HdBe-TreatmentObjective
Profile | Description | Status | URL |
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HdBe-TreatmentObjective | The treatment objective describes the desired result of the treatment/interventions in terms of the patient’s diagnosed problem. The objective and target date are entered in addition to the target value. Comparing the healthcare results to the treatment objective provides insight into the effectivity of the treatment/interventions. | draft | https://fhir.healthdata.be/StructureDefinition/HdBe-TreatmentObjective |
Instructions |
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Although the CBB model assumes there's a reference from zib TreatmentObjective to a distinct instance of CBB FunctionalOrMentalStatus (in future context), in this profile the concepts of CBB FunctionalOrMentalStatus are mapped directly as this aligns with the way the Goal resource is used. |
Goal | I | Goal | Element IdGoal TreatmentObjective Alternate namesBehandeldoel DefinitionDescribes 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. Although the CBB model assumes there's a reference from zib TreatmentObjective to a distinct instance of CBB FunctionalOrMentalStatus (in future context), in this profile the concepts of CBB FunctionalOrMentalStatus are mapped directly as this aligns with the way the Goal resource is used.
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element IdGoal.identifier External Ids for this goal DefinitionBusiness identifiers assigned to this goal by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
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lifecycleStatus | Σ ?! | 1..1 | codeBinding | Element IdGoal.lifecycleStatus proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected DefinitionThe state of the goal throughout its lifecycle. Allows knowing whether goal needs to be further tracked. No CBB concept can be mapped (implicitly). Unless Codes that reflect the current state of a goal and whether the goal is still being targeted. GoalLifecycleStatus (required)Constraints
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achievementStatus | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdGoal.achievementStatus in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable DefinitionDescribes the progression, or lack thereof, towards the goal against the target. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Indicates the progression, or lack thereof, towards the goal against the target. GoalAchievementStatus (preferred)Constraints
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdGoal.category E.g. Treatment, dietary, behavioral, etc. DefinitionIndicates a category the goal falls within. Allows goals to be filtered and sorted. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for grouping and sorting goals. GoalCategory (example)Constraints
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priority | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdGoal.priority high-priority | medium-priority | low-priority DefinitionIdentifies the mutually agreed level of importance associated with reaching/sustaining the goal. Used for sorting and presenting goals. 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. GoalPriority (preferred)Constraints
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description | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element IdGoal.description Code or text describing goal DefinitionHuman-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". Without a description of what's trying to be achieved, element has no purpose. 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. SNOMEDCTClinicalFindings (example)Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element IdGoal.description.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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text | Σ | 0..1 | string | Element IdGoal.description.text DesiredHealthcareResult / StatusName / StatusValue Alternate namesGewenstZorgresultaat DefinitionThe textual account of the treatment objective. This concept provides the option to define a treatment objective which cannot be described as a measurement value or functional/mental status. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. If the concept desired_healthcare_result is not present in this instance of CBB TreatmentObjective, but desired_health_condition is,
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subject | Σ I | 1..1 | Reference(Patient | Group | Organization) | There are no (further) constraints on this element Element IdGoal.subject Who this goal is intended for DefinitionIdentifies the patient, group or organization for whom the goal is being established. Subject is optional to support annonymized reporting. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient | Group | Organization) Constraints
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start[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdGoal.start[x] When goal pursuit begins DefinitionThe 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. GoalStartEvent (example)Constraints
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startDate | date | There are no (further) constraints on this element Data Type | ||
startCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data Type | ||
target | I | 0..1 | BackboneElement | Element IdGoal.target DesiredHealthCondition Alternate namesGewensteGezondheidstoestand DefinitionThe desired health condition is a target value which can be expressed as the patient’s functional or mental status. Allows the progress of the goal to be monitored against an observation or due date. Target is 0..* to support Observations with multiple components, such as blood pressure goals with both a systolic and diastolic target. When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met.
