Category: Certified Examiners

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Certified Examiners Trucking Management

FMCSA registry website is down. Now what?

FMCSA’s website has been down for almost 2 months…and what are you supposed to do while it is offline?  And, the log of exams you need to file when the website is back online is daunting…but, there is a better way.

Customers who are on SafeLane Health’s DOT platform haven’t missed a beat.  They still have:

  • Auto reporting to FMCSA. Even though the feds are offline, SafeLane Health’s system isn’t.  We will automatically file for customers as soon as FMCSA’s website works.
  • Better, more complete health history answers.
  • Quick access to synopsis of the guidance and links to full references.
  • Auto completion of exam certifications and reports.

Customers who utilize SafeLane Health’s DOT platform repeatedly note:

“It is so easy to use.”
“I love that all the information is complete.”
“The fact that I don’t have to hand write information on the federal documents is AMAZING.”

Replace your paper process (and the hassles with lack of reporting to FMCSA) by utilizing the industry gold standard-SafeLane Health’s DOT examination tool.  For as little as $10/mo, access the BEST way to perform DOTs. Contacts us. We’d love to show you the technology real-time.

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Certified Examiners Trucking Management

52% Reduction in “DOT” Pending Exams

We know that for many of you performing DOT examinations, they are a loss leader for your clinic.  Drivers are not prepared for their exam, costing you and your staff precious time to get more information.  If drivers need to return at a later date with more documentation, that not only frustrates the driver but also your bottom line.

By having drivers fill out the health history portion of the medical examination report (FMCSA’s 5875) before hand, all kinds of cool things can happen:

  • If applicable, they can get more information from their primary care provider, before they come to your clinic
  • They have the convenience of answering the questions on their own time and lessening the length of time spent at their appointment
  • They are required to provide more details if they say “yes” to any of the mandatory questions, giving you and your staff more information

Not only do you have better prepared drivers, you also know what the exam will entail. Our patented-technology color codes the drivers completed questionnaires (green=healthy individual, no limiting conditions, yellow=answered “yes” to potential limiting conditions, red=quite complex, answered “yes” to several limiting conditions, and black=most likely will not certify) helping your staff schedule clinic flow and prioritize who will examine the more less healthy individuals.

reducedvisits

The University of Utah Occupational Health Clinic system saw the benefits of SafeLane Health’s DOT exam interface and after only 49 exams, saw a 52% reduction in pending exams.  With such an immense improvement, they could see that their once-upon-a-time loss leader exams are now a revenue stream.

Trucking management benefited too, because for those drivers who had to spend precious time gathering more information before they could be certified, knew that they were prepared for their exam and could increase their odds of being certified on the first visit.

reducepending

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Certified Examiners Evidence-Based Research Trucking Management

Why paper could be killing your process

Paper. Such an easy, cheap way to document, store and pass around information.  All you need is a writing utensil, some filing cabinets, maybe a scanner, and you can collect health history information efficiently and quickly.  There is just one problem. Paper doesn’t alert you, talk back to you, ensure that everything required is being filled out.  It also takes time to get from one person to another (e.g. clinic communicating to an employer), doesn’t give you a database to perform analysis, doesn’t ask clarifying questions.  Worse, when it is scanned and loaded into a record keeping system, the file often gets assigned a random file name and gets lost in the depths of a patient’s file…

To illustrate, we recently looked at DOT exams performed on paper.  We found almost 2% missing or incomplete data (did that guy really have a heart attack or did he just leave blank unintentionally?),  and that several drivers had to return at a later time with more documentation from their primary care provider before they could be cleared (extra visits means more time and more cost to the clinic—may be worth mentioning our system asks driver to bring more info with them to their appointments, reducing the return visits substaintially).

