Invalid Signature on Chart

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Hersheydmd
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Invalid Signature on Chart

Post by Hersheydmd » Mon Apr 13, 2015 11:14 pm

A signature on a chart note or commlog is legal proof that the entry has not been altered since the signature was placed.
If there is any change in the entry the signature should disappear and the "Signed" column in the progress notes should be empty. That is usually what happens.
Occasionally, for reasons that elude me, a signature on a procedure note, becomes "invalid". But you would never know it from looking at the chart progress notes. The "Signed" column continues to display "Signed". Unless you have a reason to open up that procedure note (which is rare), you won't know that your note contains an invalid signature. If you are depending on your signatures to prove medico-legally that your note has not been altered, an invalid signature is worthless. When a signature is invalid the column should either be blank or display "Invalid", which will afford you the opportunity to go back and correct the problem. (using version 14.3.23)
This is addressed in feature request 1828
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

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jsalmon
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Re: Invalid Signature on Chart

Post by jsalmon » Tue Apr 14, 2015 9:17 am

Keep in mind that old procedures signed prior to v13.1 will always have this problem. They are most likely still valid signatures and backups can be used in order to verify validity if needed.
Viewing Old, Signed Procedures: In version 13.1, the Notes box was enhanced. As a result, if you open a procedure created before the update, the note may be be changed. Sometimes hidden characters are added or removed. Make sure to click Cancel instead of OK when exiting the window so the note is not permanently changed. Otherwise, the hidden characters will be saved, and the change to the note will invalidate any digital signature.
http://www.opendental.com/manual/procedureedit.html
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

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Hersheydmd
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Re: Invalid Signature on Chart

Post by Hersheydmd » Wed Apr 15, 2015 7:47 pm

[quote="jsalmon"]Keep in mind that old procedures signed prior to v13.1 will always have this problem. They are most likely still valid signatures and backups can be used in order to verify validity if needed.

Does that mean that after v13.1 "invalid signatures" won't occur, they'll disappear completely if there are any changes? If that is the case then there is no problem.
Also, is there any way to run a report that will show all old notes that have "invalid" signatures?
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

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jsalmon
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Re: Invalid Signature on Chart

Post by jsalmon » Thu Apr 16, 2015 11:34 am

Hersheydmd wrote:Does that mean that after v13.1 "invalid signatures" won't occur, they'll disappear completely if there are any changes?
No, that means that any procedures signed prior to v13.1 that are viewed in a version equal to or greater than v13.1 will almost ALWAYS show "invalid signatures" due to invisible characters being added / removed behind the scenes. This makes the signature validation algorithm think that a note has changed and that it should flag the signature as invalid. Therefore we suggest clicking Cancel instead of OK when viewing old signed procedures so that you do not accidentally invalidate the signature especially when you didn't change anything about the procedure.
Hersheydmd wrote:Also, is there any way to run a report that will show all old notes that have "invalid" signatures?
No, and there cannot be an SQL report written to do such a thing (well... there might be a way but it would be very complicated and I don't even want to begin to think about it). This is one of those few times where I actually have to say that this can ONLY be a feature request that is implemented programmatically (requires the signature validation algorithm) which might be a really slow "report" to run if no date filter is used (trying to find all invalid sigs on procs for all time).
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

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Hersheydmd
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Re: Invalid Signature on Chart

Post by Hersheydmd » Fri Apr 17, 2015 2:34 pm

Jason, I still don't understand.
Let's look at this from two different perspectives.
1) Looking at new procedures created after version 13.1. Are there any situations that would result in a signature showing an "invalid" status? Or, would the signature simply disappear and the note show as "unsigned" which should be what happens whenever a change occurs in a note.
2) Looking at procedures created before version 13.1, I understand that if a note is opened it is important to click cancel, not OK, otherwise the signature will be invalidated. However, what about signatures that became "invalid" before we knew this?

You can see that a note is "unsigned" when looking at the patient's chart, as the signature column is empty. However, you can't tell if a note has an "invalid" signature, it looks the same in the chart module as a "valid" signature. That is a serious defect.
Last edited by Hersheydmd on Sat Apr 18, 2015 10:15 am, edited 1 time in total.
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

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Manny Ramirez
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Re: Invalid Signature on Chart

Post by Manny Ramirez » Fri Apr 17, 2015 8:41 pm

Maybe this can be addressed using Automation. If there was a way to automate a warning if this situation arrises it will be helpful.
Manny Ramirez
Senior Network Engineer
E-ssential Networks LLC

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jsalmon
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Re: Invalid Signature on Chart