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extension | I | 0..* | Extension | Element IdGoal.target.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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. Unordered, Open, by url(Value) Constraints
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medicalDevice | I | 0..* | Extension(Reference(HdBe MedicalDevice)) | Element IdGoal.target.extension:medicalDevice Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(HdBe MedicalDevice)) Extension URLhttps://fhir.healthdata.be/StructureDefinition/ext-TreatmentObjective.MedicalDevice Constraints
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url | 1..1 | System.StringFixed Value | There are no (further) constraints on this element Element IdGoal.target.extension:medicalDevice.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. System.String Fixed Valuehttps://fhir.healthdata.be/StructureDefinition/ext-TreatmentObjective.MedicalDevice
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value[x] | 0..1 | Element IdGoal.target.extension:medicalDevice.value[x] MedicalDevice Alternate namesHulpmiddel DefinitionMedical aid the patient has to reduce the impact of the disability or disorder.
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valueReference | Reference(HdBe MedicalDevice) | There are no (further) constraints on this element Data Type | ||
measure | Σ I | 0..1 | CodeableConceptBinding | Element IdGoal.target.measure StatusName Alternate namesStatusNaam DefinitionCoded description of the functional or mental status or limitation. CodeSystem used is SNOMED CT Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Description of the Status StatusName (extensible)Constraints
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detail[x] | Σ I | 0..1 | Element IdGoal.target.detail[x] The target value to be achieved DefinitionThe 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. 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. Unordered, Open, by $this(Type) BindingCodes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. (unbound) (example)Constraints
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detailQuantity | Quantity | There are no (further) constraints on this element Data Type | ||
detailRange | Range | There are no (further) constraints on this element Data Type | ||
detailString | string | There are no (further) constraints on this element Data Type | ||
detailBoolean | boolean | There are no (further) constraints on this element Data Type | ||
detailInteger | integer | There are no (further) constraints on this element Data Type | ||
detailRatio | Ratio | There are no (further) constraints on this element Data Type | ||
detailCodeableConcept | Σ I | 0..1 | CodeableConceptBinding | Element IdGoal.target.detail[x]:detailCodeableConcept StatusValue Alternate namesStatusWaarde DefinitionThe extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical device, the evaluation of the extent of the limitation will take place without this aid. The answer codes must be selected from the subselection of the code system corresponding with the request in accordance with the rules applicable to that system. 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. Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. StatusValue (extensible)Constraints
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due[x] | Σ | 0..1 | Element IdGoal.target.due[x] Reach goal on or before DefinitionIndicates either the date or the duration after start by which the goal should be met. Identifies when the goal should be evaluated. Unordered, Open, by $this(Type) Constraints
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dueDuration | Duration | There are no (further) constraints on this element Data Type | ||
dueDate | Σ | 0..1 | date | Element IdGoal.target.due[x]:dueDate StatusDate Alternate namesStatusDatum DefinitionIndicates the date of the DesiredHealthCondition by which the goal should be met. Identifies when the goal should be evaluated.
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statusDate | Σ | 0..1 | date | There are no (further) constraints on this element Element IdGoal.statusDate When goal status took effect DefinitionIdentifies when the current status. I.e. When initially created, when achieved, when cancelled, etc. To see the date for past statuses, query history.
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statusReason | 0..1 | string | There are no (further) constraints on this element Element IdGoal.statusReason Reason for current status DefinitionCaptures 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.
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expressedBy | Σ I | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element IdGoal.expressedBy Who's responsible for creating Goal? DefinitionIndicates whose goal this is - patient goal, practitioner goal, etc. This is the individual responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.). Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Constraints
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addresses | I | 0..1 | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | HdBe Problem) | Element IdGoal.addresses Problem Alternate namesProbleem DefinitionDescription of the problem to which the treatment objective applies. Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | HdBe Problem) Constraints
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note | 0..1 | Annotation | There are no (further) constraints on this element Element IdGoal.note Comments about the goal DefinitionAny comments related to the goal. There's a need to capture information about the goal that doesn't actually describe the goal. May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
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author[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdGoal.note.author[x] Individual responsible for the annotation DefinitionThe individual responsible for making the annotation. Organization is used when there's no need for specific attribution as to who made the comment.
