Goals

CMS-CCSQ Support for Renaming “Goals” Data Class for USCDI v4

Information about patient-document goals and preferences is important for clinical decision support and care coordination. While CMS supports the addition of Treatment Intervention Preference and Care Experience Preference data elements to the Goals data class, we recognize that “Goals” and “Preferences” are related but conceptually different. Hence, we recommend reframing the Goals data class to "Goals and Preferences" to capture related data elements in one data class. This would allow for data elements such as Advance Directives and Portable Medical Orders to fit appropriately into this data class in future.

HL7 Patient Care Work Group Commendation

HL7 Patient Care Work Group would like to commend ONC for including Treatment Intervention Preference and Care Experience Preferences as data elements in the Goal data class. Providing the ability to specify patient's preferences is integral to improved patient outcomes. Thank you for your foresight. 

Clarification needed for Goals data class

Goals and preferences are not the same type of thing.  A goal is an state you wish to attain.  I preference is a choice about a pathway you would like or not like to take.  Specifically the standards have identified Treatment Preferences and Care Experience Preferences. (See both the CDA PACP Standard and the FHIR ADI Standard).  If ONC wants to keep Goals and Preferences in one data class, the name for the data class should be changed to Goals and Preferences. 

Goals are best reflected through advance directives

The goals section on the latest version seems too vague to me to be of use to clinicians and others accessing a patient's records. Instead, the previous Advance Directive section, that included 6 elements including information on the medical power of attorney and other aspects of a pertson's goals and preferences would be better to include. As a practicing palliative care nurse practitioner, I include a section on the patient's goals in my notes, but this is not the case for the other clinicians in my hospital. Adoption of Advance Directives should be considered in USCDI V2. 

NCPDP Comment

NCPDP supports comments submitted by Pharmacy HIT Collaborative for Outcome Reference and Outcome Code.