---
tags: USCDI v4
title: Goals and Preferences
cat: Moderate
---

<style>.markdown-body { max-width: 1500px; }</style>

Desired state to be achieved by a patient.

## :new: Goals and Preferences Data Elements

<!-- quote -->

Draft


Final


---
## :new: Goal Data Elements

<!-- table -->

DATA ELEMENT|APPLICABLE VOCABULARY STANDARD(S)<br/>Standards listed are required. If more than one is listed, at least one is required unless otherwise noted. If a cell is empty, an applicable vocabulary standard has not been identified.|US Core V6 Proposal
---|---|---
**Treatment Intervention Preference**<br/>Person's goals, preferences, and priorities for care and treatment in case that person is unable to make medical decisions because of a serious illness or injury.<br/><br/>Examples include but are not limited to thoughts on cardiopulmonary resuscitation, mental health treatment preferences, and thoughts on pain management.|Logical Observation Identifiers Names and Codes (LOINC) version 2.74|:new: Observation derived from US Core Simple Observation using [PACIO'a ADI Personal Intervention Preference Profile](https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/master/StructureDefinition-ADI-PersonalInterventionPreference.html) as a blueprint.
**Care Experience Preference**<br/>Person's goals, preferences, and priorities for overall experiences during their care and treatment.<br/><br/>Examples include but are not limited to religious beliefs, dislikes and fears, and thoughts and feelings to be shared.|Logical Observation Identifiers Names and Codes (LOINC) version 2.74|:new: Observation derived from US Core Simple Observation using [PACIO's ADI Care Experience Preference Profile](https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/master/StructureDefinition-ADI-CareExperiencePreference.html) as a blueprint.

### Known issues

- Could be a document/form and not discrete elements. The process of capturing this information may drive how is represented by the EHR.

- >"...concern increased about the possibility that clinicians might misinterpret patient wishes in a way that would result in errors that risk patient safety or that violate patient intent. Information context is crucial when it comes to interpreting advance directives. Directives should always be maintained in their original form - not chopped up and stored as structured data."-

### Next Steps

- Review "prior art" See details in [Background Section](#Background) below.

- **BOTTOM LINE**:

**[PACIO's ADI Care Experience Preference Profile](http://build.fhir.org/ig/HL7/fhir-pacio-adi/StructureDefinition-ADI-CareExperiencePreference.html) = UCDI Care Experience Preference**

**[PACIO'a ADI Personal Intervention Preference Profile](http://build.fhir.org/ig/HL7/fhir-pacio-adi/StructureDefinition-ADI-PersonalInterventionPreference.html) = UCDI Treatment Intervention Preference**

[Pacio ADI Project](https://confluence.hl7.org/display/PC/PACIO+Advance+Directive+Interoperability+%28ADI%29+in+FHIR) and [Pacio ADI IG (CI Build)](http://build.fhir.org/ig/HL7/fhir-pacio-adi)

- Review how system capture this information ( See if aligns with above )

### Decision

<!-- ~~Goal ??~~

~~Clinical Notes ??~~ -->

<!-- Observation :exclamation: -->

:new: Observation Profiles :exclamation: (see Table)

Details.
- derived from US Core Simple Observation
- add 2 new category codes to [US Core Category](https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/master/StructureDefinition-adi-contextualValue-extension.html)
- constrain code extensible binding to either :thinking_face:
- a single code
- PACIO code sets
- Must Support derivedFrom DocumentReference vs. USCDI requirement :thinking_face:
- Simplified version of the PACIO Profiles.
- no mandatory Narrative
- Note: Typically There will be a String Value Type and any narrative content information is available in the valueString field.
- no Must Support text elements for codes
- no [PACIO Context Extension](https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/master/StructureDefinition-adi-contextualValue-extension.html)
- no fixed status to "complete"
- adds effective[x] and performer as MustSupports.