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authorString | string | There are no (further) constraints on this element Data Type | ||
authorReference | Reference(Practitioner | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Data Type Reference(Practitioner | Patient | RelatedPerson | Organization) | ||
time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdGoal.note.time When the annotation was made DefinitionIndicates when this particular annotation was made.
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text | Σ | 1..1 | markdown | Element IdGoal.note.text Comment Alternate namesToelichting DefinitionExplanatory comments as a description of the functional or mental status. Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
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outcomeCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdGoal.outcomeCode What result was achieved regarding the goal? DefinitionIdentifies the change (or lack of change) at the point when the status of the goal is assessed. Outcome tracking is a key aspect of care planning. 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". SNOMEDCTClinicalFindings (example)Constraints
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outcomeReference | I | 0..* | Reference(Observation) | There are no (further) constraints on this element Element IdGoal.outcomeReference Observation that resulted from goal DefinitionDetails of what's changed (or not changed). Outcome tracking is a key aspect of care planning. 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.
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Goal | I | Goal | Element IdGoal TreatmentObjective Alternate namesBehandeldoel DefinitionDescribes 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. Although the CBB model assumes there's a reference from zib TreatmentObjective to a distinct instance of CBB FunctionalOrMentalStatus (in future context), in this profile the concepts of CBB FunctionalOrMentalStatus are mapped directly as this aligns with the way the Goal resource is used.
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element IdGoal.identifier External Ids for this goal DefinitionBusiness identifiers assigned to this goal by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
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lifecycleStatus | Σ ?! | 1..1 | codeBinding | Element IdGoal.lifecycleStatus proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected DefinitionThe state of the goal throughout its lifecycle. Allows knowing whether goal needs to be further tracked. No CBB concept can be mapped (implicitly). Unless Codes that reflect the current state of a goal and whether the goal is still being targeted. GoalLifecycleStatus (required)Constraints
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achievementStatus | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdGoal.achievementStatus in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable DefinitionDescribes the progression, or lack thereof, towards the goal against the target. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Indicates the progression, or lack thereof, towards the goal against the target. GoalAchievementStatus (preferred)Constraints
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdGoal.category E.g. Treatment, dietary, behavioral, etc. DefinitionIndicates a category the goal falls within. Allows goals to be filtered and sorted. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for grouping and sorting goals. GoalCategory (example)Constraints
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priority | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdGoal.priority high-priority | medium-priority | low-priority DefinitionIdentifies the mutually agreed level of importance associated with reaching/sustaining the goal. Used for sorting and presenting goals. 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. GoalPriority (preferred)Constraints
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description | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element IdGoal.description Code or text describing goal DefinitionHuman-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". Without a description of what's trying to be achieved, element has no purpose. 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. SNOMEDCTClinicalFindings (example)Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element IdGoal.description.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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text | Σ | 0..1 | string | Element IdGoal.description.text DesiredHealthcareResult / StatusName / StatusValue Alternate namesGewenstZorgresultaat DefinitionThe textual account of the treatment objective. This concept provides the option to define a treatment objective which cannot be described as a measurement value or functional/mental status. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. If the concept desired_healthcare_result is not present in this instance of CBB TreatmentObjective, but desired_health_condition is,
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subject | Σ I | 1..1 | Reference(Patient | Group | Organization) | There are no (further) constraints on this element Element IdGoal.subject Who this goal is intended for DefinitionIdentifies the patient, group or organization for whom the goal is being established. Subject is optional to support annonymized reporting. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient | Group | Organization) Constraints
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start[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdGoal.start[x] When goal pursuit begins DefinitionThe 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. GoalStartEvent (example)Constraints
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startDate | date | There are no (further) constraints on this element Data Type | ||
startCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data Type | ||
target | I | 0..1 | BackboneElement | Element IdGoal.target DesiredHealthCondition Alternate namesGewensteGezondheidstoestand DefinitionThe desired health condition is a target value which can be expressed as the patient’s functional or mental status. Allows the progress of the goal to be monitored against an observation or due date. Target is 0..* to support Observations with multiple components, such as blood pressure goals with both a systolic and diastolic target. When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met.
