You arrive at the hospital for your scheduled procedure. After checking in with the front desk, you’re directed to a busy pre-op waiting area where you’re asked to take a seat. As you wait for the nurse to call your name, you notice a small camera mounted on the ceiling above the nursing desk.
You remain seated in the crowded room, patiently waiting for your name to be called, but as time passes, you find yourself looking up at the camera repeatedly and you begin to wonder if there will be cameras in the operating room or in your hospital room during your stay, and if they are a privacy risk.
Hospitals have long used video cameras in public areas for security purposes. But there is a growing trend of using video monitoring in patient care areas such as geriatric wards, stroke units, psychiatry patient rooms, and adult and neonatal ICU’s among others, as healthcare institutions strive to achieve efficiency and safety for their patients and staff.
In many cases, the use of video cameras in healthcare settings has many benefits, and in some instances may even be necessary. However, their use in hospitals, clinics, and doctor’s offices don’t come without risks, and it’s not uncommon for patients to have questions or concerns about cameras in medical facilities. After all, hospitals and clinics are places where we expect our privacy to be respected.
In this article, we will take a look at some of the most common areas where cameras are used in healthcare and discuss the pros and cons of each. We will also explore how the use of cameras can represent a privacy risk for patients and staff, and the steps that healthcare institutions can take to mitigate these risks.
Cameras in Hospitals: Where Are They Used?
Cameras in Public Places:
It’s safe to say that cameras are commonly placed in public areas of healthcare institutions in order to help deter crime and improve safety. The most common places you will find cameras in hospitals and clinics is at entrances and exits, in waiting rooms, lobbies, hallways, and they may even be present in stairwells and elevators.
These areas are typically monitored by video surveillance systems that record activity. The footage can be used to review anything that may have happened in the event of an incident. Under most countries’ privacy laws, there is no expectation of privacy in public areas, so it’s generally accepted that cameras can be used in these areas.
Other areas of healthcare facilities where video surveillance may be used for security, that may not necessarily be open to the public, but are public in the sense that there is no expectation of privacy include: equipment storage rooms, pharmacies and medication storage rooms, laboratories, and IT rooms.
All of these locations could contain valuable equipment or drugs that could be targets for theft. By monitoring these areas with video surveillance, it helps to deter crime and also provides a record of any incidents that do occur.
However, the use of cameras and privacy gets a bit more complicated when we start talking about patient care areas.
Cameras in Patient Care Areas:
Patient care areas are places within a healthcare facility where medical care is provided. In patient care areas, patients expect a higher degree of privacy because either their body may be exposed or private medical information or personal identifiable information may be shared. These areas may include examination rooms, operating rooms, recovery rooms, and patient rooms on hospital wards and in ICU’s.
Over the years, more and more hospitals have started using video monitoring in various patient care areas with the stated goal of enhancing patient safety, improving operational efficiency and to boost ROI.
One of the earlier adopters (that we’re aware of) was Greenwich Hospital, part of Yale New haven Health. In 2012, Greenwich Hospital implemented a targeted video monitoring system as part of their fall prevention program.
Unfortunately, falls in hospitals are a common occurrence. They are the leading cause of patient injury and can often lead to fatalities. Falls can also prolong the length of hospital stay, delay rehabilitation, and can have a major financial burden on the healthcare system. In fact, according to a 2019 study, about 700,000 to 1 million falls occur in hospitalized patients in US hospitals each year. Of these, one in four falls leads to injury and approximately 1% may lead to death.
Greenwich Hospital started monitoring patients who were deemed to be at high risk for falling, using cameras placed in patient rooms to observe patient activity. The footage was monitored in real-time by trained nursing assistants who would then intervene if they saw a patient engaging in activities that put them at risk for falling.
The results of the program were impressive, with a significant decrease in falls and associated injuries. In fact, over the first year of implementing the program, they reported more that 8000 interventions and having only one fall.
Greenwich Hospital was not alone in adopting video monitoring system to improve patient safety. According to Greenwich Time, Stanford Hospital also has video monitoring systems in place in some of their patient care areas.
In addition, a recent article published in The Journal of Nursing Quality references a large academic medical center in the Pacific Northwest that has started using video monitoring in select patient care areas. Their experience was successful in the prevention of thousands of adverse events including falls, elopements and abusive behavior.
Richland Hospital, SC has also adopted a continuous video monitoring program for fall prevention which they called “tele-sitter program.” They use a mobile camera system than can be placed in any patient’s room who is at risk for falls. A trained patient support technician then monitors the feed from up to 12 cameras from a remote location, and could intervene when indicated by communicating directly with the patient and calling for nursing assistance.
