CDA R3 Flagging verified content changes

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Submitted by: Calvin E. Beebe	Revision date: Sept. 14, 2009
Submitted date: Sept. 14, 2009	Change request ID: <<Change Request ID>>

Issue

Once a verification signature occurs on clinical content, there is a need to ensure that it remain unaltered and intact to ensure the integrity of the verification. With the added support of signing portions of the narrative text content, we need to ensure that signatures recorded on content are still in effect. The process of maintaining the integrity of the content is an application behavior, we are seeking a reliable way to convey the current relationship between the narrative text originally entered and signed with the narrative text currently found in the document.

Recommendation

• It is recommended that we extended signing codes for this purpose.

Currently supported Participation Signature code values are: I for intended, S for signed, X for required.

• This proposal seeks a new code which indicates revisions made post signature to given content.

The value is proposed as “R” for revised. This would allow one to indicate both a previously obtained signature and its relationship to the current narrative text. The signature date would be unaffected, and this value would be applied to previously captured signatures, when the content (narrative text) has changed post signing.

Rationale

When the “R” revised flag is set, it indicates that the content once signed has since been changed and the verification is out of sync with the text. To access the actual revisions made since the signature would require a full audit extract of the document revisions for the document archive since the signature date.

Resolution

If a document is revised, if the signatures on the previous document are not appropriate on the content, then they are not applied to the new document. This proposal was withdrawn by the submitter based on this discussion.