An electronic signature in its simplest form is a broad term that basically refers to a piece of electronic (non-paper) documentation showing the intent of a person to sign it.

In the absence of an electronic signature, some people will print and hand-sign many documents today.

This thwarts the national and state efforts encouraging health departments to go paperless.

There are several ways to implement electronic signatures.

HIPAA defines the types of transactions that require an electronic signature, lists the entities those standards apply to, and sets some standards around what defines an electronic signature. The HIPAA regulations around electronic signatures are available here.

HIPAA does not specify most of the technical requirements or any of the user experience needed to meet the definition of an electronic signature.

However it’s good to understand the terminology around electronic signatures in order to understand the importance and implementation of them.

There are many aspects to consider when discussing electronic signatures, but for this article let’s focus on the basics:

  • What qualifies as an electronic signature?
  • Who is signing?

What qualifies as an electronic signature?

In order to understand what qualifies as an electronic signature, it’s important to understand and differentiate three terms; electronic signature, digital signature, and digitized signature.


Electronic Signature

An electronic signature as stated earlier, in its simplest form is a broad term the basically refers to a piece of electronic (non-paper) documentation showing the intent of a person to sign it.

Digital Signature

Digital signatures are NOT the same thing as an electronic signature.

While the term “electronic signature” is more broad and generic, “digital signature” is more definitive and precise.

A digital signature always involves a sort of two-way handshake, like a lock and key fitting together.

A true digital signature is typically generated by encrypted software that allows for sole usage by the signer.

A digital signature typically requires a minimum of a date stamp, and preferably includes both date and time notation.

It will also usually include a printed statement such as, “Electronically signed by,” or “Verified/reviewed by,” followed by the signer’s name and sometimes a professional designation.

An example would be: Electronically signed by Jane Smith, MSN/MPH on 10/01/2011.”

Digital Signature in EHR

Digitized Signature

A digitized signature is NOT the same thing as a digital signature.

Using Adobe signing tools to place a saved signature from a file onto a document is considered a digitized signature.

According to Priority Health, “A digitized signature is an electronic image of an individual’s handwritten signature.”(1).  A digitized signature carries some risk because the image can be copied and pasted onto other documents if stored improperly.

Who is Signing?

In the public health care setting, or public health serving home care, there are basically two categories of people signing documents: clinicians and patients.


Clinicians sign documents to attest that the clinical documentation is complete and accurate to the best of their knowledge.

This is called attestation – the act of applying a signature, physical or electronic, to content, as an indication of authorship and responsibility for the accuracy and authenticity of the information.


Patients sign documents for a variety of reasons, including:

  • To indicate they agree with the plan of care
  • To give consent to something
  • To confirm something about their personal health history

Once you understand what an electronic signature is and who should use it, you are ready to learn how electronic signatures work.

Understanding electronic signatures is the key to preparing yourself or your agency to implement them and knowing how they can benefit you.

Look for next week’s article, “Electronic Signatures for Public Health- How do they work?” to learn more on this topic.

Medical record signature requirements, Priority Health

Records Management Guidance for Agencies Implementing Electronic Signature Technologies, 2000,