Fwd: Digital Signature on the CDA

[Stuart Turner]

FYI - regarding digital signatures and attestation of CDA documents

1. Provide a non-repudiation signature that attests to the role and signature purpose of each contributor to the document in support of administrative requirements.

2. Provide delegation of rights where the signer is not the responsible individual or organization (e.g., the signer is acting as an authorized agent).

3. Provide a medical/legal attestation for the purpose of documenting transfer of clinical care (e.g. the Longitudinal Coordination of Care initiative)

~ Stuart

Begin forwarded message:

From: "Robert Dieterle" <rdie...@enablecare.us>

Date: August 14, 2013 6:42:53 AM PDT

To: "Structured Documents WG" <stru...@lists.hl7.org>

Subject: RE: Digital Signature on the CDA

Reply-To: "Robert Dieterle" <rdie...@enablecare.us>

This is the final draft of the HL7 Implementation Guide for CDA Release 2: Digital Signatures and Delegation of Rights, Release 1 – DSTU Ballot – please review and respond by end of day with any critical changes/issues that would prevent it from going to ballot in the current cycle.  Bob Dieterle

 

 

 

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[Michael Martin]

I’m an extreme pessimist on this issue.  I don’t think I’ve met three veterinarians who understand the very basics of simple single digital signatures.  I’ve seen a few very fractured attempts at implementation and maybe one correct one. 

 

Create an exam covering the FIRST of the REQUISITE KNOWLEDGE references and show me half a dozen of our actors who pass it, then I might find this much more interesting. 

 

The one part that may be useful is the process of thinking about what delegation really means in veterinary medicine.

 

I’m afraid I will have been buried dust for a long time before anyone in our group implements this stuff digitally and correctly.

 

Mike

[Stuart Turner]

Valid points.

The broader issue here is the web of trust in clinical information exchange. I assert the apparent apathy is in-part because of the paucity of implementations have limited awareness, discussion and mitigation of the potential medico-legal quagmire we could face. Note I said "potential" and "could". This is to not introduce unwarranted anxiety, however in the human healthcare space I work, in the presence of HIPPA, the most aggressively cautious and prescient individuals have been the general counsels of large hospital organizations. But despite HIPPA (and I presume their primary motivation is to limit business risk), I'm mostly satisfied they genuinely have an interest in protecting the reputation of their physicians and confidence in their consumers (patients). 

I understand your pessimism. I'm also concerned about paralysis from the anxiety of facing hurdles that seem insurmountable. The considerable body of work in (human) informatics makes it difficult to sift through. Of obvious value is the considerable and thoughtful work that has led to designs that mitigate issues that have surfaced after implementation. 

~ Stuart

 

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