Hospital Video Surveillance Guide

By Brian Rhodes, Published Jul 28, 2015, 12:00am EDT

This 16-page guide explains the key uses, design factors, and players in the Hospital Surveillance market.


A global group of 50 integrators and consultants with hospital project experience responded, each offering insights in selling, implementing, and maintaining video surveillance systems.

This is a continuation in our vertical specific survey series. Others include: 

Questions Answered

In this survey, we share insights on these aspects of hospital surveillance systems:

(1) The 3 most frequently used special locations for cameras in hospitals

(2) Why legacy systems are commonplace and important

(3) How privacy significantly impacts camera selections

(4) The uncommon approach hospitals take for monitoring

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(5) The most common VMS manufacturers selected

(6) The most widely used camera manufacturers used

(7) Why integration with other systems is uncommon

(8) What is the cause of the worst hospital specs / designs

(9) The typical storage durations held

(10) Biggest Surveillance Improvement Needed

Inside we examine each question in depth and provide the key findings their answers revealed about how hospitals buy and operate video.

Key Findings

The list below summarizes the key finding and patterns found:

  1. Camera Locations: Surveillance use is extensive in hospitals, most typically focused on narcotics or drugs storage, infant nurseries, and public entries, corridors, and waiting rooms.
  2. Legacy Analog Common: Many hospitals still use analog CCTV.  With money for updates thin, many hospitals continue to operate analog systems indefinitely.
  3. Privacy Limits Recordings: Even countries without privacy laws generally observe patient privacy rules and do not record cameras that potentially see sensitive records or areas.
  4. Full-Time Operators Typical: Many, if not most, hospitals employ full-time security staff so that cameras are viewed 24/7/365.
  5. Cameras / VMSes: Among brands, legacy analog providers are still common, but the favored IP providers are the big incumbents that often are 'safe' choices compared to cheaper, but lesser-known and riskier offerings.
  6. System Integrations: Integrating video surveillance with other systems is uncommon. Most hospitals do not integrate systems, however when it does happen infant protection and nurse call systems are common.
  7. Storage: Hospital video is typically retained for 30 days, with cost being the major limiting factor.
  8. A&E Firms Write Bad Specs: Of the various designers and specifiers, the worst overall result comes from general architecture and engineering firms.  Almost all responses describing engineer-firm headed designs did in negative terms, calling their resulting specs mediocre at best.
  9. Needed Improvements: Overall, more cameras to cover more areas are needed. However, integrating other systems with video surveillance, and better upgrade funding were also cited as big needs.

Camera Locations

Question: What are the most common locations for deploying cameras in Hospitals?  Why?

Summary: Hospitals use surveillance extensively, especially for keeping 'high value' items like drugs and infants safe. Many responses explained that cameras are used everywhere, but as a matter of funding priority high-traffic areas are covered first. Public entries, corridors, waiting areas, and garages were specifically mentioned as priorities, regardless of hospital size or geographic location.

Pharmacies & Drug Storage

Narcotics and medicine storage areas are key coverage zones for video, for the purpose of verifying proper access and mitigating theft of high-value drugs.

  • "Pharmacies -This is where the hospital I worked for for 8 years made their first analog to IP conversions. With scheduled narcotics in the area, it is not uncommon to place 10-20 cameras in an area, where under normal conditions, two would suffice. Government mandates on narcotic storage is exceptionally strict, often needing to go above and beyond minimum requirements for state approval."
  • "Meds rooms: View activity at door and Pyxis medication dispensers."
  • "Drug storage and allocation areas for tracking meds"
  • "Medicine Storage for tracking who has access."
  • "Pharmacy, dispensaries: Usually governed by oversight requirements."
  • "Pharmacy/drug storage areas for security of the high risk/high value products."
  • "We will put cameras in to cover the pharmacy as well for obvious reasons."
  • "Pharmacy: used to observe record activity."
  • "Narcotics and dosage dispensaries are critical to auditing who is using medicines for what purpose."

Maternity Wards

Cameras are typically deployed to keep tabs on newborns, often extensively.  The goal is maintain a clear chain of custody and proof of care for all infants born in a hospital.

