FAA Wants More Access to Airman Health Records

 - June 20, 2015, 9:00 AM

In response to the losses of Malaysia Flight 370 and Germanwings Flight 9525, the FAA is planning to “study the emotional and mental health of U.S. commercial pilots,” the agency stated, in a joint effort with industry representatives. The joint effort will be undertaken by the Pilot Fitness Aviation Rulemaking Committee (ARC), which was formed by a recommendation of the Commercial Aviation Safety Team (Cast). The ARC is tasked with reporting its findings by year-end. (See article on page 12.)

In a separate but seemingly related effort, the FAA is conducting a market survey for a major update to its aeromedical technology infrastructure called the Aerospace Medicine Safety Information System (Amsis). One of the functions of Amsis will be for the FAA’s Office of Aerospace Medicine (AAM) to “use the Amsis to develop a new information system for tracking and analyzing a broad selection of medical information associated with pilots, air traffic controllers and other aviation-related personnel.”

One way that Amsis will perform this tracking is to tap various sources of data to help the AAM make better decisions about the medical qualification of pilots. Or as the FAA explained, “Amsis will provide better data accessibility and a greater ability to analyze medical information and denial data to identify safety trends that could impact system safety.”

To accomplish this mission, the FAA added, “Specifically, Amsis is intended to reduce accidents and improve safety by:

  • Reducing falsification of health records and preventing pilots or ATCSs (air traffic control specialists) from operating in the [National Airspace System] when they have medical conditions hazardous to aviation safety;
  • Improving the ability to analyze medical data and identify and mitigate hazards related to specific and/or systemic airmen and ATCS health issues;
  • Improving the ability to match airmen and ATCS medical records with the electronic health records of other government agencies and departments;
  • Ensuring the accuracy and integrity of airmen and ATCS medical data;
  • Leveraging the National Health Information Network (NHIN), Health Information Exchange (HIE) system medical records, and ad hoc, regional and multi-regional HIEs, to improve the accuracy of airmen and ATCS medical data; and

*Improving the surveillance and oversight of designees and aviation industry substance-abuse programs.

Information Exchange

As of June 15, the FAA had not answered AIN’s questions about exactly which “electronic health records of other government agencies and departments” it intends to match with airmen and ATCS medical data. There are strict regulations that prevent sharing of medical data except under specific circumstances and generally requiring the permission of the person to whom the data belongs. These are codified under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). However, part of the Amsis effort, as the FAA stated above, is “Leveraging the National Health Information Network (NHIN),” among other information sources. The NHIN is actually properly termed “Nationwide” and not “National” and is a program of the Office of the National Coordinator for Health Information Technology, “established in 2004 to improve the quality and efficiency of healthcare by establishing a mechanism for nationwide health information exchange.” A means of linking organizations to the NHIN has been developed, called the Connect gateway. “Members of the NHIN Cooperative plan to use the NHIN to support secure health information exchange at national, state and local levels,” according to Connect.

Some of the 18 federal agencies involved in Connect include: Department of Health and Human Services; Centers for Disease Control and Prevention; National Institutes of Health; Department of Commerce; Department of Defense; Department of State; Department of the Treasury; Department of Veterans Affairs; Office of Personnel Management; and the Social Security Administration. AIN could not find any link between the FAA or the Department of Transportation and Connect, but it is clear from the FAA’s Amsis plans that it wants access to electronic health records from “other government agencies and departments.” Connect could be one way to do so.

Beyond a Physical

The Pilot Fitness ARC tasked with studying “the emotional and mental health of U.S. commercial pilots” is composed of government and industry experts. According to the FAA, “The ARC will examine issues including the awareness and reporting of emotional and mental health issues, the methods used to evaluate pilot emotional and mental health, and barriers to reporting such issues.”

The FAA said that “Based on the group’s recommendations, the FAA may consider changes to medical methods, aircraft design, policies and procedures, pilot training and testing, training for Aerospace Medical Examiners, or potential actions that may be taken by professional, airline or union groups.”

One of the ARC members is Dr. Quay Snyder, president and CEO of Aviation Medicine Advisory Service, who is working with NBAA on aeromedical issues, as a member of the association’s safety committee.

Doug Carr, NBAA vice president of safety, security, operations and regulation, sees the ARC’s work as important, especially for dealing with how to manage the issue of fitness for duty. “It’s not just are you or are you not tired?” he said. ARCs are not open to the public, but the public will have an opportunity to comment on any proposed regulations that result from the group’s work.

With regard to the FAA’s Amsis efforts and the possible sharing of electronic health records that might be involved, Carr said, “We don’t have a lot to say at this point. It’s a process that we hope will help speed up getting pilots their medical [certificates] and facilitate getting the records needed to support [that]. We don’t think it’s going to be carte blanche authority to get medical records from anywhere. The fact that I had a physical exam for work, while required to be disclosed, does not mean the FAA will be able to go to my physician and get my records. I think we’re a little way off from understanding what this means at a practical level.”

With advancements in technology, there is no question that medical information is becoming not only more widely available but also more easily shared electronically. The Germanwings Flight 9525 crash raises questions about the extent of authorities’ right to dig into a pilot’s medical records. Could that crash have been prevented if medical information had been shared with the airline, regulators and aeromedical licensing parties?

This is not a new issue. Civilian pilots have flown suicidal missions before; in fact, there was just such an accident on Feb. 9, 1982, when a pilot attempted to commit suicide by flying a Japan Airlines DC-8 into the ground. The pilot survived, but 24 of the other 173 people on board did not. According to “The Suicidal Pilot Who Survived” by Dietrich Alexander and published last month by the OZY website, the airline never learned the true nature of the pilot’s depression.

According to Alexander’s article, “In the aftermath of the crash, Japan Airlines says it set up a committee dedicated to reviewing ‘both the physical and mental health of flight crew for ensuring safe flight operations,’ and has an established support system in place, including psychiatric expertise.”