Document Digital Signature

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The Document Digital Signature (DSG) content profile specifies the use of digital signatures for documents that are shared between organizations.


DSG provides a mechanism for using digital signatures.


Electronic documents are being increasingly relied upon in healthcare. Signatures have been a part of the electronic documentation process in health care and have traditionally been indicators of accountability. Reliable exchange of data between disparate systems requires a standard that implements non-repudiation to prevent document creators from denying authorship and rejecting responsibility.

DSG is constrained to XDS. The document content profile can be used as a reference; however, its specifications are used in other contexts. Systems that do not use XDS can still work with their own methodologies, but those methods will not be covered in the document content profile portion of this supplement.

Other IHE clinical domains are encouraged to utilize the digital signature document described in the following document content profile to sign their clinical and administrative documents and use their defined message transfer or use of XDS. For example, Patient Care Coordination could create a patient care workflow that relies on signature or the sharing of patient consent documents.

The infrastructure to do the signing, verification, and identity management exists and is not defined in this document content profile. The specific Private Key Infrastructure (PKI) is not identified by this profile. Whichever infrastructure is selected shall adhere to ISO TS-17090 standards for PKI in healthcare.

The scope of this supplement is currently limited to by-reference signatures, where the signature is a reference to the whole document. This document content profile can be used by domains wanting to implement e-referral and e-prescription using signatures by-reference in XDS.

Other forms of signatures such as embedded signatures and partial XML signatures are out of scope for this document content profile. Eg: DICOM, PDF, Digitally signed report. An XDS Repository is not responsible to validate any signature documents it stores. Only Document Sources and Document Consumer Actors are responsible to produce and process document content.

Systems Affected

Systems involved in this profile are:



Profile Status: Trial Implementation


  • Vol. 3 - Section 5.3

Underlying Standards:

See Also

Related Profiles

This page is based on the Profile Template