Richard's Blog

 Posts Tagged ‘Electronic Signatures’

As we develop Therap I try to think not just what is the right type of documentation for providers of service to people with developmental disabilities today but also what will the technology and documentation needs be in 2 years or 5 years or 10 years.  We enjoy discussing where technology is going and how it might affect documentation or privacy or hipaa or other issues.

Last year I had a blog post called “ Has Gutenberg’s 15th Century Printing Press Really Affected Most Daily Progress Notes Yet?”

Today there was an article called “From Scroll to Screen” in the New York Times Review of Books.  Essentially the article talks about the movement from the scroll to the bound book and makes comparisons to digital searching on ebooks. Some excerpts from the article are below and the whole article is available on the New York Times website linked here . (note codex refers to bound books in the excerpts below)

The last time a change of this magnitude occurred was circa 1450, when Johannes Gutenberg invented movable type. But if you go back further there’s a more helpful precedent for what’s going on. Starting in the first century A.D., Western readers discarded the scroll in favor of the codex — the bound book as we know it today.

The codex also came with a fringe benefit: It created a very different reading experience. With a codex, for the first time, you could jump to any point in a text instantly, nonlinearly.

But so far the great e-book debate has barely touched on the most important feature that the codex introduced: the nonlinear reading that so impressed St. Augustine.

We usually associate digital technology with nonlinearity, the forking paths that Web surfers beat through the Internet’s underbrush as they click from link to link. But e-books and nonlinearity don’t turn out to be very compatible. Trying to jump from place to place in a long document like a novel is painfully awkward on an e-reader, like trying to play the piano with numb fingers.

To me certain books work pretty well for the Nook for example – a novel or a piece of non-fiction which I didn’t have a need to search back and forth to find different information. However, I have found that travel guides are really difficult to use on the nook – and really the internet creates the best user experience in finding hotels (for conference planning or for travel) because you can just click on links and find new pieces of information.

It seems interesting to me how documentation will evolve as more and more entry level DSPs have significantly more experience on smartphones and the internet than senior people in an organization might have.

There will just be a different perspective on how one should be able to find information.  I had never before thought about the change from the scroll to a book almost 2000 years ago. Suddenly it was possibly to be searching around a document (a book) rather than have a scroll the size of a basketball court to lay information on to find something.

In some ways an e-book is completely different than a scroll in that you can search for keywords. But if you try using a Nook to find something and its either a common keyword or you don’t know the word – the Nook can be quite slow compared with flipping pages on a regular paper book.

What similar changes occur when going from paper to electronic documentation. There are many benefits to electronic documentation (electronic signatures, time and date stamping, knowing who read a document and more).  But it also is a change. And for people used to one technology (paper, scrolls, nooks, whatever) the act of switching can be a challenge.

These are actually some of my favorite discussions and sessions at conferences. Thinking about how to implement these changes in technology.

I spend a lot of time thinking about what is an electronic signature.  We follow guidelines such as New York State’s Electronic Signature and Records Act (ERSA) Guidelines. Justin had a good blog post on this.

Justin wrote how Therap achieves these by:

1. By having staff sign off on your statement of intent and/or electronic use/signature policy.
2. Therap’s electronic signature on each page is tied to the user though our three-part log in
3. Therap’s extensive physical, software, hardware, and network security along with the prevention of direct user access to the data protect your signature.  This combined with update and activity tracking ensure that you know exactly who does what in your system.
4. Therap has affirmative save, submit, approve and other buttons on pages.

We spend a lot of time and effort making sure that Therap is acceptable as an electronic signature.  And even then many providers are concerned and ask questions.

Then today on the  CYB3RCRIM3 I found a blog post  called  Authenticating a Pseudonymous MySpace Posting
by Law Professor Susan Brenner.

From the blog post it seems one side argued that anyone could have posted certain information which the state wanted to include in the trial.  The prosecution apparently cited

• “As to the adequacy of authentication, the prosecution cited “the content of the profile, which included Ms. Barber’s photograph, her date of birth, and the references to her children.”

And

The inherent nature of social networking Web sites encourages members who choose to use pseudonyms to identify themselves by posting profile pictures or descriptions of their physical appearances, personal background information, and lifestyles. This type of individualization may lend itself to authentication of a particular profile page as having been created by the person depicted in it. That is precisely what occurred here. The Court of Appeals ultimately decided that the printout HAD been authenticated:

There is further information on this case on cyb3rcrim3.  This blog discusses many interesting legal cases involving the internet.

I realize there is more to the case described above than it being an electronic signature. But when I think about the issues we have had with many surveyors and providers regarding concerns of how to know something is really an electronic signature -and then I read how a myspace account is used by the state prosecution in  a murder trial – it just seems like different government agencies are taking different interpretations.

When we see an electronic signature we go to intent – to prove someone intended to sign something. In the case described the issue was basically proving someone was behind the information in the myspace account.

But an interesting issue is raised of whether items like photographs and childrens names (which are essentially public information) can be used to prove signature or even ownership of an account.

