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Security in healthcare

Healthcare facilities are inherently difficult places to keep secure. On the one hand patients should be able to gain access without going through too much red tape, and staff and visitors need to come and go through many different areas at all sorts of times. They also have a duty of care to protect their patients, and perhaps more importantly their restricted and sometimes dangerous drugs, from unauthorised access.

In this article we asked representatives of several companies to identify some of the requirements and solutions particular to healthcare sites, from access control and surveillance through fire protection and management platforms.

Access control

What are the key elements of access control?

Walter Rautenbach, neaMetrics & Suprema SA: Identification, authentication and authorisation are the basic elements of access control that should ideally be present for a solution to be effective. These elements provide the tools to protect, control, monitor and restrict employees, patients and visitors.

Breaking it down further, access control can be divided into physical and logical access and these two should preferably, but not essentially, be integrated with one another. For example, by bridging the physical and logical access divide, doctors authorise scripts through biometrics, access to stock is controlled through physical access and dispensing is controlled like scripts.

Physical access at doors is a good starting point to restrict entry/access to controlled areas such as research facilities, medical stores, dispensaries, theatre, specialised equipment, children’s wards and ICU. But logical access control is necessary, for example for the protection of the personal health information of patients, for issuing prescriptions and for managing stock.

Access control in the healthcare industry goes beyond simply controlling doors and can be integrated with time and attendance for staff, CCTV, emergency evacuation rollcall, stock management, issuing of prescriptions, medical aid, patient flow control, etc.

Chelesile Moya, IDEMIA Identity and Security South Africa: Biometrics is not only more secured and hygienic but it is also more convenient. The key elements of integrating biometrics for access control in any environment are convenience, performance, reliability, integration potential for instance to make use of health and safety occupational procedure, responsiveness to hygiene concerns i.e. units that can be cleaned with sanitiser and/or to be contactless and the security of ensuring that the fingerprint belongs to the actual person.

Do local healthcare companies understand what is available?

Rautenbach: I believe that healthcare is as educated as other industries, if not more, when it comes to physical access control. In many cases the need for access control in the healthcare sector exceeds the needs of other environments and have been implemented accordingly. We are seeing more and more healthcare companies also moving from flawed tags and cards to implementing biometrics to overcome the weaknesses of sharing these with unauthorised personnel.

Some implementations of substandard equipment have caused setbacks where technology, especially biometrics, is not functioning at critical high-pressure times. Setbacks of this nature are not unique to healthcare and we are at the point in the cycle where users are realising that all are not equal and that more than initial price should be considered.

Moya: The local healthcare companies are aware of the access control technologies that are available to the market. However, the need to sustain healthcare costs is critical, thus the strength of our solutions is that they fit the healthcare user needs, at the right price without compromising on quality.

Given the hustle and bustle, are card or tag access solutions viable?

Rautenbach: In most cases card and tag systems do not deliver what is required, meaning true control of who can access which areas. This does not mean that there is no place for card access as it might still be a good solution to allow patients, with no motivation to share their cards, to navigate through a healthcare facility based on their requirements. This does not mean that biometrics would not serve the same purpose here but a lack of willingness to participate and in some cases a lack of knowledge and also practicality (wheelchairs, crutches) definitely create challenges. Systems that support a combination of biometrics and cards are therefore beneficial where rules and implementation can be adjusted during the lifetime of the system and that caters for non-employees. Employee access to restricted areas should without a doubt utilise biometrics.

Given the intrinsic nature of dirt in the healthcare sector, touch biometrics can be used in controlled environments, but it is preferable to use touchless biometrics in the presence of blood, bodily fluids, etc. Once again implementing hybrid systems, supporting multiple biometric types (face, fingers) can assist in overcoming these challenges.

Five years ago facial recognition was still very unreliable but technology improvements have made this modality very popular in gloved environments, warehouses where employees are carrying boxes, industrial environments where dirt and chemicals play a major role and even for corporates striving for aesthetic appeal.

What products do you supply that would be beneficial to the healthcare market?

Rautenbach: Suprema’s range of finger, face and card readers, managed under one single management platform, allows for easy hybrid implementations suitable for any need. All biometric readers include card/tag readers and users (employee/patient/visitor) can be configured to use biometrics, card/tag, pin or any combination needed. Therefore, mixed implementations are easily supported, enabling clients to enforce the use of biometrics by employees and then allowing visitors/patients to use a card only.

To change these rules as time goes by also does not require replacement of hardware. Suprema’s new generation readers make this even easier by featuring multi-card (different card types) reading technology, meaning that if you previously invested in very expensive cards (formerly sold as ‘more secure’ when biometrics were not available) and you want to change to a cheaper card type, then there is no need to dispose of your current cards. These also include NFC and BLE mobile credentials, meaning your mobile can be used as a card, ruling out excuses such as ‘I lost my card’.

