{
  "resourceType": "StructureDefinition",
  "id": "Goal",
  "meta": {
    "lastUpdated": "2021-01-04T23:01:24.148+00:00"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
      "valueString": "Clinical.Care Provision"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 2
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
      "valueCode": "patient"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "pc"
    },
    {
      "url": "http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status",
      "valueCode": ".status = entered-in-error"
    }
  ],
  "url": "http://hl7.org/fhir/StructureDefinition/Goal",
  "version": "4.6.0",
  "name": "Goal",
  "status": "draft",
  "date": "2021-01-04T23:01:24+00:00",
  "publisher": "Health Level Seven International (Patient Care)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org/fhir"
        }
      ]
    },
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/patientcare/index.cfm"
        }
      ]
    }
  ],
  "description": "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.",
  "fhirVersion": "4.6.0",
  "mapping": [
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Goal",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
  "derivation": "specialization",
  "differential": {
    "element": [
      {
        "id": "Goal",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "0,0"
          }
        ],
        "path": "Goal",
        "short": "Describes the intended objective(s) for a patient, group or organization",
        "definition": "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.",
        "comment": "Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.",
        "min": 0,
        "max": "*",
        "mapping": [
          {
            "identity": "v2",
            "map": "GOL.1"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode<=OBJ]."
          },
          {
            "identity": "w5",
            "map": "clinical.careprovision"
          }
        ]
      },
      {
        "id": "Goal.identifier",
        "path": "Goal.identifier",
        "short": "External Ids for this goal",
        "definition": "Business 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.",
        "comment": "This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)).  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.",
        "requirements": "Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "rim",
            "map": ".id"
          }
        ]
      },
      {
        "id": "Goal.lifecycleStatus",
        "path": "Goal.lifecycleStatus",
        "short": "proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected",
        "definition": "The state of the goal throughout its lifecycle.",
        "comment": "This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid.",
        "requirements": "Allows knowing whether goal needs to be further tracked.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "code"
          }
        ],
        "isModifier": true,
        "isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalLifecycleStatus"
            }
          ],
          "strength": "required",
          "description": "Codes that reflect the current state of a goal and whether the goal is still being targeted.",
          "valueSet": "http://hl7.org/fhir/ValueSet/goal-status"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.status"
          },
          {
            "identity": "v2",
            "map": "GOL-18-goal life cycle status"
          },
          {
            "identity": "rim",
            "map": ".statusCode in-progress = active (classCode = OBJ) cancelled = aborted"
          }
        ]
      },
      {
        "id": "Goal.achievementStatus",
        "path": "Goal.achievementStatus",
        "short": "in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable",
        "definition": "Describes the progression, or lack thereof, towards the goal against the target.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalAchievementStatus"
            }
          ],
          "strength": "preferred",
          "description": "Indicates the progression, or lack thereof, towards the goal against the target.",
          "valueSet": "http://hl7.org/fhir/ValueSet/goal-achievement"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": ".statusCode achieved = complete sustaining = active"
          }
        ]
      },
      {
        "id": "Goal.category",
        "path": "Goal.category",
        "short": "E.g. Treatment, dietary, behavioral, etc.",
        "definition": "Indicates a category the goal falls within.",
        "requirements": "Allows goals to be filtered and sorted.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalCategory"
            }
          ],
          "strength": "example",
          "description": "Codes for grouping and sorting goals.",
          "valueSet": "http://hl7.org/fhir/ValueSet/goal-category"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.class"
          }
        ]
      },
      {
        "id": "Goal.continuous",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "GF#17755."
          }
        ],
        "path": "Goal.continuous",
        "short": "After meeting the goal, ongoing activity is needed to sustain the goal objective",
        "definition": "After meeting the goal, ongoing activity is needed to sustain the goal objective.",
        "comment": "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).",
        "requirements": "Allows for a system to programmatically update achievementStatus upon finding evidence the goal has been met.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "boolean"
          }
        ]
      },
      {
        "id": "Goal.priority",
        "path": "Goal.priority",
        "short": "high-priority | medium-priority | low-priority",
        "definition": "Identifies the mutually agreed level of importance associated with reaching/sustaining the goal.",
        "comment": "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)\r\rThe 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\".",
        "requirements": "Used for sorting and presenting goals.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalPriority"
            }
          ],
          "strength": "preferred",
          "description": "The level of importance associated with a goal.",
          "valueSet": "http://hl7.org/fhir/ValueSet/goal-priority"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.grade"
          },
          {
            "identity": "rim",
            "map": ".priorityCode"
          }
        ]
      },
      {
        "id": "Goal.description",
        "path": "Goal.description",
        "short": "Code or text describing goal",
        "definition": "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\".",
        "comment": "If no code is available, use CodeableConcept.text.",
        "requirements": "Without a description of what's trying to be achieved, element has no purpose.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalDescription"
            }
          ],
          "strength": "example",
          "description": "Codes providing the details of a particular goal.  This will generally be system or implementation guide-specific.  In many systems, only the text element will be used.",
          "valueSet": "http://hl7.org/fhir/ValueSet/clinical-findings"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          },
          {
            "identity": "v2",
            "map": "GOL-3.2-goal ID.text"
          },
          {
            "identity": "rim",
            "map": ".text"
          }
        ]
      },
      {
        "id": "Goal.subject",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "Goal can exist out of context of care plan, so subject is needed per GF#12776."
