!-- 0..* Reference(Condition|Observation|MedicationStatement|
   NutritionOrder|ServiceRequest|RiskAssessment) Issues addressed by this goal --></addresses>
 <note><!-- 0..* Annotation Comments about the goal --></note>
 <outcomeCode><!-- 0..* CodeableConcept What result was achieved regarding the goal? --></outcomeCode>
 <outcomeReference><!-- 0..* Reference(Observation) Observation that resulted from goal --></outcomeReference>
</Goal>

JSON Template

{
  "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 | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
  "category" : [{ CodeableConcept }], // E.g. Treatment, dietary, behavioral, etc.
  "priority" : { CodeableConcept }, // high-priority | medium-priority | low-priority
  "description" : { CodeableConcept }, // R!  Code or text describing goal
  "subject" : { Reference(Patient|Group|Organization) }, // R!  Who this goal is intended for
  // start[x]: When goal pursuit begins. One of these 2:
  "startDate" : "<date>",
  "startCodeableConcept" : { CodeableConcept },
  "target" : { // C? Target outcome for the goal
    "measure" : { CodeableConcept }, // C? The parameter whose value is being tracked
    // detail[x]: The target value to be achieved. One of these 3:
    "detailQuantity" : { Quantity },
    "detailRange" : { Range },
    "detailCodeableConcept" : { CodeableConcept },
    // due[x]: Reach goal on or before. One of these 2:
    "dueDate" : "<date>"
    "dueDuration" : { Duration }
  },
  "statusDate" : "<date>", // When goal status took effect
  "statusReason" : "<string>", // Reason for current status
  "expressedBy" : { Reference(Patient|Practitioner|RelatedPerson) }, // Who's responsible for creating Goal?
  "addresses" : [{ Reference(Condition|Observation|MedicationStatement|
   NutritionOrder|ServiceRequest|RiskAssessment) }], // Issues addressed by this goal
  "note" : [{ Annotation }], // Comments about the goal
  "outcomeCode" : [{ CodeableConcept }], // What result was achieved regarding the goal?
  "outcomeReference" : [{ Reference(Observation) }] // Observation that resulted from goal
}

Turtle Template

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


[ 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 | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
  fhir:Goal.category [ CodeableConcept ], ... ; # 0..* E.g. Treatment, dietary, behavioral, etc.
  fhir:Goal.priority [ CodeableConcept ]; # 0..1 high-priority | medium-priority | low-priority
  fhir:Goal.description [ CodeableConcept ]; # 1..1 Code or text describing goal
  fhir:Goal.subject [ Reference(Patient|Group|Organization) ]; # 1..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 ]
  fhir:Goal.target [ # 0..1 Target outcome for the goal
    fhir:Goal.target.measure [ CodeableConcept ]; # 0..1 The parameter whose value is being tracked
    # Goal.target.detail[x] : 0..1 The target value to be achieved. One of these 3
      fhir:Goal.target.detailQuantity [ Quantity ]
      fhir:Goal.target.detailRange [ Range ]
      fhir:Goal.target.detailCodeableConcept [ CodeableConcept ]
    # Goal.target.due[x] : 0..1 Reach goal on or before. One of these 2
      fhir:Goal.target.dueDate [ date ]
      fhir:Goal.target.dueDuration [ Duration ]
  ];
  fhir:Goal.statusDate [ date ]; # 0..1 When goal status took effect
  fhir:Goal.statusReason [ string ]; # 0..1 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|NutritionOrder|ServiceRequest|
  RiskAssessment) ], ... ; # 0..* Issues addressed by this goal
  fhir:Goal.note [ Annotation ], ... ; # 0..* Comments about the goal
  fhir:Goal.outcomeCode [ CodeableConcept ], ... ; # 0..* What result was achieved regarding the goal?
  fhir:Goal.outcomeReference [ Reference(Observation) ], ... ; # 0..* Observation that resulted from goal
]

Changes since R3

Goal

Goal.subject

Min Cardinality changed from 0 to 1

Goal.addresses

Type changed from Reference(Condition|Observation|MedicationStatement|NutritionOrder|ProcedureRequest|RiskAssessment) to Reference(Condition|Observation|MedicationStatement|NutritionOrder|ServiceRequest|RiskAssessment)

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (2 errors).). Note: these have note yet been updated to be R3 to R4

