Mitre to research mining electornic records for FAA

flyingron said:
FAA has tasked Mitre to look into mining electronic medical records to "validate" 8500-8.

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Better MITRE than many other folks. I worked for them for 25 years (but in the Intelligence field) . As a Federally Funded Research and Development Center and non-profit, they'll not sell our stuff at least. I wouldn't trust a for-profit. They have a long history of trusted work including maintaining a lot of very personalized safety data.
 
Pugs said:
Better MITRE than many other folks. I worked for them for 25 years (but in the Intelligence field) . As a Federally Funded Research and Development Center and non-profit, they'll not sell our stuff at least. I wouldn't trust a for-profit. They have a long history of trusted work including maintaining a lot of very personalized safety data.
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Not as secure as the VA and SS…oh wait lol

Honestly these records shouldn’t even be online and should require the same burden of proof to access without direct authentication as a police search
 
Can anyone tell from the brief and concise (/s) abstract what they plan to actually do, what problem they are addressing:

"The FAA Office of Aerospace Medicine (AVS-AAM) plays a key role in aviation safety by establishing medical standards for flight fitness and by issuing pilot medical certifications. To gather the information needed to perform this role, the FAA uses a network of Aviation Medical Examiners who administer pilot examinations at specified intervals. MITRECAASD explored the feasibility of electronic medical record data integration into the aeromedical certification process to expedite the collection of already available information. The research involved literature review and policy analysis,workflow analysis of the existing MedXPress website, database analysis, terminology mapping, stakeholder process mapping, and preliminary integration testing with major Electronic Health Record (EHRs) vendors. The study recommended addressing different workflows for different stakeholders and ensuring that the Privacy Policy is up todate and accurately reflects current implementations. The report underscored the need for legal consultation during the implementation process, as different data ownership regulations apply depending on who accesses and owns the data.It also recommended the use of health aggregation services, such as health information exchanges and Patient HealthRecord patient-data aggregators, to gather the necessary longitudinal data from EHRs needed for the pilot examination."
 
Let'sgoflying! said:
I thought the new fed was all about improving efficiency.
This seems to be the opposite.
Maybe this will speed up the ridiculous med review backlog? (I have my doubts)
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"expedite the collection of already available information."

doesn't seem "opposite" to me.

full disclosure: I used to work for MITRE (but not CAASD), so I have maybe a little more understanding of an FFRDC than the average bear. I retired in 2017 and there ain't no way I'm going back to work...
 
Racerx said:
Cliff notes?
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To me it reads like they will drag your insurance claims (along with whatever other information they have like disability claims to social security administration) into their system. So your health intake is mostly up to date
 
Racerx said:
Cliff notes?
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I ran it through ChatGPT (hopefully this is allowed by the mods to paste in, but I will take down if not.) I found it helpful to understand more thoroughly.

TL;DR of the Document:​

The report, prepared by MITRE for the FAA Office of Aerospace Medicine (AVS-AAM), evaluates the feasibility of integrating Electronic Health Records (EHRs) into the pilot aeromedical certification process. It examines how EHR data can be used to expedite medical evaluations for pilots by automating the collection of already available medical information.

Key Findings:​

  1. Feasibility of EHR Integration:
    • The study finds that EHR data can technically be used to populate FAA Form 8500-8, which is required for pilot medical certification.
    • Integration with FHIR (Fast Healthcare Interoperability Resources) APIs can streamline data retrieval from healthcare providers.

  2. Potential Benefits:
    • Faster certification & recertification by reducing reliance on manual data entry.
    • Reduction in non-disclosure issues, as pilot medical history can be validated against existing records.
    • Use of patient health data aggregators (e.g., Apple Health, CommonHealth, Health Information Exchanges) to simplify data collection.
    • Automatic certification for low-risk applicants, reducing administrative burden.

  3. Challenges and Considerations:
    • Data availability & ownership: Not all medical history is easily retrievable, and data may be spread across multiple healthcare providers.
    • Legal & privacy concerns: HIPAA and 21st Century Cures Act regulations require careful handling of pilot medical data.
    • Standardization issues: FAA currently uses ICD-10, whereas EHR systems rely on SNOMED & LOINC, necessitating mapping and crosswalks for compatibility.
    • Security concerns: FAA would need to implement OAuth 2.0, X.509 security certificates, and Trusted Exchange Frameworks (TEFCA) to ensure safe data exchange.

