Representing Data Provenance

Document Metadata

The Document Metadata defined in IHE XDS/XCA/XDR/XDM and in IHE MHD (using FHIR DocumentReference); provides full Provenance for the document the metadata describes. The metadata also describes things beyond just Provenance. See https://profiles.ihe.net/ITI/HIE-Whitepaper/index.html#2-principles-of-ihe-for-health-document-sharing

Document Digital Signature

The IHE-Document Digital Signature (DSG) profile Implementation Guide provides a method for digitally signing documents. Where documents are any form of stream of bytes including CDA and FHIR-Documents. The DSG profile is normative and can provide integrity protection with attribution to the signer.  The Normative publication at IHE is --  https://profiles.ihe.net/ITI/TF/Volume1/ch-37.html 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.

IHE - Document Sharing

The IHE Document Sharing includes Provenance of documents that are shared.  See the IHE whitepaper describing the Foundations of Document Sharing exchanges https://profiles.ihe.net/ITI/HIE-Whitepaper/index.html# see the normative specification on Document Sharing metadata     https://profiles.ihe.net/ITI/TF/Volume3/ch-4.1.html#4.1.3