The early October wildfires in Northern California and recent spate of hurricanes in the Southeast and Puerto Rico reinforce the fact that the healthcare community is in need of more stringent attention to organized and community-supported Emergency Management.

Regulating Healthcare Facilities

With the potential for catastrophes in the future, the Centers for Medicare and Medicaid Services (CMS) has been working on "All-Hazards" Emergency Preparedness for several years and published CMS-3178 - The Final Rule for Healthcare Emergency Preparedness on September 16, 2016. 

The purpose of this new regulation is to:
(1) Establish consistent emergency preparedness requirements across provider and supplier networks,
(2) Establish a more coordinated response to natural and man-made disasters, and
(3) Increase patient safety during emergencies.

This is not a sleepy regulation that gives the healthcare industry up to five years to prepare, like HIPAA (Healthcare Insurance Portability and Accountability ACT). This rule mandates that if healthcare facilities do not comply by November 15, 2017, they risk not receiving Medicare and Medicaid reimbursements in December.

Who does this affect? This applies to seventeen Medicare and Medicaid provider sectors, ranging from Ambulance Service companies to hospice providers, clinical laboratories and everything in between. 

The Seventeen Disciplines

  1. Hospitals
  2. Religious Nonmedical Health Care Institutions (RNHCIs)
  3. Ambulatory Surgical Centers (ASCs)
  4. Hospices
  5. Psychiatric Residential Treatment Facilities (PRTFs)
  6. All-Inclusive Care for the Elderly (PACE)
  7. Transplant Centres
  8. Long-Term Care (LTC) Facilities
  9. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
  10. Home Health Agencies (HHAs)
  11. Comprehensive Outpatient Rehabilitation Facilities (CORFs)
  12. Critical Access Hospitals (CAHs)
  13. Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
  14. Community Mental Health Centers (CMHCs)
  15. Organ Procurement Organizations (OPOs)
  16. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  17. End-Stage Renal Disease (ESRD) Facilities

Beyond the techno jargon and acronyms, the goals of the Rule recognise that there are systemic gaps
that must be closed by establishing consistency and encouraging coordination across the Emergency
Preparedness sector of the United states and its possessions. For example, “The Rehabilitation Center” in Hollywood Hills, Florida that had a portable generator and window air conditioning units because of the extreme heat, causing fourteen deaths, probably would have avoided that tragedy had there been better planning and training for a long-term power failure.

“You can’t just back up a generator to a nursing home and plug it in,” said Bob Asztalos, a Florida lobbyist at a recent Florida state hearing. Ironically, this facility was “across the street” from a major hospital and some pre-planning and installation of an “emergency” generator connection with the hospital’s power plant could also have helped immensely. There were several other factors to this tragedy-refer to this website for a CBSN video about the facility.

Las Vegas Shooting

The Oct. 1 mass shooting in Las Vegas where over twenty area hospitals were dealing with victims further reinforces the need for better “community-wide” support and communications.

Further, there are four requirements that facilities must fulfill complete before the deadline:

  • Risk Assessment and Planning Document
    Each individual facility must (internally or externally) perform a Risk Assessment to identify the areas that must be dealt-with to conform with the Final Rule.

  • Policies and Procedures
    Based on the Risk Assessment, develop an emergency plan using an all-hazards approach focusing on capabilities and capabilities that are critical for a full spectrum of emergencies, or disaster specific to the respective location(s).

  • Communications Plan
    Develop and maintain a communications plan to ensure that Patient care must be well coordinated within the facility, across healthcare providers and with State and Local public health departments and emergency systems

  • Training and Testing Plan
    Develop and maintain training and testing programs, including initial and annual re-training, conducting drills and exercises (full-participation and tabletop) in an actual incident that tests the plan.
Hospital waiting room
The Rule specifically aims at smaller facilities such as Eldercare Homes and Laboratories that are more focused on patient service

Hardware And Software Demand

What does this mean to the healthcare security and support community? While this rule does not apply specifically to healthcare security and safety departments, consultants who have experience in healthcare risk, vulnerability and threat assessments are best positioned to provide the necessary assessments in a timely manner.

