1.7.1 - release

SHINNYHRSN - Local Development build (v1.7.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Change Log

# SHIN-NY FHIR Implementation Guide Change Log

The chagnes described below are grouped into categories that broadly explain the changes made in resent releases. If you have a question regarding these changes or would like to request addiitonal changes, please visit our Jira Service Desk.

## 2025 Releases

### v1.7.1

#### FHIR IG TEST: 12/4/25, Validation QA Expected: 12/9/25

The following changes were made based on feedback regarding the 1.7.0 release and to allow for additional languages.

- Updated SHINNYLanguageVS to include the "id" code for Indonesian and the "so" code for Somali.
- Added the ICD10 code back to the ConditionFoodInsecurityExample instance of the Condition resource, as it was accidentally removed during testing of the 1.7.0 release.
- Fixed the patient.language attribute to reflect "en" for English within the PatientExampleExtendedLanguages example.

### v1.7.0

#### FHIR IG TEST: 11/10/25, Validation QA Expected: 12/9/25

The following changes were made to improve the user experience, to align with updates to the MVD and the Operations Manual, and in response to user feedback.

- Updated the invariant Organization-ID to ensure it was working at the level of the organization instead of at the level of the bundle.
- Updated the invariant SHINNY-Resources-Profile-Check to ensure all meta profiles are accurately referencing the SHINNY HRSN profiles.
- Updated the invariant SHINNY-Bundle-Encounter-RI to ensure all referenced Encounter resources are included in the bundle.
- Removed the following Observation Assessment examples as they were determined to be unnecessary: AssessmentTransportationExampleNewNeed and AssessmentFoodInsecurityExampleNotWanted.
- Added language to the home page to clarify the process for accepting bundles based on the Encounter status.
- Updated the SHINNYAdministrativeQuestionnaire to ensure multiple answers can be provided for each question.
- Removed values from the SHINNYServiceDuplicationQuestionnaire and the SHINNYAdministrativeQuestionnaire examples, to align with the updates made to the MVD and the Operations Manual.

### v1.6.3

#### FHIR IG PROD: 10/1/25, Validation PROD: 10/6/25

The following changes were made to remedy issues with the previously published 1.6.2 release.

- Updated the invariant SHINNY-Bundle-Obs-hasMember-RI to ensure it is properly checking specific reference IDs rather than counting references for validation.

### v1.6.2

#### FHIR IG TEST:

The following changes were made to remedy issues with the previously published 1.6.1 release.

- Updated the invariants SHINNY-Bundle-Obs-hasMember-RI and SHINNY-Bundle-Obs-derivedFrom-RI to ensure they are properly checking that all hasMember and derivedFrom references are included in the bundle.
- Changed the cardinality for Consent.provision to 1..1 requiring the inclusion of this element. This was needed to validate the Consent.provision.Type requirement.
- Added documentation describing the proper use and applicable valuesets for the various language elements within the IG.

### v1.6.1

#### FHIR IG TEST:

The following changes were made to remedy issues with the previously published 1.6.0 release.

- Added an optional SNOMED slice for category within the Observation Screening profile. The SNOMED codes are provided when a SDOH category is "sdoh-category-unspecified". The formatting for all examples with that SDOH category were updated to ensure each category provided had its own slice.
- Updated the SHINNYLanguageVS value set to clearly show a list of the language codes included. This list includes all the Common Languages as well as any language requested to date.

### v1.6.0

#### FHIR IG TEST:

The following changes were made to improve the user experience, to align with updates to the MVD and the Operations Manual, and in response to user feedback.

- Added the "Individuals with an Intellectual or Developmental Disability" (intellectual-developmental-disability) value as an option for the Enhanced Population Check question within the Administrative Questionnaire.
- Confirmed additional languages requested were part of the "All Languages" value set and provided the link to that complete value set within the Patient and Observation Screening resources. The link can be found here.
- Added a new example bundle called TaskExampleMultipleEncounters with more than one encounter.
- Added new examples for the following scenarios: when a need was recorded in error (AssessmentFoodInsecurityExampleIncorrect), when a need was recorded but assistance was not wanted (AssessmentFoodInsecurityExampleNotWanted), when a new need was discovered after the initial screening (AssessmentTransportationExampleNewNeed and ObservationResponseTransportationInsecurity93030-5NewNeed), and when a need was recorded but resolved before assistance was provided (ConditionFoodInsecurityExampleResolved and ProcedureExampleConditionResolved).
- Updated cardinality to require the SDOH category for the following profiles: Observation Assessment, Observation Screening Response, Condition, Procedure, and Service Request.
- Updated the home page to align with the Operations Manual.

### v1.5.3

#### Validation PROD: 7/24/25

The following changes were made in response to user feedback based on the previous 1.5.0 release in the production environment.

- Updated the invariant SHINNYScreeningHousingComponent to accept a missing component when a dataAbsentReason is included because the value for the housing question with code 96778-6 is not available.