  • "Birthing area - identify who is coming / going."
  • "Hospitals are chaos, and you never know when you'll have an attempted infant abduction."
  • "All entrances into infant/maternity ward."
  • "Nurseries; kids and abduction concerns"
  • "Anywhere a baby might be seen is important to ensure they aren't taken."
  • "Baby wards get lots of cameras!"
  • "NICU and Delivery Areas, because no one wants to lose sight of babies for a minute."

Public Main Entries, Waiting Rooms, and Lobbies

At the locations where the public at large enters a facility or interacts with medical staff, patients, and the public, surveillance is a priority. 

  • "Visitor/Waiting Areas - After repeated issues, some minor, others serious, we required any new construction or remodel projects to include at least one camera in each waiting room. In some areas of the hospital, you can expect these to be utilized 24 hours. Expect vagrancy, theft, and other issues dependent on hospital location."
  • "Hallways/Entry/Exits - Documentation and visual proof of someone's entire time within the facility is often important. Whether its providing information to police or finding a lost patient, cameras in these areas are great assets in the security field."
  • "Entrances and exits for people tracking."
  • "Exterior building entrances: used to observe and record people coming and going.  Receptionists and check-in desks: used to observe and record activity and assess panic alarms coming from these locations. "
  • "Main entrances: Record all entry/exit activity. This is a common camera placement for any commercial system. "
  • "Common areas like waiting rooms and high-security areas like front desks entry's and roof access points."
  • "Lobby areas: monitor general activity, very typical problem areas, deterrence... payment desks."

Parking Lots and Garages

The areas where vehicles are parked and stored are densely covered as well.  However, video in these areas are not typically collected for reasons other than simple accident investigation or verifying prowlers are not hiding in dark corners.

  • "Parking areas - post incident information and live viewing for safety."
  • "Parking lots, parking garages, valet, elevators. These are the high traffic areas that are used most often. Valet cameras are used to dispute damage claims."
  • "Parking areas: used for vandalism deterrence, employee escorts (usually use PTZ for these)and parking enforcement. Also commonly used in fire lanes for illegal parking and traffic monitoring. "
  • "Our garage systems are vast with lots of blind corners, cameras promote safety for patrons/employees."
  • "Parking Garages - For visitor safety and liability."
  • "Vehicle parking areas, both inside garages and out.  Lots of incidents from damages, vandalism, to collisions."

ERs and Trauma Treatment Rooms

The next tier of surveillance priorities fall to Emergency Rooms and adjoining waiting areas. Several comments noted the unpredicatable and sometimes violent and highly emotional environment of ER waiting rooms.

  • "Emergency Department - This area is just as important in design as pharmacies. Especially when designed as a 24 hour care center, having proper coverage is critical for patients, staff, and visitors. From drug seekers to patients in mental health crisis', above average performance and camera saturation is mission critical."
  • "There have been fistfights and stabbings in the ER waiting room.  The stuff that happened at the accident scene carries into the ER sometimes."
  • "Lots of coverage in ER areas. As to why, the goal we have always been asked to achieve is "who is coming and going", and the ER has by far the most diverse and uncontrolled population compared to other areas."
  • "Critical Condition Treatment, where crowds may be highly emotional and conditions dire."
  • "Trauma Departments have many cameras in the lobbies and intake areas.  Keeping tabs on patients, their escorts, and monitoring traffic is important to operations."

NOT Inside Patient Rooms

However, not all areas are covered.  Several comments made clear that privacy is strictly preserved by avoiding any cameras in patient rooms. These responses were from various regions, not limited to regions under jurisdiction of privacy laws.

  • "Everywhere, as long as you can't see into a private room. You need a view of every exterior door, every elevator bay, every stairwell, the loading dock, the pharmacy, the OB suite, behavioral health and detox, the gift shop, the cashier, etc."
  • "Patent Recovery Rooms are off-limits to surveillance."
  • "No cameras are allowed in rooms with overnight beds."
  • "Privacy is important, but outside of rooms cameras are widely used."

Typical Hospital Users

Question: Who typically uses the surveillance system? How often are live operators used?

Summary: In general, hospital surveillance systems are viewed 24/7/365 in real-time by at least one guard, but several larger facilities with fully staffed departments with multiple operators.