#### :arrow_right: [Care Experience and Treatment Intervention Preference Profile and Examples](https://healthedata1.github.io/USCDI4-Sandbox/artifacts.html#goals-and-preferences)

### IG Updates

- [ ] USCDI Mapping Table
<!-- - [ ] Update US Core Profile
- [ ] New US Core Profile/Extension -->
- [ ] Implementation Specific Guidance
- [ ] New Example(s)
<!-- - [ ] Update Example(s) -->
------

### Background

Submission highlights:
- Reference to Prior USCDI V2 Submission
1. [USCDI Proposal for Advance Directives Data Class 20201022.docx](https://www.healthit.gov/isa/sites/isa/files/webform/uscid_webform/1201/USCDI%20Proposal%20for%20Advance%20Directives%20Data%20Class%2020201022.docx)
- References Standards in this Domain
1. CCDA [HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP)](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=434)
- >"In limited use in production environments"
- Updated: updated CCDA ADI IG: [CDAR2_IG_PACP_E1_STU3_Vol1_2023MAR](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=473) ?
>focuses on defining a standard representation for the above-described Type 1 Content Patient Authored... Modifications have been made to align this work with additional advance directive data exchange standardization taking place in the HL7 FHIR PACIO Advance Directive Interoperability Implementation Guide. and HL7 CDA R2 Implementation Guide: ePOLST: Portable Medical Orders About Resuscitation and Initial Treatment" (Which, I cannot find)

3. [Pacio ADI Project](https://confluence.hl7.org/display/PC/PACIO+Project+Advance+Directive+Interoperability+(ADI)+in+FHIR) and [Pacio ADI IG (CI Build)](http://build.fhir.org/ig/HL7/fhir-pacio-adi)

- **BOTTOM LINE**:

**[ADI Care Experience Preference Profile](https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/master/StructureDefinition-PADI-CareExperiencePreference.html) = UCDI Care Experience Preference**

**[ADI Personal Intervention Preference Profile](https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/master/StructureDefinition-PADI-PersonalInterventionPreference.html) = UCDI Treatment Intervention Preference**
- Project Launched in 2020
- Status: IG Jan 2022 Ballot, Final JIRA tickets for STU1 Ballot ready for approval

- Document Based: OverView of PACIO ADI Document


- FHIR Goal to represent Patient Goals
- Goals, Preferences, and Priorities for Certain Healthcare Conditions - Preference CarePlans that contain the person’s goals to be considered active under specific situations or conditions
- Goals, Preferences, and Priorities Personal Care Experience - Quality of Life related personal care experiences, personal goals, and priorities
- Goals, Preferences, and Priorities Upon Death - Goals, preferences, and priorities a person has at the time of or soon after there death
- **FHIR Observation for Individual Preferences**
- FHIR Composition
- All document format (including FHIR Documents) saved as Binary resource
- Digital Signature support
- Focus on Human Readability:
- Requires Narrative (`text`)
- Must Support of `CodeableConcept.text`
- Authentication and Authorization Requirements ( including Capabilities and Scopes)
4. >"Implementation of the data element is not burdensome. All of the LOINC codes, value sets and data transport standards exist and are widely and freely accessible."
5. Comments:
- > Placing both under the GOALS data category removes them from an "advance healthcare decision" context to a certain extent
- > The Advance Directive observation is a critical component of the advance healthcare decision-making process; it is part of the clinical workflow that enables "confirmation" that what is wanted by the person has been validated by a clinician as being authentic for that person, which begins the workflow to activate those decisions into the treatment or care plan.
> The PACIO Community strongly recommends the “Advance Directive Observation” data element be advanced to USCDI Level 2.
> - Type I: Patient-Authored Advance Directive Information
> - Type II: Practitioner-Authored Encounter-Centric Advance Directive Information
> - Type III: Orders for Life-Sustaining Treatments

- > There are multiple forms that are in use across the U.S. to represent this
type of content such as POLST, MOLST, POST, MOST, and the like

- Terminology recommendations [here](https://www.healthit.gov/isa/sites/isa/files/2021-09/USCDIv3%20ADI_Comments_20210927v3_0.pdf) and in the Pacio IG

#### USDCI V4 deals with the "Content Type I"


### IG Updates

- [ ] USCDI Mapping Table
<!-- - [ ] Update US Core Profile
- [ ] New US Core Profile/Extension -->
- [ ] Implementation Specific Guidance
- [ ] New Example(s)
<!-- - [ ] Update Example(s) -->
------