Digital Signatures in EMR

Update: I found this really great digital signature solution for EHRs that might be worth considering as well.

I think there is a ton of misunderstanding about digital signatures. So, hopefully in this post I can clear up some of the confusion of the various types of digital signatures that can occur. It’s important to understand some of the intricacies since there are a number of choices out there. I’ve been working through some of this digital signature stuff for months now and in the next month we’re finally going to have all of the digital signatures implemented in our office.

The first method of digital signature is basically using your login to sign something. This is the most common digital signature in an EMR and many people don’t even realize that what they are doing is digitally signing their chart. Some EMR programs don’t even ask you to physically sign the chart. Instead, they leave the note open for a certain time period. After that time period, then the note will essentially be locked so that nothing can be changed. Why does this type of signature work? Basically it knows that you were the one that logged in and the EMR logs who enters what piece of data. Essentially, the program is leaving your virtual signature throughout the chart as you enter your information. Pretty neat as long as that EMR has a good audit program so you can see who entered what information on a patient.

The second method is similar to the first in that it uses your username. Often, it may use some of the same principles of the first method by keeping track of who entered what information. However, in this method each electronic note requires you to click a button to “digitally sign” the clinical note. This can also apply to lab or x-ray results. This is the type of digital signature that we use most in our clinic. Each note has a button that lets you sign the note electronically. After clicking the button it imprints your name, credentials and the date and the time of the signature. The date and time is especially useful on lab results so we can know when a doctor may have read the lab results.

The third method is what I call “electronic signature” because it literally takes your physical signature and captures is electronically. Everyone should be familiar with this if they have been to a grocery store or Walmart. Basically all of the major chains are accepting your credit card signature electronically now. I can’t say how much I appreciate the digital signature in stores when I’m holding a baby. Have you ever tried to sign a piece of paper while holding a baby in one arm. It’s nearly impossible, but I digress.

I honestly haven’t heard of many (if any) doctor’s offices that are using a signature pad like Walmart does. However, it really is something that is an essential feature of an EMR that wants to have patients fill our their information electronically. Ok, some larger practices can distribute logins to all their patients. However, even then you’d probably need a physical signature to give them the login. My clinic is currently implementing this technology. The signature pads aren’t cheap, but I think they are well worth the money. It basically allows us to make every patient form electronic. This was never possible before since so many required a signature. Capturing a digital signature is what we’re doing to capture this information.

I hope for the signature pads to all to go live in the middle to end of August so look for more information on this coming soon. Is there anyone else using digital signatures with their EMR?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

9 Comments

  • I like the idea. A kiosk for registration that they could fill out the paperwork online and sign the blocks on the screen would be really neat.

  • Thank-you for this post it was informative.
    I have seen some EMR systems that when printing notes to send to a referring doctor or providing a copy of the Medical Record to the patient have a note saying something to the effect — “This record is digitally signed” and name of the practitioner. Is this required by HIPAA. I have seen other systems that do not do this on printed records.
    Thank you,
    Ken.

  • Ken,
    I’ve never personally seen any law stating that you had to do this. However, I’m not a lawyer so take it for what it’s worth.

    I’ve seen both myself and we actually do have the “This document is signed electronically” on most of our notes that were signed with a user’s unique login. I think our EMR provider added this in more as a benefit to people who we send our records to and not as much as a legal requirement.

    The real problem with digital signatures is that they are new enough that there really isn’t much case law on them. So, we aren’t really sure what the courts will do. Although I think it’s also a good sign that we don’t have any case law, because that means that not many people have tried to challenge digital signatures.

    Just a few of my own thoughts.

  • Thank-you for your response.
    Even CCHIT in their specifications do not address this issue. In fact they state that electronic signature standards are still evolving. We will see what the future brings.
    -Ken

  • Hi,

    I have an installation of OpenEMR and am trying to figure out how to integrate signature pad from http://www.ambir.com/ Can anyone guide me to a step-by-step guide or something. I know I have to use notegen.php. Any guidance would be helpful.

    Sincerely,

  • Tariq,
    I’ve only used a different vendor, and our EMR vendor did all the hard work integrating. Although, I know that our signature pad provider had an SDK that our EMR vendor used to integrate the signature pad into the EMR product. I imagine Ambir would have something similar that could be done with OpenEMR. However, it will certainly take some development on the OpenEMR side.

    I’ll reach out to a contact I have at Ambir to see if they can offer any help. Maybe they’d be willing to help contribute some code to the OpenEMR project in order to support their signature pads. It would be an interesting marketing tool for their signature pads since OpenEMR has really gained some traction.

    I’ll also tell you that signature pads can save SOOOO much scanning if implemented the right way in an EMR.

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