Another example looked at the paper process of one large employer and how they were handling their respirator clearances. The collection of the employee’s health history was done on paper and all employees were required to fill out the paper at one location.  This required those employees who didn’t work at the main location to spend time in the car traveling from satellite offices and the employer paying a lot more time for a task that took a few minutes to complete.  The employee also had to seal their responses in a plain envelope and hand to HR (imagine the steps the employee had to go through if it was discovered that they forgot to sign, didn’t answer all the questions, etc.).  This sealed envelope technique was the company’s way of keeping the employee’s information confidential before handing it over to their medical director (who works offsite, part-time and had to travel to the main location on a weekly basis).  The medical director was then tasked with keeping the files secure and in a locked cabinet.  In one instance, a clearance came into question and the medical director had to go through over 300 completed health histories to find the correct paper record.

These examples (and there are so many more) all lead to the same point: Paper is completely killing your process, wasting valuable time, ramping up costs and ensuring that mistakes/incomplete information will be part of the equation.  So, ahem, why are you using paper?

SafeLane Health’s cloud-based, secure, HIPAA compliant, easy-to-use, technology solves all the above problems.  It evens gives you so much more time in the day to, say, brew several cups of coffee.  A couple of other cool features:

  • Gives you the ability to track trends over time where, for instance,  you can see if a worker no longer has the seizure disorder he claimed last year or has lost weight and says he no longer has high blood pressure
  • Ques workers that they are due for re-certification and need to call your clinic to make an appointment (and complete the online questionnaire) 30 days before expiration
  • Sends emails immediately to an employer when a medical clearance is complete-and the pass/fail status of the employee
  • Saves you and your staff a TON of time (automatically files to FMCSA for DOT exams, automatically generates clearance letters for respirator exams)
  • Gives you data to understand a working population like never before (“Hey, employer, you have a very large population with high blood pressure. May want to consider a wellness training around what your employees can do about high blood pressure)

So, consider all of the cost savings and reduction in errors you can achieve by saying “Goodbye, Paper. Hello, SafeLane.”  And, for $2 a completed questionnaire and $10 a month/provider, you can see how much more you’ll spend staying with paper.  Contact us and we’ll show you real-time the benefits.

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Certified Examiners Evidence-Based Research Truckers Health Trucking Management

Constellation of Health Conditions Creates Unsafe Truck Drivers

Researchers, clinicians, and safety professionals have known for a while that health impacts a truck driver’s performance but it has been unclear if combinations of health factors increase crash risk and what type of health conditions are cause for concern…until now.

Matt Thiese, PhD, MSPH, and President of SafeLane Health, recently published his latest research in Journal of Occupational and Environmental Medicine.  The research findings indicate if a truck driver has three or more health conditions (more on those later) he is two and a half times more likely to cause a DOT reportable crash or preventable crash. He also discovered that those crashes will happen much sooner than those compared to a “healthy” truck driving population.

A DOT reportable crash is defined as an occurrence involving a commercial motor vehicle which results in: a) A fatality b) Bodily injury to a person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident, OR c) One or more of the vehicles incurs disabling damage, requiring it to be towed from the scene.  A preventable crash is defined by the company’s accident analysis group as the driver may have taken action to prevent the crash.

Dr. Thiese’s research analyzed at over 38,000 truck drivers involved in over 13,000 crashes (a HUGE sample size by research standards) and the 13 conditions that contribute to crash risk (these conditions have been identified by the Federal Motor Carrier Safety Administration and are specifically asked about on the medical examination report):

  1. Body Mass Index > 35 kg/m2
  2. Diabetes Mellitus requiring medication
  3. Cardiovascular Disease or Dysrhythmias
  4. Hypertension
  5. Requirement for Visual Exemption
  6. Obstructive Sleep Apnea
  7. Renal disease
  8. Pulmonary disease with pulmonary function test abnormality
  9. Epilepsy seizure free for>10 years
  10. Musculoskeletal disease requiring medical, surgical or prosthetic treatment
  11. Stroke or paralysis
  12. Major psychiatric illness
  13. Opioid or benzodiazepine use

So, what does this mean?  Lets say, for example, we studied 100 “healthy” truck drivers (those drivers who have two or less conditions) over 12 months and found those healthy drivers had 100 accidents.  Then, we looked at 100 truck drivers with three+ conditions. The findings would show the drivers with the three+ conditions not only had 100 crashes within the first four to five months of the 12 month period, but also ended up having 250 crashes over the course of the 12 months. These findings are in the same order of magnitude as the causal link that has been found with smoking and heart attacks. Read: big freaking deal.

