FEED MONITOR A monitor that displays camera feeds from the ORs and hallways sits at the control desk at the DISC Surgery Center in California.

EYE IN THE SKY Are Cameras in the OR a HIPAA Violation?

More and more surgical facilities are boosting OR efficiency by mounting closed caption cameras in their ORs. The cameras link to a master camera-feed monitor that charge nurses can watch, so they can alert the turnover team when surgery is nearing completion, dispatch extra help or equipment, and let providers know when rooms are ready for the next case.

But do the cameras pose a threat to patient privacy and violate HIPAA? That could depend on the monitor's location: a secure control room (good) or behind the control desk where the charge nurse sits (not as good). A department of health inspector told a nurse manager to unplug the OR camera system because it violated HIPAA. The monitor sat behind the control desk where the charge nurse sits. The desk area is not enclosed, and sometimes the charge nurse walks away.

The nurse manager, who asked that we not use her name, argued that the OR cameras weren't compromising patient privacy. One, she said, the cameras weren't recording, only displaying a room-status camera feed on the monitor. Two, the cameras weren't hooked into the facility's network. And three, the images in no way identified the patient. Plus, access to the monitors is closely guarded — only employees can go behind the desk and the monitors are password-protected.

Get patient consent when adding these systems, says Karen Reiter, RN, CNOR, RNFA, an administrator at DISC Sports and Spine Center in Southern California. She says her facility has cameras in clinical areas, but that part of the patient consent form specifically includes photography.

"We have been questioned about it at each inspection, but when we show the consent it was OK," says Ms. Reiter. She also notes that the facility has a safety-viewing screen on the camera-feed monitor to help protect privacy.

Others say that it's not only the feed monitor at the control desk that can cause patient privacy problems. One administrator noted that it's important to have secure storage systems for the cameras' recordings. She says that her facility has cameras, but none are focused on clinical areas. "We monitor hallways and periphery," she says. "If cameras are to be included in clinical areas, then specific release has to be attained every time and appropriate mechanisms for storage and retrieval have to be in place along with policies and procedures."

The question of cameras in the OR doesn't just affect patient privacy. One administrator says the cameras could have heavy implications in lawsuits. "Something else to consider is the potential liability that is raised when and if your facility were to be named in a lawsuit claiming malpractice of any sort," he says, noting those files could be subpoenaed.

— Kendal Gapinski