Electronic Signature

The discharge summary says "reviewed and approved". By whom? When? Can you prove it a year from now?

In most systems, "approved" is a status field anyone with the right permission can flip, and nobody can tell whether the content changed after the approval. When a clinical document has legal or medico-legal weight (a discharge summary, a consent, a diagnosis report), a checkbox isn't evidence.

Attestations in openEHR

openEHR has a built-in concept for this: the attestation. An attestation is a record, attached to a specific version of a clinical document or demographic record, saying that somebody reviewed that version and vouches for it. It is part of the same audit model as the AUDIT_DETAILS attached to every change, so it travels with the version and is versioned with it.

An attestation captures:

  • Who attested and when, like any other audit record.
  • Proof: the digital signature or other evidence supplied by the signing system.
  • Reason: why the attestation was made (for example "Reviewed and approved by the attending physician").
  • Pending flag: whether the attestation is still waiting to be completed, for example a document that has been prepared but is not yet signed.

How Atomik handles them

Atomik stores attestations as part of the version they refer to. You can attach one when you commit a COMPOSITION or a demographic actor through the REST API, using the attestation headers of the request (openEHR-ATTESTATION.reason, openEHR-ATTESTATION.proof and openEHR-ATTESTATION.is_pending). See the API reference for the exact syntax.

Attestation data is indexed, so it can be queried and reviewed alongside the rest of the audit information of a version in the Web Console.

Current scope

  • Attestations apply to the whole object (the full version). Attesting only specific items inside a document is not supported yet.
  • The reason is stored as plain text. Coded reasons are not supported yet.
  • Atomik stores the proof it receives; producing and verifying the cryptographic signature is the job of the signing system (for example your application or an external signature service).

When to use them

  • Documents that must be signed by a clinician before they are considered final.
  • Workflows where a document is drafted by one person and approved by another (use the pending flag until the approval happens).
  • Regulated environments where you need to show, later, exactly which version was approved and by whom.

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