### v1.5.2

#### Validation PROD: 6/23/25

The following changes were made in response to user feedback based on the previous 1.5.0 release in the test environment.

- Updated the invariant SHINNY-Bundle-Patient-Encounter-RI to allow for more than one Encounter within a Referral Bundle when the additional Encounter is related to a Procedure.

### v1.5.1

#### QA ONLY VERSION

The following changes were made in response to user feedback based on the previous 1.5.0 release in the test environment.

- Changed the descriptive text for the Task-StatusReason rule to reflect the Task Status(es) OHIP included in their issue brief that require a StatusReason.
- Updated the ObservationResponseInadequateHousing96778-6 example to include multiple housing problems in the component format.
- Fixed duplicated SDOH codes in the ServiceRequestActiveExample example.
- Updated SHINNYStatusReasonVS ValueSet to include all new values added to the CodeSystem.

### v1.5.0

#### QA ONLY VERSION

The following changes were made to improve the user experience, to align with updates to the MVD, and in response to user feedback.

- A rule was added to the screening question relating to housing problems (96778-6), where a list of problems can be provided. The new rule requires the format of the answer to this specific question to be provided as a component. The example for this screening question (ObservationResponseInadequateHousing96778-6) was updated to reflect this.
- A rule was added to require consent when submitting screening bundles.
- A rule was added to ensure the statusReason attribute is provided for any task with a status of rejected, failed, canceled, or completed.
- A rule was added to ensure SDOH categories are provided for service requests in the same way they have been for the screenings.
- The ADL/IADL question was removed from the service duplication questionnaire response example.
- The patient examples for race and ethnicity were updated to show how the detailed extension can be used to include additional values including "Other Race". In addition, these examples were updated to show how multiple race or ethnicities can be included as a list.
- An extension was added for observation to capture the language of the screening and/or assessment.
- A new example was created to show how "unknown" can be provided for screening questions 1 through 8 and how "Declined to Answer" can provided for screening questions 9 through 12.
- The NYS-HRSN Questionnaire code system and examples were updated to show how the NYSAHCHRSN code can be used in addition to a LOINC code for screenings.

### v1.4.5

#### Validation PROD: 5/15/25

The following change was made as a hot fix to ensure prior updates to invariants/constrains are working correctly.

- This update corrects an error with 1.4.4 where only organizations were allowed as observation.perfomer and prevented performers that were not an organization. More detail to the constraints around the observation.performer was added to ensure multiple performers can be included as long as one of those performers is an organization.

### v1.4.4

#### Validation QA: 5/8/25

The following change was made as a hot fix to ensure prior updates to invariants/constrains are working correctly.

- This update adds more detail to the constraints around the observation.performer and ensures multiple performers can be included as long as one of those performers is an Organization.

### v1.4.3

#### Validation QA: 5/5/25

The following change was made as a hot fix to ensure prior updates to invariants/constrains are working correctly.

- As part of the 1.4.0 release, to ensure alignment with updates to the MVD, we added an invariant/constraint to require the "observation.performer.reference". We additionally added rules to ensure the performer was referencing an organization, but the additional rules were not working. This update ensures these rules are working correctly.

### v1.4.2

#### Validation PROD: 5/24/25

The following changes were made in response to user feedback based on the previous 1.4 releases in the test environment.

- Restricted the rule/invariant added in 1.4.0 for observation.performer to only require this element for screening grouper bundles.
- Added language to the Encounter profile documentation to clearly describe the use of the SDOH profile for Location.
- Updated the home page to clearly show there are two acceptable values for the housing status, "housing-instability" and "homelessness".

### v1.4.1

#### Validation QA: 5/3/25

The following changes were made in response to user feedback based on the 1.4.0 release in the test environment.

- The FHIR cardinality for Patient.identifier:CMS (Medicaid CIN) has been updated to be required. This was done to align the cardinality with an existing rule.
- Added the SDC URL as the meta.Profile for all QuestionnaireResponse examples.
- Updated the URL for the Organization.type Code System within all Organization examples.
- Updated the home page to remove the "_" that was appearing before "Mold" and "Lack of heat".
- Updated the Encounter.type Value Set to align with the options listed on the home page.
- Updated an outdated URL on the home page for the Minimum Viable Dataset.

### v1.4.0

#### Validation QA: 5/3/25

The following changes were made to improve the user experience, to align with updates to the MVD, and in response to user feedback.

- All examples missing the Meta.profile element have been updated to ensure this information is represented in all resource examples. In addition, this element is now required for all resources.
- All resources with an existing reference to the Encounter resource have been updated to ensure that Encounter reference is required.
- The FHIR cardinality for the following properties has been updated to ensure these data elements are required for submission.
  - Consent.provisionType
  - Observation.performer
  - Condition. asserter
  - ServiceRequest.requester
  - Task.owner
- Added Task.lastModified to the Task resource examples where appropriate.
- Added a new Language value set to include American Sign Language (ASL).