  4. Special Issuances & Recertifications:
    • Special medical conditions (e.g., diabetes, cardiovascular issues) can be tracked more efficiently through continuous monitoring of health data.
    • EHRs can assist with recertification by automatically retrieving updated medical history, reducing wait times for pilots needing medical clearance.

  5. Recommendations:
    • Develop a Concept of Operations (CONOPS) to define how the FAA will incorporate EHR data.
    • Engage with EHR vendors & health data aggregators to facilitate seamless data exchange.
    • Incentivize pilots to use EHR-based certification processes by offering faster turnaround times.
    • Ensure FAA's privacy policies are up to date to comply with evolving regulations.

Final Verdict:​

The study concludes that integrating EHR data into the FAA pilot medical certification process is technically feasible and could significantly improve efficiency. However, legal, privacy, and technical implementation challenges need to be addressed before full adoption.
 
Roller said:
Not as secure as the VA and SS…oh wait lol

Honestly these records shouldn’t even be online and should require the same burden of proof to access without direct authentication as a police search
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How familiar are you with HIPAA and covered entities?
 
Your health information is already out there. Many doctors offices these days upload your healthcare records to a "health information exchange". For example, this lets doctors see your active prescriptions from other practices when you sign up as a new patient.

From what I've heard, the military is already using this to pull your medical records when you enlist. I know of at least one person who got disqualified at MEPS because Genesis (the military's EHR system) flagged a discrepancy between what this person self-reported and what the health information exchange knew about them.

For those wondering if the FAA has the authority to access this info...

HIPAA has a carve out for the government. In particular, 45 CFR § 164.512(d) gives "health oversight agencies" (which includes the FAA's medical division) the right to access your health files without your consent. Even if the records aren't online, the FAA can theoretically request hardcopies from your doctor if they really wanted to conduct an investigation.

Also, the HIPAA form you sign with your doctor also gives them the permission to upload your data to the health information exchange.

(And don't even get me started on all the information your health insurance company has on file for you...)
 
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Roller said:
Not worth the paper it’s printed on these days with the databases and data breaches

It’s good in theory
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Is that just a personal opinion or do you have anything to back it up?

Having spent my career in healthcare and dealing with HIPAA extensively at several levels within the government, I disagree. What expertise do you bring to the table to make such an assertion? Wishful thinking, to support a narrative, seems to be involved.
 
2024 Medicare data breach
Just under 1M people’s data
SS numbers DOB claims

2015 OPM
chinese breach, 21M people’s data
SS DOB etc

2006 VA
26M people
Similar as above

I could go on

The fact that it’s all cool that the FAA found a workaround for accessing personal medial data via insurance coding, that alone shows how your privacy ends where a goverment workers curiosity begins

Add to that how many hackers have gotten into these systems

Yeah, it’s good in theory

IMO any access to this data should generate a report that’s sent to the persons whose data was accessed, it should include the full name and title of who accessed it and why. This would include anyone who ran a license plate, your insurance files, and so on. The idea that getting the insurance codes is somehow different than just giving Oklahoma workers our full medical files is laughable
 
It always seemed to me as if the FAA medical clowns just kept tacking on requirements because they are too lazy to blast through a stack of apps. I've seen that behaviour in business and in the military (as a contractor). Kick the can.
This isn't from the current administration, and certainly should even get to the point of being able to flag only those applications that really need human intervention, not just fill out form.
This is one of the uses of AI that is proper and solid, but I'll bet it does little more than fill in the blanks when you hit MedExpress.
 
Diagnosis codes, automated. They always could get them, it was just to cumbersome to do it on all 720,000 airmen. The day of "just leave it off the form" is gone.
 
Llewtrah381 said:
Is that just a personal opinion or do you have anything to back it up?