I am at HIMSS 2010 in Atlanta this week. Looking forward to their sessions including ARRA, electronic signatures, HIEs and more.

We had our first New York City User Group meeting today. Thanks to Services for the Underserved for hosting and refreshments.

Other agencies in attendence included Cardinal McCloskey Services, Cay Community Services Organization, and Center for Family Support.

Jim Kelly, Justin Brockie (via phone) and I presented with discussions on a range of New York topics including billing, reshab plans, medicaid service coordination, ISPs and more.

As it always seems in New York, a good discussion was held on OMRRD and OMIG and policies of electronic signatures.

The group was already discussing future meetings. So look for announcements of date and time.

We recently posted information about a New York City User Group meeting for November 20 to be hosted by Services for the Underserved.

Our user groups are often held as webinars over the phone and internet. We also hold many meetings in person. We recently held meetings in Buffalo and Monitcello New York as well as Washington DC and Hartford, CT.

One benefit for me personally for a New York City User Group is that the meeting will be close enough to my house that I could actually walk to the meeting after dropping my kids at school and still be on time. I will probably take the subway though -as it is about 3 miles from where I live.

The New York meetings will have a mix of national and local issues – including using Therap to help comply with OMRDD regulations, discussions of electronic signature issues in New York, medicaid service coordinator issues and more topics.

There is a longer list on the site including phone user groups for North Dakota and South Dakota. The Oregon user group will be incorporated into the conference being held in Salem, Oregon in 2 weeks.  And of course we have our annual national provider administrator conference coming up in Fishkill, NY in February

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I read an interesting blog post on FanGraphs attempting to quantify the potential benefit of Yankees Manager Joe Girardi pinchrunning Freddy Guzman for Alex Rodriquez in the 9th inning of a baseball game (excerpted below)

Now, we have to eliminate all the plays where speed won’t really matter – either runner could easily score on a ball that gets to the wall, given that they’d be running on contact with two outs. Neither runner likely scores on a blooper down the line that just finds the chalk or a ground ball past the first baseman that hooks into the corner. The ball has to get past the outfielders for there to be a play at the plate, but not so far past them that they couldn’t get it back in fast enough to make it close at home.
So now we’re talking about a fraction of those one in twenty odds. The real odds of that one specific play happening? One in 50? One in 75? It’s somewhere in there.

I must admit that I find those type of mathematical analyses more interesting that most. But the reason for this post is not to disseminate information about Yankee pinchrunning decisions. And its not to just mention baseball in a Therap blog post- as Justin has not tagged the Mets since June 9.

I started thinking about how much essentially free societal statistical analyses and resources are employed analyzing baseball decisions when compared with equivalent analyses regarding providing services to people with developmental disabilities. Obviously if a baseball fan blogs about a decision it doesn’t really help one team or the other gain an advantage – as the information is available to the public and both teams. But it can help provide better information to both teams.

Many other industries are using predictive markets or monitoring twitter to help in decisions.

To what extent is this happening with services and supports to people with developmental disabilities.
I did some google searches and came up with the following results

Baseball strategy blogs – 13,400,000 responses
Electronic Signature Blogs 1,060,000 responses
Baseball blogs – 53,400,000
Developmental Disability Blogs 323,000

Obviously if there really were 323,000 interesting blogs with analysis of services, supports, management issues, family issues and other topics regarding and analyzing developmental disability that would be more than enough to create some additional useful ideas – that could be implemented by more people than just say Joe Girardi deciding not to pinch-run for Alex Rodriquez in the future.
Keep in mind that many google searches return results like this for Missouri developmental disabilities electronic signature blogs – meaning the google search really is just combining the keywords and really has to do with other issues.

Missouri School of Journalism: Seven to Receive the Prestigious …
Aug 4, 2009 … The Missouri School of Journalism has awarded the Missouri Honor Medal for Distinguished … history and overcoming developmental disabilities. … which recognizes outstanding achievements in electronic journalism. … sports, technology and other subjects with signature wit and irreverence. …
www.journalism.missouri.edu/news/…/08-04-honor-medals.html – Cached – Similar

And that was about the 2nd item on the list.

But if blogs and other websites are replacing old fashioned journalism – as people like Jeff Jarvis are saying – then where are the investigative reports on how various states are dealing with electronic signatures with regard to provision of service to people with developmental disabilities. Many states have increased their analyses of records through some sort of Medicaid Inspector General or other audit procedure. States require forms to be signed contemporaneously with services in many cases. With wet ink signatures there are limits to certain audit trails. How are agencies – both governmental and private provider – balancing the tradeoffs and benefits between wet-ink and electronic documentation.
If there are lots of books and blogs about whether to walk a batter in the 9th inning of a tie game- why is there such limited analysis of signature signoffs in an industry that spends perhaps $60 billion in federal and state money annually. What sort of analysis has been done regarding how much time people spend driving paper around. Could you imagine if people – in their recreational free time and being aware of HIPAA and PHI and sensitive to agency confidentiality and other concerns –commented on how much time they spend driving paper around – and how with better or different procedures they could have saved time to spend with the people they support – or saved overtime dollars or saved gasoline.