Hospital Security Guards Most Common Users

  • "The security staff, with maybe one or two admininstrators for oversight. Yes, all have 1-2 live operators, but they will tell you that live operator is easily distracted with other calls, incidents, etc. so they rely on archive footage even though there is somebody watching."
  • "Hospital police / security. There seem to always be live operators."
  • "Security guards. Continually in large hospital, after normal business hours at smaller locations."
  • "Security departments take a leading role in video surveillance. Most of our hospitals have a central dispatch center with video walls. In addition individual units may have a live viewing station to assist in workflow management, particularly in large surgical areas."
  • "Security personnel. Generally there is a SOC for live monitoring"

Real-time Live Operators 

Hospitals generally do not just use surveillance as a forensic tool.  The most cases, viewing staff is scheduled for around the clock viewing, week after week:

  • "Hospital staff (monitoring station 24/7) police (monitor as needed - generally after the fact due to an incident)"
  • "Our systems (we had 3 separate platforms), were manned 24 hours a day at two separate stations."
  • "Security operators / facility management It is typically used and monitored 24/7"
  • "Safety & security officers or team at hospital. live operators are available 24 / 7"
  • "Virtually all systems are used by on site security guards. Most facilities have 24x7 guard coverage"
  • "Most larger hospitals will have a 24/7 security departments which view cameras form a central Security Operations Center. It is also common for certain departments to have the ability to view a sub-set of the cameras, for example Emergency Department may view cameras at ambulance entrance, Receiving Department may views cameras at loading dock. It is also common to have separate, stand-alone surveillance systems for clinical use. These systems are used for patient observation and are monitored by nursing staff, not security. These are most commonly used in Mental Health and Memory Care Units."

Privacy Regulations?

Question: Do patent privacy regulations (e.g., HIPAA in US) impact system design or camera placement? In what areas? What are the main challenges with compliance?

Summary: Patient information privacy is mandated by HIPAA in the US, and PIPEDA in Canada, but is not a significant restriction elsewhere. The methods of complying generally mean restricting viewing to authorised staff (no public view), not recording cameras that potentially may 'see' sensitive information, and not recording into patient rooms:

Big Issue in North America 

  • "HIPPA effects placement & if recording is allowed, especially in patient rooms. Need to get their legal dept's approval. Sometime video live viewing is permissible in patient area, but recording is not allowed."
  • "Definitely. There no cameras placed where chart information can be viewed and except for local (not recording) cameras, there are none placed in any sleeping area."
  • "HIPPA will sometimes be used as the reason for not having more interior cameras. Also, privacy regulations will drive the camera system to it's own network and not have it sharing infrastructure with the Hospital's IT network."
  • "Our designs must be signed off by the HIPPA coordinator to make sure they are not violating the rules."
  • "We don't install cameras facing receptionist screens to avoid seeing confidential records."

Restricted Access to Records/ No Recording Typical

Rather that employing elaborate access controls for recorded video that may contain sensitive details, a common strategy is simply to not record video from potentially affected scenes:

  • "HIPPA is generally not a problem as long as both live and recorded video can only be viewed by authorized hospital staff."
  • "Main challenges are in maintaining the security and confidentiality of the information so it does not become public or is misused."
  • "In such instances, we would most likely deploy "view only" cameras with no recording."
  • "If video is not recorded, it generally is not a problem if the viewing areas are restricted to authorized people."

Little Formal Restriction Elsewhere

Elsewhere in the world, patient privacy is a pragmatic, but not legislated issue.  General rules of thumb dictate avoiding camera placement in certain areas, but enforcement is informal if an issue at all:

  • "For us, there are not of those kind of impacts."
  • "In Saudi Arabia, privacy regulations are not a big concern except on operating rooms and clinic rooms."
  • "There is no problem with this in Brazil."
  • "No issues in Ireland.  We do not place cameras in wardrooms."
  • "Not typically to Hungary.  This is a question in common areas where it is allowed to use with for example 2 days recording storage time."
  • "Privacy is not legislated, just expected. Regulations have no impact to Europe hospital designs."

Common Camera Manufacturers

Question: What camera manufacturers do you most often see in hospital surveillance systems? Any idea why they are chosen?

