Comment

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 -- https://profiles.ihe.net/ITI/HIE-Whitepaper/index.html#26-value-of-metadata The IHE metadata is described -- https://profiles.ihe.net/ITI/TF/Volume3/ch-4.1.html#4.1.3 Where each element contributing to Provenance is highlighted.

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 -- https://profiles.ihe.net/ITI/TF/Volume1/ch-37.html 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.