1.    A person’s signature is unique to that individual
2.    Applying the signature to paper is in the sole control of the signer
3.    The signature is physically part of the document being agreed to
4.    A signature can be examined by a handwriting expert and legally authenticated as coming from the signee or not.

How can the electronic counterpart satisfy these criteria? 

Let’s examine three basic types of electronic signatures used in business applications today.

The Digital Signature Using a Certificate Authority

This digital signature is the most sophisticated form of electronic signature.  It requires that each party be issued a Certificate Authority (CA) from a trusted 3rd party. 

This CA assures the signing participants that each party is who they say they are and when the digital signature is executed it is locked to the document in a tamper-proof manner.  All four legal criteria are satisfied. 

CA’s can be obtained from companies like DigiCert at a cost of around $175 per year.  However, using this in a dental practice is not practical. 

The other party to an agreement is likely a patient who will not have a CA and have no interest in obtaining one in order to consent to dental treatment.
 
Digitized Electronic Signatures Using a Signature Pad

This is the more common approach in a dental office.  A digitized electronic signature is obtained with our old friend the signature pad and stylus and then associated with the document being agreed to.  

The signature pad does much more than capture the image of the person’s autograph.  It records the details of the pen movement events.  This includes the path and the speed of the pen, the pressure exerted as well as the direction and loops in the stroke. 

This is vital to item “4” in our legal criteria.  It may look like a simple image of the signature, but much more is captured in the process.  It electronically contains all of this ancillary data about the signature and is often the reason that a signature captured in this manner appears on a separate page to the document. Separate but electronically linked in a tamper-proof manner.

Most dental office vendors sell a signature pad that falls into the “digitized electronic signature” category.  It is relatively low cost, captures the signature in a familiar, intuitive manner along with the forensic data described above and locks it to the agreed document.  

Image Signatures Using a Tablet Computer

This is the most simplistic approach.  An image of the autograph is placed on the document giving the impression of official-ness, but the signature is not locked to the document and in fact can be moved to other documents with the click of a mouse.  

With the advent of touch screen computers and tablets it is possible to capture an image signature without a signature pad, however this method does not record the forensic data necessary to satisfy the vital 4th criteria in our legal definition.  

I’m not saying that image signatures have no place in a small business.  They can be used in situations where there is very high trust between the parties or where there is little of real value at stake. 

I would say that this does not apply to treatment consent or a financial arrangement document in the dental practice.

It is easy to manipulate an image signature and if you are relying on this method to signify patient agreement, you may want to rethink that approach.  

The venerable signature pad will be with us for the foreseeable future.

Understanding your needs for authentication and non-repudiation and that they match the signature capture approach you are employing could turn out to be a very valuable right click for your practice.