Structure

Name	Flags	Card.	Type	Description & Constraints
Goal	TU		DomainResource	Describes the intended objective(s) for a patient, group or organization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	External Ids for this goal
status	?!Σ	1..1	code	proposed \| accepted \| planned \| in-progress \| on-target \| ahead-of-target \| behind-target \| sustaining \| achieved \| on-hold \| cancelled \| entered-in-error \| rejected GoalStatus (Required)
category	Σ	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc. GoalCategory (Example)
priority	Σ	0..1	CodeableConcept	high-priority \| medium-priority \| low-priority GoalPriority (Preferred)
description	Σ	1..1	CodeableConcept	Code or text describing goal SNOMED CT Clinical Findings (Example)
subject	Σ	1..1	Reference(Patient \| Group \| Organization)	Who this goal is intended for
start[x]	Σ	0..1		When goal pursuit begins GoalStartEvent (Example)
startDate			date
startCodeableConcept			CodeableConcept
target	I	0..1	BackboneElement	Target outcome for the goal + Goal.target.measure is required if Goal.target.detail is populated
measure	Σ I	0..1	CodeableConcept	The parameter whose value is being tracked LOINC Codes (Example)
detail[x]	Σ I	0..1		The target value to be achieved
detailQuantity			Quantity
detailRange			Range
detailCodeableConcept			CodeableConcept
due[x]	Σ	0..1		Reach goal on or before
dueDate			date
dueDuration			Duration
statusDate	Σ	0..1	date	When goal status took effect
statusReason		0..1	string	Reason for current status
expressedBy	Σ	0..1	Reference(Patient \| Practitioner \| RelatedPerson)	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? SNOMED CT Clinical Findings (Example)
outcomeReference		0..*	Reference(Observation)	Observation that resulted from goal
Documentation for this format

UML Diagram (Legend)

XML Template

<Goal xmlns="http://hl7.org/fhir"> 
 <!-- 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 | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected -->
 <category><!-- 0..* CodeableConcept E.g. Treatment, dietary, behavioral, etc. --></category>
 <priority><!-- 0..1 CodeableConcept high-priority | medium-priority | low-priority --></priority>
 <description><!-- 1..1 CodeableConcept Code or text describing goal --></description>
 <subject><!-- 1..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>  <!--  0..1 Target outcome for the goal -->
  <measure><!--  0..1 CodeableConcept The parameter whose value is being tracked --></measure>
  <detail[x]><!--  0..1 Quantity|Range|CodeableConcept The target value to be achieved --></detail[x]>
  <due[x]><!-- 0..1 date|Duration Reach goal on or before --></due[x]>
 </target>
 <statusDate value="[date]"/><!-- 0..1 When goal status took effect -->
 <statusReason value="[string]"/><!-- 0..1 Reason for current status -->
 <expressedBy><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson) Who's responsible for creating Goal? --></expressedBy>
 <addresses><!-- 0..* Reference(Condition|Observation|MedicationStatement|
   NutritionOrder|ServiceRequest|RiskAssessment) Issues addressed by this goal --></addresses>
 <note><!-- 0..* Annotation Comments about the goal --></note>
 <outcomeCode><!-- 0..* CodeableConcept What result was achieved regarding the goal? --></outcomeCode>
 <outcomeReference><!-- 0..* Reference(Observation) Observation that resulted from goal --></outcomeReference>
</Goal>

JSON Template

{
  "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 | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
  "category" : [{ CodeableConcept }], // E.g. Treatment, dietary, behavioral, etc.
  "priority" : { CodeableConcept }, // high-priority | medium-priority | low-priority
  "description" : { CodeableConcept }, // R!  Code or text describing goal
  "subject" : { Reference(Patient|Group|Organization) }, // R!  Who this goal is intended for
  // start[x]: When goal pursuit begins. One of these 2:
  "startDate" : "<date>",
  "startCodeableConcept" : { CodeableConcept },
  "target" : { // C? Target outcome for the goal
    "measure" : { CodeableConcept }, // C? The parameter whose value is being tracked
    // detail[x]: The target value to be achieved. One of these 3:
    "detailQuantity" : { Quantity },
    "detailRange" : { Range },
    "detailCodeableConcept" : { CodeableConcept },
    // due[x]: Reach goal on or before. One of these 2:
    "dueDate" : "<date>"
    "dueDuration" : { Duration }
  },
  "statusDate" : "<date>", // When goal status took effect
  "statusReason" : "<string>", // Reason for current status
  "expressedBy" : { Reference(Patient|Practitioner|RelatedPerson) }, // Who's responsible for creating Goal?
  "addresses" : [{ Reference(Condition|Observation|MedicationStatement|
   NutritionOrder|ServiceRequest|RiskAssessment) }], // Issues addressed by this goal
  "note" : [{ Annotation }], // Comments about the goal
  "outcomeCode" : [{ CodeableConcept }], // What result was achieved regarding the goal?
  "outcomeReference" : [{ Reference(Observation) }] // Observation that resulted from goal
}

