Goal

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.

Overview

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.

This profile is used to define the content that will be returned by the API Server in response to requests to access Goal resources. All elements described in the Definition and Detailed Definitions below are supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

This resource is referenced by: CarePlan.

List of profiles we support:

Definition

The official URL for this profile is:

https://fhir.athena.io/StructureDefinition/ah-goal

The base definition for this profile is:

Goal

NameFlagsCard.TypeDescription & Constraintsdoco
.. Goal0..*GoalDescribes the intended objective(s) for a patient, group or organization
... idΣ0..1stringLogical id of this artifact
... metaΣ0..1MetaMetadata about the resource
... implicitRules?!Σ0..1uriA set of rules under which this content was created
... text0..1NarrativeText summary of the resource, for human interpretation
... contained0..*ResourceContained, inline Resources
... Slices for extension1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ahChartSharingGroup0..1Reference(Organization)athenahealth Chart Sharing Group
URL: https://fhir.athena.io/StructureDefinition/ah-chart-sharing-group
... ahPractice1..1Reference(Organization)athenahealth Practice
URL: https://fhir.athena.io/StructureDefinition/ah-practice
... modifierExtension?!0..*ExtensionExtensions that cannot be ignored
... identifier0..*IdentifierExternal Ids for this goal
... lifecycleStatus?!Σ1..1codeproposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
Binding: GoalLifecycleStatus (required): Codes that reflect the current state of a goal and whether the goal is still being targeted.

... achievementStatusΣ0..1CodeableConceptin-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.

... priorityΣ0..1CodeableConcepthigh-priority | medium-priority | low-priority
Binding: GoalPriority (preferred): The level of importance associated with a goal.

... descriptionΣ1..1CodeableConceptCode or text describing goal
Binding: SNOMEDCTClinicalFindings (example): 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.

... subjectΣ1..1Reference(Patient | Group | Organization)Who this goal is intended for
... targetI0..*BackboneElementTarget outcome for the goal
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... modifierExtension?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... due[x]Σ0..1date (YYYY-MM-DD)Reach goal on or before

doco Documentation for this format

Detailed Definitions


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.

Cardinality 0..*
Type Root
Comments Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

Goal.id

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

Cardinality 0..1
Type string
Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Goal.meta

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.

Cardinality 0..1
Type Meta

Goal.implicitRules

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.

Cardinality 0..1
Type uri
Comments 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.

Goal.language

The base language in which the resource is written.

Cardinality 0..1
Type code Binding: CommonLanguages (preferred)
Comments 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).

Goal.text

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.

Cardinality 0..1
Type Narrative
Comments 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.

Goal.contained

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.

Cardinality 0..*
Type Resource
Comments 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.

Goal.extension

An Extension

Cardinality 1..*
Type Extension

Goal.extension:ahChartSharingGroup

An Extension used to reference a specific athenahealth chart sharing group Organization.

Cardinality 0..1
Type Extension(AthenaChartSharingGroup)

Goal.extension:ahPractice

An Extension used to reference a specific athenahealth practice Organization.

Cardinality 1..1
Type Extension(AthenaPractice)

Goal.modifierExtension

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).

Cardinality 0..*
Type Extension
Comments 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.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Goal.identifier

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.

Cardinality 0..*
Type Identifier
Comments 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.
Requirements Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers.

Goal.lifecycleStatus

The state of the goal throughout its lifecycle.

Cardinality 1..1
Type code Binding: GoalLifecycleStatus (required)
Comments 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.

Goal.achievementStatus

Describes the progression, or lack thereof, towards the goal against the target.

Cardinality 0..1
Type CodeableConcept Binding: GoalAchievementStatus (preferred)

Goal.priority

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

Cardinality 0..1
Type CodeableConcept Binding: GoalPriority (preferred)
Comments 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".
Requirements Used for sorting and presenting goals.

Goal.description

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".

Cardinality 1..1
Type CodeableConcept Binding: SNOMEDCTClinicalFindings (example)
Comments If no code is available, use CodeableConcept.text.
Requirements Without a description of what's trying to be achieved, element has no purpose.

