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.
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.
|For more information, here are three relevant pages from the Spring 1999 issue of The Federal Air Surgeon’s Medical Bulletin:|
Notice to All AMEs:
AMCS Internet Access Mandatory October 1
Aeromedical Certification Division Staff Report
Because of “Year 2000” complianceissues, we will have a new Aeromedical Certification System (AMCS) Internet softwareprogram in place by October 1, 1999. Aviation medical examiners (AMEs) who are currentlyusing the DOS-based Version 9.5 of AMCS to transmit FAA Form 8500-8 medical examinationdata to the Federal Aviation Administration will no longer be able to use it on that date.Instead, you will use your computer and modem to access the Internet to electronicallysubmit examination data to the AMCS. Additional information will be provided in the summerissue of the Bulletin.
To describe how the new system will work, we have compiled 19 typical questions aboutthe new way of doing business.
1. How do I become an AMCS Internet v1.0 user?
You will be notified and sent an instruction package with the Web site address and log-on information when the AMCS Internet v1.0 is ready to go on-line.
2. What are my responsibilities as an AMCS Internet user?
An AME who participates in the AMCS program will be responsible for entering and transmitting all FAA Form 8500-8 application data using AMCS Internet v1.0. Once you have entered the data using the AMCS Internet v.1.0, you will then mail the original copy to the Aeromedical Certification Division in Oklahoma City.
3. How long does it take to enter FAA Form 8500-8 application data into the AMCS?
Once the initial learning curve has been passed, we estimate that a reasonably proficient individual can enter an average application in five to seven minutes. Individuals with previous PC and Internet experience will generally find the AMCS Internet v1.0 to be a very easy application to learn. Individuals with no computer and Internet experience will generally require a slightly longer time to become proficient. Please note that the five- to seven-minute estimate is partially offset by the amount of time that was previously spent in typing the back of the form. The AMCS Internet v1.0 will be able to copy previous application history for print outs. This, combined with a faster processor and Internet connection, will significantly reduce data entry time.
4. What does the new AMCS do for me?
Assists you in eliminating accidental, missing, or out-of-range data on the FAA Form 8500-8
Warns you of data that do not meet certification standards
Allows you to exercise your best judgment to take proper certification actions.
5. Do I have to enter the data while the applicant is in the office?
No. But you must enter and validate the application before issuing the certificate to the applicant. The application will be automatically transmitted during validation. If you do not enter the application data while the applicant is in the office, we recommend that you either have the applicant return to pick up the certificate, or mail it to the applicant.
6. What computer hardware/software do I need?
The AMCS Internet v1.0 system requirements will support most computer operating systems and platforms. However, whatever computer system you use must be able to support:
An Internet Protocol (IP) dial-up or local area network connection
An Internet Service Provider (ISP) to provide the IP dial-up or network connection
The latest versions of World Wide Web browsers Microsoft Internet Explorer® or Netscape Navigator®
When considering a new computer system or upgrade, we recommend that, for maximumperformance, you also consider the latest computer industry standards and models.
7. How much does the AMCS Internet v1.0 software cost?
There is no software for you to install on your computer. The only cost will be for your Internet service provider connection.
8. Will the AMCS Internet v1.0 work on my Macintosh?
AMCS is designed as an Internet resource, so you will be required to run the latest Macintosh version of either Microsoft Internet Explorer® or Netscape Navigator®.
9. When will the AMCS Internet program start?
It will become operational and on-line some time before October 1999. The program is currently under development.
10. Whom do I call for help?
When the AMCS Internet version goes on-line, then you will able to call the AMCS Hotline during normal business hours and they will answer your questions.
11. Do I send my applications to the Region if I’m either a new AME or a new seniorAME?
New AME policies vary from Region to Region. Please contact your Regional Flight Surgeon for more information. However, all applications are to be entered via the AMCS Internet v1.0.
12. Do I have to transmit all of my applications using the AMCS Internet v1.0? Whatif they contain extensive lab reports?
All applications, including deferrals, should be entered using the AMCS Internet v1.0. Attachments may be mailed with the original form with the signature and a cover letter on your office letterhead identifying the airman by name, social security number, and application date. Any additional comments about the applicant may be entered in Item 60.
