Scott Rolfe, clinical manager of emergency services at University Medical Center in Las Vegas, can locate at the click of a computer mouse the emergency room nurses, doctors and other members of his 125-person staff anywhere in the 28,000-square-foot facility at a moment's notice. He can track their movements on a monitor, call them directly via a microphone on his computer without a noisy, systemwide page and communicate rapidly and privately hands-free when needed.
Although 504-bed UMC has nearly 200 video cameras throughout its 25-acre, eight-building campus, this Orwellian scenario doesn't require video cameras to monitor the comings and goings of hospital staff. It relies on local positioning technology, similar on a small scale to the satellite-based global positioning system, included in state-of-the-art hospital security systems. Those systems, which promise to keep out unauthorized intruders and prevent baby abductions, also are capable of logging in when employees arrive for work and leave the hospital as well as tracking when they go into a restroom or step out for a smoke.
Fourteen months after the Sept. 11 terrorist attacks, America remains a nation consumed by worries about safety and security. Hospitals, which serve both as potential targets for criminals and terrorists as well as healing institutions for victims of crime and terror, have invested millions of dollars in high-tech security systems. Joseph Freeman, chief executive officer of Newtown, Conn.-based market research and consulting firm J.P. Freeman Co., says though the hospital security market is highly fragmented, spending will increase 13% this year from 2001 to $272 million. That figure does not include guard or investigation services but does include burglary, access-control video surveillance, closed-circuit TV, biometrics and locator product spending.
Sales of radio frequency-based tracking systems have skyrocketed in the past few years, from about $1.8 million in 1999 to nearly $21 million this year, according to New York-based consulting and research firm Frost & Sullivan. The firm predicts that sales of such systems will exceed $66 million in 2004.
The latest healthcare security systems typically include multiple video cameras and monitors, access-control systems with automatic door locks, employee and patient identification software, and baby-matching systems that make it nearly impossible to abduct a newborn or accidentally assign an infant to the wrong parents.
Hospital risk managers and facilities directors say the new systems reduce the risk of theft, wandering patients and potential attacks against patients and employees, while protecting both groups and improving productivity. So why aren't more U.S. hospitals installing these programs?
In spite of all the whiz-bang benefits, including tighter security, greater productivity, reduced liability, stronger risk management and peace of mind, the high-tech security programs also pose barriers. Obstacles to hospitals purchasing and implementing such programs include employee and physician concerns of potential privacy violations and union objections that the programs could be used as spying tools to support disciplinary actions and cost. Most of the sophisticated tracking programs cost at a minimum in the low six figures and can exceed $1 million for full-hospital or system installation.
American Hospital Association spokesman Richard Wade says the high cost of these state-of-the-art systems has deterred some hospitals from making purchases. Wade says today's economic realities of reduced government and managed-care reimbursements, higher insurance costs and government mandates for compliance with the Health Insurance Portability and Accountability Act of 1996 compel hospitals to prioritize spending.
"The biggest priority for most hospitals now is information systems that help with documentation, billing and patient safety," Wade says. "The question is how do you align those priorities?"
Wade says health systems typically consider integrating new high-tech security systems when planning replacement hospitals or large expansions. But he concedes some CEOs are deterred by the potential for intruding into the privacy of patients, employees and visitors, posing divisive labor and physician issues.
When looking at these systems, hospital administrators and boards face a dilemma: The programs work so well that they frighten key hospital constituencies, particularly unions and physicians. Some fear the intrusion of an unseen Big Brother and question whether the systems function as just another way of disciplining employees, tracking their time away from their stations or punishing vocal union members.
Page Gravely, a healthcare defense lawyer with the Richmond, Va., firm Crews & Hancock who specializes in hospital risk-management issues, agrees that the technology can be a double-edged sword.
"But you have to be absolutely clear what your reasons are for implementing it," Gravely says. "It's important not to put technology before your people or the policy-development process."
Gravely says the decision to purchase a security system is often incident-driven: a baby abduction, a shooting in the ER or a fire claiming patient lives.
"Buying this sophisticated technology can be a wise investment, but administrators need to clarify their expectations and be prepared to deal with the secondary risk issues posed by the systems," he says.