Summary: Existing analog systems are prevalent in hospitals. As a result, migrating to IP often includes legacy analog cameras and brands not typical of new IP-only based systems:

Legacy Analog Common

  • "We see a lot of Bosch and Pelco, especially with the older analog systems that we end up replacing. Most of the time the reason for the original selection is lost, as that person has moved on."
  • "Being in LA we see a lot of older system running Pelco analog."
  • "I have specified Bosch, Pelco, and Axis. No particular reason to use them. Many hospitals still use DVRS and started migrating to digital systems. The aforementioned vendors have encoders for seamless migration."
  • " For legacy / analog systems, we see mostly Pelco and Bosch. "
  • "Our largest hospital system has standardized on Pelco. This was actually determined before we started working with them."
  • "I usually see older Pelco (Endora), Panasonic, or Bosch analog video systems."
  • "Since the hospital I worked for has been around a while, everything was Pelco. They just thought that was the only thing out there so that's what they bought."

Premium Brands Preferred

Beyond legacy consierations, IP systems favor premium incumbents that are viewed as 'safe' choices for performance and ongoing support:

  • "Always big names like Axis, Bosch, Pelco, and Panasonic."
  • "Axis, Bosch, Pelco, Panasonic, Sony. Product choice decisions are commonly made by the client rather than the consultant, and are often based on the preferences of in-house facilities and maintenance personnel. Many of the larger hospital chains have company-wide standards for equipment which must be complied with."
  • "Sony - Top Quality and Stability"
  • "We use a lot of Avigilon, Axis and Samsung in hospitals. Our competitors use Axis, Pelco, Bosch, Honeywell and Panasonic. The customer almost always wants "their brand" because they feel it's the best."
  • "Avigilon and Axis are most common for IP. Mostly because of marketing push."
  • "The top 3 that I have dealt with are Sony, Pelco and Axis. Realabilty is a primary concern followed by continued use of existing systems and price."

Common VMSes Deployed

Question: Which VMSes do you most often see in Hospital surveillance systems? Any idea why they are chosen?

Summary: Because legacy analog systems are in use, about 1/3 of the answers mentioned that VMSes are not typical in hospitals because they are using DVR recorders. Beyond that, many answers mentioned that final VMS choices often are financially motivated by discounted or free camera/recording bundles:

  • "Same answer as the camera brands question. There's a lot of opportunity here. Many places are still on DVRs and have no idea what a VMS is."
  • "Typically there are old DVRs."
  • "Pelco for reasons stated in #8. Now I see a lot of exacq and milestone."
  • "In our geography, Lenel LNVR is used the most because it was added as a part of the access system."
  • "DVRs are used."

Bundled Deals Common

  • "Free bundled software for smaller ones from Axis and Hikvision."
  • "We have utilized Pelco. Primarily due to low cost and no license fees on cameras."
  • "Exacq... It's easy to use and part of the hardware purchase."
  • "VMS bundled from manufacture. Because its free."
  • "Also in some private small hospitals not very offen but there are some NVRs with "free" VMS with limited number of cameras."

Premium Brands Safe Selection

When new VMSes are purchased, selections typically fall to major offerings.  Unlike School Video, where VMS choices are heavily fragmented, hospitals stick with well-represented and well-supported platforms:

  • "We see all kinds of things. Exacq, Milestone, OnSSI, American Dynamics, Honeywell (more than you think), Pelco, Verint."
  • "Genetec and Exacq for Hi/Lo type of selections.  Both platforms are good in hospitals."
  • "Milestone, ONSSI, Avigilon, Exacq. I think most of the hospitals had two or three and at some point tried to consolidate on one."
  • "Milestone, Nice, Genetec are the VMSes sees in hospital surveillance systems. which can integrate easily with third party software for other systems."
  • "We have seen a wide variety of VMS's, including Exacq, Openeye, and Pelco."

Special Applications

Question: How frequently do you integrate with specialty applications like nurse-call, infant protection/anti-theft alarms, or wander management? Which ones are most common?