### v1.3.0

#### Validation PROD: 3/6/25

The following changes were made to improve the user experience, to align with updates to the MVD, and in response to user feedback.

- Added an example for a Screening Procedure where an amount of time and the HCPCS code G0136 can be provided. Also added an example of linking this procedure to the screening observation in the AHCScreeningGroup96777-8 example using an Observation.partOf reference.
  - Within the ScreeningProcedureExample the amount of time was modifed to align with the example code.
- Removed the following options for the Enhanced Population Check:
  - Individuals with Substance Use Disorders
  - Individuals with an Intellectual or Developmental Disability
  - Individuals with Serious Mental Illness
  - High-Risk Children Under 6 Years Old
  - Juvenile Justice-Involved, Foster Care Youth and Those Under Kinship Care
- Added the following option for the Enhanced Population Check:
  - High Risk Children Under 18 Nutrition Only
- Removed the following option for the Service Duplication Check:
  - Supportive Housing
- Removed the following option for the Clinical Criteria Check:
  - Currently in an Institutional Setting
- Included the Consent profile in the SHINNY-Resources-Profile-Check invariant to ensure consent profiles are included in submission bundles.
- Added a error invariant that ensures every Organization profile includes a code type of NPI, TAX, or MA.
  - Added additional text as well as updated examples for clarity regarding the specific codes.
- Updated the SHINNY-Bundle-Encounter-Location-RI invariant to loosen the requirement for the location within the Encounter, while ensuring the location IDs within the Encounter and Location profiles are consistent when present.
- Updated the cardinality for the MR identifier assigner to 1..1.
- Included guidance documentation regarding the timestamps associated with task statuses in the Task for Referral Management profile.

### v1.2.3

The following changes were made in response to user feedback.

- Updated the Encounter-Location-RI invariant/rule to specifically ensure that the location referenced in the Encounter is included as a Location.

## 2024 Releases

### v1.2.2

The following changes were made in response to user feedback.

- Corrected spelling errors in the SHINNYQuestionnaires code system.
- Updated descriptive language for profiles on the Artifacts Summary page.

### v1.2.1

The following changes were made in response to user feedback.

- Added a value of "Other Eligible Population" and associated code for the Enhanced Population Check question, which is part of the Administrative Questionnaire.
- Corrected a typo for the Assessment Approval Questionnaire code.
- Added a new consent example and bundle to clarify the profiles needed for a negative consent.
- Updated the Service Duplication Questionnaire example to ensure all questions are visible.

### v1.2.0

The following changes were made to improve the user experience.

- Removed all questionnaire profiles that were specific to a single questionnaire and replaced these with a general questionnaire profile. All questionnaires are now based on the general questionnaire profile.
- Bundles that previously included questionnaire and questionnaire response examples now only include the questionnaire response example. Note that all questionnaire responses must include a link to the questionnaire.
- Added additional codes to the SHINNYQuestionCodesVS value set and the SHINNYQuestionnaires code system.
- Updated the SHINNYOutreachQuestionnaire to accommodate multiple instances of this questionnaire and to add a new element “Outreach Method” used to capture the method of contact used to reach out to the patient.
- Added an option of “None of the above” for the SHINNYAdministrativeQuestionnaire questions.
- Updated the cardinality of the SHINNYMeta profile to 1..1, requiring that this is included in all bundles.
- Added two new invariants, one to enforce profile validations and another to validate the CIN format/pattern.
- Created the SHINNYDisablityQuestionnaire that can now be submitted with screening or assessment bundles.
- Added the SHINNYStatusReasonVS value set to accommodate service request status reasons and included this in the SHINNYSDOHTaskForReferralManagement profile.
- Made several formatting updates at the profile level.
- Improved documentation within several profiles for added clarity based on feedback.

### v1.1.0

#### Error and Warning Resolution

The following changes have been made to resolve errors or warnings.

- Unique ValueSets were created for a number of elements.
- Several formatting issues were resolved within a number of profiles.
- A variety of updates were made to many of the examples.
- Unique Questionnaire profiles were created for each of the SHIN-NY Questionnaires.
- A new CodeSystem was added for the Questionnaire profiles to clearly describe the questionnaires, elements, and values.
- Parameters were added to capture the appropriate version of SNOMED.

### v1.0.0

#### Improvements

The following changes were made to improve the user experience.

- Added a Support link to the Public Jira help desk.
- Added this Change Log to track changes made to the IG.
- Fixed various typos and formatting issues on the Home page.
- Added a parent and child relationship in the PatientExample to show how these relationships are applied within the IG.
- Added additional text to several Resource Profiles with more details describing the parameters within the resource.

#### Error and Warning Resolution

The following changes have been made to resolve errors or warnings.

- New profile examples were added to several bundle examples.
- Coding systems for several examples have been added.
- Several invariants have been updated.
- Several URLs have been updated. All changes to working URLs have been redirected to prevent any broken links.
- The requirement for the inclusion of a performer for all observations has been suppressed for observations that do not have a performer.