Somebody's watching

Though visitors at facilities run by Carolinas HealthCare System might realize that they're walking past security cameras, most have no inkling of the advanced technology and analytics tracking them.

Behind the scenes, an advanced video monitoring system tracks feeds from digital and analog cameras arrayed across the system's facilities in North and South Carolina 24 hours a day, using motion-detection and facial-pattern-recognition algorithms to produce pictures of passers-by and notes of when quiet periods are disturbed by unusual activity.

Bryan Warren, senior manager of corporate security for Carolinas HealthCare, says the video-analytics system made by 3VR recently came in handy in fingering a thief who had used an old ID badge from a hospital construction contractor to go on site and pilfer $30,000 worth of copper.

“We were able to go back, find this person, and get a face shot of him,” Warren says. “We took that back to the contractor, who said, ‘Hey, that's so-and-so, he used to work for us and we fired him two weeks ago.' Case solved.”

Experts say hospitals in increasing numbers are deploying security and telecommunications technology more commonly associated with courthouses, banks and 911 dispatch centers, and they're being used for far more than nabbing copper thieves. Deploying more technology has become a common reaction as security threats inside healthcare facilities remain at elevated levels.

Statistics from the Occupational Safety and Health Administration say hospital nurses face more than triple the average chance of being assaulted on the job as an average American worker. Joint Commission records show an elevated level of violence in healthcare facilities in 2011, one year after the organization issued a Sentinel Event Alert for such incidents in 2010.

Hospitals are adopting everything from remotely controlled access doors and 21st century digital surveillance systems to badges and pendants that can remotely track people's whereabouts.

Just out on the horizon, hospital security officials are looking ahead to advances such as facial-recognition software that can accurately compare visitors' faces to known mug shots and send alerts when specific people arrive on campus, such as estranged spouses or past perpetrators.

The Holy Grail of hospital security, experts say, is a system that could combine every security-related system into a single converged enterprise, which, when linked with the IT and human resources departments, could scan for patterns or anomalies and improve overall “situational awareness.”

The downside is that the growth of these systems can create a kind of security creep: Megapixel cameras gobble up bandwidth that would otherwise be used for patient-care needs, and growing budgets for new gadgetry consume capital funds that would otherwise go toward expenses such as electronic health records or information security.

Because of the need to balance the demands on time and resources, security officials say the acquisition of new security technologies can expose conflicts and weaknesses between departments in a hospital.

“A critical aspect of this is the security administrator must work closely with the IT department, because the IT department has the responsibility to vet all these technologies and make sure they fit into the overall system,” says Robert Owles, president at Owles Security Consulting, Waco, Texas. “There should be a big concern if there is a gap in cooperation or communication between the director of IT and the director of security.”

Though hospitals once occupied a sacred place in the minds of Americans, healthcare facilities today are subject to the same kinds of violence and disruptive behavior as any commercial building or school.

That's why healthcare architects start pushing security needs before the first shovelful of dirt ever flies for a new project.

Scot Latimer, managing director of healthcare solutions at real-estate management firm Jones Lang LaSalle, says healthcare facilities are conceived with an eye toward keeping patients and visitors out of blind corners. One key question to consider is whether metal detectors will be needed.

“We always ask that question, and depending on what we have seen compared to other places, we might turn up the volume on that question or be more proactive: ‘We really think you should think about this' or ‘We will add the room so that you can add this later if you want it,'” Latimer says.

Observers say the areas of a hospital most in need of security enhancements include traditionally sensitive areas such as emergency departments, behavioral health sections, parking lots, pharmacies and nurseries, as well as IT departments where personal health information is physically stored on hardware.

But security precautions have always conflicted with hospital administrators' desire to have their buildings feel welcoming and accessible.

Tony York, senior vice president of Denver-based security outsourcing firm HSS, says limiting access is one of the first security solutions—particularly for Level 1 trauma centers and urban hospitals in general.

“It used to be all doors were open day and night,” he says. “Primarily what you're starting to see is organizations are getting into securing and controlling access to an organization, limiting the number of portals.”

Common access-control technologies include badge-swipe readers and ID cards that transmit signals to open doors as the wearer comes near. In some places, they're being supplemented with biometric scanners such as fingerprint and palm readers, says Mac McMillan, CEO of CynergisTek.

Another growing technology in hospitals is the use of communication pendants worn by staff members.

Rob Devitt, CEO of Toronto East General Hospital in Ontario, Canada, says the 475-bed hospital provided pendants to all of its patient-care staff several years ago. Every device includes a button that, when pressed twice, triggers an all-call for security staff in what the hospital calls a Code White.

Each pendant also has an active RFID (radio frequency identification) tag that tells security officers the precise location of the staff member requesting assistance.

“It's been brilliant,” Devitt says. “Our response times to Code Whites dropped 50%, which meant our security officer was on the scene in less than a minute on average. This in a building that has nearly a million square feet.”

The system cost roughly $2 million Canadian several years ago, he says, including the installation of ubiquitous wireless technology throughout the hospital.

By far the most common security technology cited by experts is the security camera.

Nearly every hospital is already outfitted with cameras, but most are old analog units essentially hooked up to VCRs.

Jim Stankevich, healthcare manager with Software House, a subsidiary of Tyco Security Products, says hospital administrators across the country are considering upgrading to digital cameras.

The newer units—also called IP cameras—have better resolution, zooming capabilities and wider fields of view. But they can run into the hundreds or thousands of dollars apiece.

“I would say most hospitals have anywhere from 50 to hundreds of cameras, so you're talking a big investment. And when you talk about the higher megapixels, you're getting IT involved because the data over the network comes into play,” he says. “It's not a simple, easy conversion and it's not inexpensive, so I think most people are coming up with two- and three-year plans.”

In the meantime, security officers can have feeds from their analog and digital cameras fed into a common analytics recorder, which can scan the traditional, lower-resolution images in ways similar to how the newer pictures are processed.

“You can have analog cameras out there coming into a very smart digital recorder that is satisfying your needs, so you may not want to switch,” says Tim Dewell, director of facility solutions at Diebold. “Traditionally, the reason people would change typically is because the image quality and resolution is better with IP cameras.”

In state-of-the-art security systems, cameras have the largest impact when they're combined with other systems—for example, using them in conjunction with access-control systems to monitor for unusual patterns like certain badges being used to access pharmacy shelves.

“Putting these systems together has an accretive value that is sometimes more valuable than the individual systems themselves, so we are seeing some activity in combining these systems,” says Bill Lawrence, director of service solutions and platforms at ADT Security Services. “By correlating these events through this higher-level (system) … you have much broader situational awareness.”

However, many security experts such as Carolinas HealthCare's Warren—who is also president-elect of the International Association for Healthcare Security & Safety—emphasized that technology is no replacement for competent staff.

“Taking in the entire scope and breadth of technology, one of the most important things to remember is that while it is an important force-multiplier, it does not replace training and it does not replace staff,” Warren says. “The best camera in the world can't reach out and stop the bad guy.”