PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot

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## Resource Profile: Personal Intervention Preference

Defining URL: | http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-PersonalInterventionPreference
Version: | 0.1.0
Name: | PADIPersonalInterventionPreference
Title: | Personal Intervention Preference
Status: | Active as of 12/6/21 8:50 PM
Definition: | This profile is used to represent a personal preference for a type of medical intervention (treatment) request under certain conditions.
Publisher: | HL7 Patient Empowerment Working Group
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-PersonalInterventionPreference

The Personal Intervention preference represents the patient’s preferences for treatment interventions based on their personal goals and priorities. The patient may indicate whether they wish to issue an advance directive (instruction) to receive intubation, tube feeding, life support, and/or pain management to name a few. The preferences may be documented in narrative form or the result of selecting from a list of options provided by the content creator/implementer. Enabling the patient to state the interventions they want to receive so the care team is aware of those preferences can have a meaningful impact on the ability of the provider to deliver person-centered care that reflects the patient’s values and priorities for treatment.

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from PADIGoal

Summary

Mandatory: 1 element
Must-Support: 1 element

Slices

This structure defines the following Slices:

- The element Goal.category is sliced based on the value of value:$this

This structure is derived from PADIGoal

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | PADIGoal | Describes the intended objective(s) for a patient, group or organization
Slices for category |  | 2..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Slice: Unordered, Open by value:$this Binding: Intervention Preferences (extensible)
category:type | S | 1..1 | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/PADIGoalCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: intervention-preference
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal | I | 0..* | PADIGoal | Describes the intended objective(s) for a patient, group or organization
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text | S | 1..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External Ids for this goal
lifecycleStatus | ?!S Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
achievementStatus | Σ | 0..1 | CodeableConcept | in-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.
Slices for category | S Σ | 2..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Slice: Unordered, Open by value:$this Binding: Intervention Preferences (extensible)
category:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | S Σ | 0..1 | string | Plain text representation of the concept
category:type | S Σ | 1..1 | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/PADIGoalCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: intervention-preference
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | S Σ | 0..1 | string | Plain text representation of the concept
priority | Σ | 0..1 | CodeableConcept | high-priority | medium-priority | low-priority Binding: GoalPriority (preferred): The level of importance associated with a goal.
description | S Σ | 1..1 | CodeableConcept | Code 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.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
padi-contextualValue-extension |  | 0..1 | (Complex) | Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who this goal is intended for
start[x] | Σ | 0..1 |  | When goal pursuit begins Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date |
startCodeableConcept |  |  | CodeableConcept |
target | S I | 0..* | BackboneElement | Target outcome for the goal
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
measure | S Σ I | 0..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
detail[x] | S Σ I | 0..1 |  | The target value to be achieved Binding: (unbound) (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.
detailQuantity |  |  | Quantity |
detailRange |  |  | Range |
detailCodeableConcept |  |  | CodeableConcept |
detailString |  |  | string |
detailBoolean |  |  | boolean |
detailInteger |  |  | integer |
detailRatio |  |  | Ratio |
due[x] | S Σ | 0..1 |  | Reach goal on or before
dueDate |  |  | date S |
dueDuration |  |  | Duration |
statusDate | Σ | 0..1 | date | When goal status took effect
statusReason |  | 0..1 | string | Reason for current status
expressedBy | S Σ | 1..1 | Reference(US Core Patient Profile) | Who's responsible for creating Goal?
addresses |  | 0..* | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment) | Issues addressed by this goal
note | S | 0..* | Annotation | Comments about the goal
outcomeCode |  | 0..* | CodeableConcept | What result was achieved regarding the goal? Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".
outcomeReference |  | 0..* | Reference(Observation) | Observation that resulted from goal
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal | I | 0..* | PADIGoal | Describes the intended objective(s) for a patient, group or organization
text |  | 1..1 | Narrative | Text summary of the resource, for human interpretation
lifecycleStatus | ?!Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
Slices for category | Σ | 2..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Slice: Unordered, Open by value:$this Binding: Intervention Preferences (extensible)
category:All Slices |  |  |  | Content/Rules for all slices
text | Σ | 0..1 | string | Plain text representation of the concept
category:type | Σ | 1..1 | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/PADIGoalCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: intervention-preference
text | Σ | 0..1 | string | Plain text representation of the concept
description | Σ | 1..1 | CodeableConcept | Code 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.
subject | Σ | 1..1 | Reference(US Core Patient Profile) | Who this goal is intended for
target | I | 0..* | BackboneElement | Target outcome for the goal
measure | Σ I | 0..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
detail[x] | Σ I | 0..1 |  | The target value to be achieved Binding: (unbound) (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.
detailQuantity |  |  | Quantity |
detailRange |  |  | Range |
detailCodeableConcept |  |  | CodeableConcept |
detailString |  |  | string |
detailBoolean |  |  | boolean |
detailInteger |  |  | integer |
detailRatio |  |  | Ratio |
due[x] | Σ | 0..1 |  | Reach goal on or before
dueDate |  |  | date |
expressedBy | Σ | 1..1 | Reference(US Core Patient Profile) | Who's responsible for creating Goal?
note |  | 0..* | Annotation | Comments about the goal
Documentation for this format