What do these findings mean for certified medical examiners?

At a minimum, it means examiners need to be on alert for the number of conditions a driver presents during his health history and during the exam.

Medical Examiners also have an opportunity to inform and educate drivers who are either on the cusp of three conditions-or those who already hold that distinction-about the crash risk that is associated with having these health conditions. Examiners can refer the driver back to his primary care provider to prescribe a different medication, work on a weight loss program, or even work with trucking companies to get the driver healthier. This truly could save not only the truck driver’s life but also those who share the road with him.

Trucking Companies have a lot to gain too

If trucking management understands the health of its drivers, management can (at a minimum) prioritize safety and wellness programs. More importantly, though, it can better understand its crash risk and the timeline in which those crashes will occur.  This gives new insight into recruitment efforts, turnover rates and even tenure.  Not only knowing who falls into the three+ condition bucket but also knowing who is in the two condition category holds a lot of powerful information to implement change.

Drivers can reap the biggest benefits

If drivers understand how their health is not only affecting their safety on the road, but also the safety of others, it could be the impetuous for change.  Their lives are figuratively (and literally) on the line, especially when they cross the threshold into a constellation of having three or more conditions.

What should be done with these findings?

Getting truck drivers healthier is a priority, but so is education. Educating truck drivers that they are 2 or 3 times more likely to cause a preventable crash with three or more contributing health conditions, could be a reality check. Working with employers to have them understand the severity of health and crash risk can help bring about change.  And, alerting examiners during the exam process of the contributing conditions will ensure proper certification lengths given.  If we all work together, we can truly make our roadways safer.

truckingmanagement_pitch

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Certified Examiners

FMCSA 2018 requirements. Are you Ready?

In 18-months time, more will be required by FMCSA

Beginning in June 2018, FMCSA will require a lot more information to be submitted after an exam is completed.  Currently, Medical Examiners need to submit the information on the driver’s certificate. But in 2018, FMCSA will require all of the examination be recorded and submitted to its database. As a result, if you don’t plan ahead, you and your team will spend a lot more time submitting data to the agency.

ExamAssist offers an easy solution

Few companies currently offer the ability to submit on a providers behalf, ExamAssist is one of those and is already filing for its customers with a click of a button. Once an exam is complete, the required information gets automatically pushed to FMCSA, taking a lot of busy work off an assistant’s and/or examiner’s plate.

Quick and Error Free
Because ExamAssist automatically submits the information entered during the exam, miskeying or other data entry mistakes are non-existent.  In addition, Medical Assistants who are currently using the system, are celebrating they no longer have to log anything within FMCSA.

For as little as $2.00 per exam (or even less if you perform more than 25 exams per month) you can use ExamAssist for yourself.  Not only will your submissions be taken care of, but you will also gain access to the best DOT software available.

Set up a 10-minute call to learn more

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Certified Examiners Diabetes Evidence-Based Research Truckers Health

Insulin-Using Diabetics Survey Results

SafeLane Health conducted an independent survey to assess examiners opinions and understanding of the MRB’s recommendations. Here are the results:

Question 1: Drivers are required to report and stop driving after severe hypoglycemia based on this proposal.

Statement 1 results

Comments:

The FMCSA proposal is focused on the periodic certification exam ONLY. It is silent on management of hypoglycemia in between exams.

Not clear that driver is stop driving and report if there is hypoglycemic event

But how are you going to know if they don’t self report? Drivers could easily hide this fact unless they were in an accident. And even then you might not know the medical facts and if they lead to the accident.

we relaying on drivers to sel report. if they are truthful then they are out of work not sure how many drivers can afford to be out of work. so I feel drivers will under report hypoglycemic events.

Bottom Line:

Just over half of the respondents agreed that drivers are required to report a severe hypoglycemic event, however, there are concerns that drivers won’t report the event because it is reliant upon the driver self reporting.  Not all examiners interpreted MRB’s proposal the same way.  More than 1/3 of the examiners said that drivers under this proposal drivers are not required to stop driving and report the event.