13. What sort of documentation is available?
AMCS Internet v1.0 is still in development and we will begin testing it soon. We will send documentation availability announcements to you when available.
14. What sort of training is available?
Training announcements will be sent out when the software program has been validated and is ready for use by AMEs.
15. What time of day can I connect?
You can connect to the Internet 24 hours a day, seven days a week. If you have trouble connecting, contact you local ISP. If you have trouble using AMCS Internet v1.0, you will be able to contact the AMCS Internet Hotline during regular business hours, and they will investigate the problem.
16. Do I need a special phone line?
Although a special phone line is not necessary, you may find it convenient.
17. What speed modem should I use?
Whatever modem and speed is compatible with your ISP. A fast modem will allow a fast Internet connection.
18. May I have the applicant enter the information from the front of the FAA Form8500-8 directly into the AMCS Internet version?
No. The applicant should not enter the data from the front of the form into the Aeromedical Certification System because he or she could conceivably view data on your other aviation medical applicants.
19. Can I use this software for military and Air Traffic Control (ATC) applications?
No. There currently are no plans to use the AMCS Internet program for entering ATC or military applications.
Dr. Silberman manages the Civil Aeromedical Institute’s Aeromedical Certification Division.
Aeromedical Certification in 1999 and Beyond
Aeromedical Certification Update, by Warren S. Silberman, DO,MPH
Having just seen the movie, Shakespearein Love, with the wife and girls, I’m in the mood for writing a short play about howwe conduct the certification business is going to change. Remember, though, that I’m adoctor, and while my vision of the future may not be poetic, it is realistic, based on avery plausible scenario. After all, I’m using my computer’s keyboard, not ink-stainedfingers 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 airmanapplicant with the new and improved, FAA Form 8500-8 (scheduled to be distributed inSeptember 1999), along with a suitable writing instrument. airman applicant completes thefront side of the form, and with a flourish, signs block 20. Nurse Ratchet escorts him tothe clinic room that has been designated for flight examinations.
ACT I, SCENE II. The laboratory, a chamber where physical examinations areconducted.
Nurse Ratchet, acting the part of the stern, yet compassionate inquisitor, uses thetools of her trade to observe and record her patient’s hidden signs: how beats the heartwithin him, how mightily does the blood course through his veins… now she whispers tohim of chocolate donuts and other meaningless gibberish to see if he can comprehend thelow decibels she has uttered in the still chamber. Finally, she directs his rapt gaze to agraphic that is inscribed with tiny little lines designed to see if the vision is sharp orin need of focal augmentation. She records the results of these preliminary tests andexits the chamber to another nearby chamber, where she will examine the contents of acontainer with a yellowish fluid that was provided earlier by airman applicant as aprerequisite to any further proceedings.
ENTER, the Good Physician. GP is a warm, friendly person, very busy but prone touttering small talk about the weather, airplanes, golf, the FAA. GP greets airmanapplicant with a smile and a handshake. Surveying the form the nurse provided, he bolts tohis office computer and summons the Internet, using Fast Flight Service.com, the servicethat 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 CertificationSystem (AMCS) to locate airman applicant’s medical files. As if by magic, his historicaldata illuminates the screen with facts, information about how he fared on his last medicalexamination, the exam before that, and as far back as to when airman applicant first beganto ply the skies as a fledgling aviator.
GP invites airman applicant to view the computer images, and they discuss theinformation it provides them. GP then presses the ENTER button and the historical data isnow 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 ofunrestricted flight. Once satisfied that it will, GP scribbles out his findings on theback portion of the 8500-8, signs the form, and hands it to Nurse Ratchet, who replacesthe busy doctor at the computer console to enter the new examination data. One last lookto 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 pageof the 8500-8, which is his copy of the front side of the 8500-8, for him to have and tohold until the next visit.
airman applicant exits the antechamber, proclaiming to one and all that, for anothertwo years, he is a happy man.