Post by jsalmon » Mon Apr 20, 2015 10:39 am

Hersheydmd wrote:1) Looking at new procedures created after version 13.1. Are there any situations that would result in a signature showing an "invalid" status?
Yes. When the note or user has changed (outside of the procedure edit window) the note will show as invalid. For notes created and viewed in versions after 13.1, I can only see the scenario of database manipulation being the cause of such changes thus we want to let you know that something has changed since the last time you signed the procedure most likely without your knowledge.
Hersheydmd wrote:Or, would the signature simply disappear and the note show as "unsigned" which should be what happens whenever a change occurs in a note.
The signature will simply disappear and the note will show as "unsigned" if you change the user or note from within the procedure edit window which is what we are expecting you to do. We created the Chart Module 'audit trail' mode inside the Show tab so that you can see the history of the procedure note and when it was signed and when a user changed or it became unsigned. NOTE, the audit trail view and typical progress notes grid do not indicate invalid signatures. Hence your feature request #1828
Hersheydmd wrote:2) Looking at procedures created before version 13.1, I understand that if a note is opened it is important to click cancel, not OK, otherwise the signature will be invalidated. However, what about signatures that became "invalid" before we knew this?
Those procedures might still be "valid" but can only be verified by opening up a backup prior to accidentally clicking OK which invalidated it in the first place. We could probably write some funky code that could take the time to guess at reinserting those invisible characters that Microsoft strips out behind the scenes under our feet. The odds of getting a false positive I would imagine is slim (the stars would have to align to do so) but the possibility is still there. I think we just decided it was safest to have people load up their backups. At the time, back around v13.1, that was a very plausible solution. But now that users are on v15.X, it makes it a bit tricky to load up the correct versions of OD (v13.1.X) and find the corresponding backup. I like your request #1828 the best. That will be the real solution in my opinion.
Hersheydmd wrote:However, you can't tell if a note has an "invalid" signature, it looks the same in the chart module as a "valid" signature. That is a serious defect.
I agree. Are you noticing this happening a lot? Does it happen often with recent procedures? It very well could be a bug that I'm not aware of so if you can duplicate it somehow with a process from within Open Dental I'd be very eager to fix it for you.

As for the feature request, you've been the only one to vote on it so far so I can't really guarantee much. Let me see if I can convince the higher ups that this is very misleading and almost a bug in order to get this escalated into v15.2. The hardest part to combat is when I'm asked "Why not double click on the procedure when in doubt".
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

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jsalmon
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Re: Invalid Signature on Chart

Post by jsalmon » Mon Apr 20, 2015 10:43 am

Manny Ramirez wrote:Maybe this can be addressed using Automation. If there was a way to automate a warning if this situation arrises it will be helpful.
I've thought about this as well but couldn't seem to find an elegant solution. Everything I could think of ended up in an annoying pop up occurring just before leaving the procedure edit window. I think the odds of old proc notes becoming invalidated due to opening them in recent versions and click OK is slim enough to merit not having a pop up every time you edit something.
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

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Hersheydmd
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Re: Invalid Signature on Chart

Post by Hersheydmd » Tue Apr 21, 2015 5:53 am

jsalmon wrote: Yes. When the note or user has changed (outside of the procedure edit window) the note will show as invalid.
How does that happen without our knowledge?
jsalmon wrote:I can only see the scenario of database manipulation being the cause of such changes thus we want to let you know that something has changed since the last time you signed the procedure most likely without your knowledge.
If you want us to know that there has been a change then it needs to be visible in the chart module. No one is going around reopening old notes just for the hell of it.
jsalmon wrote: Hersheydmd wrote:
However, you can't tell if a note has an "invalid" signature, it looks the same in the chart module as a "valid" signature. That is a serious defect.

I agree. Are you noticing this happening a lot? Does it happen often with recent procedures? It very well could be a bug that I'm not aware of so if you can duplicate it somehow with a process from within Open Dental I'd be very eager to fix it for you.
Is it happening a lot? I wouldn't know since I don't often open up old notes. But I do notice it every once in a while. What I fear is that it has happened in many instances that I don't know about.
Yesterday, it happened on a new note (v.14.3.23). Don't know why. I typed and signed a note, clicked OK, then remembered something that I wanted to add to it. I reopened the note (less than a minute later) and the signature box said "invalid..." I have no clue what caused it, and I don't think I could repeat it if I tried.
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

allends
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Re: Invalid Signature on Chart

Post by allends » Fri Jun 12, 2015 3:05 pm

I believe we have a fix for this Dr. Hersh.
In 15.2.7 and 15.1.29 we have deployed a fix that should make your old notes, that were incorrectly displaying as invalid, and display them as valid again.

When you update please update this thread and let me know if this is still occurring.
Thanks,
Allen
Open Dental Software
http://www.opendental.com

tgriswold
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Re: Invalid Signature on Chart

Post by tgriswold » Fri Jun 12, 2015 4:13 pm

Adearmondsattler is partially correct. We released a fix so that procedures signed in older versions (pre 13.1) will no longer show "invalid signature" just because there are returns in the note. However, the chart module will still show signed for any signed note. The chart module does not differentiate between an invalid signature and a valid one, just that it was signed. You still need to open the procedure itself to see if the signature was valid.
Travis Griswold
Open Dental Software
http://www.opendental.com

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