Operating with an Aggressive Dose of Security

CentraCare Health System takes a multi-pronged approach to medical safety and patient care

• By Fredrik Nilsson
• Apr 01, 2013

Four hospitals (St. Cloud, Long Prairie, Melrose and Sauk Centre), five long-term care facilities, nearly a dozen clinics and numerous specialty services operate under the growing CentraCare Health System umbrella in central Minnesota. In the past four years, Centra- Care’s growth has skyrocketed, and so, too, has the need to upgrade its security systems.

CentraCare’s security department has been working hard to coordinate safety and security measures at all of its locations. Faced with a variety of legacy analog cameras and DVRs, an aging access control system and difficult-to-secure narcotics cabinets, the collaborative healthcare group began searching for new technologies to help maintain central oversight of its increasing number of facilities and mitigate risks to patients and staff.

This search led CentraCare to Pro-Tec Design, a PSA Security Network owner and security system integrator based in Minneapolis. Together, they embarked on a multi-year, multi-pronged project that started with replacing the old access control system while shoring up narcotics supervision by integrating IP video, and ended with the hospital’s security team discovering new and innovative uses for their IP security system from the ambulance bays to the ER to the helipad.

Suturing Security Holes

As more medical facilities were brought under the CentraCare name, disparate systems and old technologies between the different properties were raising internal concerns about potential risk and liability. Some facilities used DVR-based, analog surveillance systems. Some relied solely on the presence of security staff. In either case, there was no way for CentraCare to integrate surveillance between the sites or centrally monitor the cameras.

Surveillance wasn’t initially top of mind, however. Access control was CentraCare’s first priority. While many of the facilities used magnetic card readers to restrict employee and public access, it was questionable whether it would be cost effective to expand that system as the number of CentraCare acquisitions continued to grow. All the facilities that housed controlled substances used standard key-entry medicine cabinets. While it required two, separate keys to open a cabinet, duplicate keys had been made and remade over the years, so without an integrated video system, there was no way to monitor who was actually using them.

With the help of Pro-Tec, CentraCare began a systematic upgrade of its security systems across its growing number of facilities.

“[CentraCare] initially called us in to replace their old card reader system,” said Tim Ferrian, director of sales and marketing for Pro-Tec Design. “With all their acquisitions, expanding the existing system would have been cost-prohibitive.”

Pro-Tec recommended Lenel On- Guard, a more scalable, IP-based access control system that could be easily managed over the health system’s network. In addition, CentraCare also began rolling out new drug lockers that could only be opened by authorized hospital staff swiping new ID cards.

“We eliminated the two-key system, but the solution wasn’t foolproof yet,” said Bill Becker, director of safety and security for CentraCare Health System. “Someone could still borrow someone else’s ID to get into the locker.”

This led the security conversation toward video surveillance, and what CentraCare could do with IP-based technology to verify who was really swiping the ID card.

“We’ve now adopted a redundant, cross-reference approach to controlling access to narcotics,” Becker said. “Not only is Pro-Tec Design installing card readers on every new drug locker, they’re flush-mounting miniature network cameras in the dropped ceilings to record who’s actually opening the locker.”

Originally, Pro-Tec installed fixed-dome network cameras from Axis Communications and leveraged privacy masking in Milestone XProtect VMS to ensure that only the locker was seen on video and not the rest of a patient’s room. Today, they have moved toward pinhole-sized and HDTV-quality AXIS P12 Network Cameras that are narrowly focused solely on the drug lockers.

Following the success of the narcotics monitoring solution, CentraCare extended this two-part, access control/ video strategy to other sensitive areas in the hospitals and clinics, including the pharmacies, human resource offices and other high, security-risk locations.

“Coupling these network cameras with access control has become the standard of care for CentraCare,” Becker said.

When CentraCare first decided to expand its surveillance project, Pro-Tec attached video encoders to existing, analog cameras to digitize the video streams and connect to the network that ran back to the main security office in St. Cloud Hospital. Since then, a majority of the legacy cameras have been replaced by more-advanced, high resolution network cameras.

Today, more than 300 surveillance cameras keep watch over CentraCare properties, stretching hundreds of miles across central Minnesota. Only a handful of the original analog cameras, now network-enabled with encoders, are still in place. All the cameras are managed through Milestone XProtect video management software from the health system’s security center. “Because CentraCare runs fiber between most of their facilities, we’re able to stream the video back to St. Cloud’s security center for storage,” Ferrian said. “Where the pipeline is too small, we record and store the video locally. The security director and his team can still view live and recorded video from all the cameras in the system.”