Security Integrators and other support vendors should also be ready for a demand for the following hardware and software to support the mandates of this regulation:

  1. Intelligent Access Control
  2. Visitor Management
  3. Mass Evacuation Alert Programs and Systems
  4. More extensive use of video surveillance so management can quickly assess an incident
  5. Interoperability appliances that community on public service networks
  6. Backup systems for all electronic functions from the Network Architecture to the simplest of healthcare support tools
  7. Electrical Upgrades
  8. Provision of Fresh Water and disposal of Sewage capabilities when the facility infrastructure fails
  9. Additional HVAC support through the facility’s backup systems
  10. Vendors for Fuel and other types of off-site support
  11. Suppliers of day-to-day supplies and medicine
  12. Communications support in the event of landline and cell phone failures

What Should The Healthcare Community Do?

What does this mean to the healthcare community? This Rule is not intended to focus only on large and medium-sized hospitals. It specifically aims at smaller facilities such as Eldercare Homes and Laboratories that are more focused on patient service rather than preparing the facility for a disaster.

Download the entire rule and resource information from the ASPR-TRACIE website. ASPR-TRCIE has been a leader in providing for those desiring additional support in this and other areas of healthcare emergency preparedness. While this rule focuses on Emergency Preparedness, it obviously touches on Business Continuity, Facility Management, Community Relations, Human Resources and other disciplines in the healthcare community. Make sure the C-Suite is aware of this rule and emphasize the timeliness.

Download PDF version

In case you missed it

Top 10: What Were Security Professionals Reading About In 2017?
Top 10: What Were Security Professionals Reading About In 2017?

