Aeromedical Certification in 1999 and Beyond
From The Federal Air Surgeon's Medical Bulletin, Spring 1999.
Aeromedical Certification in 1999 and Beyond
Aeromedical Certification Update, by Warren S. Silberman, DO, MPH
Having just seen the movie Shakespeare in Love with the wife and girls, I'm in the mood for writing a short play about how we conduct the certification business is going to change. Remember, though, that I'm a doctor, and while my vision of the future may not be poetic, it is realistic, based on a very plausible scenario. After all, I'm using my computer's keyboard, not ink-stained fingers to compose this little ditty.
ACT I, SCENE I. The place: A good physician's antechamber, anywhere in the US. The time: about one year hence.
Enter, airman applicant, who has arrived for his FAA third-class medical examination. Nurse Ratchet, who has toiled for the kindly doctor for these many years, presents airman applicant with the new and improved, FAA Form 8500-8 (scheduled to be distributed in September 1999), along with a suitable writing instrument. airman applicant completes the front side of the form, and with a flourish, signs block 20. Nurse Ratchet escorts him to the clinic room that has been designated for flight examinations.
ACT I, SCENE II. The laboratory, a chamber where physical examinations are conducted.
Nurse Ratchet, acting the part of the stern, yet compassionate inquisitor, uses the tools of her trade to observe and record her patient's hidden signs: how beats the heart within him, how mightily does the blood course through his veins now she whispers to him of chocolate donuts and other meaningless gibberish to see if he can comprehend the low decibels she has uttered in the still chamber. Finally, she directs his rapt gaze to a graphic that is inscribed with tiny little lines designed to see if the vision is sharp or in need of focal augmentation. She records the results of these preliminary tests and exits the chamber to another nearby chamber, where she will examine the contents of a container with a yellowish fluid that was provided earlier by airman applicant as a prerequisite to any further proceedings.
ENTER, the Good Physician. GP is a warm, friendly person, very busy but prone to uttering small talk about the weather, airplanes, golf, the FAA. GP greets airman applicant with a smile and a handshake. Surveying the form the nurse provided, he bolts to his office computer and summons the Internet, using Fast Flight Service.com, the service that was purchased for a pittance, a mere $14.95 per month.
Using the username and password provided by the Aeromedical Certification Division (AMCD) in Oklahoma City, GP uses the newest version of the Aeromedical Certification System (AMCS) to locate airman applicant's medical files. As if by magic, his historical data illuminates the screen with facts, information about how he fared on his last medical examination, the exam before that, and as far back as to when airman applicant first began to ply the skies as a fledgling aviator.
GP invites airman applicant to view the computer images, and they discuss the information it provides them. GP then presses the ENTER button and the historical data is now transported to the AMCD files. Inviting airman applicant now to occupy a tiny table, GP examines him to determine if his body is prepared to withstand the rigors of unrestricted flight. Once satisfied that it will, GP scribbles out his findings on the back portion of the 8500-8, signs the form, and hands it to Nurse Ratchet, who replaces the busy doctor at the computer console to enter the new examination data. One last look to be sure all is correct, and she submits the file to the AMCD.
ACT I, SCENE III. The Antechamber.
Nurse Ratchet finishes using the office printer to produce a new medical certificate. GP signs the document and presents it to airman applicant with a restriction noted that "Holder Must Wear Corrective Lenses." AA is also presented with the third page of the 8500-8, which is his copy of the front side of the 8500-8, for him to have and to hold until the next visit.
airman applicant exits the antechamber, proclaiming to one and all that, for another two years, he is a happy man.
Well, you get the idea. This is our vision of the future with the new Internet-based AMCS. To take this scenario a step further, let's say the airman was being followed for mild hypertension. This will give you a view from within the Aeromedical Certification Division and is a representation of how we will handle the workflow. The data GP just submitted has been received, instantaneously matched, but causes the system to produce a reject message.
A clerk receives a list of rejected applications, with airman applicant's name listed, retrieves his case from the files with a PI number, and determines that he has been followed for mild essential hypertension. The file, along with the other files that came in that day with PI numbers, is sent to the scanning area to be indexed and scanned into the new electronic medical file that was developed on this airman. The case is then reviewed for quality control and placed into AMCD's new Document Imaging and Workflow System, which is also part of the new way that business is being conducted.
The case is then sent to a Legal Instrument Examiner's workflow box, an instantaneous workflow layout that she is able to access on her work station computer.
The reviewer clicks on the icon with the airman's MID number and reviews the hypertension follow-up report that GP had inserted into block 60 of the 8500-8. The report sent in by GP was quite favorable, so the reviewer clicks on the drop-down box with a list of all the letters that AMCD uses and brings up an Eligibility letter shell, inserts the blood pressure blurb, presses Print, and the Eligibility letter gets printed. The letter is reviewed, signed, and sent out all within 24 hours of the examination.
At the end of your busy workweek, you package up the 50 FAA examination forms that you completed, and mail them to the AMCD where they are permanently stored. The Federal Air Surgeon has determined that the AMCD will be the repository for the original 8500-8's.
Fellow aviation medical examiners, this is going to be reality in a few months! Dr. Jordan, through your Regional Flight Surgeons, has requested that all aviation medical examiners use the above system exclusively by October 1, 1999.
The sequence of events you read above will already be a reality for many aviation medical examiners by the time you read this. From March of 1999, until October 1, 1999, we will be testing the system in "real-time" with volunteers participating in the final systems check of the Aeromedical Certification System.
Dr. Silberman manages the Civil Aeromedical Institute's Aeromedical Certification Division.
The Federal Air Surgeon's Medical Bulletin Spring 1999