CentraCare currently has about 108 terabytes of total raw storage across the system residing on Pivot3 servers.

“Every year we add more storage,” Ferrian said. “And, every year they find more places where cameras would be useful that are going to need that storage.”

Expanding from Risk Management to Patient Care

While risk management might have been the initial impetus for tightening security, CentraCare continues to broaden its use of network surveillance cameras to include other areas of its operation. Today, Becker’s security team uses the IP cameras on a daily basis to help the medical staff improve safety and patient care.

For instance, security uses HDTV-quality IP cameras to keep an eye on high-risk patients in the emergency and psychiatric evaluation rooms. If an officer watching the video monitor observes a patient growing restless or agitated, they will immediately enter the room to keep the patient from falling off the cart or becoming unruly. The XProtect Smart Client interface allows security to see multiple views at a time, saving the cost of stationing an officer in every room.

“In keeping with HIPAA regulations and our own privacy and confidentiality policies, we don’t record the video in those rooms. We only view it live,” Becker said.

In addition to more traditional locations for video surveillance, such as front entrances, gift shops and food service operations, CentraCare security uses fixed dome network cameras with audio recording capability to monitor their weapons screening area. Security checks everyone entering the building for firearms and other potentially harmful objects.

“Being able to compare what’s being said with what you’re seeing clearly on the screen, helps us in addressing complaints against our officers,” Becker said.

He recalled one person who accused a CentraCare officer of being rude, patting him down inappropriately and then stealing his cellphone. When Becker offered to show the accuser the recorded video of the alleged incident, the complaint immediately evaporated.

Responding to Emergency Fly-ins and Drive-ins

Pro-Tec Design also installed vandal-resistant and weather-proof fixed domes on St. Cloud’s helipad and in the ambulance bay. Becker explains that the cameras serve a dual purpose: to expedite the dispatch of medical personnel and to keep the transport areas safe. The exceptional light sensitivity of the IP cameras make them a good fit for the variable lighting conditions in these outdoor locations because the day/night and wide dynamic range functionalities deliver crisp images around the clock.

CentraCare authorizes Life Link III, its air ambulance service, to monitor the helipad camera from their own dispatch center to make sure they’re not directing one of their helicopters to an occupied pad.

“It’s a good safety catch,” Becker said.

For added protection, Becker always assigns an officer to the helipad, when a helicopter is scheduled to land. That officer is required to maintain constant radio contact with the air service. CentraCare is using this surveillance strategy for the helipads at the Melrose and Sauk Centre Hospitals, as well.

From surveillance stations in the emergency trauma center, security also monitors activity in the ambulance bay, a fast-paced hub of activity that can hold up to as many as six ambulances at a time. Because the IP cameras support audio, Becker’s team has both eyes and ears on the situation to determine if the arrival is a medically, high-risk patient who needs additional emergency staff attention or if a problem patient has arrived and the presence of a security officer is needed.

Protecting the NICU, PICU and Birthing Rooms

The more CentraCare familiarizes itself with the IP surveillance system, the more opportunities seem to arise. For instance, CentraCare has most recently deployed IP cameras along the third floor hallways of St. Cloud Hospital to monitor foot traffic. Coverage of this area was a priority, since the ward houses newborns, infants and mothers.

Because hallway lights are dimmed at night for patient comfort, it was important to install cameras that could deliver clear video in lowlight conditions. Almost immediately after installing new Axis fixed domes, security was able to use the digital PTZ and highly light-sensitive Lightfinder capabilities to track, and ultimately catch, a thief as he passed through the ward. As an added precaution, the healthcare system has long-range plans to install the same cameras inside the neonatal and premature infant care units and the birthing rooms.

While CentraCare staff remains dedicated to respecting the privacy of their patients, they continue to apply an aggressive dose of surveillance to all their facilities to ensure the safety and security of their patients and staff. According to Becker, the pushback from patients has been nearly nonexistent and CentraCare staff has welcomed the step up in security.

“Our employees firmly believe that the cameras and microphones are there for their protection,” he said.

This article originally appeared in the April 2013 issue of Security Today.