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extension | I | 0..* | Extension | Element IdGoal.target.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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. Unordered, Open, by url(Value) Constraints
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medicalDevice | I | 0..* | Extension(Reference(HdBe MedicalDevice)) | Element IdGoal.target.extension:medicalDevice Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(HdBe MedicalDevice)) Extension URLhttps://fhir.healthdata.be/StructureDefinition/ext-TreatmentObjective.MedicalDevice Constraints
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url | 1..1 | System.StringFixed Value | There are no (further) constraints on this element Element IdGoal.target.extension:medicalDevice.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. System.String Fixed Valuehttps://fhir.healthdata.be/StructureDefinition/ext-TreatmentObjective.MedicalDevice
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value[x] | 0..1 | Element IdGoal.target.extension:medicalDevice.value[x] MedicalDevice Alternate namesHulpmiddel DefinitionMedical aid the patient has to reduce the impact of the disability or disorder.
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valueReference | Reference(HdBe MedicalDevice) | There are no (further) constraints on this element Data Type | ||
measure | Σ I | 0..1 | CodeableConceptBinding | Element IdGoal.target.measure StatusName Alternate namesStatusNaam DefinitionCoded description of the functional or mental status or limitation. CodeSystem used is SNOMED CT Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Description of the Status StatusName (extensible)Constraints
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detail[x] | Σ I | 0..1 | Element IdGoal.target.detail[x] The target value to be achieved DefinitionThe 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. 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. Unordered, Open, by $this(Type) BindingCodes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. (unbound) (example)Constraints
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detailQuantity | Quantity | There are no (further) constraints on this element Data Type | ||
detailRange | Range | There are no (further) constraints on this element Data Type | ||
detailString | string | There are no (further) constraints on this element Data Type | ||
detailBoolean | boolean | There are no (further) constraints on this element Data Type | ||
detailInteger | integer | There are no (further) constraints on this element Data Type | ||
detailRatio | Ratio | There are no (further) constraints on this element Data Type | ||
detailCodeableConcept | Σ I | 0..1 | CodeableConceptBinding | Element IdGoal.target.detail[x]:detailCodeableConcept StatusValue Alternate namesStatusWaarde DefinitionThe extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical device, the evaluation of the extent of the limitation will take place without this aid. The answer codes must be selected from the subselection of the code system corresponding with the request in accordance with the rules applicable to that system. 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. Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. StatusValue (extensible)Constraints
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due[x] | Σ | 0..1 | Element IdGoal.target.due[x] Reach goal on or before DefinitionIndicates either the date or the duration after start by which the goal should be met. Identifies when the goal should be evaluated. Unordered, Open, by $this(Type) Constraints
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dueDuration | Duration | There are no (further) constraints on this element Data Type | ||
dueDate | Σ | 0..1 | date | Element IdGoal.target.due[x]:dueDate StatusDate Alternate namesStatusDatum DefinitionIndicates the date of the DesiredHealthCondition by which the goal should be met. Identifies when the goal should be evaluated.
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statusDate | Σ | 0..1 | date | There are no (further) constraints on this element Element IdGoal.statusDate When goal status took effect DefinitionIdentifies when the current status. I.e. When initially created, when achieved, when cancelled, etc. To see the date for past statuses, query history.
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statusReason | 0..1 | string | There are no (further) constraints on this element Element IdGoal.statusReason Reason for current status DefinitionCaptures 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.
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expressedBy | Σ I | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element IdGoal.expressedBy Who's responsible for creating Goal? DefinitionIndicates whose goal this is - patient goal, practitioner goal, etc. This is the individual responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.). Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Constraints
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addresses | I | 0..1 | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | HdBe Problem) | Element IdGoal.addresses Problem Alternate namesProbleem DefinitionDescription of the problem to which the treatment objective applies. Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | HdBe Problem) Constraints
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note | 0..1 | Annotation | There are no (further) constraints on this element Element IdGoal.note Comments about the goal DefinitionAny comments related to the goal. There's a need to capture information about the goal that doesn't actually describe the goal. May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
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author[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdGoal.note.author[x] Individual responsible for the annotation DefinitionThe individual responsible for making the annotation. Organization is used when there's no need for specific attribution as to who made the comment.
