Spanning a long and varied three decade career in military medicine with the Royal Australian Air Force (RAAF) and Australian Defence Force (ADF), Air Vice-Marshal (AVM) Tracy Smart demonstrated her versatility and capabilities in both local and overseas appointments in places such as the United States, Timor Leste and the Middle East. Ahead of the HIMSS Asia Pacific conference in November, AVM Smart talks about her role as Surgeon General ADF and Commander Joint Health, the ongoing digital health developments at the organisation and some of the most rewarding moments in her distinguished military career.

Could you share with us briefly about your role as Commander Joint Health and Surgeon General ADF?

Essentially, my Surgeon General ADF and Commander Joint Health roles are quite distinct, with different responsibilities.

As the Commander Joint Health, I am responsible for health support to the Australian Defence Force in the National Support environment to ensure the health preparedness of our members. This means that all military members not deployed on operations are receiving their health support health centres around the country under my command, and are accessing specialist civilian services through our ADF Health Services Contract. It’s my aim to ensure that our people are fit to deploy and that those who become wounded, ill or injured receive timely, high quality health care, when required.

As Surgeon General ADF I am the senior doctor, and the authoritative source of strategic health advice to Defence and the Government. I also exercise technical authority across all Defence health services, where ever they are delivered. This includes those health services delivered by our single Services - Navy, Army and Air Force – in the operational space.

Some of the key functions that are executed through Joint Health Command headquarters in Canberra in support of both these roles are:

•             The provision of health advice to Commanders at all levels

•             Developing health policy and programs

•             Delivery of health services to the ADF through a network of facilities in Australia and overseas

•             Coordination of the joint health capability domain

•             Coordination of health research

•             Capability coordination of health material

The roll out of ADF’s own e-Health information system throughout Australia was completed in December 2014. Could you give us some key updates/developments on the e-Health information system since its launch almost 4 years ago?

Defence electronic Health System (DeHS) is the first and only nation-wide digitally connected primary healthcare system in Australia. Since its roll out in December 2014, there have been significant improvements in patient episode data entry and reporting to enable the comprehensive health care system delivered by the ADF within Australia, on exercises and on operations.

We have seen major improvements in patient care, due to the availability of a holistic eHealth record that is accessible by all clinical craft groups, when they need it, regardless of geographic location. Patient privacy and confidentiality have also improved due to role based access.

Clinical governance has been improved due to the implementation of patient recall and follow-up workflows and system diary entries. Additionally, we now have superior health intelligence and reporting, supporting both clinical decision making and health administration as well as driving workplace efficiencies and rates of effort.

Over the past 12-18 months, DeHS functionality has enabled Joint Health Command to pursue a number of initiatives such as enhanced mental health screening via the Patient Portal, and inter-agency information sharing agreements with Department of Veterans’ Affairs and the Commonwealth Superannuation Corporation to enable prompt processing of member claims for compensation and entitlements when they are transitioning from service.

As well as being implemented across our Australian-based health centres, DeHS is now in use on overseas deployments at some of our fixed based locations.

What do you think are the key challenges and opportunities in the Digital Health Strategy of the ADF?

Digital health systems will enhance the ADF’s capability through a prevention focused, and rehabilitation oriented approach to Defence health care.

As with the implementation of any major strategy, the ADF Digital Health Strategy will present some challenges along the way. Some of the challenges include financial constraints on health care delivery and adoption of technologies, and the rising demand for health care services within the ADF and in the Australian community.

Despite the challenges, I see some fantastic opportunities in the ADF Digital Health Strategy including enabling patients and providers to make informed treatment decisions, whilst also improving clinical outcomes, health business efficiencies, and human performance through disease prevention and injury rehabilitation.

Overall, these opportunities contribute directly to ADF capability through health readiness, and ensure members are receiving care that is command responsive and member centric.

How is the ADF working with the Australian Digital Health Agency with regards to the recently launched National Digital Health Strategy & Framework for Action?

Defence has been working very closely with the Australian Digital Health Agency for many years, and particularly as we plan for the implementation of our future system.

Our recently developed ADF Digital Health Strategy complements the National agenda led by the Australian Digital Health Agency and is consistent with both the Agency’s Strategy and Framework. It also builds upon Joint Health Command’s existing leadership in digital healthcare, recognising the Defence electronic Health System (DeHS) as the first and only nation-wide digitally connected primary healthcare system.

The Strategy has been developed in alignment with the My Health Record initiative and will assist in the development of digital health systems that enable improved and more transparent access to and personal control of Defence health information and records. It will inform our future system to ensure that it provides secure, instant access to a patient’s information – whether it is within our health care centres, on board our ships and aircraft, or on exercises and deployments. For our health care providers, digital health systems will provide the necessary technology to reduce their administrative burden so that they can spend more time with patients.

You have a vast experience and long service record both within the ADF and also in international peacekeeping duties such as in Timor Leste. What would you say are the most rewarding experiences in your distinguished career with the military?

I have had many rewarding experiences during my career. It is an honour and a privilege to serve my country and I reflect on this every day when I put on my uniform. It is particularly satisfying to be in the top job and drive strategic and cultural change across our health system and the broader ADF.

A particular highlight for me was serving as part of the United Nations Assistance Mission in Rwanda. My role was Officer Commanding Clinical Services and Aeromedical Evacuation Operations Officer, and as a Squadron Leader I was also the senior RAAF Officer in what was primarily an Army mission. Although our main job was to provide health care to the UN troops, most of our work was humanitarian – caring for the local population. This included people who we rescued from around the country by aeromedical evacuation or by road, and those we chose to treat who had presented to the Kigali General Hospital but who were too sick to be managed there.

This was an incredibly difficult deployment. We saw many clinical problems that were beyond our previous experience – from the effects of war, such as machete wounds, grenade and mine injuries, to all number of tropical diseases. We also saw lots of kids, many of them orphaned and suffering from malnutrition and diseases, and some of whom died on our watch. We sometimes had to “play God” – allowing people including children to die due to our limited capacity, many of whom would have lived in a first world country. This was very hard on our people, particularly those with kids back home.

The toll this mission has taken has been extreme. A 2014 Department of Veterans’ Affairs study found that over 32% of those who served now had an accepted claim for a mental health condition. However, there were many positive aspects and it was an incredibly rich experience for me. A personal highlight was caring for the children of Rwanda, including those from the Mother Teresa orphanage in Kigali. As I saw it, each child we saved or left a positive imprint upon had the potential to grow up and make a positive difference in their country, and so represented a small victory. I feel very proud of the work myself and others did over there, how we contributed to stabilising what has become a successful nation, and of how courageous our people were.

I don't think I'd be where I am now, Surgeon General ADF and Commander Joint Health, without my experience in Rwanda. I may not even still be in the ADF. I learned a lot about myself, about leadership, and about resilience, embracing the view that “whatever doesn't kill you makes you stronger”. In other words, while some tragically have developed PTSD, I believe that I have experienced “post traumatic growth”. It has given me confidence that I can challenge myself in extreme situations and survive.

Air Vice-Marshal Tracy Smart is a speaker at the inaugural International Military Health IT (IMHIT) track on Day 2 of HIMSS AsiaPac 18 in Brisbane this November.