Our most popular articles in 2017 reflected changing trends in the U.S. security market, from deep learning to protection of mobile workers, from building automation to robotics. Again in 2017, the most read articles tended to be those that addressed timely and important issues in the security marketplace. In the world of digital publishing, it’s easy to know what content resonates with the market: Our readers tell us with their actions; i.e., where they click.   Let’s look back at the Top 10 most-clicked articles we posted in 2017. They are listed in order here with the author’s name and a brief excerpt.  1. Las Vegas Massacre Demands Reevaluation of Hospitality Sector Security The Oct. 1, 2017, sniper attack from a 32nd-floor room at Mandalay Bay, overlooking 22,000 people attending a country music festival, has been compared to “shooting fish in a barrel.” When the bullets rained down, there was nowhere to hide. The attack came from outside the “perimeter” of the event, so any additional screening of attendees would not have prevented it. There are also implications of the Las Vegas massacre for the hospitality industry. Hotels and resorts such as Mandalay Bay have not generally embraced technologies like the explosives scanners or X-ray machines used at airport terminals, at least not in the United States. 2. Deep Learning Algorithms Broaden the Scope of Video Analytics [Zvika Ashani] Until recently there have been minimal applications of Machine Learning used in video analytics products, largely due to high complexity and high resource usage, which made such products too costly for mainstream deployment. However, the last couple of years have seen a tremendous surge in research and advances surrounding a branch of Machine Learning called Deep Learning. The recent increased interest in Deep Learning is largely due to the availability of graphical processing units (GPUs). GPUs can efficiently train and run Deep Learning algorithms The last couple of years have seen a tremendous surge in research and advances surrounding a branch of Machine Learning called Deep Learning 3. Home Security Systems: Why You Need to Upgrade From 3G to 4G Technology [Missy Dalby] The current communication method for most home security systems is via CDMA and 3G (GSM) technologies. With the emergence of faster, better, and stronger 4G LTE technology, carriers are migrating away from old technology standards and methods towards new, more efficient ones. As such, the older technology is going dark, and soon. Manufacturers of cellular modules have stopped making them. At the end of 2018 they will stop letting customers add systems utilizing 3G radios to their channels. 4. Diving into AI and Deep Learning at NVIDIA’s San Jose Conference [Larry Anderson] Video analytics applications fall under NVIDIA's “AI City” initiative, which they describe as a combination of "safe cities" (video surveillance, law enforcement, forensics) and "smart cities" (traffic management, retail analytics, resource optimization). Depending on the application, AI City technology must function in the cloud, on premises and/or at the edge. NVIDIA’s new Metropolis initiative offers AI at every system level, from the Jetson TX2 "embedded supercomputer" available at the edge, to on-premises servers (using NVIDIA’s Tesla and Quadro) to cloud systems (using NVIDIA’s DGX). 5. Physical Security Evolves to Protect Mobile Workers [Annie Asrari] With an increasing number of employees traveling and working remotely, the days of a dedicated worker who commutes to and from a single location every day of the week are just about over. Security professionals must take a second look at their policies and procedures for employee safety. To protect employees in this new mobile world, where people, assets and brand reputation threats may face higher than normal levels of safety and security risks, businesses must focus less on securing physical, four-wall perimeters and instead take a global approach to security that focuses on protecting traveling, remote and lone workers. Businesses must take a global approach to security that focuses on protecting traveling, remote and lone workers 6. New Security Technologies Driving Excitement on Busy ISC West Day One [Larry Anderson] ISC West in Las Vegas kicked off April 5 with an expanding focus on new technologies and new applications, including some that go beyond any narrow definition of security. “Technology is disrupting the market and executives are taking our solutions beyond security,” says Moti Shabtai, CEO and President of Qognify. “They are starting with security and quickly moving to other risk and business continuity issues in the organizations. They want a clear return on investment (ROI), which we can deliver if we move from covering a limited island of ‘security’ issues and give them the value of also managing risk, safety, and operations.” 7. Optimizing Building Automation for Good Return on Investment [Minu Youngkin] Smart buildings are on the rise around the world, not only because a growing number of companies are considering their environmental impact, but also because of the dramatic cost savings that can be realized through integration. In every building that has an integrated security and access control system, an opportunity awaits to also integrate the building’s energy use, water use, ventilation and more. The key is to effectively convey the tremendous potential of this new technology to the end user. 8. ISC West 2017: How Will IT and Consumer Electronics Influence the Secuirty Industry? [Fredrik Nilsson] A good way to predict trends [at the upcoming ISC West show] is to look at what’s happening in some larger, adjacent technology industries, such as IT and consumer electronics. Major trends on these fronts are the most likely to influence what new products will be launched in the electronic security industry. Proof in point is H.264, an advanced compression technology ratified in 2003 and adopted as the new standard by the consumer industry a few years later. By 2009, it became the new compression standard for the video surveillance industry as well. Violence will continue to challenge the healthcare sector in the future 9. The Future of Healthcare Security: Violence Response and Emergency Preparedness [Ben Scaglione and David LaRose] Violence will continue to challenge the healthcare sector in the future. Domestic violence, child abuse, behavioral health, drug and alcohol abuse will all continue to challenge hospital staff in the Emergency Department, Women’s Health, and behavioral health areas. The Hazard Vulnerability Assessments (HVA) along with facility wide risk assessments helps in defining risk severity and identifying historical patterns of violence. 10. Robot Revolution: Uncovering the Real Value of Security Robots [Steve Reinharz] The security coverage that a robot offers in the case of a shopping mall can be easily overshadowed by the fact that the machines seem to serve to entertain the population. Instead, security robots can best be utilized for more high-level roles, such as in critical infrastructure sites, corporate campuses and educational facilities, where wide, expansive spaces require continuous protection. In these locales, security can be difficult to achieve, as cost, location and lack of resources make the logistics of deployment difficult.

How To Prepare For Active Shooter Incidents | Infographic
How To Prepare For Active Shooter Incidents | Infographic

This Active Shooter infographic summarises information about trends among active shooter incidents, and outlines how an organization can develop a plan before tragedy occurs, including:   Statistics on the numbers and types of recent active shooter incidents. A profile of common traits among active shooters. How to prepare beforehand, and what to do when the police arrive. How organizational planning ensures maximum preparedness. Pre-attack indicators to look for. Be sure to share this information with coworkers and managers. Awareness is key to preventing active shooter incidents, and to minimising their tragic consequences. When sharing this infographic on your website, please include attribution to  SecurityInformed.com More resources for active shooter preparedness: How hospitals can prepare for active shooter attacks Six steps to survive a mass shooting Technologies to manage emergency lockdowns  How robots can check for active shooters  Background checks to minimise insider threats Gunfire detection technologies for hospitals, retail and office buildings 21 ways to prevent workplace violence in your organisation Non-invasive security strategies for public spaces    