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authorString | string | There are no (further) constraints on this element Data Type | ||
authorReference | Reference(Practitioner | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Data Type Reference(Practitioner | Patient | RelatedPerson | Organization) | ||
time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdGoal.note.time When the annotation was made DefinitionIndicates when this particular annotation was made.
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text | Σ | 1..1 | markdown | Element IdGoal.note.text Comment Alternate namesToelichting DefinitionExplanatory comments as a description of the functional or mental status. Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
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outcomeCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdGoal.outcomeCode What result was achieved regarding the goal? DefinitionIdentifies the change (or lack of change) at the point when the status of the goal is assessed. Outcome tracking is a key aspect of care planning. 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". SNOMEDCTClinicalFindings (example)Constraints
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outcomeReference | I | 0..* | Reference(Observation) | There are no (further) constraints on this element Element IdGoal.outcomeReference Observation that resulted from goal DefinitionDetails of what's changed (or not changed). Outcome tracking is a key aspect of care planning. 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.
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Goal | I | Goal | Element IdGoal TreatmentObjective Alternate namesBehandeldoel DefinitionDescribes 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. Although the CBB model assumes there's a reference from zib TreatmentObjective to a distinct instance of CBB FunctionalOrMentalStatus (in future context), in this profile the concepts of CBB FunctionalOrMentalStatus are mapped directly as this aligns with the way the Goal resource is used.
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element IdGoal.identifier External Ids for this goal DefinitionBusiness identifiers assigned to this goal by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
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lifecycleStatus | Σ ?! | 1..1 | codeBinding | Element IdGoal.lifecycleStatus proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected DefinitionThe state of the goal throughout its lifecycle. Allows knowing whether goal needs to be further tracked. No CBB concept can be mapped (implicitly). Unless Codes that reflect the current state of a goal and whether the goal is still being targeted. GoalLifecycleStatus (required)Constraints
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achievementStatus | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdGoal.achievementStatus in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable DefinitionDescribes the progression, or lack thereof, towards the goal against the target. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Indicates the progression, or lack thereof, towards the goal against the target. GoalAchievementStatus (preferred)Constraints
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdGoal.category E.g. Treatment, dietary, behavioral, etc. DefinitionIndicates a category the goal falls within. Allows goals to be filtered and sorted. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for grouping and sorting goals. GoalCategory (example)Constraints
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priority | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element IdGoal.priority high-priority | medium-priority | low-priority DefinitionIdentifies the mutually agreed level of importance associated with reaching/sustaining the goal. Used for sorting and presenting goals. 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. GoalPriority (preferred)Constraints
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description | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element IdGoal.description Code or text describing goal DefinitionHuman-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". Without a description of what's trying to be achieved, element has no purpose. 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. SNOMEDCTClinicalFindings (example)Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element IdGoal.description.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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text | Σ | 0..1 | string | Element IdGoal.description.text DesiredHealthcareResult / StatusName / StatusValue Alternate namesGewenstZorgresultaat DefinitionThe textual account of the treatment objective. This concept provides the option to define a treatment objective which cannot be described as a measurement value or functional/mental status. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. If the concept desired_healthcare_result is not present in this instance of CBB TreatmentObjective, but desired_health_condition is,
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subject | Σ I | 1..1 | Reference(Patient | Group | Organization) | There are no (further) constraints on this element Element IdGoal.subject Who this goal is intended for DefinitionIdentifies the patient, group or organization for whom the goal is being established. Subject is optional to support annonymized reporting. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient | Group | Organization) Constraints
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start[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdGoal.start[x] When goal pursuit begins DefinitionThe 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. GoalStartEvent (example)Constraints
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startDate | date | There are no (further) constraints on this element Data Type | ||
startCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data Type | ||
target | I | 0..1 | BackboneElement | Element IdGoal.target DesiredHealthCondition Alternate namesGewensteGezondheidstoestand DefinitionThe desired health condition is a target value which can be expressed as the patient’s functional or mental status. Allows the progress of the goal to be monitored against an observation or due date. Target is 0..* to support Observations with multiple components, such as blood pressure goals with both a systolic and diastolic target. When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met.
