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.

Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Indicates whether the goal has been reached and is still considered relevant.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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

Allows measuring outcome and whether goal needs to be further tracked.

An Extension

R4: Goal.lifecycleStatus additional codes

Element Goal.lifecycleStatus is mapped to FHIR STU3 element Goal.status as RelatedTo. The mappings for Goal.lifecycleStatus do not allow expression of the necessary codes, per the bindings on the source and target. The target context Goal.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid.

R4: Goal.achievementStatus additional types (CodeableConcept) additional types from child elements (coding)

Element Goal.achievementStatus is mapped to FHIR STU3 element Goal.status as SourceIsBroaderThanTarget. The mappings for Goal.achievementStatus do not cover the following types: CodeableConcept. The mappings for Goal.achievementStatus do not cover the following types based on type expansion: coding.

Human-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding".

If no code is available, use CodeableConcept.text.

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.

Without a description of what's trying to be achieved, element has no purpose.

R4: Goal.lifecycleStatus additional codes

Element Goal.lifecycleStatus is mapped to FHIR STU3 element Goal.status as RelatedTo. The mappings for Goal.lifecycleStatus do not allow expression of the necessary codes, per the bindings on the source and target. The target context Goal.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid.

R4: Goal.achievementStatus additional types (CodeableConcept) additional types from child elements (coding)

Element Goal.achievementStatus is mapped to FHIR STU3 element Goal.status as SourceIsBroaderThanTarget. The mappings for Goal.achievementStatus do not cover the following types: CodeableConcept. The mappings for Goal.achievementStatus do not cover the following types based on type expansion: coding.

R4: Goal.target.detail[x] additional types (string, boolean, integer, Ratio)

Element Goal.target.detail[x] is mapped to FHIR STU3 element Goal.target.detail[x] as SourceIsBroaderThanTarget. The mappings for Goal.target.detail[x] do not cover the following types: boolean, integer, Ratio, string. The target context Goal.target.detail[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Goal.target. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Goal.target.measure defines a coded value.

R4: Goal.expressedBy

Element Goal.expressedBy is mapped to FHIR STU3 element Goal.expressedBy as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Goal.expressedBy with unmapped reference targets: PractitionerRole. This is the individual responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.).

R4: Goal.addresses

Element Goal.addresses is mapped to FHIR STU3 element Goal.addresses as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Goal.addresses with unmapped reference targets: ServiceRequest.

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.

Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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).

Need to allow connection to a wider workflow.

Indicates whether the goal has been reached and is still considered relevant.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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

Allows measuring outcome and whether goal needs to be further tracked.

unique id for the element within a resource (for internal references)

An Extension

R4: Goal.lifecycleStatus additional codes

Element Goal.lifecycleStatus is mapped to FHIR STU3 element Goal.status as RelatedTo. The mappings for Goal.lifecycleStatus do not allow expression of the necessary codes, per the bindings on the source and target. The target context Goal.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid.

R4: Goal.achievementStatus additional types (CodeableConcept) additional types from child elements (coding)

Element Goal.achievementStatus is mapped to FHIR STU3 element Goal.status as SourceIsBroaderThanTarget. The mappings for Goal.achievementStatus do not cover the following types: CodeableConcept. The mappings for Goal.achievementStatus do not cover the following types based on type expansion: coding.

Primitive value for code

Indicates a category the goal falls within.

Codes for grouping and sorting goals

Allows goals to be filtered and sorted.

Identifies the mutually agreed level of importance associated with reaching/sustaining the goal.

Extensions are available to track priorities as established by each participant (i.e. Priority from the patient's perspective, different practitioners' perspectives, family member's perspectives)

The ordinal extension on Coding can be used to convey a numerically comparable ranking to priority. (Keep in mind that different coding systems may use a "low value=important".

The level of importance associated with a goal

Used for sorting and presenting goals.

Human-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding".

If no code is available, use CodeableConcept.text.

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.

Without a description of what's trying to be achieved, element has no purpose.

Identifies the patient, group or organization for whom the goal is being established.

Subject is optional to support annonymized reporting.

The date or event after which the goal should begin being pursued.

Codes describing events that can trigger the initiation of a goal

Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery.

Indicates what should be done by when.

Allows the progress of the goal to be monitored against an observation or due date.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Goal.target.detail[x] additional types (string, boolean, integer, Ratio)

Element Goal.target.detail[x] is mapped to FHIR STU3 element Goal.target.detail[x] as SourceIsBroaderThanTarget. The mappings for Goal.target.detail[x] do not cover the following types: boolean, integer, Ratio, string. The target context Goal.target.detail[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Goal.target. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Goal.target.measure defines a coded value.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.

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

The target value of the focus to be achieved to signify the fulfillment of the goal, e.g. 150 pounds, 7.0%. Either the high or low or both values of the range can be specified. When a low value is missing, it indicates that the goal is achieved at any focus value at or below the high value. Similarly, if the high value is missing, it indicates that the goal is achieved at any focus value at or above the low value.

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

Indicates either the date or the duration after start by which the goal should be met.

Identifies when the goal should be evaluated.

Identifies when the current status. I.e. When initially created, when achieved, when cancelled, etc.

To see the date for past statuses, query history.

Captures the reason for the current status.

This will typically be captured for statuses such as rejected, on-hold or cancelled, but could be present for others.

Indicates whose goal this is - patient goal, practitioner goal, etc.

This is the individual reponsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.).

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Goal.expressedBy

Element Goal.expressedBy is mapped to FHIR STU3 element Goal.expressedBy as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Goal.expressedBy with unmapped reference targets: PractitionerRole. This is the individual responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.).

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The identified conditions and other health record elements that are intended to be addressed by the goal.

Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Goal.addresses

Element Goal.addresses is mapped to FHIR STU3 element Goal.addresses as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Goal.addresses with unmapped reference targets: ServiceRequest.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Any comments related to the goal.

May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.

There's a need to capture information about the goal that doesn't actually describe the goal.

Identifies the change (or lack of change) at the point when the status of the goal is assessed.

Note that this should not duplicate the goal status.

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"

Outcome tracking is a key aspect of care planning.

Details of what's changed (or not changed).

The goal outcome is independent of the outcome of the related activities. For example, if the Goal is to achieve a target body weight of 150 lb and a care plan activity is defined to diet, then the care plan’s activity outcome could be calories consumed whereas goal outcome is an observation for the actual body weight measured.

Outcome tracking is a key aspect of care planning.