The results of these programs are promising and suggest that video monitoring can be an effective tool in preventing falls and other adverse events in hospitals.
Other healthcare setting where cameras have been used to monitor patients include psychiatry ward patient rooms when patients are identified to be at high risk for self harm or violent behavior. In addition, cameras have also been used in other clinical settings such as adult and children’s ICUs including neonatal ICUs.
While traditionally cameras have not been used in regular patient rooms in hospitals, this is starting to change. According to ModernHealthcare, since the start of the global COVID-19 pandemic, many hospitals have resorted to adopt video monitoring as a way to enable care providers to remotely monitor and communicate with patients in an attempt to continue to provide care while protecting staff from exposure to the virus.
Other hospitals took on a more customized system including Banner Health that fitted televisions in patient rooms with mini-computers, pan-tilt-zoom cameras and speakerphones. to create virtual care endpoints that allowed physicians or nursing staff to initiate virtual visits with patients while minimizing contact and maintaining physical distancing.
A similar experience was reported at MarinHealth in the San Francisco Bay Area where the hospital installed cameras with integrated speakers and microphones in many of their patient rooms, including ICU rooms to allow virtual patient care.
Overall, there seems to be a trend towards the use of patient video monitoring systems in healthcare settings, particularly hospitals, and its use is supported with a large body of scientific evidence. In addition, the use of video monitoring has expanded to other healthcare settings outside of hospitals.
For examples sleep clinics use video cameras as an integral part of sleep studies that are used to diagnose sleep apnea. Patients undergoing a sleep study are typically monitored overnight in a sleep lab, which is basically a private bedroom in a sleep clinic.
During their overnight stay, patients’ vitals signs, brain waves, heart activity, breathing and leg movements are carefully monitored. Most of this data is collected by monitors attached to the patients before they go to sleep, however, a video camera is also set up in the rooms so that the sleep technicians can also observe the patients throughout the night. This allows them to monitor sleeping positions and look for any abnormal movements or breathing patterns during sleep.
Cameras in Hospitals: What Value Do They Provide?
There are many benefits that come with using cameras in healthcare.
Having cameras in and around a healthcare facility can help to deter theft. This is especially important in areas such as pharmacies and medical supply rooms where drugs and other valuable items are kept.
Video footage can be used to review what happened in the event of an incident such as a fall, assault, or theft. This footage can then be used to help improve safety in the future.
Cameras can also be used to monitor patients for their safety. This is especially important in high-risk areas such as the NICU, PICU, ICU, and recovery rooms. Video footage can be used to review any changes in condition and take appropriate action if needed.
Some patients can be a danger to themselves and others. In cases of high-risk patients, cameras are used to monitor movements and accidents in order to prevent potential problems.
Deter Abuse and Harassment
This works for both hospital staff and patients. Having interactions between healthcare providers and patients or healthcare providers and their co-workers be recorded can help to prevent any potential abuse or harassment from happening. When people know an area is being monitored, it may minimize transgressions and keep disputes from going too far.
Efficiency and Operational Cost Reduction.
According to ZipRecruiter.com, the National average annual salary for a hospital patient sitter in the United States is about $40,000. With the use of cameras in patient rooms to monitor high-risk patients in different healthcare settings, one nursing assistant or technician can monitor feeds from up to 12 cameras in some instances, which can reduce staffing costs.
Risks Associated with Cameras in Healthcare
While the use of cameras provides several benefits, there are also potential risks that need to be considered.
Theft of Footage
One of the biggest reasons why HIPAA violations occur is because of failure to secure and encrypt data.
If patient data is not properly secured, it can be stolen in a number of ways. One way is through hackers who gain access to the hospital’s network and steal patient data. Another way is through physical theft, such as when a laptop containing unencrypted patient data is stolen from a hospital employee’s car.
Theft of patient data can have devastating consequences, both for the patients whose data has been stolen and for the hospital. Not only can it lead to identity theft and fraud, but it can also damage the hospital’s reputation and cost them a lot of money in fines.
Prone to Tampering
Disgruntled employee dishonesty is one of the top most common reasons why there are privacy violations.
Healthcare professionals are people too, and while it’s not an excuse, it’s not uncommon for some to access files they’re not supposed to. Whether it’s out of curiosity, to snoop on a friend or a celebrity, or to commit fraud, there are a number of reasons why hospital employees might access patient files without permission.
Unlawful and Negligent Recording
If hospitals do not perform a risk analysis and have policies in place to ensure patient privacy and personal health information is protected, they can be in hot waters.
