Generated Narrative: StructureDefinition profile-Goal Name Flags Card. Type Description & Constraints Goal 0..* Goal Describes the intended objective(s) for a patient, group or organization #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:continuous 0..1 boolean R5: After meeting the goal, ongoing activity is needed to sustain the goal objective (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Goal.continuous #xD; status #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:lifecycleStatus 0..1 code R5: proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected additional codes URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Goal.lifecycleStatus Binding: GoalStatus (required): Codes that reflect the current state of a goal and whether the goal is still being targeted. #xD; extension:achievementStatus 0..1 CodeableConcept R5: in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Goal.achievementStatus Binding: R5GoalAchievementForR3 (0.1.0) (preferred): Indicates the progression, or lack thereof, towards the goal against the target. #xD; subject #xD; Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:subject 1..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: subject URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; target #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:detail 0..1 string, boolean, integer, Ratio R5: detail additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Goal.target.detail #xD; expressedBy #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:source 0..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: source URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; addresses #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:addresses 0..* ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R5: addresses URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; Documentation for this format
Cross-version Profile for R5.Goal for use in FHIR STU3
This cross-version profile allows R5 Goal content to be represented via FHIR STU3 Goal resources.
Describes the intended objective(s) for a patient, group or organization
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.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL NOT contain any narrative
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
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 set of rules under which this content was created
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).
Text summary of the resource, for human interpretation
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.
R5: After meeting the goal, ongoing activity is needed to sustain the goal objective (new)
Element `Goal.continuous` has a context of Goal based on following the parent source element upwards and mapping to `Goal`. Element `Goal.continuous` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). For example, getting a yellow fever vaccination for a planned trip is a goal that is designed to be completed (continuous = false). A goal to sustain HbA1c levels would not be a one-time goal (continuous = true).
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
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.
proposed | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
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.
Allows measuring outcome and whether goal needs to be further tracked.
Indicates whether the goal has been met and is still being targeted
.statusCode in-progress = active (classCode = OBJ) achieved = complete sustaining = active (classCode=OBJC) cancelled = aborted
unique id for the element within a resource (for internal references)
R5: proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected additional codes
R5: `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.
R5: in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable additional types
R5: `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.
E.g. Treatment, dietary, behavioral, etc.
Indicates a category the goal falls within.
high-priority | medium-priority | low-priority
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
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.
Without a description of what's trying to be achieved, element has no purpose.
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.
Identifies the patient, group or organization for whom the goal is being established.
Subject is optional to support annonymized reporting.
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Element `Goal.subject` is mapped to FHIR STU3 element `Goal.subject` as `SourceIsBroaderThanTarget`. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `Goal.subject` with unmapped reference targets: Group, Organization, Patient.
Literal reference, Relative, internal or absolute URL
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.
Logical reference, when literal reference is not known
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 date or event after which the goal should begin being pursued.
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.
Codes describing events that can trigger the initiation of a goal
Allows the progress of the goal to be monitored against an observation or due date.
Goal.target.measure is required if Goal.target.detail is populated
(detail.exists() and measure.exists()) or detail.exists().not()
(exists(f:*[starts-with(local-name(.), 'detail')]) and exists(f:measure)) or not(exists(f:*[starts-with(local-name(.), 'detail')]))
R5: `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.
The parameter whose value is being tracked
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.).
Element `Goal.source` is mapped to FHIR STU3 element `Goal.expressedBy` as `SourceIsBroaderThanTarget`. The standard extension `alternate-reference` has been mapped as the representation of FHIR R5 element `Goal.source` with unmapped reference targets: CareTeam, Patient, Practitioner, PractitionerRole, RelatedPerson. This is the individual or team responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.).
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.
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 R5 element `Goal.addresses` with unmapped reference targets: Condition, MedicationRequest, MedicationStatement, NutritionOrder, Observation, Procedure, RiskAssessment, ServiceRequest.
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.
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
What result was achieved regarding 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.
Outcome tracking is a key aspect of care planning.
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"
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.