Goal.subject

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

Cardinality 1..1
Type Reference(Patient | Group | Organization)
Requirements Subject is optional to support annonymized reporting.

Goal.target

Indicates what should be done by when.

Cardinality 0..*
Type BackboneElement
Comments 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.

Goal.target.id

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

Cardinality 0..1
Type string

Goal.target.extension

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.

Cardinality 0..*
Type Extension
Comments 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.

Goal.target.modifierExtension

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).

Cardinality 0..*
Type Extension
Comments 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.
Requirements Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Goal.target.due[x]

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

Cardinality 0..1
Type date (YYYY-MM-DD)
Requirements Identifies when the goal should be evaluated.

Interactions

READ

Read interactions are executed as specified in the HL7 FHIR RESTful API read specification. To read Goal resources, an application will perform an HTTP GET specifying the logical ID of the Goal being retrieved.

The [patient|user|system]/Goal.read authorization scope is required.

GET
/fhir/r4/Goal/{logicalId}
Try in Postman

Parameters

required

conditional required

Name Type Description
logicalId string (REQUIRED) The logical ID of the resource (alias: Resource.id). It is specified in the URL path and not as a query parameter.

Response Codes

Response code Description
200 OK The requested Goal resource was found and is contained within the body of the HTTP response.
400 Bad Request The server could not understand the request due to invalid syntax. The body of the HTTP response will contain an OperationOutcome resource that indicates the invalid request could not be processed.
404 Not Found The requested resource does not exist. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
410 Gone The requested resource has been permanently deleted from server with no forwarding address. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

GET SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Goal resources using the HTTP GET method, an application will perform the HTTP GET specifying the query parameters associated with the Goal in the URL.

The [patient|user|system]/Goal.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Provenance.read

GET
/fhir/r4/Goal
Try in Postman

Parameters

Goal search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
patient reference (CONDITIONAL REQUIRED) Goal.patient resource reference to FHIR Patient resource
_count number The number of Goal resources to return per page for paged search results.
_id token (CONDITIONAL REQUIRED) Goal._id resource reference to FHIR Goal resource
cursor token Search by cursor token for first resource to return in a paged search result
ah-brand reference Search by athenahealth Brand (e.g., 'ah-brand=Organization/a-[practiceId].Brand-[brandId]') for resources containing the 'Athena Brand' Extension
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
ah-department reference Search by athenahealth Department (e.g., 'ah-department=Organization/a-[practiceId].Department-[deptId]') for resources containing the 'Athena Department' Extension
ah-provider-group reference Search by athenahealth Provider Group (e.g., 'ah-provider-group=Organization/a-[practiceId].PG-[providerGroupId]') for resources containing the 'Athena Provider Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Goal:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
  • Goal:ah-brand - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-department - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-practice - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-provider-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

POST SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Goal resources using the HTTP POST method, an application will perform the HTTP POST specifying the query parameters associated with the Goal in the request body.

The [patient|user|system]/Goal.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Provenance.read

POST
/fhir/r4/Goal/_search
Try in Postman

Request Header

Content-Type: application/x-www-form-urlencoded

Request Body

param1=value1&param2=value2...

Parameters

Goal search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
patient reference (CONDITIONAL REQUIRED) Goal.patient resource reference to FHIR Patient resource
_count number The number of Goal resources to return per page for paged search results.
_id token (CONDITIONAL REQUIRED) Goal._id resource reference to FHIR Goal resource
cursor token Search by cursor token for first resource to return in a paged search result
ah-brand reference Search by athenahealth Brand (e.g., 'ah-brand=Organization/a-[practiceId].Brand-[brandId]') for resources containing the 'Athena Brand' Extension
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
ah-department reference Search by athenahealth Department (e.g., 'ah-department=Organization/a-[practiceId].Department-[deptId]') for resources containing the 'Athena Department' Extension
ah-provider-group reference Search by athenahealth Provider Group (e.g., 'ah-provider-group=Organization/a-[practiceId].PG-[providerGroupId]') for resources containing the 'Athena Provider Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Goal:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
  • Goal:ah-brand - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-department - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-practice - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Goal:ah-provider-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
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