          }
        ],
        "path": "Goal.subject",
        "short": "Who this goal is intended for",
        "definition": "Identifies the patient, group or organization for whom the goal is being established.",
        "requirements": "Subject is optional to support annonymized reporting.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Group",
              "http://hl7.org/fhir/StructureDefinition/Organization"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "v2",
            "map": "PID-3-patient ID list"
          },
          {
            "identity": "rim",
            "map": ".participation[typeCode=PAT].role[classCode=PAT]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "Goal.start[x]",
        "path": "Goal.start[x]",
        "short": "When goal pursuit begins",
        "definition": "The date or event after which the goal should begin being pursued.",
        "requirements": "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.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "date"
          },
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalStartEvent"
            }
          ],
          "strength": "example",
          "description": "Codes describing events that can trigger the initiation of a goal.",
          "valueSet": "http://hl7.org/fhir/ValueSet/goal-start-event"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.planned"
          }
        ]
      },
      {
        "id": "Goal.target",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "GF#12090, GF#17572."
          },
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "400,0"
          }
        ],
        "path": "Goal.target",
        "short": "Target outcome for the goal",
        "definition": "Indicates what should be done by when.",
        "comment": "When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met.",
        "requirements": "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.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "condition": [
          "gol-1"
        ],
        "constraint": [
          {
            "key": "gol-1",
            "severity": "error",
            "human": "Goal.target.measure is required if Goal.target.detail is populated",
            "expression": "(detail.exists() and measure.exists()) or detail.exists().not()",
            "xpath": "(exists(f:*[starts-with(local-name(.), 'detail')]) and exists(f:measure)) or not(exists(f:*[starts-with(local-name(.), 'detail')]))",
            "source": "http://hl7.org/fhir/StructureDefinition/Goal"
          }
        ]
      },
      {
        "id": "Goal.target.measure",
        "path": "Goal.target.measure",
        "short": "The parameter whose value is being tracked",
        "definition": "The parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "gol-1"
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalTargetMeasure"
            }
          ],
          "strength": "example",
          "description": "Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-codes"
        }
      },
      {
        "id": "Goal.target.detail[x]",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "GF#17573."
          }
        ],
        "path": "Goal.target.detail[x]",
        "short": "The target value to be achieved",
        "definition": "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.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Quantity"
          },
          {
            "code": "Range"
          },
          {
            "code": "CodeableConcept"
          },
          {
            "code": "string"
          },
          {
            "code": "boolean"
          },
          {
            "code": "integer"
          },
          {
            "code": "Ratio"
          }
        ],
        "condition": [
          "gol-1"
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalTargetDetail"
            }
          ],
          "strength": "example",
          "description": "Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal."
        }
      },
      {
        "id": "Goal.target.due[x]",
        "path": "Goal.target.due[x]",
        "short": "Reach goal on or before",
        "definition": "Indicates either the date or the duration after start by which the goal should be met.",
        "requirements": "Identifies when the goal should be evaluated.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "date"
          },
          {
            "code": "Duration"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.done[x]"
          }
        ]
      },
      {
        "id": "Goal.statusDate",
        "path": "Goal.statusDate",
        "short": "When goal status took effect",
        "definition": "Identifies when the current status.  I.e. When initially created, when achieved, when cancelled, etc.",
        "comment": "To see the date for past statuses, query history.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "date"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.recorded"
          }
        ]
      },
      {
        "id": "Goal.statusReason",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "GF#10615."
          }
        ],
        "path": "Goal.statusReason",
        "short": "Reason for current status",
        "definition": "Captures the reason for the current status.",
        "comment": "This will typically be captured for statuses such as rejected, on-hold or cancelled, but could be present for others.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ]
      },
      {
        "id": "Goal.source",
        "path": "Goal.source",
        "short": "Who's responsible for creating Goal?",
        "definition": "Indicates whose goal this is - patient goal, practitioner goal, etc.",
        "comment": "This is the individual or team responsible for establishing the goal, not necessarily who recorded it.  (For that, use the Provenance resource.).",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Practitioner",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson",
              "http://hl7.org/fhir/StructureDefinition/CareTeam"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.source"
          }
        ]
      },
      {
        "id": "Goal.addresses",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "GF#19335."
          }
        ],
        "path": "Goal.addresses",
        "short": "Issues addressed by this goal",
        "definition": "The identified conditions and other health record elements that are intended to be addressed by the goal.",
        "requirements": "Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Condition",
              "http://hl7.org/fhir/StructureDefinition/Observation",
              "http://hl7.org/fhir/StructureDefinition/MedicationUsage",
              "http://hl7.org/fhir/StructureDefinition/MedicationRequest",
              "http://hl7.org/fhir/StructureDefinition/NutritionOrder",
              "http://hl7.org/fhir/StructureDefinition/ServiceRequest",
              "http://hl7.org/fhir/StructureDefinition/RiskAssessment"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.why[x]"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=SUBJ].target[classCode=CONC]"
          }
        ]
      },
      {
        "id": "Goal.note",
        "path": "Goal.note",
        "short": "Comments about the goal",
        "definition": "Any comments related to the goal.",
        "comment": "May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.",
        "requirements": "There's a need to capture information about the goal that doesn't actually describe the goal.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Annotation"
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "GOL-16-goal evaluation + NTE?"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
          }
        ]
      },
      {
        "id": "Goal.outcome",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "GF#11116."
          },
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "400,100"
          }
        ],
        "path": "Goal.outcome",
        "short": "What result was achieved regarding the goal?",
        "definition": "Identifies the change (or lack of change) at the point when the status of the goal is assessed.",
        "comment": "Note that this should not duplicate the goal status; 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.",
        "requirements": "Outcome tracking is a key aspect of care planning.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableReference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Observation"
            ]
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "GoalOutcome"
            }
          ],
          "strength": "example",
          "description": "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\".",
          "valueSet": "http://hl7.org/fhir/ValueSet/clinical-findings"
        }
      }
    ]
  }
}