Taking it one step further by looking at the challenges presented by old buildings, where rewiring for the new IP era would cost more than the system itself, Suprema’s CoreStation is the ideal solution. This intelligent centralised access control component allows for using current standard two wire serial cables (RS-485) used for legacy Wiegand readers to be used without a need for new wiring.

Moya: Different types of biometrics are available for different uses and IDEMIA manufactures products such as the Morpho Wave Compact, the 3D Face Reader and we use integrated solutions such as biometrics to ensure identification and access control.

Surveillance

How important is video surveillance in healthcare?

Roy Alves, Axis Communications: Video surveillance is extremely important in assisting everyday operations for example. It can be used to safeguard hospital staff from workplace violence, prevent drug diversion and supply theft, protect infants from abduction or mix-ups, restrict unwanted visitor access, and visualise and communicate with those in distress, particularly with high-risk patients.

Extending the video surveillance further, two-way communications can be provided with nurse call technology. With a range of on-board cameras it is now possible to equip ambulances and emergency response vehicles with remote visual access to assess a patient’s condition.

What benefits does surveillance offer healthcare facilities apart from recording the coming and going of people?

Alves: The main objective with video surveillance would be to improve safety and security for both hospital personnel and patients. Furthermore, a network video solution offers a wide range of possibilities to make a hospital less attractive for break-ins and robberies. As a result, there is the benefit for a safer work environment and reduced costs. With an access control solution the hospital can also easily keep track of who has access and is coming in and out of hospital facilities. Another important aspect would be to deploy a network video door station providing efficient entrance control and visitor verification.

The use of intelligent cameras with motion detection and active tampering alarms helps to quickly detect suspicious actions prior to a crime – in many instances cameras are being interfered with prior to something happening, whereby there is no video coverage of the event after the fact. Cameras automatically send images to a security guard’s phone or tablet if any of the cameras are tampered with, which also saves time wasted in responding to false alarms.

Would video analytics assist in healthcare?

Alves: The facial recognition analytic matches faces taken from real-time video with a database of previously stored images of faces. You categorise the faces in the database based on your application need – be it access control, VIP detection or wanted individuals. When a face is captured on the camera, the matching takes place in real time, and a match or non-match either allows or denies access, or triggers an alarm alerting pre-determined stakeholders to take appropriate action.

Another useful ability of facial recognition is to identify a patient’s demographic (age and gender) that might be entering the hospital or sitting in the patients waiting room. This works together with a number of recent analytics that are maximising in-hospital performance, providing better insight into patient behaviour and floor space activity – ensuring that hospital staff focus on patient engagement, efficiently monitoring queues, and re-allocating hospital staff in real time to better service patients’ needs.

Analytics within these smart cameras, strategically positioned at the entrances, are also able to do people counting in order to understand the patterns of the hospital’s busy periods. Using a number of ceiling-mounted panoramic cameras opens up the possibility to understand movement of the facilities based on heat maps, extending this to overview the queue areas/pay points and patient waiting rooms to create an action rule when patients are waiting too long.

What products or solutions does your company offer the healthcare market?

Alves: Axis provides a wide range of smart network cameras that cater for all these healthcare facilities’ requirements, Axis also provides a range of complete high-quality network audio systems for various use cases in hospitals to improve security on the premises with event-triggered announcements and direct callouts, live or scheduled announcements in different zones at the right time and right place, or lastly to create ambiance with easy and flexible scheduling of great-sounding background music.

As suggested Axis also provides access control solutions that are truly open, providing the freedom to mix and match best-of breed hardware and software and to integrate them seamlessly with other systems, including the surveillance system. They can be used for everything from basic identification and entry control to advanced access management. Lastly, Axis provide a range of video management software platforms that create a single management interface that is intuitive and easy to manage.

Fire safety

What fire safety solutions should healthcare organisations have in place to ensure the safety of employees, visitors and patients?

Brett Birch, Technoswitch: The primary aim of a hospital facility is to not evacuate patients unless absolutely necessary. In order to achieve this, significant thought must be given to addressing the potential fire risks found in healthcare organisations. Investigations worldwide show remarkable similarities in terms of the main causes of fire in healthcare facilities, namely cooking equipment, contained trash, electrical wiring and lighting, heating equipment, and clothes dryers and washers.

Focus on prevention as far as possible – this is vital during the initial build phase. Materials used in the design and construction of hospitals should be non-combustible/non-flammable, should have adequate fire resistance ratings, and should not emit toxic gases or smoke during a fire. On a daily basis, prevention can also be practiced through good housekeeping, alert staff and the use of appropriate fire detection.

Early warning is vital – a fire detection system in a healthcare facility must be able to provide warnings early enough to allow for verification, local control and mitigation. Reduction in false alarms is also critical in order to prevent unnecessary evacuation, and again the choice of fire detection technology plays a big role in achieving early warning, yet at the same time avoiding nuisance alarms.