Intelligent Surveillance: AI For Police Body-worn Cameras
Intelligent Surveillance: AI For Police Body-worn Cameras

Working together to develop an intelligent body-worn camera for public safety users, Motorola Solutions and artificial intelligence (AI) company Neurala are demonstrating how AI can be added to everyday devices such as smart phones using existing hardware platforms.  AI software, working at the “edge,” provides the capability to add AI functionality to existing cameras, such as Motorola’s Si500 body-worn camera. An agreement to develop the products follows Motorola’s strategic investment in Neurala in January 2017. “The technology is real, as our prototypes have demonstrated,” says Massimiliano “Max” Versace, Neurala CEO. “The technology will mature dramatically by the end of the year.” A final, marketable product from Motorola might be a year or more away, and the timing will depend on extensive testing in the meantime, he says. The goal is to enable police officers to more efficiently search for objects or persons of interest, such as missing children or suspects. Adapting Hardware For Artificial Intelligence Neurala’s learning capabilities “at the edge” are hardware-agnostic; its software-only focus enables the principles of artificial intelligence to be applied to a variety of hardware platforms, including low-cost platforms used inside smart phones. Typically, cost and the need for speed are limitations that determine what hardware can be leveraged using the software. The goal is to enable police officers to more efficiently search for objects or persons of interest, such as missing children or suspects In the case of the Motorola body-worn camera, AI functionality is being added to existing hardware in the device, which is much like a smart phone encased in the form factor of a body-cam. Today’s smart phones include cameras, gyroscopes and accelerometers to provide sufficient data to drive AI applications. Software adapts existing hardware to transform them into AI devices capable of continuous learning in the field. Finding Missing People In Crowds Neurala and Motorola are promoting the new agreement with a use case of how a policeman’s body-worn camera could help find a missing child in a crowd. A network “pushes” a photo of a missing child to a network of 1,000 body-worn and/or dashboard cameras in the field, which employ AI to search for the child within each camera’s field of view and then provide an alert when a match is found. The cameras operate passively, without involving police officers, in effect automating the process without police officers having to look at every face in a crowd. AI’s contribution is to eliminate the need for humans to do repetitive or boring work, such as look at hours of video footage. Neurala began working in AI 11 years ago, long before the current buzz in the market. In a sense, awareness has caught up with the company, which has been developing its technologies ahead of the curve. “The same technology could be applied to closed circuit cameras to detect other objects,” says Versace. “The Neurala Brain is neural network software that can be trained to find a variety of objects, such as backpacks or vehicles, in the air or on the ground.” AI’s contribution is to eliminate the need for humans to do repetitive or boring work, such as look at hours of video footage   Adding AI To Existing Security Devices Other applications are also being developed. For example, Neurala has applied its technology to help the Lindbergh Foundation fight poaching of elephants and rhinos in southern Africa using video from drones as part of its Air Shepherd Program. Neurala’s software helps human analysts by searching through terabytes of video, including infrared, in real time as the drone is flying, pinpointing animals, vehicles and poachers during the day and at night. Versace expects the first applications of AI on existing products, including cameras and drones, before it is applied to robotics and other new applications. In effect, Neurala provides a “brain plug-in” that can add AI to change an existing solution from a passive sensor to a device that is “active in its thinking,” he adds. AI is here to stay, says Versace. “The market should know that AI has reached a point of no return. Companies that don’t use AI will be left behind. It’s the way to go to amplify your output.” Does Artificial Intelligence Threaten Humans? However, the technology isn’t perfect and shouldn’t be expected to be. “It’s still a growing technology, so you can’t expect 100 percent correct performance, especially if you deploy it in a constrained environment such as a cell phone,” says Versace. “AI can approximate 90 percent of a human’s ability to detect an object, and it’s tireless and can work 24 hours a day. It’s a liberating technology that takes on jobs that are not interesting, such as looking for a backpack on a computer screen.” AI tends to engender anxiety among some, with people like Elon Musk warning of an existential threat of the technology and a coming AI apocalypse. We should all relax, says Versace. “It’s a liberating technology,” he says. “Anyone who talks about AI as dangerous is not an AI expert. The less you know about AI, the more alarmist you are.” He suggests the physical security market should “learn more about it so they won’t be so scared.”