For example, he says, hospital security and staff must be better trained to respond if a weapons-detection system detects a gun. The technology alone won't disarm potentially harmful visitors. Added training and even more security personnel may be required at a higher cost. And if the hospital advertises its state-of-the-art system to the public, it could face a higher standard of liability in negligence or wrongful injury suits if that system fails.
Carl Mogavero, president of the Glendale Heights, Ill.-based International Association for Healthcare Security and Safety, agrees. His organization has 1,700-members, mostly hospital security system directors. Mogavero, who is director of security services at 181-bed Cook Children's Healthcare System in Fort Worth, Texas, says hospital managers must conduct risk assessments before shopping around for security systems.
Mogavero says hospital security officials face a delicate balancing act between safety and security, privacy, risk management and cost-effectiveness concerns. "Legally there are certain areas where we can't set up video monitors or tracking systems, like employee locker rooms and toilets, but there are some areas we have to keep an eye on. And reasonable people can come to an agreement about what they do and do not want."
Michael Liebowitz, director of risk management and safety at 334-bed Bridgeport (Conn.) Hospital and a vice president of the Risk Insurance Management Society, a not-for-profit educational association for risk-management professionals, says his hospital could use its badge-identification system to discipline employees but does not.
"That would require permission from senior management," Liebowitz says. "The system is not turned on for that purpose."
But he says it is capable of tracking employees and staff physicians entering and leaving the garage. He cites an example of a physician who was supposed to be working a day shift at the hospital but left the building each day for extended periods and denied the absences.
"We used the technology only one time to confront him about his disappearances but never took action. Once he realized we had him, that kind of behavior stopped immediately," Liebowitz recalls.
Liebowitz says the ID-monitoring system is comparable to the posting of security cameras. "I don't see this as a privacy issue," he says.
Carol Bickford, a nurse and senior policy fellow at the Washington-based American Nurses Association, says her association hasn't yet developed a policy about the high-tech systems.
"But it's on the horizon," Bickford says. "In the last year or two we've taken many calls about these technologies. There is clearly the issue of purpose: Why are they needed? We think the technology must be appropriately installed. If that means tagging (intravenous) poles, wheelchairs and other equipment and patients, then that has some antitheft, time management and safety value. But if the monitors and badges are identifying where employees are moving and are locating monitors in places that invade the privacy of individuals, then those issues must be addressed in collective-bargaining agreements to prevent them from being used for punitive reasons."
Bickford says she hopes nurses aren't being singled out for tracking for productivity reasons. "That denigrates the concept of professionalism," she says.
Bickford's concerns are not echoed by officials at the 1.5 million-member Service Employees International Union, a Washington-based organization that represents several hundred thousand nurses and other healthcare workers. An SEIU spokeswoman says although the issues of workplace privacy and the systems' potential as disciplinary tools concern the union, they have not yet been presented as contract-negotiating points.
Facing the unknown
Deborah McKay, a University Medical Center nurse and member of SEIU Local 1107 in Las Vegas, which represents nurses and other healthcare workers at UMC and other hospitals, says there were some concerns when the system first was proposed.
"People will always resist the unknown," McKay says. "But they assured us it wouldn't be installed in restrooms. And once the system was up and running, we immediately saw how beneficial it was for us. We can show patients and family members when there's a question or complaint when we were there. And if a doctor needs me, he can call me in the room as opposed to having somebody going into every room looking for me. It saves a lot of time and helps us address patient needs better and faster."
Officials at hospitals that installed the programs, which are produced by industry systems-control companies and medical equipment manufacturers such as Andover Controls, General Electric Co., Hill-Rom, Honeywell and Johnson Controls, say top management and boards must initiate the effort and seek buy-in from all affected parties.
UMC CEO William Hale says his management team and board made safety its No. 1 priority. "There was some screaming from unions about Big Brother, but we were able to educate everyone that we weren't doing this to spy on them but to protect our patients and employees," Hale says.
He acknowledges the hospital has not yet documented tangible savings from the installation of the high-tech security systems. But he notes that safety was the top priority, not return on investment.
"We're still young in the process," says Hale, who notes that UMC earned $10.1 million in net income on fiscal 2001 revenue of $359.4 million. "Our medical-error rate has fallen since we installed our prescription drug-monitoring system. In the long run, we expect this will save us money from a liability standpoint. We hope to see lawsuits and employee accidents going down."