Question 2: How many severe hypoglycemic events are acceptable over time? Assuming there is a process to stop driving for 6 months after each episode of severe hypoglycemia, then in the worst case, this would tally to 2 events per year, or over 5 years, 10 events total. This compares with the prior limit of 2 in 5 years. If the proposal does not preclude driving after severe hypoglycemia, then the number of events could be far higher. The proposal as written will be sufficiently safe.

Statement 2 results

Comments:

NO hypoglycemic episode is without risk. What is “severe hypoglycemia?” Is a crash necessary to limit certification? What about NIDDM drivers who are oral hypoglycemic agents? They are just as worrisome. A driver who is feeling unwell and not eating can get behind his oral agent, and this is LESS amenable to simple feeding.

Old recommendation of 2 in 5 years better.

I think 2 events in 5 years is much better and some would agrue 2 events in a lifetime is grounds for disqualification.

Bottom Line:

Nearly 3/4 of examiners disagreed that the current proposal is sufficiently safe.  Based on comments it appears that there is disagreement about what is safe, but most examiners agree that this current recommendation is not safe.

Question 3: If a driver does not monitor the glucose but then does so for 1 month, the proposal allows driving. As behaviors so frequently revert, is this sufficient assurance of ongoing monitoring?

Statement 3 results

Comments:

Just like the driver who loses weight to get his BMI below 35 or 33, or whatever the limit is – better habits are difficult to maintain. We do not know how to motivate stable behavioral change.

No it’s not sufficient assurance of ongoing monitoring.

Financially, this is more palatable. Would recommend a shorter certification period and recommend the company place the individual in their own non-regulated f/u program in addition if this is available. 

Bottom Line:

Nearly 4 out of 5 examiners believed that glucose monitoring for 1 month is not sufficient.  There is concern that drivers would do the minimal possible to maintain driving certification. The proposal should be changed for a longer monitoring period.

Question 4: The MRB recommendations include an outline of a questionnaire, but it does not specify what should be done with negative or varying responses (e.g., a question regarding not being on a stable regimen for the past 3 months; drivers who do not monitor the glucose at least every 4 hours while driving). There should be specificity.

Statement 4 results

Comments:

There is no room for wiggling here. Our chiropractic brethren need specific guidance. Every 4 hr monitoring is not ideal; should be upon awakening, post-prandial, pre-prandial, and every 4 hrs if not eating.

Yes, there should be specificity in the questionnaire.

again this is ALL based on drivers self reporting. I feel this whole proposal is dangerous.

Bottom Line:

Examiners unanimously agreed that there needs to be more specific guidance with how to handle glucose testing variability.

Question 5: The presence and extent of complicating conditions that are allowable is unclear (e.g., neuropathy, nephropathy).

Statement 5 results

Comments:

“Signs of target organ damage” is clear. However, to what extent does an examiner go fishing for evidence? Opening a can of worms.

More specificity in the degree or extent of complicating conditions should be included.

Bottom Line:

Most examiners agreed that additional clarification is needed regarding allowable complicating conditions.

Question 6: There is unclear guidance on whether to allow someone to drive with diabetic nephropathy, including requirements to stage the nephropathy as per prior Medical Expert Panel and MRB recommendations.

Statement 6 results

Comments:

I’m good with extremes, but in stage 3 CKD, where is the line drawn?

This guidance is not good. It should be clarified. No GFR < 30

Bottom Line:

Examiners unanimously agreed that the guidance is not clear enough to certify someone with diabetic nephropathy, particularly in moderately severe cases.

Additional Comments:

The deletion of the requirement to see an endocrinologist quarterly is laudable, but there should be greater emphasis on the qualifications of the MD, DO, etc. e.g. primary care or FM or IM.

Who ultimately determines the ability to drive-an endocrinologist, intern, mid level?

All of this is subject to the driver’s compliance and honesty. Unfortunately, many drivers will do anything to keep their CDL. I do not believe insulin dependent individuals should be able to maintain a CDL.

