Goal

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. Refer to the US Core Goal profile.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	External Ids for this goal Details 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. 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.
lifecycleStatus	✓	code	proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Details The state of the goal throughout its lifecycle. This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid.
achievementStatus		CodeableConcept	in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Details Describes the progression, or lack thereof, towards the goal against the target.
category		CodeableConcept[]	E.g. Treatment, dietary, behavioral, etc. Details Indicates a category the goal falls within.
priority		CodeableConcept	high-priority | medium-priority | low-priority Details 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".
description	✓	CodeableConcept	Code or text describing goal Details 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.
subject	✓	Reference< Patient | Group | Organization >	Who this goal is intended for Details Identifies the patient, group or organization for whom the goal is being established.
start[x]		date, CodeableConcept	When goal pursuit begins Details The date or event after which the goal should begin being pursued.
target		GoalTarget[]	Target outcome for the goal Details Indicates what should be done by when. When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.
measure		CodeableConcept	The parameter whose value is being tracked Details The parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
detail[x]		Quantity, Range, CodeableConcept, string, boolean, integer, Ratio	The target value to be achieved Details 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. 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.
due[x]		date, Duration	Reach goal on or before Details Indicates either the date or the duration after start by which the goal should be met.
statusDate		date	When goal status took effect Details Identifies when the current status. I.e. When initially created, when achieved, when cancelled, etc. To see the date for past statuses, query history.
statusReason		string	Reason for current status Details 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.
expressedBy		Reference< Patient | Practitioner | PractitionerRole | RelatedPerson >	Who's responsible for creating Goal? Details Indicates 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.).
addresses		Reference< Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment >[]	Issues addressed by this goal Details The identified conditions and other health record elements that are intended to be addressed by the goal.
note		Annotation[]	Comments about the goal Details Any comments related to the goal. May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
outcomeCode		CodeableConcept[]	What result was achieved regarding the goal? Details 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.
outcomeReference		Reference<Observation>[]	Observation that resulted from goal Details 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.

Search Parameters

Name	Type	Description	Expression
identifier	token	External Ids for this goal	Goal.identifier
patient	reference	Who this goal is intended for	Goal.subject.where(resolve() is Patient)
achievement-status	token	in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable	Goal.achievementStatus
category	token	E.g. Treatment, dietary, behavioral, etc.	Goal.category
lifecycle-status	token	proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected	Goal.lifecycleStatus
start-date	date	When goal pursuit begins	Goal.start as date
subject	reference	Who this goal is intended for	Goal.subject
target-date	date	Reach goal on or before	Goal.target.due as date

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details 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.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details 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		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can 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 information is added later.
contained		Resource[]	Contained, inline Resources Details 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. 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.
modifierExtension		Extension[]	Extensions that cannot be ignored Details 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.

Usage

A Goal in health care services delivery is generally an expressed desired health state to be achieved by a subject of care (or family/group) over a period or at a specific point of time. This desired target health state may be achieved as a result of health care intervention(s) or resulting from natural recovery over time. For example:

• A goal of a plan for a condition such as a diabetes might specify desired outcome(s) (e.g. HgbA1c level =<5.6% in 3 months) as a result of interventions such as medication therapy, nutritional management and/or increase physical activity.
• A goal of a procedure might be to meet the intended objective of the procedure (e.g. wet-dry-dressing changes twice a day; goal: wound healed completely in 2 weeks) or to prevent an unintended complication (e.g. repositioning a patient every two hours: goal to maintain skin integrity)

Goals may address the prevention of illness, cure or mitigation of a condition, prolongation of life, or mitigation of pain and discomfort.

When dealing with groups, goals may also reflect health state, such as a reduction of addiction behaviors. However, they may also reflect population health objectives such as education, screening, etc.

Organizational goals are typically not health state specific but may instead identify measurement targets such as infection control, cost management, patient satisfaction, etc.

Relationships

Goals are typically established in the context of a CarePlan. However, goals may also be directly referenced by request-type resources (e.g. MedicationRequest or ServiceRequest) by using an extension.

A goal represents a specific goal instance for a particular patient, group, etc. It is not intended to be used to define types of potential goals as part of an order set or protocol definition. Protocol definitions and order sets are supported through PlanDefinition. The Goal resource is intended to be used once an order set is instantiated or assigned to a patient, which is when the potential goals become the actual goals, if not changed or deleted.

Goals are often evaluated using Observations.

Referenced By

• CarePlan