I have built a custom workflow based on Microsoft's Windows WorkFlow Foundation (WWF) which allows the MA take the PDF examine it and route it to the appropriate person. The app allows the doc to add notes to the pdf and when the doc clicks complete the file is indexed, locked and saved in the patient's folder. It is possible to pull up a patient, and see all the documents we have on file for him/her.
As to digital signatures we do not use "digital signatures," and I doubt that many people are using them. A transparent graphic of my signature is not a digital signature and in many cases is far more insecure than an actual signature.
A digital signature on the other hand, must provide at least 3 things:
1) authentication - that the signature is authentic
2) integrity -that the document has not changed since it was signed
3) non-repudiation - does not allow denial that the person who was authenticated actually signed the document.
I know this sounds like a lot of Hocus Pocus, but digital signatures usually require some sort of Public Key Encryption technology.
