April 15, 1999 The FAA Throws AMEs a Curve

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by	Brent Blue, M.D.

About the Author ... Brent Blue lives in Jackson Hole, Wyoming. He is a physician specializing in family practice and emergency medicine, an FAA-desginated senior aviation medical examiner (AME), and AVweb's chief expert on aviation medicine. Dr. Blue served as medical advisor to the U.S. Aerobatic Team, and owns two airplanes a Flaglor HighTow (a Fleet 16B modified by Ken Flaglor to a larger engine) open-cockpit biplane and a Cessna 340 pressurized twin.

Doctor Warren Silberman took on a big job last year when he assumed the reins of the Civil Aeromedical Institute (CAMI), which is responsible for all FAA Airman Medical Certification. The place was a mess of paperwork with over 50,000 medical certificate applications caught up in the quagmire. Silberman quickly reduced that backlog to 10,000 medicals, and began to computerize the entire process so that every medical certificate application would be in the computer, and any medical records sent to CAMI in Oklahoma City would be scanned in also.

In the Spring 1999 issue of The Federal Air Surgeon's Medical Bulletin, Silberman announced that the process was ready to move to the next level by using the Internet to transmit medical applications to Oke City. He told AMEs that the new Aeromedical Certification System (AMCS) Internet software program will be up and running by October 1, 1999 — considered a drop-dead date because the old software currently in use is not Y2K-compliant — and its use will be mandatory for all AMEs from that date forward. This news was pretty much in line with what AMEs expected, and most are happy to see CAMI's continued efforts to streamline the processing of medical certificates.

FAA Approval While You Wait?

However, Silberman's announcement contained an unexpected curveball that AMEs were not expecting, and that has many of them alarmed. It seems that not only will each medical certificate application (FAA Form 8500-8) have to be entered online by the AME into CAMI's computer system, but the AME will have to receive electronic approval online before issuing the certificate to the airman! Uh oh!

In the past, AMEs would typically check over the applicant's 8500-8 for accuracy, give the exam, type up the new medical certificate, hand it to the airman, and send him happily on his way. Later on, the information would be entered into the computer and sent to Oklahoma City by modem. If the CAMI computer was down, or if it didn't like one or more data items on the application form (which happens frequently), the airman wasn't affected.

Under the new AMCS scheme announced by Dr. Silberman, however, the AME cannot issue the certificate until the data has been entered into the CAMI computer and an approval returned online. Under the best of circumstances, this will mean the airman will have to wait a few more minutes for his certificate. But if the CAMI computer is down or cranky, or if the AME's Internet service provider is down, or if the AME's modem isn't working, or a whole host of other potential problems arise, it could mean a long delay for the applicant. In some cases, the applicant would have to return later to pick up the certificate, or perhaps even wait to receive it by mail.

Government-Issue Software

Now, the FAA seems to think all AMEs have staff which enter the data, and it is no hassle for the physician. I do not know about the other guys, but I do about 100 physicals a year and I enter all the data myself. Since 80% of AMEs in the U.S. do 30 or fewer exams per year, I bet they also enter the data themselves ... if they use the computer at all!

Why do I enter the data myself? Because the expensive custom software the FAA created is horrible! In fact, on every medical I have submitted over the past three years, there has been a glitch in the software which asked why I am issuing the certificate in spite of the "problem" with the application. For the past three years, the response I've entered has always been "Bad Computer Program." Sometimes I add "Please Contact Me" just to see if anyone reads the things in Oke City. No one ever has ever contacted me.

Now, call me a doubting Thomas, but if I have to submit a medical in real time on the Internet and the approval has to come from Oklahoma City electronically prior to my printing a certificate, there are going to be some unhappy cowboys in my office!

I consider myself to be pretty computer- and Internet-literate. I run a business that is Internet-based, I am the Medical Editor for AVweb, and I have been an Assistant Sysop on Compuserve's AVSIG forum for years. If I'm having this much trouble with the CAMI computer system, just imagine what impact it will have on AMEs that are less cybersavvy. Somehow, I'm not convinced that it is in the best interests of either the FAA or the pilot community to make this leap of faith to a compulsory real-time Internet-based approval process, especially considering that the FAA has not gotten the worms out of the current modem-based program that we've been using for years.

Not All AMEs Are Net-Ready

The new system will also drive some computer-phobic AMEs out of the system, which is both good and bad. On one hand, it certainly will encourage some of the less interested ones to drop their AME status. At the same time, it may also discourage some rural AMEs who only perform the medicals as a service for geographically challenged pilots.

Currently, all AMEs are "supposed" to submit medical applications and EKGs electronically by modem to Oklahoma City. The fact remains that only about half of AMEs do so, in spite of an absolute requirement that ALL EKGs be submitted via modem, and that all recently-appointed AMEs must submit the 8500 exam form electronically.

Don't get me wrong: There is nothing wrong with online submission. It's basically a good idea. The only part of CAMI's plan that's a bad idea is the new requirement that prevents an AME from printing a medical certificate until all the data on the Form 85800-8 has been entered online and an approval received from Oke City. No longer will the AME have the option of issuing the certificate first and entering the data later. So if the online system hiccups, the pilot doesn't get his certificate in a timely fashion.

My suggestion for Dr. Silberman would be twofold. First, get all current AMEs up-to-speed with the existing modem-based software before moving to the Internet. Second, use the Internet for data entry of applications and EKGs, but not for real-time approval. Leave the immediate approval, referral, or denial in the hands of the AMEs where it is now. The present system can work with some minor modifications, but raising the stakes when the AMEs are not ready may be a step backward for an agency that is trying to move forward.