Summary: Hospitals largely do not integrate systems together, as the majority (~60%) of responses explained systems are kept seperate even if integration is possible.  When systems are combined with video, Infant Protection (anti-theft) and Nurse-Call (emergency assistance) are at the top of the list:

Integrations Not Typical

  • "We had almost no integration's. Institutions like this often have very closed systems that do not integrate well with each other."
  • "Ironically these features are requested in specifications more and more often but they are seldom actually implemented."
  • "There is no integration between systems. Nurse call systems and other systems are all stand alone."
  • "Generally not integrated with other applications."
  • "Inetgrations with these systems is usually minimal, and limited to video call-up during alarm conditions. "
  • "Most VMS are not integrated with other systems. The most common of these systems are Nurse-call and infant abduction."
  • "These other systems are typically present, but integrating them with the video system isn't quite as common."
  • "No integration was required, these systems are treated as stand-alone."
  • "We have not integrated with any these systems."
  • "In my experience, they never integrated with other system."

Infant Protection

  • "A smart, progressive hospital will integrate access controls/video surveillance with infant protection. The purpose is to have the ability to "lock" down the hospital during an infant abduction potentially stopping the abductor or slowing them down which boosts the ability to find them."
  • "Infant protection is the most common. We have not integrated nurse call or wonder management into the security system yet."
  • "Nurse call: Never.  Infant protection/ wander management: Sometimes."
  • "Usually Infant during maternity section upgrades."
  • "Infant protection has been the most common. Need to be very particular about that especially around egress areas and stairwells. Haven't done a video integration with wander management."

Nurse-Call Systems

  • "Of all other systems, nurse call integrations happen but it's still not common."
  • "Nurse call alot for reporting purposes."
  • "Nurse call applications are becoming more applicable in some hospitals."
  • "Not frequently. The most frequent integration is with access control and nurse call systems."

Recording Storage Duration

Question: How long are recordings typically kept?  What drives this?

Summary: One month is most common among hospitals. However, while no 'global' regulations on retention exist, several answers indicated local or organizational minimums must be adhered to:

Minimum One Month Typical

  • "Like most of our customers, hospitals want 30 days on all cameras."
  • "30 days is typical."
  • "We see thirty days often, and it doesn't take a crazy investment for most systems."
  • "The minimum is 30 days."
  • "1 month to 45 days is what they have and use."
  • "In all the hosiptals we've done, 30 days is normal."

Driven by Regulations

As far as leading reasons driving duration limits, cost of storage was the clear reason why video is not kept longer:

  • "Our law is a minimum 7 days"
  • "14 to 30 Days - Administration and sometimes the legal department sets limitations or requirements on total video storage."
  • "2 days by the law."
  • "30 days -3 departments."
  • "It seems one month retention is written into the rulebook."

Longer Durations Wanted

  • "30 days is still the "unwritten rule". They'd all like to store more, but again, cost for add'l storage is an issue."
  • "At [the hospital's] request, we have quoted a SAN that can hold 2 years, but it has yet to be approved yet."
  • "60 to 90 days. Essentially they would like to keep longer but the storage cost requires some compromises to be made."
  • "They want years, even multiple years, but do not have the money to support it, so they stick with about 6 months."

Who Writes the Specifications?

Question: Who typically writes the hospital surveillance system specification? Does this result in good results? Why or why not?

Summary: Unlike City Video systems, where consultants almost always take the lead, hospitals are much more diverse.  Responses generally broke into three equal parts: Consultants, Internal Committees lead by Experts, and A&E led designs.  In general, integrators suggested giving them direct authority to recommend systems was the 'best' choice, but results with Consultants and Internal Experts are generally acceptable.  This sentiment turns very negative quickly when general engineering firms are used, with many comments that resulting designs are 'a total mess' and sometimes 'nonsense specifications'. 

When Consultants Take Lead

  • "Usually the head of security or the Customer brings in a Consultant. Neither are usually end up in a good result. Both either specify a Cadillac of features but only have a budget for a Yugo. Sometimes the head of security is skimpy of the device counts because of budget restraints. Sometimes the Consultant shouldn't be designing security because all he knows is what he reads in a trade magazine."
  • "Consultants do a pretty good job in hospitals."
  • "New or large hospitals normally use a security consultant smaller facilities or adding additional cameras by the hospital security director and staff. It depends on the consultant and if they have kept up with the vast changing landscape of cameras and VMS."
  • "Security consultants. Results are good in general but they are not written to a project specific. So they can be fixed during inplmentations."
  • "Hospitals are also more likely than most clients to hire an independent security consultant to right their specs. If the right consultant, this can yield good results, unless the consultant's hands are tied by the client's predetermined product choices."

