Security cameras have become part of the public landscape, but do they have a place in the medical office? This article will provide an overview of the issues connected with installing video cameras in the office and a framework for deciding whether such surveillance might fit your practice. 1
Attitudes toward video vary. Some consider it a violation of their privacy, while others love posting videos on social media. Regardless of perspective, it is generally acknowledged that security cameras can help prevent unsafe incidents and all would agree that office safety is important to patients, doctors, and staff.
There are no specific federal laws that outline exactly what, where, and how safety video surveillance can be used in a medical office. California law states that cameras cannot be used where individuals have a “reasonable expectation of privacy” but does not specifically address medical offices. Moreover, the California Medical Board, California Medical Association, and American Medical Association have not published official positions on office security cameras. Without such explicit guidance, a physician’s efforts to promote a safe location must be carefully balanced with the obligation to safeguard Protected Health Information (PHI) under HIPAA and other laws. So, where should you begin? It is always best to start with a written policy. Here are some elements to include in a policy:
Purpose — Start with the legitimate purpose for use of a security camera system. Presumably, it is for patient, staff, and physician safety and security.
Locations — Security cameras should be visible – not concealed – and are only allowed in the “public” or common areas (such as the waiting room) and cannot be placed in exam rooms, bathrooms, or other areas where people have a reasonable expectation of privacy. Hallways may be more problematic because of the possibility of the camera’s view extending into an exam room. Cameras should be positioned to avoid view of PHI, such as charts or computer monitors.
Employees — Make sure that employees know there are security cameras. Employees should sign an acknowledgement of the use of cameras, especially if there are cameras in employee work areas – such as a nurses’ station – where workers may have some expectations of privacy. Do not place cameras in employee lunch or break rooms.
Audio — The security system cannot include audio. Audio surveillance is considered eavesdropping and may be a violation of California Penal Code 632.
Postings, notification — Signage stating that there is a nearby security camera should be placed. This discourages claims that someone reasonably expected the area to be private and supports the legitimate purpose — safety. If five percent or more of your patients speak another language, the signage also needs to be in that language.
Archiving — To be consistent with the safety purpose of video surveillance, it is likely you will not need to keep video files for very long. Indeed, safety-purposed video is frequently recorded over or regularly purged. You'll need to plan how footage showing an incident will be maintained. Determine who will be responsible for managing the system, who will have access to the files, and under what circumstances.
Security — The system must be secure, both physically (i.e., locked in a cabinet) and digitally (i.e., password protected).
Privacy considerations — A patient’s visit to the doctor’s office is considered PHI and subject to HIPAA regulations. Therefore, if there is an incident, the identities and images of innocent bystanders will need to be protected.
We hope that these considerations provide a useful entrée into using video to help create a safe office environment. In the unfortunate event of an incident, we encourage our CAP members to call the CAP Hotline at 800-252-0555.
Michael Valentine is a Senior Risk Management and Patient Safety Specialist for CAP. Questions or comments related to this article should be directed to mvalentine@CAPphysicians.com.
1This article is not intended as legal advice and no attorney-client relationship is intended or should be implied. This article is intended as a general overview and a starting point on the issue of medical office video surveillance. Please consult an attorney for advice regarding your actual practices and policies for security cameras.