Digital Signature Solution Frees the People (to sign Electronic Medical Records)

It would probably be a stretch to compare Beth to the legendary Joan of Arc, since Beth didn't lead her nation's people in battle. However, her business decisions did empower the medical staff at the hospital to leave their desks. And she's a fan of French toast.

Beth, the Records Director at a leading pediatric hospital, was responsible for finding a mobile signing capability for the organization's electronic medical records, enabling the medical staff to sign documentation from multiple locations throughout the hospital. While the organization had an electronic medical records process in place, its lack of an electronic signing solution was forcing the organization to reintroduce paper into the workflow for signing purposes, essentially offsetting the benefits the electronic medical records provided in expedited workflow and cost reduction. Additionally, the use of a printer, scanner and fax in the existing paper-based authorization process forced the signer to work from an office, an impractical scenario for the hospital's mobile medical staff.

In addition to forcing the organization to reintroduce paper into the workflow, the hospital's initial signing process required the medical staff to sign records in their offices, reducing the time available to interact with their patients. Beth sought a solution that would allow the medical staff to sign documentation from multiple locations throughout the hospital, expedite documentation processing, reduce workflow costs, and maintain HIPAA compliance. The solution also needed to be verifiable by the external parties and partners that the hospital sent signed documentation to.

In order to decide upon the most effective solution for the hospital's needs, Beth performed a review of the hospital's workflow processes. During her review she established that the most active 25 Doctors were signing approximately 30 documents per workday each and that the average associated costs per document worked out to approximately $6 in printing, scanning,  archiving  and searching/replacing the occasional lost form. With 600 signatures per signer each month, multiplied by $6 per document, each signer was costing the hospital approximately $43,000 a year. Beth understood that by offering electronic signing capability, she could eliminate the substantial costs associated with a paper-based workflow and speed up documentation processing.

As Beth reviewed the options available to the hospital, she saw that a digital signature solution best addressed the hospital's specific requirements. A standards-based digital signature solution would satisfy the HIPAA regulations calling for the hospital to ensure the confidentiality and integrity of the electronic health information it manages. In addition, a standards-based solution would allow third parties to validate the signatures, improving the external collaboration the hospital maintained with its paper-based signing approach.

Once digital signatures were defined as the most relevant solution for the hospital's needs, Beth began researching the various solutions available. As a standards-based solution with Public Key Infrastructure (PKI)  underpinnings, the CoSign® digital signature solution immediately became a front-runner in Beth's considerations due to its ability to deploy without affecting the pre-existing digital certificate initiative (credentialing approach) that the hospital had in place. Discussions with ARX revealed how the CoSign CA (Certificate Authority) would actually complement the enterprise-wide vision for a digital certificate initiative via its scalability. Eventually, Beth became convinced that implementing CoSign and utilizing a CoSign CA would actually simplify their enterprise-wide initiative and facilitate the hospital's collaboration with external parties.

An equally important feature CoSign provided was its ability to embed signature records directly into signed documents, enabling every captured signature to travel with the document. This Portable Signature Format (CoSign PSF™) enabled anyone to verify and retain proof of identity, intent, and document integrity without costly, complicated, or proprietary software. Such a scenario would allow the hospital's external partners to easily validate its signed documentation as easily as they had in the hospital's original process.

Finally, Beth also realized that CoSign's ability to support any user authentication scheme including LDAP, Active Directory®, or PKI mechanisms would be a significant benefit to the hospital and simplify enrollment and maintenance of signers.

With the knowledge that she could easily increase the number of users at a later date, the initial CoSign deployment Beth designed focused on a group of 25 hospital physicians that most frequently approved documentation at the hospital. With each physician's paper-based signatures costing the hospital $43,000 in paper-related costs each year, Beth's decision to implement the CoSign digital signature solution saved the hospital over $1M dollars in the first year of implementation alone. Moreover, the hospital returned its investment in the first two months of its implementation.

In order to address the medical staff's need for a signing solution that allowed for mobility and proximity to their patients, Beth designed the CoSign digital signature solution for deployment via strategically placed kiosks throughout the hospital's facilities. Each kiosk housed a shared terminal that allowed multiple users to access the necessary medical documentation and sign with their individual CoSign digital signature. This strategy freed the physicians from the confines of their desktops, allowing them the flexibility to digitally sign documentation within the closest proximity possible to the patients they were treating. For her work, Joan of Arc was canonized as one of France's patron saints. Beth is satisfied with a good parking space at the hospital.