Having spent my career in healthcare and dealing with HIPAA extensively at several levels within the government, I disagree. What expertise do you bring to the table to make such an assertion? Wishful thinking, to support a narrative, seems to be involved.
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I work in this space. We pay $250K/yr to get full medical, rx, test results/vitals and encounter notes data on ~310MM Americans since 2010 -- with some variance based on when providers went to electronic recordkeeping. It's mostly all out there, with a few holdouts like Kaiser (for now, they seem to be headed to the darkside lately and I expect to get their data sometime soon). We buy from a commercial data broker, and these datasets are available from a half dozen different vendors with varying degrees of completeness and depth. The trick is the various "anonymization" schemes that are trivially de-anonymized that provide a thin veneer of legitimacy.

HIPAA also has a real loose interpretation of who is an "interested party" in giving care (thus unlocking access). I mainly work on the underwriting/carrier/reinsurance side of the house which is pretty far removed from the doctor-patient privilege, yet I get everything in realtime on any of our covered lives.

==

I like this part of the Mitre proposal. I feel that NFW would CAMI release the reins for something like this, but that'd be a dream AND slam dunk scenario as far as i can tell:

Automatic Certification
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Automatic certification refers to a future system where applicants could be receive a medicalcertification without visiting an AME in-person, as currently required by FAA medical standards.Provided automatic certification (or auto-certification) is allowable in the future, vendors alreadysupport the data protocols needed for successful implementation.The functionality itself is similar to an application for a credit card, which includes a credit historycheck and algorithms to determine credit limit based on credit history. Fetching data to completeform items in Form 8500-8 and verify applicants do not have disqualifying conditions or DNImedications is technically feasible. The interoperability protocols are intended to reduce manualdata collection and review for typical applicants, and the systems can electronically perform thesame (or similar) workflow and responses as a paper application. Eliminating wait times byenabling the system to automatically certify users that meet approved rulesets (i.e., nodisqualifying conditions) is a question of policy and liability, not one of technology.
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just curious, I wonder how many would be surprised by what is in their medical record that their provider hasn’t told them. Case in point, years ago I pulled my medical records and found like 10 different problem codes (related, but still unique) I didn’t know I had, because nobody bothered telling me.
 
schmookeeg said:
I work in this space. We pay $250K/yr to get full medical, rx, test results/vitals and encounter notes data on ~310MM Americans since 2010 -- with some variance based on when providers went to electronic recordkeeping. It's mostly all out there, with a few holdouts like Kaiser (for now, they seem to be headed to the darkside lately and I expect to get their data sometime soon). We buy from a commercial data broker, and these datasets are available from a half dozen different vendors with varying degrees of completeness and depth. The trick is the various "anonymization" schemes that are trivially de-anonymized that provide a thin veneer of legitimacy.
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I suspect I know the answer because information asymmetry makes the world go round, but will any of the data brokers sell an individual's records back to them, or is it only wholesale?
 
GeorgeC said:
I suspect I know the answer because information asymmetry makes the world go round, but will any of the data brokers sell an individual's records back to them, or is it only wholesale?
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For ours, it's a bulk situation. I'm not aware of anyone doing retail per-person lookups, but man, what pilot wouldn't want to verify the "medical coding adventures" the docs are running on them before sitting for the medical renewal? Fascinating biz idea there :)
 
schmookeeg said:
I work in this space. We pay $250K/yr to get full medical, rx, test results/vitals and encounter notes data on ~310MM Americans since 2010 -- with some variance based on when providers went to electronic recordkeeping. It's mostly all out there, with a few holdouts like Kaiser (for now, they seem to be headed to the darkside lately and I expect to get their data sometime soon). We buy from a commercial data broker, and these datasets are available from a half dozen different vendors with varying degrees of completeness and depth. The trick is the various "anonymization" schemes that are trivially de-anonymized that provide a thin veneer of legitimacy.

HIPAA also has a real loose interpretation of who is an "interested party" in giving care (thus unlocking access). I mainly work on the underwriting/carrier/reinsurance side of the house which is pretty far removed from the doctor-patient privilege, yet I get everything in realtime on any of our covered lives.