Chris Roth, UMC's director of facilities, says the life-safety system includes components from multiple vendors integrating fire and smoke detector alarms, access-control systems that include automated door and elevator locks, nearly 200 video cameras controlled by a state-of-the-art monitoring multiplex, heating and air conditioning controls, a nurse-locator system that relies on local positioning technology in the ER and intensive-care unit, and a baby-matching and abduction-prevention system.
"Our first priority is protecting the lives of patients and the people who work here," Roth says. "All of our systems are automated but can interface manually, and are buffered by backup generators. On a computer screen a technician can pull up floor maps of each building, floor, wing and room. The level of detail and specificity is amazing."
For example, if a piece of missing equipment is tracked to the garage, security can prevent the thief from leaving the parking lot.
Roth says UMC spent $500,000 to install the Hill-Rom nurse-locator system in about 20% of the facility and has budgeted about $2.5 million to complete the job. In addition, the hospital has spent another $2 million on its infant-security program and on integrating its fire alarm and heating and air conditioning-control system. He says the move to purchase and install high-tech hospital security systems was driven by the county-owned hospital's administration and supported by its board of trustees, who also serve as Clark County commissioners.
He says the systems were introduced with the promise that they would not be used for disciplinary purposes and would not monitor restrooms.
Winning over skeptics
The hospital's three emergency rooms-- pediatric, adult and trauma--logged a combined 111,000 visits last year. Emergency services manager Rolfe says the new 59-bed adult ER alone is triple the size of the old facility and bigger than many hospitals.
"In our old ER we were on top of each other and people were easier to reach and communicate with," Rolfe says. "But emergency room physicians and nurses are extremely independent people and the new system presented an issue. It was an issue we were prepared to address multiple times. We showed the staff how separated we would be in the new facility and pointed out that we wanted this to provide better patient care. Before we moved in we gave them a chance to try it out and play with it."
Rolfe says he uses the access-locator system to find doctors, nurses, staff and equipment. He says the new system decreases overhead paging, a constant annoyance, because he can locate a nurse and talk directly with him or her. "We don't have time to waste looking for staff members in the emergency department," he says.
Rolfe says nurses put up the most initial resistance.
"They wondered why we wanted to watch them and follow them, and we were kind of taken aback," he recalls. "We said we were just trying to make it easier for them to do their jobs."
He cites as an example a patient's relative complaining that no hospital staff had responded to the patient after repeated requests for help. The relative filed a formal complaint. "We were able to pull up documentation that proved someone had arrived within 35 seconds and we were able to dispute that (complaint)," he says.
Rolfe says the ER has attached tracking locators on valuable equipment and telephones needed for patient care. "I can find out quickly that the ventilator I need is in Bed 8," he says. "That's been a big benefit."
The hospital formed a committee several years ago to study the problem of infant abduction after a baby's kidnapping at a neighboring hospital garnered national headlines. Staff learned that since 1986, 187 babies have been abducted from hospitals, but in the same time more than 25,000 babies were mismatched, Roth says.
"We felt very good about our infant abduction-prevention system, but we were not doing anything about baby and mother matching," he says, pointing out that more than 450 babies are born each month at UMC. "We decided that was a void we needed to fill. So we took a good system and made it better, integrating our existing card access-control system and camera monitors with a baby-matching system."
That security system was installed this year in the hospital's seventh-floor tower housing labor and delivery units. Immediately after delivery, mothers and babies are fitted with matching identification bands containing identical matching tracking devices. The security system, which combines infrared detectors and radio frequency antenna, is integrated into the floor's elevators and doors.
"If a baby presents without being discharged, or leaves with someone other than its mother, it will be trapped on the floor. Elevators will remain open and doors will be locked shut and escape prevented. Red lights flash on the floor and security is alerted."
Roth says another benefit of the nurse-locator system is it makes it possible to track staffing needs.
"If people aren't responding timely to patient calls, we can record that and increase staff when it's needed," he says. "This can be a very valuable management tool."
He says there are many intangible benefits that probably go unrealized.
"A secure environment doesn't always show a return on investment. It's hard to quantify the impact of nurses or doctors being unable to find needed equipment quickly or somebody unauthorized walking out the door with a laptop. I think we'll save money lost through theft. But we're trying to quantify the savings and we're documenting our tangible savings. It's not just about the dollars, though."