The use of appropriate suppression techniques is critical in order to minimise damage or the loss of property and life. A comprehensive evacuation plan needs to be in place so that, should the preventative and suppression measures described above fail, all staff members are aware of, trained, and experienced in executing the evacuation plan.

Do healthcare organisations understand the importance of fire safety and pay attention to making sure they comply with regulations and best practices?

Birch: One would hope that with the recent fires in healthcare facilities in South Africa (Groote Schuur, January 2018, 1 death; Swartland Hospital, March 2017, no loss of life but patients evacuated) and in the world (South Korea, January 2018, 37 dead; Coventry Hospital UK, March 2018, no loss of life but patients evacuated) that all relevant parties have had a wake-up call and now realise that it is no longer a case of ‘if we have a fire’, but ‘when we have a fire’.

Compliance with regulations should be a given, but unfortunately we know that this is not always the case. Furthermore, the South African regulations are out of date – the reality is that SANS 10139 Fire Detection and Alarm Systems for Buildings is 5 years old and even worse, SANS 322 Fire Detection and Alarm Systems for Hospitals is 13 years old!

Technology has moved on and findings from fire investigations done during the past 5 to 10 years have resulted in changes to international standards such as the UK’s BS 5839 (on which our SANS 10139 is based) that was updated in 2017. The BS 5839 standard has made specific additions and recommendations with regards to fire detection in healthcare facilities that should ideally be included within SANS 10139 and/or SANS 322 as a matter of urgency.

Fortunately there is a significant amount of best practices available internationally, that local hospital management could use as a resource to ensure that they are keeping abreast with best fire safety practices worldwide, while still complying to – and in most cases exceeding – the local standards.

Given the prevalence of people who are not personnel, how does the site prepare for fire evacuations of people who can’t be part of a practice run?

Birch: A comprehensive evacuation plan needs to be in place and reinforced through regular evacuation training and preparedness. Designated personnel must be appointed and be given specific responsibilities to carry out – and these should be clearly identified in the evacuation plan.

Most modern fire alarm systems in healthcare facilities are now equipped with public address systems that can multitask by providing both automated emergency communication messages and live messaging. A well-designed public address system plays an important role in communicating evacuation messages to visitors who are not familiar with the hospital’s evacuation procedures.

What products and solutions do you have for the healthcare market?

Technoswitch has a range of products which are suitable for healthcare facilities, such as:

• Intelligent fire detection systems which will pinpoint the location of a fire and which offer unique functionality such as a complete false alarm management solution called AlarmCalm.

• VESDA very early warning aspirating smoke detection systems which are ideally suited to protect the computer rooms, operating theatres, MRI facilities, laboratories, nuclear medicine and sterilisation areas.

• Kitchen fire suppression systems to ensure any fires occurring in the kitchens (the biggest cause of fires in hospitals) are contained and quickly extinguished.

• Stat-X Aerosol fire suppression systems for the protection of electrical cabinets and switchgear.

• The Agrippa vibrating pillow alarm which is the convenient solution to cater for the safety of the deaf and hard of hearing when a fire alarm is sounding.

Management platform

What features or benefits, apart from what is necessary as a minimum, should healthcare organisations be looking for in management platforms?

Neil Cameron, Johnson Controls: A BMS (building management system) is not only a management platform that provides a single view and management of multiple building technologies, it is also crucial to ensure that a healthy environment is maintained in a clinic or hospital. The BMS controls and manages the pressurisation of areas and zones, assisting with bacteria control. For example, high pressure is required in theatres and low pressure is required in quarantine areas, ensuring bacteria doesn’t migrate into other parts of the hospital or clinic. The BMS monitors this pressure and regulates it if doors are left open, ensuring no cross contamination.

The BMS also ensures temperatures are maintained optimally in specific environments. For example, an operating room or theatre needs to be colder than a baby nursery.

What does your company offer these organisations in a management platform?

Cameron: Our flagship Metasys BMS solution is a management platform that integrates and manages all components in a building such as heating, ventilation, air-conditioning (HVAC), security including CCTV, alarms, access controls as well as fire detection and suppression. However, it delivers more than just management of the building. Analysing information gathered from the devices and solutions creates an intelligent building, moving beyond building management. Integration with back-end HR solutions, email calendars and more can simplify work life and enhance productivity.

We are perpetually working on enhancements such as the Enterprise Management platform that sits on top of a number of BMS solutions including our own Metasys. Through data analysis, performance improvements, fault finding and corrective action is enhanced, and energy costs can also be significantly lowered.

For more information contact:

Axis Communications, +27 11 548 6780, [email protected], www.axis.com

IDEMIA, +27 11 286 5800, [email protected], www.idemia.com

Johnson Controls, +27 11 921 7141, [email protected], www.johnsoncontrols.com

neaMetrics, 0861 632 638, [email protected], www.neametrics.com

Suprema, +27 11 784 3952, [email protected], www.suprema.co.za

Technoswitch, 27 11 794 9144, [email protected], www.technoswitch.co.za

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