When Internal Experts Take Lead

Many integrator members explained that they have key voices even when Internal Experts are tasked with driving system specifications:

  • "The security director. They occasionally use an engineer to assist. The results are honestly very good most times, but that's because the hospital security director position is a lucrative one, so they can hire a highly qualified person to oversee such a project."
  • "Many larger hospitals now have technical security staff that expertise in security and surveillance system. Many of these techs previously worked for integrators and are often called upon to write specs for new projects. Having great technical skills does not necessarily make someone a great spec writer (this is a skill in itself), so often times these specs are less than perfect."
  • " We work with their internal team that manages the system to design the system. They know what they need covered and we design the system to meet their needs."
  • "The director of security does that and is a retired police officer. I've seen good and bad."
  • "The security team writes the spec and works with the IT department for approval on the network. This work because the IT department monitors bandwidth usage on the hospital network."

When Outside Engineers Take Lead

Overall, the worst results were reported when external engineering or architecture firms are tasked to develop designs and specifications:

  • "Our experience is that when the A&E does write the specs, they are often over specified and don't specifically address the actual needs of the client, but what someone else thinks they need."
  • "Architects or MEP firms (that do not specialize in security) frequently put a few symbols and notes on a drawing and call it done. The result is a hodge-podge over time. The best results are where a low-voltage systems consultant with security expertise designs the system. (That's me!)"
  • "Has been engineering firms but they mostly don't understand the special requirements of the healthcare industry. Don't think I've seen a single spec that made sense coming from an Engineer."
  • "Specifications are usually given by electrical design engineer. This result in bad results because he don't have competence in security surveillance."
  • "Unfortunately, in many cases, the task of writing of the hospital's surveillance spec is given to the project electrical engineer as a part of the overall electrical design. Unless the engineering firm has a security/surveillance specialist on staff, the results can sometimes be disastrous."

Biggest Improvement Needed

Question: How would you improve the hospital surveillance systems you have worked on?

Summary: Hospitals generally want more cameras and tight integrations with other internal systems:

More Cameras

  • "I would include more common ares cameras to track incidents and possible trails thru the facility."
  • "More cameras."
  • "Utilization of more HD cameras. Utilization of coax to Ethernet converters to keep system upgrade cost down. Utilization of wireless IP for remote lots/gates."
  • "More camera density would help."
  • "They need more cameras with better specifications."
  • "Having more cameras to view more areas.  This is the biggest need."
  • "Use of more 360 degree cameras."
  • "There are big deadspots that need coverage, and even cheap cameras could be used."

More Integrations

Other comments made it clear that a simple revamp of new technology (higher resolutions, more capable designs) would have a big impact:

  • "Try to integrate access control with CCTV as well as fire detection system. Also integration with nursing call is a good idea."
  • "Integration with other systems."
  • "More alarm inputs and analytics for call-ups. We have seven hospital clients, and none of them can actually watch all their cameras. The operator keeps the most useful views up, and doesn't ever look at the back stairwell exit door, at least until they go into investigative mode. Meanwhile, it's a shady exterior door, and it'd be useful to pay attention whenever it opens."
  • "Better integration with third party systems such as access control BMS and CCTV. Integration between IP patient entertainment and MATV."
  • "Combine the video surveillance with access control and intrusion to work as one complete security system and have it manned at a central security control room. Even guard tours can be done via access control (with the right system)."

More Funding

Other comments made it clear that a simple revamp of new technology (higher resolutions, more capable designs) would have a big impact:

  • "Improvements are limited by the budget, we always try to maximize the number of cameras for the budget."
  • "Cost drives most decisions, which means there's a LOT of improvements that we'd like to make. It's the reality of that market, though, so they do the best with what they have to work with. Ideally, things work out the best when the hospital budgets appropriately so that the right solution can be used rather than just what they might be able to afford."
  • "Expand thier budgets."
  • "Upgrades cost money, and that needs to happen first in the facilities we do."

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