Electronic signature and its application in healthcare institutions

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Electronic signature in different areas of life

In previous articles, we have discussed the use of different levels of e-signatures in HR, in real estate agency practices and cross-sectionally in various other industries , such as public administration, banks, IT companies and other types of entities. Similar to these cases, e-signature can also be applied in ambulance services, hospitals and other healthcare facilities.

Electronic signatures are an integral part of the digital transformation that healthcare is undergoing. We are witnessing an unprecedented boom in telemedicine, the number of patient portals is gradually increasing around the world, and European regulation for health data is also in the pipeline. All this requires new data solutions, increased data protection and cybersecurity, in which e-signatures can play an important role.

Specifics of digitalization in healthcare

Although the use of e-signatures in healthcare is not only possible but also desirable, in this sector we encounter various legislative restrictions that partially hinder its use.

Unlike other sectors where contractual documentation is not specifically regulated by law, in healthcare almost every document in relation to the patient is part of the medical record. Act No 576/2004 Coll. on health care determines not only the manner of keeping this documentation, but also its formality. Therefore, if the law does not allow the use of a biometric signature, the healthcare institution cannot arbitrarily decide to do so. Therefore, if the law does not allow it, a healthcare facility cannot decide that a biometric signature, for example, will suffice.

The Health Care Act already refers to the electronic form of signature in its § 20 Forms of keeping medical records. From this section we select:

• Health records shall be kept in an electronic health record book in the national health information system with an advanced electronic signature of the health professional.
• Medical records shall be maintained in written form or in electronic form with a qualified electronic signature, unless this Act provides that written form is required.
• Health records in electronic form with a qualified electronic signature shall be kept on a recording medium in text form, graphic form or in audiovisual form.
• Health records may be kept in electronic form with a qualified electronic signature only if:
  1. security copies of data files are made according to health informatics standards at least once every working day,
  2. accurate records shall be kept of the backup copies of data files made and shall be stored in a place accessible only to persons authorized to make backup copies,
  3. a copy of the archived data is made before the end of the life of the record on the archival medium and the data on the old medium is removed,
  4. archival copies shall be made at least once a year, and the method of making archival copies shall make it impossible to carry out additional interventions in them.

Thus, the law states that medical records shall be maintained in written form or in electronic form with a qualified electronic signature. However, if the healthcare facility does not have a qualified device to produce the QES only the option of written record keeping comes into consideration.

Electronic documentation can therefore be kept, but technically all the requirements set out in the law, as set out in points (a) to (d) above, must be ensured. The medical records must not only be kept in the form of a written electronic document but must also be in paper form. This is mainly to eliminate any risk of loss of medical records.

Our tip: For signatures and seals you need to arrange LTP (Long Term Preservation), for more information see the Archive section.

There are several successful examples in Slovakia where digitalization works. For example, there is a functioning ezdravie system with various modules:

• electronic health book eZK – patient’s health documentation in electronic form, which the patient accesses through an ID card with a chip or an electronic proof of residence via the National Health Portal,
• erecept – electronic prescribing and dispensing of medicines, medical devices or dietetic foods,
• ePN – computerization of the certificate of temporary incapacity for work,
• enarodenie – e-services related to the birth of a child.

The ezdravie system is to be further expanded and gradually more areas will be added that will electricize other areas of paper documentation.

Our tip: We can also digitize healthcare services with all documentation in a different way – through NFQES services. Contact us for more information.

Levels of electronic signature in healthcare

But let’s get more into the practice of e-signatures in healthcare. Real cases of practice show that several levels of e-signature can be applied in this sector.

Digital signature

In practice, digital signatures are mostly used for client authentication and for the purpose of transferring medical records between healthcare facilities. The client is verified in person at the branch based on a phone number and email address and signs the document with a simple electronic signature (online or on a biometric signature board). The exchange of medical documentation then takes place between facilities without further patient interaction. This method works well in practice; we at NFQES have successfully implemented it at the Medante polyclinic.

Advanced electronic signature

An advanced electronic signature provides a higher level of security and is suitable, for example, for the electronic purchase of premium healthcare services. Digital signatures can also be used for this purpose.

Qualified electronic signature

In addition to the fact that qualified electronic signature can be used for keeping medical records, healthcare institutions also need it for communication with health insurance companies and public administration institutions (e.g. the Financial Administration and others). Of course, QES can also be used for communication with healthcare recipients (e.g. B2B contract for provision of healthcare benefits for employees – extra check-ups, discounts at the dentist, etc.).

Electronic signing with NFQES

All levels of electronic signatures (from digital to advanced to qualified electronic signatures) in transactions used in healthcare are made possible by our comprehensive SaaS platform.

Our tip: For advanced integrations of selected features of the NFQES platform into your own HR system, we have prepared our own API. For more sophisticated services that enable you to digitize your signing processes, we are happy to help you implement these within our enterprise solutions, which can be implemented in-house or hosted on our end.

Electronic signatures have the potential to change the traditional functioning of healthcare facilities, facilitating communication with suppliers, customers, patients, and between healthcare facilities. Combined with other digital tools, it can significantly support the efficiency and quality of care provided in healthcare facilities.

Contact us and we’ll be happy to help you secure a qualified electronic signature and archive so you can keep everything fully electronic.