Data Element


NACHC, PRAPARE and Care Plans

NACHC is strongly supportive of the use of both the Goals and Interventions concepts already present in UCSDIv2 although does not agree with the proposal to break up goals into multiple data elements based on the domain of the care plan.


  • The intent of the Care Plan DAM is to normalize problem list items with other health concerns and social needs on a relatively equal footing and to refocus the care plans around the patient’s stated goals.
  • The effect of creating a separate concept for SDOH goals undoes the intent of Goals as described by the DAM. While it seems that coded elements would improve interoperability, in fact coded goals in the sense of social services and health concerns reduces the patient-centered nature of the Goals concept and instead encourages care team members to document a generic “goal” which is not the one stated by the patient but instead the closest coded concept.
  • The use of coded terms should not be prohibited, but the emphasis of the goals field should be on the patient’s stated goals in addition to those which might be added by care team members (e.g. increased ROM to 90* or Hba1c <7)


 Please see attached document for a detailed summary of our comments on SDoH

2022-04-30 NACHC USCDIv3 Letter of Support_2.pdf

Lantana Consulting Group Comment

Lantana recommends clarifying the relationship between SDOH Goals and US Core Goal.subject, which requires a reference to the Patient for which the goal is created. It would be useful to clarify how SDOH Goals and Patient Goals are associated and how they are linked via FHIR.

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