By Dr. Taleya Girvan, Clinical Informatics Analyst at the Ministry of Health & Wellness, Jamaica, and Dr Keisha Barwise, Digital Health Standards and Health Informatics Consultant, Ministry of Health & Wellness, Jamaica, SNOMED International Member Forum representatives and members of the National Release Centre for Jamaica.

Jamaica first joined SNOMED International in April 2023 after having an Affiliate License for almost a year. The Affiliate License afforded us access to learning resources, and allowed us to experiment with how to use SNOMED CT. During this time, we successfully created a proof of concept Health Information Exchange, using SNOMED CT as the clinical language to normalize data from two health databases and plan for the vocabulary that would be used in the upcoming EHR pilot. In April 2023, after completing the procurement of our national Electronic Health Record (EHR) system pilot, we became a full SNOMED International Member — making us the first Caribbean Member country. Jamaica is represented in SNOMED International by the Information Systems for Health Branch of the  Ministry of Health and Wellness (MOHW) which serves as the hub of all things SNOMED CT in the Ministry.

Since officially becoming a Member, we have established the National Release Centre (NRC) and we are in the process of establishing standards and guidelines for national access and distribution of SNOMED CT (and other terminologies). We have continued to attend SNOMED International Business Meetings and Expos (virtually and in person in Atlanta in 2023), a cadre of our staff have completed the SNOMED CT Foundation course, and some are currently pursuing the Implementation Course. We have also launched sensitization efforts to introduce SNOMED CT to healthcare providers across Jamaica, including at the National Health Research Conference, the Caribbean Connect Conference and MOHW Digital Health Standards Workshop.

Being a SNOMED International Member brings a wealth of opportunities, including access to comprehensive training programs, the SNOMED International  Implementation Team and innovative tools such as Snap2SNOMED, the RefSet and Translation Service, and Simplex. These tools not only allow us to incorporate local colloquial terms into our EHR, ensuring our health system reflects our unique language and culture, but they have also enabled us to create mappings from SNOMED CT to proprietary Laboratory Information Management System (LIMS), such as ROCHE & Senaite LIMS for lab code integration. Additionally, we've partially mapped SNOMED CT to the International Classification of Procedures in Medicine (ICPM), facilitating the seamless integration of surgical procedures into the EHR and other electronic applications developed by the Ministry.

So, what exactly is SNOMED CT?

SNOMED CT is the “most comprehensive, multilingual clinical healthcare terminology in the world. It is a resource with comprehensive, scientifically validated clinical content. The clinical terminology has unmatched depth, enabling clinicians to record data with consistency and enhanced accuracy. SNOMED CT supports the development of comprehensive high-quality clinical content in electronic health records, and provides a standardized way to represent clinical phrases captured by the clinician and enables automatic interpretation of these.”  

SNOMED CT creates a common language for clinical information, and ensures consistent and standardized data, benefiting patients, healthcare providers, researchers and data scientists.

Imagine a patient being admitted to various hospitals and diagnosed with the same disorder, but worded differently – for example, at Hospital A, the patient is diagnosed with Intervertebral Disc Prolapse; at Hospital B, the diagnosis is Prolapsed Intervertebral Disc, and at their local Health Centre, the diagnosis is Slipped Disc: three diagnoses that have the same clinical meaning. When data is recorded using these diverse descriptions, data analytics would prove to be challenging. SNOMED CT allows new software to capture data consistently, regardless of the specific user or healthcare setting. This standardized data is then easier to analyze and use within the application. This is just one example of how SNOMED CT can be used to improve healthcare delivery and interoperability in the Jamaican healthcare system.

Now, Jamaicans (and Caribbean people overall) – we are known for our vibrant culture – our music, food, fashion, and language. For example,  “Hand middle” means the palm of the hand. “Running Belly” refers to “diarrhoea.” If a patient says the doctor “sound me,” it means that they used a stethoscope to listen to their chest. 

With these unique expressions in mind and an awareness of Jamaicans living across the diaspora, we embarked on a journey to incorporate OUR colloquial language into SNOMED CT – to add synonyms to existing medical concepts, as well as to create new concepts relevant to our healthcare setting.

Under the patient and brilliant tutelage of Kai Kewley, Alejandro Lopez Osornio and Anne Randorff Højen from SNOMED International’s Implementation team, we learned how to use the RefSet and Translation tool, as well as the Simplex tool. Every two weeks, we would faithfully meet first thing on a Monday morning (afternoon for our tutors) to learn, brainstorm and troubleshoot.

We were only too excited to use these tools! We hit the ground running. We had already curated a list of Jamaican terms used to describe medical concepts with input from doctors across the island, and we mapped them to SNOMED CT. We also created new concepts in Simplex to represent codes from our local laboratory systems that had no SNOMED CT equivalent. We also created concepts for locally relevant medical terms; for example, “ex-marijauna smoker.”

After a few minor hiccups which were expertly resolved by the SNOMED International team, we got the exciting news in early July 2024; the first release of the SNOMED CT Jamaican Edition was on the horizon! Also, once successfully released, we could be the first country to release an edition using Simplex. As Jamaicans would say, “glad bag buss,” which means we could hardly contain our excitement.

On the morning of July 25, 2024, we heard the words “Congratulations on the release of the first SNOMED CT Jamaican Edition.” A month later, in August 2024, the Jamaican Edition of SNOMED CT was made public in the SNOMED browser. We. Did. It.

This is a huge accomplishment for the Jamaican National Release Centre and for the Ministry of Health and Wellness.

What’s Next

Now that we have the RF2 files for the SNOMED CT Jamaican Edition, it is possible to integrate these into various software programs including our EHR and other data collection platforms to standardize clinical documentation across the country. We will continue to create new medical concepts as needed and relevant to our healthcare setting.

We are also excited to share our journey and experiences with SNOMED CT and encourage other countries especially in the Caribbean to consider SNOMED CT in the region’s Digital Health transformation. In the meanwhile, the Jamaican NRC will continue to upskill and strengthen our team so we can continue to enhance the healthcare system for Jamaica and by extension, our region.

We would like to extend our gratitude to the SNOMED International, especially Suzy Roy, Kai Kewley and Alejandro Lopez Osornio, for their dedication, encouragement, patience, and genius minds. In Jamaica we say “Big up yuhself! Nuff Respec’ ”

We are eager to witness the transformative and exciting changes that SNOMED CT will bring to our nation's digital health sector.

Look out, world, the Jamaican ladies have taken a seat at the Digital Health table.

For more information on Jamaica’s implementation, contact:

The Jamaica National Release Centre at ntrc@moh.gov.jm, Dr. Taleya Girvan, taleya.girvan@moh.gov.jm, Dr. Keisha Barwise keisha.barwise@moh.gov.jm