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extension | I | 0..* | Extension | Element IdGoal.target.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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. Unordered, Open, by url(Value) Constraints
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medicalDevice | I | 0..* | Extension(Reference(HdBe MedicalDevice)) | Element IdGoal.target.extension:medicalDevice Optional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. 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. Extension(Reference(HdBe MedicalDevice)) Extension URLhttps://fhir.healthdata.be/StructureDefinition/ext-TreatmentObjective.MedicalDevice Constraints
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url | 1..1 | System.StringFixed Value | There are no (further) constraints on this element Element IdGoal.target.extension:medicalDevice.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. System.String Fixed Valuehttps://fhir.healthdata.be/StructureDefinition/ext-TreatmentObjective.MedicalDevice
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value[x] | 0..1 | Element IdGoal.target.extension:medicalDevice.value[x] MedicalDevice Alternate namesHulpmiddel DefinitionMedical aid the patient has to reduce the impact of the disability or disorder.
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valueReference | Reference(HdBe MedicalDevice) | There are no (further) constraints on this element Data Type | ||
measure | Σ I | 0..1 | CodeableConceptBinding | Element IdGoal.target.measure StatusName Alternate namesStatusNaam DefinitionCoded description of the functional or mental status or limitation. CodeSystem used is SNOMED CT Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Description of the Status StatusName (extensible)Constraints
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detail[x] | Σ I | 0..1 | Element IdGoal.target.detail[x] The target value to be achieved DefinitionThe 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. 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. Unordered, Open, by $this(Type) BindingCodes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. (unbound) (example)Constraints
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detailQuantity | Quantity | There are no (further) constraints on this element Data Type | ||
detailRange | Range | There are no (further) constraints on this element Data Type | ||
detailString | string | There are no (further) constraints on this element Data Type | ||
detailBoolean | boolean | There are no (further) constraints on this element Data Type | ||
detailInteger | integer | There are no (further) constraints on this element Data Type | ||
detailRatio | Ratio | There are no (further) constraints on this element Data Type | ||
detailCodeableConcept | Σ I | 0..1 | CodeableConceptBinding | Element IdGoal.target.detail[x]:detailCodeableConcept StatusValue Alternate namesStatusWaarde DefinitionThe extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical device, the evaluation of the extent of the limitation will take place without this aid. The answer codes must be selected from the subselection of the code system corresponding with the request in accordance with the rules applicable to that system. 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. Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. StatusValue (extensible)Constraints
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due[x] | Σ | 0..1 | Element IdGoal.target.due[x] Reach goal on or before DefinitionIndicates either the date or the duration after start by which the goal should be met. Identifies when the goal should be evaluated. Unordered, Open, by $this(Type) Constraints
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dueDuration | Duration | There are no (further) constraints on this element Data Type | ||
dueDate | Σ | 0..1 | date | Element IdGoal.target.due[x]:dueDate StatusDate Alternate namesStatusDatum DefinitionIndicates the date of the DesiredHealthCondition by which the goal should be met. Identifies when the goal should be evaluated.
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statusDate | Σ | 0..1 | date | There are no (further) constraints on this element Element IdGoal.statusDate When goal status took effect DefinitionIdentifies when the current status. I.e. When initially created, when achieved, when cancelled, etc. To see the date for past statuses, query history.
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statusReason | 0..1 | string | There are no (further) constraints on this element Element IdGoal.statusReason Reason for current status DefinitionCaptures 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.
