Digital signatures in electronic health records: a scoping review

Purpose This scoping review sought to understand the current knowledge on using digital signatures in implemented electronic health records (EHR). Methods Our research was carried out on ACM Digital Library, ArXiv, Embase, Engineering Village, IEEE Digital Library, LILACS, Livivo, PubMed/MEDLINE, Scopus, and Web of Science, and gray literature was searched on Google Scholar and ProQuest Theses and Dissertations. Studies related to and associated with using digital signatures and their different types of extensions and forms of storage in EHR worldwide were included. Six authors independently collected the information and assessed the methodological quality of the studies, which quality was evaluated using the JBI Critical Appraisal Checklist. Results A total of 8,834 studies were initially identified, and 4,592 remained after excluding the duplicated records. Ninety-three studies were selected for the full-text screening phase, and nine studies were included for analysis following the eligibility criteria. Five studies were limited to drug prescriptions, two were associated with using image records and two studies did not specify the digital signature use purpose. The most cited signature storage format was XML. The included studies addressed six signature compression technologies, such as COPRIS and LINCOS, ECDSA, IPFS, and JPEG 2000. Regarding signature storage architecture, seven studies reported remote storage, while only one used local storage. Other two studies associated local and remote storage with in-app storage. Conclusions Despite the numerous advantages of EHR in health institutions, file security should be a priority in system development, and it still needs to evolve for safe and efficient health data usage. Further research is recommended for developing digital signatures, considering factors such as the time required to store health files.