Make the guidance as clear as possible where the evidence supports that guidance. Minimize ambiguity. The less open to interpretation the better. That way CME’s across the board will be more consistent in the application of the guidance.

If the FMCSA is indeed to promote safety, I strongly encourage banning insulin dependent drivers based on the research available.

SafeLane Health has compiled all of the relevant research concerning insulin-using diabetics and driver safety.

The following is the current Medical Review Board’s (MRB) recommendations:

The 2016 MRB report recommended that insulin treated diabetic drivers may be qualified to drive if:

  • Provides an assessment form completed and signed by treating medical provider. (Must be MD, DO, PA or Nurse Practitioner)
  • Has a complete ophthalmologic or optometric dilated eye exam at least every 2 years, documenting degree of retinopathy/macular edema if present.

Under this proposal, the driver may be qualified for a maximum of 1 year unless they have experienced:

  1. Severe hypoglycemia in the past 6 mo.
  2. Blood sugar
  3. Hypoglycemia without warning symptoms
  4. Uncontrolled diabetes (HbA1C > 10%)
  5. Stage 3 or 4 diabetic retinopathy (permanent disqualification)
  6. Signs of target organ damage (disqualified until matter is resolved by treatment if possible)
  7. Inadequate record of self-monitoring of blood glucose (driver should be disqualified until min. of 1 month adequate glucose records
  • If the driver has had an episode of severe hypoglycemia, blood sugar < 60 mg/dl or hypoglycemia unawareness within previous 6 mo, driver should be medically disqualified for at least 6 mo.
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Certified Examiners Diabetes Evidence-Based Research Truckers Health

Diabetic Crash Risk-What the Research Says

Original Research Summary

Diabetes mellitus has been associated with an increased risk for motor vehicle crashes (Cox 09; Hansotia 91; Harsch 02; Hemmelgarn 2006; Koepsell 94; Kagan 10; Laberge-Nadeau 00; Lonnen 08; Skurtveit 09) however, a few studies did not find a statistically significant relationship (Cox 03; Songer 88; Stevens 89; Ysander 66). There are no randomized controlled trials to directly address the crash risk of diabetic drivers treated with insulin compared to those not treated with insulin.

There are 4 published cohort studies that have quantified crash risk. The only prospective cohort study of diabetic drivers reported that more than half (52%) reported at least one hypoglycemia-related driving event, including loss of memory, citation for reckless driving, and having someone else take control of the vehicle (Cox 09). Risk of these events were significantly higher for diabetics with either a history of severe hypoglycemia and insulin pump usage. A large retrospective cohort study (3.1M drivers) found crash risk doubled comparing drivers treated with insulin (40% elevated risk) to diabetic drivers using oral diabetic drugs (20% elevated risk) (Skurtveit 09). Two other retrospective cohort studies reported 32% elevated crash risk among all diabetics (Hansotia 91) while another failed to find a statistically significant difference in crash risk between diabetics in general and diabetics using insulin in Great Britain (Lonnen 08).

There are nine published case-control and cross-sectional studies evaluating the relationship between diabetic drivers and crashes. The studies with the strongest study designs and largest sample sizes found elevated crash risk associated with diabetes mellitus. Of the studies which evaluated insulin use, most suggested higher crash risk among diabetic drivers using insulin as compared to diabetic drivers not using insulin.

Evidence Report Summary

The FMCSA Medical Review Board’s evidence report notes that the risk of crash among insulin users in the USA is a 2.76-fold increased risk (Tregear, 11). The evidence also suggests relatively modest increased risks for use of oral hypoglycemic agents by 28%.

Discussion

A 2.76-fold increased crash risk is quite large, and beyond reported risks associated with nearly all other conditions. The 2.76-fold increased risk estimate for insulin use is so high, that it means that there are, at best a small minority of insulin-using drivers who may be reasonably safe. It demonstrates that the overwhelming majority of insulin using drivers
are unsafe for driving commercial vehicles.

The US-based data are naturally the most important to address the to the question of safety, as European countries’ populations have comparatively minor needs to drive motor vehicles (meaningful options include walking, multiple mass transit modes,
etc.), thus the populations are not comparable to the US.