Well, you get the idea. This is our vision of the future with the new Internet-basedAMCS. To take this scenario a step further, let’s say the airman was being followed formild hypertension. This will give you a view from within the Aeromedical CertificationDivision and is a representation of how we will handle the workflow. The data GP justsubmitted has been received, instantaneously matched, but causes the system to produce areject 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 beenfollowed for mild essential hypertension. The file, along with the other files that camein that day with PI numbers, is sent to the scanning area to be indexed and scanned intothe new electronic medical file that was developed on this airman. The case is thenreviewed for quality control and placed into AMCD’s new Document Imaging and WorkflowSystem, 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 instantaneousworkflow 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 thehypertension follow-up report that GP had inserted into block 60 of the 8500-8. The reportsent in by GP was quite favorable, so the reviewer clicks on the drop-down box with a listof all the letters that AMCD uses and brings up an Eligibility letter shell, inserts theblood pressure blurb, presses Print, and the Eligibility letter gets printed. The letteris 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 youcompleted, and mail them to the AMCD where they are permanently stored. The Federal AirSurgeon 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 medicalexaminers use the above system exclusively by October 1, 1999.
The sequence of events you read above will already be a reality for many aviationmedical examiners by the time you read this. From March of 1999, until October 1, 1999, wewill be testing the system in "real-time" with volunteers participating in thefinal systems check of the Aeromedical Certification System.
The Federal Air Surgeon’s Column
The Vagaries of Budgets
- Editorial, by Jon L. Jordan, MD, JD
My several years as a manager of afederally funded program has taught me the necessity of paying close attention to allmatters related to budget administration. In essence, it has become clear to me that allprograms—productive or nonproductive, good or bad—all live or die by the skillof the manager in securing and judiciously expending funds.
I have been blessed with an energetic and knowledgeable staff to assist me in thesematters, and I can say without hesitation that the funding successes experienced by theOffice of Aviation Medicine have been more a product of the work of my staff than my ownpersonal effectiveness.
There are times, however, when even the most effective manager and staff are unable tosecure the optimum resources that would permit program growth and the most desirableproductivity.
Over the years I have seen many "ups" and "downs" in the financialposture of the FAA and, in particular, the Office of Aviation Medicine. Among others, Iremember quite well those instances when the agency verged on total shutdown, whenreduction-in-force notices were prepared for distribution to employees, when certainemployees were given financial incentives to vacate their positions so that staffinglevels could be painlessly reduced, and when travel and training were canceled to conservefunds (including the conduct of AME seminars). Unfortunately, the FAA, including theOffice of Aviation Medicine, again finds itself experiencing financial difficulties.
The fallout for the Office of Aviation Medicine, while not disastrous, is damaging. Tomeet funding shortfalls, we have curtailed employee travel and training, and hiring of newemployees to fill vacated positions has been "frozen." To accommodateanticipated continuing funding shortfalls, the staffing level for future years has beenreduced by seven positions. Further actions will have to be taken if additional reductionsare required.
The short-term impact of our funding limitations is being felt throughout the Office ofAviation Medicine, but, with a few exceptions, will not be felt by AMEs. One majorexception, however, is in respect to a potential resurgence of extensive delays in theprocessing of airman medical certification applications at the Aeromedical CertificationDivision, where we currently have a number of position vacancies that cannot be filledbecause of the employment "freeze." By its nature, the processing of medicalcertification applications is heavily personnel-dependent, and even a small reduction instaffing severely compromises our ability to make the system run smoothly.
It is, in part, these ups and downs in funding that lead us to develop systems forprogram delivery that are less personnel-dependent. Automation of ECG transmission andprocessing is one, and, of course, implementation of the Airman Medical CertificationSystem (electronic transmission of medical certification examination data) and DocumentImaging Workflow Systems (scanning of medical information into a computer data base) areothers. The development of the Computer-Based Information module as a substitute for someseminar attendance was another initiative driven not only by a need to relieve a financialburden on AMEs, but also to lessen our dependence on funding.
It is essential that we continue to seek ways to become less dependent upon thevagaries of our budget process and the undulating availability of resources. I am hopefulthat all of you will join us in our objective of providing the best possible service tothe flying public in the most cost beneficial manner.
Your diligence in the accurate recording and transmission of Form 8500-8 data, soliddecision-making, and adapting to full use of the new electronic systems will helpsignificantly.
The Federal Air Surgeon’s Medical Bulletin • Spring 1999