Digital Signatures in EMR

Posted on July 27, 2007 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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?