==

I like this part of the Mitre proposal. I feel that NFW would CAMI release the reins for something like this, but that'd be a dream AND slam dunk scenario as far as i can tell:
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You wouldn't by chance be talking about Change Healthcare data, would you? :)
 
ArrowFlyer86 said:
You wouldn't by chance be talking about Change Healthcare data, would you? :)
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No and actually I haven't heard of them, so I raise my "data brokers who do this" claim to at least 7 :)

Our broker is somewhat secretive but if you're in this space it's the one that starts with "K" -- although IBM was one of the runner ups under consideration
 
bbchien said:
Diagnosis codes, automated. They always could get them, it was just to cumbersome to do it on all 720,000 airmen. The day of "just leave it off the form" is gone.
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And the days of paying cash are here, docs should have to read this when they encounter a pt

“You have the right to be sick. Anything help you seek can and will be used against you in an administration office. You have no rights in administrative law. If you cannot afford an attorney, oh well, if I code something wrong you will be unemployable and probably lose your family and life as you know it. Do you understand the situation I have just described to you? With these abuses in mind, do you wish to seek treatment?”


Be cool if we could have a anonymous insurance option, like some type of blockchain insurance type deal where someone could get help, doc could get paid but all the details were only accessible to the pt unless they provided a code to unlock the files
 
This is why I didn’t try to lie… That and also I also desire to be morally upstanding.

Anyway, I’m sure there will be absolutely no negative consequences for the aviation industry if they try this.

Queue the headline, a few years from now “SCANDAL: >50% of pilots lie on their medicals.”
 
FlyingBiscuit said:
This is why I didn’t try to lie… That and also I also desire to be morally upstanding.

Anyway, I’m sure there will be absolutely no negative consequences for the aviation industry if they try this.

Queue the headline, a few years from now “SCANDAL: >50% of pilots lie on their medicals.”
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That’s already been shown without this. Roughly 50% of a sampling of ~ 3,000 pilots in flight school admitted hiding medical details (mental or physical) from the FAA/AME.

That’s what gets me so heated about being in a deferral for 2 years. I feel like the sucker for being forthright and honest yet grounded, while those liars are living their dreams.

Sucks.
 
DJTorrente said:
Diagnosis codes are about getting the doctor paid; not the health of the patient/airman.
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Tell that to the FAA.

If they want to make things more efficient with "already available information," they should make their &*(%#)&(@ Med"XPress" web site pre-fill all of the information you've already filled out on previous applications, especially including medical visits within the past three years that you've already entered.

That's the thing that annoys me most about a first class. I had a bad cold two years ago and I've told you about it four times already dammit! :mad2: I feel like it's just inviting us to trip up, so I screenshot every single screen of MedXpress every time, and refer to the previous one when filling out the next one so that I don't screw anything up by accident. Ugh.
 
That is so easy. Just use the same AME for renewals. I comment: "prior office visits commented upon, on last medical 09/28/2024". Done with those.


The reason you have to keep reporting (over and over and over and over) is you might be going to any AME and he won't know about those past events. And FAA has to comply with the HIPAA laws.
 
bbchien said:
That is so easy. Just use the same AME for renewals. I comment: "prior office visits commented upon, on last medical 09/28/2024". Done with those.


The reason you have to keep reporting (over and over and over and over) is you might be going to any AME and he won't know about those past events. And FAA has to comply with the HIPAA laws.
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Is there any reason an airman can't report "previously disclosed on medical application dated 99-MAR-2156" without regard to who the AME is? It's all going to the same FAA, and more specifically to the same office in OKC. What if the change of AME isn't voluntary for the airman (retirement, etc.)?
 
UTLonghorn_1979 said:
That’s already been shown without this. Roughly 50% of a sampling of ~ 3,000 pilots in flight school admitted hiding medical details (mental or physical) from the FAA/AME.

That’s what gets me so heated about being in a deferral for 2 years. I feel like the sucker for being forthright and honest yet grounded, while those liars are living their dreams.

Sucks.
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Sure the evidence exists, but since the data is anonymized the FAA can’t do anything about it, so the issue can be ignored. I suppose this is their attempt to do something about it. However, when the FAA has everyone’s medical records, they cannot legally ignore the problem anymore and will be forced to send out emergency revocations en masse. Suddenly >50% of pilots will be grounded, and commercial aviation grinds to a halt. That will be the real scandal that most people and importantly, Congress, will care about.
 
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