Enhanced CDA with Electronic Signature

One of the key technologies in electronic medical record (EMR) is electronic signature which allows healthcare practitioners to sign off on electronic healthcare records. In order to implement electronic signature in clinical environment, two main factors should be considered: how to preserve the electronic signature data and the related contextual information in the EMR documents; how to introduce the tasks of EMR document electronic signature and validation into routing clinical workflow without disarranging well accepted working processes. This paper presents an enhanced CDA structure which extends HL7´s CDA with the signature data presentation based on XML Digital Signature standard. In addition, the optimized workflow of clinical document with electronic signature has been designed. The enhanced CDA and related workflow has been used in the EMR system and implemented in the actual clinical environment. The result shows it can well solve the above problems and satisfy the applicable demands.