This structure is derived from PADIGoal

Summary

Mandatory: 1 element
Must-Support: 1 element

Slices

This structure defines the following Slices:

- The element Goal.category is sliced based on the value of value:$this

Differential View

This structure is derived from PADIGoal

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal |  | 0..* | PADIGoal | Describes the intended objective(s) for a patient, group or organization
Slices for category |  | 2..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Slice: Unordered, Open by value:$this Binding: Intervention Preferences (extensible)
category:type | S | 1..1 | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/PADIGoalCategoryCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: intervention-preference
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Goal | I | 0..* | PADIGoal | Describes the intended objective(s) for a patient, group or organization
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text | S | 1..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External Ids for this goal
lifecycleStatus | ?!S Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
achievementStatus | Σ | 0..1 | CodeableConcept | in-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.
Slices for category | S Σ | 2..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Slice: Unordered, Open by value:$this Binding: Intervention Preferences (extensible)
category:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | S Σ | 0..1 | string | Plain text representation of the concept
category:type | S Σ | 1..1 | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/PADIGoalCategoryCS
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: intervention-preference
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | S Σ | 0..1 | string | Plain text representation of the concept
priority | Σ | 0..1 | CodeableConcept | high-priority | medium-priority | low-priority Binding: GoalPriority (preferred): The level of importance associated with a goal.
description | S Σ | 1..1 | CodeableConcept | Code 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.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
padi-contextualValue-extension |  | 0..1 | (Complex) | Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who this goal is intended for
start[x] | Σ | 0..1 |  | When goal pursuit begins Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.
startDate |  |  | date |
startCodeableConcept |  |  | CodeableConcept |
target | S I | 0..* | BackboneElement | Target outcome for the goal
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
measure | S Σ I | 0..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
detail[x] | S Σ I | 0..1 |  | The target value to be achieved Binding: (unbound) (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.
detailQuantity |  |  | Quantity |
detailRange |  |  | Range |
detailCodeableConcept |  |  | CodeableConcept |
detailString |  |  | string |
detailBoolean |  |  | boolean |
detailInteger |  |  | integer |
detailRatio |  |  | Ratio |
due[x] | S Σ | 0..1 |  | Reach goal on or before
dueDate |  |  | date S |
dueDuration |  |  | Duration |
statusDate | Σ | 0..1 | date | When goal status took effect
statusReason |  | 0..1 | string | Reason for current status
expressedBy | S Σ | 1..1 | Reference(US Core Patient Profile) | Who's responsible for creating Goal?
addresses |  | 0..* | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment) | Issues addressed by this goal
note | S | 0..* | Annotation | Comments about the goal
outcomeCode |  | 0..* | CodeableConcept | What result was achieved regarding the goal? Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".
outcomeReference |  | 0..* | Reference(Observation) | Observation that resulted from goal
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet / Code
Goal.language | preferred | CommonLanguages Max Binding: AllLanguages
Goal.lifecycleStatus | required | GoalLifecycleStatus
Goal.achievementStatus | preferred | GoalAchievementStatus
Goal.category | extensible | PADIInterventionPreferencesVS
Goal.category:type | example | Pattern: intervention-preference
Goal.priority | preferred | GoalPriority
Goal.description | example | SNOMEDCTClinicalFindings
Goal.start[x] | example | GoalStartEvent
Goal.target.measure | example | LOINCCodes
Goal.target.detail[x] | example |
Goal.outcomeCode | example | SNOMEDCTClinicalFindings