Turtle Template

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


[ 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 | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
  fhir:Goal.category [ CodeableConcept ], ... ; # 0..* E.g. Treatment, dietary, behavioral, etc.
  fhir:Goal.priority [ CodeableConcept ]; # 0..1 high-priority | medium-priority | low-priority
  fhir:Goal.description [ CodeableConcept ]; # 1..1 Code or text describing goal
  fhir:Goal.subject [ Reference(Patient|Group|Organization) ]; # 1..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 ]
  fhir:Goal.target [ # 0..1 Target outcome for the goal
    fhir:Goal.target.measure [ CodeableConcept ]; # 0..1 The parameter whose value is being tracked
    # Goal.target.detail[x] : 0..1 The target value to be achieved. One of these 3
      fhir:Goal.target.detailQuantity [ Quantity ]
      fhir:Goal.target.detailRange [ Range ]
      fhir:Goal.target.detailCodeableConcept [ CodeableConcept ]
    # Goal.target.due[x] : 0..1 Reach goal on or before. One of these 2
      fhir:Goal.target.dueDate [ date ]
      fhir:Goal.target.dueDuration [ Duration ]
  ];
  fhir:Goal.statusDate [ date ]; # 0..1 When goal status took effect
  fhir:Goal.statusReason [ string ]; # 0..1 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|NutritionOrder|ServiceRequest|
  RiskAssessment) ], ... ; # 0..* Issues addressed by this goal
  fhir:Goal.note [ Annotation ], ... ; # 0..* Comments about the goal
  fhir:Goal.outcomeCode [ CodeableConcept ], ... ; # 0..* What result was achieved regarding the goal?
  fhir:Goal.outcomeReference [ Reference(Observation) ], ... ; # 0..* Observation that resulted from goal
]

Changes since DSTU2

Goal

Goal.subject

Min Cardinality changed from 0 to 1

Goal.addresses

Type changed from Reference(Condition|Observation|MedicationStatement|NutritionOrder|ProcedureRequest|RiskAssessment) to Reference(Condition|Observation|MedicationStatement|NutritionOrder|ServiceRequest|RiskAssessment)

See the Full Difference for further information

This analysis is available as XML or JSON.

Alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

9.6.3.1 Terminology Bindings

Path	Definition	Type	Reference
Goal.status	Indicates whether the goal has been met and is still being targeted	Required	GoalStatus
Goal.category	Codes for grouping and sorting goals	Example	GoalCategory
Goal.priority	The level of importance associated with a goal	Preferred	GoalPriority
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.	Example	SNOMED CT Clinical Findings
Goal.start[x]	Codes describing events that can trigger the initiation of a goal	Example	GoalStartEvent
Goal.target.measure	Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.	Example	LOINC Codes
Goal.target.detail[x]	Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.	Unknown	No details provided yet
Goal.outcomeCode	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"	Example	SNOMED CT Clinical Findings

Path

Definition

Type

Reference

Goal.status

Indicates whether the goal has been met and is still being targeted

Required

GoalStatus

Goal.category

Codes for grouping and sorting goals

Example

GoalCategory

Goal.priority

The level of importance associated with a goal

Preferred

GoalPriority

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.

Example

SNOMED CT Clinical Findings

Goal.start[x]

Codes describing events that can trigger the initiation of a goal

Example

GoalStartEvent

Goal.target.measure

Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.

Example

LOINC Codes

Goal.target.detail[x]

Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.

Unknown

No details provided yet

Goal.outcomeCode

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"

Example

SNOMED CT Clinical Findings

9.6.3.2 Constraints

gol-1: On Goal.target: Goal.target.measure is required if Goal.target.detail is populated (expression on Goal.target: (detail.exists() and measure.exists()) or detail.exists().not())

9.6.4 Search Parameters

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

Name	Type	Description	Expression	In Common
category	token	E.g. Treatment, dietary, behavioral, etc.	Goal.category
identifier	token	External Ids for this goal	Goal.identifier	26 Resources
patient	reference	Who this goal is intended for	Goal.subject (Patient)	29 Resources
start-date	date	When goal pursuit begins	Goal.start.as(date)
status	token	proposed \| accepted \| planned \| in-progress \| on-target \| ahead-of-target \| behind-target \| sustaining \| achieved \| on-hold \| cancelled \| entered-in-error \| rejected	Goal.status
subject	reference	Who this goal is intended for	Goal.subject (Group, Organization, Patient)
target-date	date	Reach goal on or before	Goal.target.due.as(date)