Document Digital Signature

IHE Document Digital Signature (DSG) profile Implementation Guide provides digital signature capability across any kind of document. This includes CDA and FHIR-Documents with the same solution. 

Find the normative specification from IHE --

37 Document Digital Signature (DSG)

The Document Digital Signature (DSG) Profile defines general purpose methods of digitally signing of documents for communication and persistence. Among other uses, these methods can be used within an IHE Document Sharing infrastructure (e.g., XDS, XCA, XDM, XDR, and MHD). There are three methods of digital signature defined here: Enveloping, Detached (manifest), and SubmissionSet.

  • An Enveloping Signature is a Digital Signature Document that contains both the signature block and the content that is signed. Access to the contained content is through removing the Enveloping - Digital Signature. Among other uses, this method should not be used with Document Sharing infrastructure.
  • A Detached Signature is a Digital Signature Document that contains a manifest that points at independently managed content. Detached signatures leave the signed document or documents in the original form. Among other uses, this method is recommended for use with a Document Sharing infrastructure to support Digital Signatures, as this method does not modify the original Document Content. This method uses the Document Sharing “SIGNS” relationship provides linkage.
  • A SubmissionSet Signature is a Detached Signature Document that attests to the content in a SubmissionSet by: containing a manifest of all the other Documents included in the SubmissionSet, and a reference to the SubmissionSet. The Document Sharing “SIGNS” relationship may be used but is not required.

Ink-on-paper signatures have been a part of the documentation process in health care and have traditionally been indicators of accountability. Reliable exchange and storage of electronic data between disparate systems requires a standard that implements equivalent non-repudiation to prevent document creators from denying authorship and rejecting responsibility.

Document Metadata

The Document Metadata defined and used by IHE XDS/XDR/XCA/XDM provides complete Provenance for the document, in addition to other functionality.

see IHE publication --

The IHE metadata is described --

Where each element contributing to Provenance is highlighted.

CDA IG needs work

Document last updated with ballot comments Release1 - Sep 30, 2015. This document has seen little use and needs further definition. As kwboone stated the FHIR definition is better suited.  For the sake of implementation there needs to be a better operational definition of provenance and at what level is this expected. Document, section, data?  From the ONC 2nd Annual Forum it was clear that the industry has not engaged with the concept of data level provenance in a way that can be shared.

Consider HL7 FHIR Provenance…

Consider HL7 FHIR Provenance resources, which are much better suited.