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expressedBy | Σ I | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element IdGoal.expressedBy Who's responsible for creating Goal? DefinitionIndicates whose goal this is - patient goal, practitioner goal, etc. This is the individual responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.). Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Constraints
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addresses | I | 0..1 | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | HdBe Problem) | Element IdGoal.addresses Problem Alternate namesProbleem DefinitionDescription of the problem to which the treatment objective applies. Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | HdBe Problem) Constraints
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note | 0..1 | Annotation | There are no (further) constraints on this element Element IdGoal.note Comments about the goal DefinitionAny comments related to the goal. There's a need to capture information about the goal that doesn't actually describe the goal. May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
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author[x] | Σ | 0..1 | There are no (further) constraints on this element Element IdGoal.note.author[x] Individual responsible for the annotation DefinitionThe individual responsible for making the annotation. Organization is used when there's no need for specific attribution as to who made the comment.
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authorString | string | There are no (further) constraints on this element Data Type | ||
authorReference | Reference(Practitioner | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Data Type Reference(Practitioner | Patient | RelatedPerson | Organization) | ||
time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element IdGoal.note.time When the annotation was made DefinitionIndicates when this particular annotation was made.
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text | Σ | 1..1 | markdown | Element IdGoal.note.text Comment Alternate namesToelichting DefinitionExplanatory comments as a description of the functional or mental status. Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
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outcomeCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element IdGoal.outcomeCode What result was achieved regarding the goal? DefinitionIdentifies the change (or lack of change) at the point when the status of the goal is assessed. Outcome tracking is a key aspect of care planning. 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". SNOMEDCTClinicalFindings (example)Constraints
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outcomeReference | I | 0..* | Reference(Observation) | There are no (further) constraints on this element Element IdGoal.outcomeReference Observation that resulted from goal DefinitionDetails of what's changed (or not changed). Outcome tracking is a key aspect of care planning. 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.
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Mapping FHIR profile to CBB
Path | map | CBB | comment |
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Goal.description.text | StatusName | HdBe-FunctionalOrMentalStatus | implicit, main mapping is on Goal.target.measure |
Goal.description.text | StatusValue | HdBe-FunctionalOrMentalStatus | implicit, main mapping is on Goal.target.detailCodeableConcept |
Goal.target.extension:medicalDevice.value[x] | MedicalDevice | HdBe-FunctionalOrMentalStatus | |
Goal.target.measure | StatusName | HdBe-FunctionalOrMentalStatus | |
Goal.target.due[x]:dueDate | StatusDate | HdBe-FunctionalOrMentalStatus | |
Goal.note.text | Comment | HdBe-FunctionalOrMentalStatus | |
Goal | TreatmentObjective | HdBe-TreatmentObjective | |
Goal.description.text | DesiredHealthcareResult | HdBe-TreatmentObjective | |
Goal.target | DesiredHealthCondition | HdBe-TreatmentObjective | |
Goal.target.detail[x]:detailCodeableConcept | StatusValue | HdBe-TreatmentObjective | |
Goal.addresses | Problem | HdBe-TreatmentObjective |
zib TreatmentObjective difference
Concept | Category | Description |
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Goal |
textual | Replaced notion of zib with CBB and replaced wording of OutcomeOfCare with TreatmentObjective. |
target.measure |
terminology | Included only SNOMED CT as CodeSystem of valueSet StatusName and loosened binding to extensible in alignment with CBB FunctionalOrMentalStatus. |
target.measure |
textual | Aligned descriptions of several elements with the CBB FunctionalOrMentalStatus elements. |
target.detailCodeableConcept |
terminology | Included only SNOMED CT as CodeSystem of valueSet StatusValue and loosened binding to extensible in alignment with CBB FunctionalOrMentalStatus. |
Terminology Bindings
Path | Name | Strength | URL | ConceptMap |
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Goal.target.measure | StatusName | extensible | https://fhir.healthdata.be/ValueSet/StatusName | No bound ConceptMap |
Goal.target.detail[x] | StatusValue | extensible | https://fhir.healthdata.be/ValueSet/StatusValue | No bound ConceptMap |