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Abstract:This report examines the institutional and high-level technology aspects associated with potential mandated
electronic reporting of every commercial driver license (CDL) driver fitness-for-duty medical examination
performed by a medical examiner on the National Registry of Certified Medical Examiners (NRCME). To gauge
views and concerns of effected stakeholders, the research team developed a “Base Scenario” outlining the elements
of the potential system. A review via interviews was conducted, a similar concept administered by the Federal
Aviation Administration was examined, ongoing electronic medical records initiatives in the Department of Health
and Human Services were examined, and related third-party system approaches were studied. A historical review
was conducted of related recommendations from Congress and other institutions, including the Commercial
Driver’s License Advisory Committee. Implementation of the NRCME will improve the quality of medical
examinations. However, it will not close the number of significant gaps that allow fraud. Based on the findings of
these reviews and stakeholder input, three alternative approaches to a mandated electronic records system were
examined, including a nationally-based system, a distributed State-based system, and a distributed medical
examiner-based system. Architectural approaches were defined and analyzed relating to each approach. The
researchers concluded that the most effective approach for Federal Motor Carrier Safety Administration
consideration would be a nationally-managed system that would address the gaps. Appendix C outlines a proof of
concept to test and evaluate the recommendations for implementing electronic transmission and housing of medical
status and examination reports in an accessible database.
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