While rare, it does unfortunately occasionally happen. In one instance at the Women’s Center at Sharp Grossmont Hospital in La Mesa, California, as many as 1,800 birthing women were illegally recorded in their delivery room. The cameras were positioned in such a way that their faces and genital areas were visible. In 2016, 81 women sued the hospital for “invasion of privacy, unlawful recording of confidential information, negligent infliction of emotional distress, and breach of fiduciary duty,” according to nbcnews.
In another example, a cosmetic center in Toronto, ON had a network of 24 cameras in different locations on its premises including in examination rooms, the operating room, and the pre-operative room. These cameras were recording continuously 24/7 for security purposes, but would often capture footage of patients undressing, and the clinic did not have patient consent for recording. The Information and Privacy Commissioner of Ontario (IPC) conducted an investigations. In its decision 98, IPC concluded that the clinic’s “blanket use of surveillance cameras for non-healthcare purposes” violated the Personal Health Information Protection Act of Ontario.
Compliance With Privacy Regulations
The use of cameras in hospitals and other healthcare facilities is generally more regulated than in other public areas due to the increased expectation of privacy.
In the United States, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a US federal law that protects the privacy of patient health information.
Under HIPAA, sensitive patient information such as medical records and test results can only be shared with authorized individuals. Unauthorized individuals who try to access this information without the patient’s consent or knowledge can be fined or imprisoned.
A HIPAA violation is when protected information is carelessly or deliberately revealed without authorization through negligence, malpractice, or malicious intent. HIPAA is an important law that protects the privacy of patient’s sensitive medical information. By ensuring that this information is only shared with authorized individuals, HIPAA helps to keep patients’ health information private and secure.
To comply with HIPAA, video monitoring in healthcare institutions, whether for security or healthcare purposes, is only permitted in certain locations and must be operated correctly to protect the privacy of the patient.
In general, the use of cameras in patient care areas is only allowed if:
- There is a justifiable reason for the camera to be installed at every specific location.
- A risk analysis is performed to determine any risks to the confidentiality of patient information at any location being considered for placement of a camera.
- Restriction on location of cameras so cameras will not be placed in, or have view of, areas that are designated for personal hygiene or undressing, or in areas where patients or staff have a reasonable expectation of privacy.
- There is no other reasonable means to achieve the same purpose without the use of cameras.
- The patient is made aware of the camera and where possible the patient, their guardian or substitute decision maker have given their consent.
- The footage is kept secure by employing different measures such as encryptions, and limiting and controlling access to authorized personal, and automatic log off settings after pre-set periods of inactivity.
- Ensuring monitors that display the feeds are positioned in areas where only authorized personnel have access, and are not visible to the public.
- Ensure security cameras installed over nursing stations do not have view of video monitoring feeds or nursing computers that may display confidential patient information.
- Have policies within every healthcare institution that defines the principles and procedures related to collection, access, use and disclosure of video footage and health information captures by security or health video monitoring systems.
The Personal Health Information Protection Act (PHIPA) is a Canadian law that protects the privacy of patient health information.
Under PHIPA, personal health information can only be collected, used, and disclosed with the patient’s consent, unless it is authorized or required by law. Like HIPAA, hospitals and other healthcare organizations in Canada must take steps to protect patients’ personal health information from unauthorized access, disclosure, or use.
The Surveillance Camera Code of Practice (UK)
Introduced under the Protection of Freedoms Act 2012 by the United Kingdom, the Surveillance Camera Code of Practice outlines the rules, regulations, and expectations, of the operation of CCTV systems.
The code says, “The government is fully supportive of the use of overt surveillance cameras in a public place whenever that use is: in pursuit of a legitimate aim; necessary to meet a pressing need; proportionate; effective, and; compliant with any relevant legal obligations.”
Meaning, if there is a legitimate aim for using surveillance cameras, such as the safety of patients, and it is necessary to meet a pressing need, such as the monitoring of high-risk areas, then the use of video monitoring is permitted.
The code also states that any organization operating CCTV systems must take steps to protect the privacy of individuals.
Cameras are becoming increasingly commonplace in healthcare settings as a way to improve safety and security, and to improve patient care. While the benefits of video monitoring are clear, there is also the potential for privacy breaches. Placing cameras in patient rooms without patient consent can quickly become a slippery slope toward a HIPPA violation.
When used correctly and with the proper consent and clear policies, cameras can be an important tool in healthcare settings, but it bares the question: How will we know when we’re being watched? It may depend on your location, as some countries and states have different privacy laws.
There are many questions that still need to be answered when it comes to the use of cameras in healthcare. However, one thing is certain: the use of cameras in healthcare is a growing trend that is here to stay.