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  1. FHIR Specification Feedback
  2. FHIR-35078

Goals vs Observations

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US PACIO Advance Directive Interoperability (FHIR)
    • 0.1.0
    • Patient Empowerment
    • STU
    • FHIR Artifacts
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      After conversations with multiple interested parties and WGs, it has been determined that the Care Experience Preferences and Personal Intervention Preferences are not representing Goals, but rather are Observations of a patient's preferences.

      Make the following changes:

      • Rename the PADIGoalCategoryCS CodeSystem to PADIPreferenceCategoryCS with definition of "Advance Directive Preference Category".
      • Remove the code "personal-goal" from this CodeSystem
      • Remove the ValueSet PADIHealthGoalsVS
      • Change PADIPersonalGoal Goal.category[type] to fixed value
        http://loinc.org|87528-6
      • Remove PADIPersonalGoal Goal.category binding (currently a non-slice binding to leave it open)
      • Change the Intervention Preference Profile from Goal to Observation
        • Add extension ContextualValueExtension 0..1 to root
        • Make Observation.text 1..1 MS
        • Make Observation.status fixed "final"
        • Make this Observation.category have a slice fixed to PADIPreferenceCategoryCS|intervention-preference 
        • Make Observation.code binding to PADIInterventionPreferencesVS (extensible)
        • Make Observation.subject cardinality 1..1 and only US Core Patient
        • Make Observation.value[x] cardinality 1..1
      • Change the Care Experience Preference Profile from Goal to Observation
        • Add extension ContextualValueExtension 0..1 to root
        • Make Observation.text 1..1 MS
        • Make Observation.status fixed "final"
        • Make this Observation.category have a slice fixed to PADIPreferenceCategoryCS|care-experience-preference
        • Make Observation.code binding to PADICareExperiencePreferencesVS (extensible)
        • Make Observation.subject cardinality 1..1 and only US Core Patient
        • Make Observation.value[x] cardinality 1..1
      • Move the PADI Goal abstract profile constraints to the ADI Personal Goal profile.
      • Change the PADIPersonalGoal inheritance from PADIGoal to US Core Goal
      • Remove the PADI Goal Profile
      • Modify the CapabilityStatement to reflect these modifications.
      • Add guidance to the Preference Care Plan profile on associating these Observations with the CarePlan resource (referenced by CarePlan.supportingInfo).

       

       
       

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      After conversations with multiple interested parties and WGs, it has been determined that the Care Experience Preferences and Personal Intervention Preferences are not representing Goals, but rather are Observations of a patient's preferences. Make the following changes: Rename the PADIGoalCategoryCS CodeSystem to PADIPreferenceCategoryCS with definition of "Advance Directive Preference Category". Remove the code "personal-goal" from this CodeSystem Remove the ValueSet PADIHealthGoalsVS Change PADIPersonalGoal Goal.category [type] to fixed value http://loinc.org |87528-6 Remove PADIPersonalGoal Goal.category binding (currently a non-slice binding to leave it open) Change the Intervention Preference Profile from Goal to Observation Add extension ContextualValueExtension 0..1 to root Make Observation.text 1..1 MS Make Observation.status fixed "final" Make this Observation.category have a slice fixed to PADIPreferenceCategoryCS|intervention-preference  Make Observation.code binding to PADIInterventionPreferencesVS (extensible) Make Observation.subject cardinality 1..1 and only US Core Patient Make Observation.value [x] cardinality 1..1 Change the Care Experience Preference Profile from Goal to Observation Add extension ContextualValueExtension 0..1 to root Make Observation.text 1..1 MS Make Observation.status fixed "final" Make this Observation.category have a slice fixed to PADIPreferenceCategoryCS|care-experience-preference Make Observation.code binding to PADICareExperiencePreferencesVS (extensible) Make Observation.subject cardinality 1..1 and only US Core Patient Make Observation.value [x] cardinality 1..1 Move the PADI Goal abstract profile constraints to the ADI Personal Goal profile. Change the PADIPersonalGoal inheritance from PADIGoal to US Core Goal Remove the PADI Goal Profile Modify the CapabilityStatement to reflect these modifications. Add guidance to the Preference Care Plan profile on associating these Observations with the CarePlan resource (referenced by CarePlan.supportingInfo).      
    • Brian Meshell / Dave Hill : 7 - 0 - 0
    • Correction
    • Non-compatible

    Description

      The IG lacks consistency in the structure for representing ADI preferences. Some are represented as Goals:

      • ADI Care Experience Preference
      • ADI Personal Goal
      • Personal Intervention Preference

      and others as Observations:

      • ADI Autopsy Observation
      • ADI Organ Donation

      Yet no justification or rationale explains the choice as to which structure was used or why a single structure couldn't represent them all. Additionally, in the case of the Goal profiles, it is quite unusual to use LOINC terms (which are observation identifiers expecting a result value to carry with them) as category codes.

      Further, the Capability Statement (http://hl7.org/fhir/us/pacio-adi/2022Jan/CapabilityStatement-padi.html) notes that Care Experience Preference and Personal Intervention Experience are profiles on Observations, which is not what the profile Structure Definitions reflect.

      I think a detailed review and consistency check is needed, as well as a narrative justification about when these preferences should be structured as Observations and when they should be structured as Goals.

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            bmeshell Brian Meshell
            dvreeman Daniel Vreeman
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              Updated:
              Resolved: