電子簽名法與電子病歷

　　電(dian)子(zi)病(bing)(bing)(bing)歷(li)(li)(li)是(shi)醫(yi)療(liao)(liao)(liao)信(xin)息(xi)(xi)(xi)(xi)化(hua)的(de)一部分(fen)。醫(yi)療(liao)(liao)(liao)信(xin)息(xi)(xi)(xi)(xi)化(hua)是(shi)一個(ge)(ge)比較大的(de)概念，基本可以包括(kuo)三個(ge)(ge)部分(fen)：電(dian)子(zi)病(bing)(bing)(bing)歷(li)(li)(li)、電(dian)子(zi)處方、電(dian)子(zi)支付以及醫(yi)院內部信(xin)息(xi)(xi)(xi)(xi)化(hua)；遠程醫(yi)療(liao)(liao)(liao)、網上掛號；醫(yi)療(liao)(liao)(liao)信(xin)息(xi)(xi)(xi)(xi)服(fu)務。 根據美國(guo)醫(yi)學計算(suan)機(ji)(ji)化(hua)委(wei)員(yuan)會1991年的(de)定義，計算(suan)機(ji)(ji)化(hua)病(bing)(bing)(bing)歷(li)(li)(li)是(shi)指存(cun)(cun)在一個(ge)(ge)系統中的(de)電(dian)子(zi)病(bing)(bing)(bing)歷(li)(li)(li)，這(zhe)個(ge)(ge)系統可支持使用者(zhe)(zhe)獲得完整、準(zhun)確的(de)資(zi)(zi)料；提示和(he)警示醫(yi)療(liao)(liao)(liao)人員(yuan)；給予臨床決策服(fu)務；連(lian)接管理(li)、書(shu)刊(kan)目錄(lu)、臨床基礎知識以及其(qi)它設備。電(dian)子(zi)病(bing)(bing)(bing)歷(li)(li)(li)并不是(shi)將現(xian)(xian)有紙(zhi)病(bing)(bing)(bing)歷(li)(li)(li)簡單地電(dian)子(zi)計算(suan)機(ji)(ji)化(hua)，它不僅包括(kuo)了(le)患者(zhe)(zhe)紙(zhi)張(zhang)病(bing)(bing)(bing)歷(li)(li)(li)的(de)原有內容，而且反映了(le)患者(zhe)(zhe)整個(ge)(ge)的(de)醫(yi)療(liao)(liao)(liao)過程，儲存(cun)(cun)了(le)患者(zhe)(zhe)全部的(de)醫(yi)療(liao)(liao)(liao)信(xin)息(xi)(xi)(xi)(xi)，包括(kuo)病(bing)(bing)(bing)史、各種檢(jian)驗檢(jian)查(cha)和(he)影像資(zi)(zi)料，是(shi)對個(ge)(ge)人醫(yi)療(liao)(liao)(liao)信(xin)息(xi)(xi)(xi)(xi)及其(qi)相關(guan)處理(li)過程綜合化(hua)的(de)體現(xian)(xian)。還有，電(dian)子(zi)健(jian)(jian)康(kang)記錄(lu)這(zhe)個(ge)(ge)概念可能要比電(dian)子(zi)病(bing)(bing)(bing)歷(li)(li)(li)更(geng)準(zhun)確些，因為它其(qi)實也應(ying)包括(kuo)健(jian)(jian)康(kang)人的(de)保健(jian)(jian)信(xin)息(xi)(xi)(xi)(xi)、公(gong)共(gong)衛生信(xin)息(xi)(xi)(xi)(xi)等。

　　電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)(li)的(de)最大優勢(shi)在于超(chao)越傳統(tong)病(bing)(bing)歷(li)(li)的(de)管理(li)(li)模(mo)式，提(ti)(ti)供(gong)電(dian)(dian)子(zi)(zi)(zi)存儲(chu)、查詢、統(tong)計、電(dian)(dian)子(zi)(zi)(zi)數(shu)據交換和互操作等功能(neng)(neng)，而這些功能(neng)(neng)中有些是(shi)(shi)傳統(tong)病(bing)(bing)歷(li)(li)所根(gen)本無(wu)法達到。概括起來，這種超(chao)越主要表現(xian)(xian)(xian)在三(san)個方(fang)(fang)面(mian)：其(qi)一，充分的(de)信(xin)息共(gong)享(xiang)，不(bu)(bu)同(tong)(tong)醫(yi)(yi)生、不(bu)(bu)同(tong)(tong)部(bu)門(men)、不(bu)(bu)同(tong)(tong)醫(yi)(yi)院乃至相(xiang)關環(huan)節，如患者(zhe)本人(ren)、保險機(ji)構、支付機(ji)構、管理(li)(li)部(bu)門(men)、科研機(ji)構等原則(ze)上都可(ke)以實現(xian)(xian)(xian)在任(ren)何時候(hou)、任(ren)何地點調(diao)閱(yue)全部(bu)記(ji)錄(lu)；其(qi)二，電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)(li)是(shi)(shi)實現(xian)(xian)(xian)智能(neng)(neng)化(hua)醫(yi)(yi)療(liao)(liao)的(de)基礎，可(ke)以提(ti)(ti)供(gong)藥物配制禁(jin)忌、醫(yi)(yi)療(liao)(liao)方(fang)(fang)法不(bu)(bu)當提(ti)(ti)示(shi)等預(yu)警(jing)功能(neng)(neng)；其(qi)三(san)，電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)(li)可(ke)以提(ti)(ti)供(gong)電(dian)(dian)子(zi)(zi)(zi)圖書、電(dian)(dian)子(zi)(zi)(zi)雜(za)志及(ji)(ji)最新(xin)診療(liao)(liao)方(fang)(fang)法等豐(feng)富的(de)相(xiang)關信(xin)息。有了這樣的(de)超(chao)越，我(wo)們(men)不(bu)(bu)僅不(bu)(bu)難想(xiang)象電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)(li)將(jiang)在提(ti)(ti)高病(bing)(bing)歷(li)(li)利用(yong)效率、避免重(zhong)復(fu)檢查、便于醫(yi)(yi)療(liao)(liao)信(xin)息的(de)保存和傳遞、實現(xian)(xian)(xian)信(xin)息共(gong)享(xiang)、提(ti)(ti)高醫(yi)(yi)療(liao)(liao)水(shui)平、減少醫(yi)(yi)療(liao)(liao)事(shi)故(gu)以及(ji)(ji)降低(di)費用(yong)等方(fang)(fang)面(mian)起的(de)積極(ji)作用(yong)，也就不(bu)(bu)難理(li)(li)解為什(shen)么(me)英國政府(fu)要花十(shi)年耗費55億英鎊去(qu)推(tui)廣電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)(li)了。

　　在(zai)我(wo)國(guo)(guo)，電(dian)子(zi)病歷(li)的(de)(de)推(tui)廣(guang)應用(yong)也得到了相關部(bu)門的(de)(de)高度重視，《全國(guo)(guo)衛生(sheng)信息化發展(zhan)綱要(yao)（2003-2010年(nian)）》中(zhong)(zhong)指出，我(wo)國(guo)(guo)衛生(sheng)改革的(de)(de)目的(de)(de)是(shi)充分利(li)用(yong)有限的(de)(de)衛生(sheng)資源(yuan)，用(yong)比較低(di)廉的(de)(de)費用(yong)提(ti)供(gong)比較優質的(de)(de)服務，滿(man)足廣(guang)大人民(min)群(qun)眾基本醫(yi)(yi)療服務需(xu)要(yao)。衛生(sheng)部(bu)曾(ceng)強調“國(guo)(guo)內三(san)甲以上的(de)(de)醫(yi)(yi)院都(dou)需(xu)要(yao)實行信息化管理”，電(dian)子(zi)病歷(li)在(zai)其中(zhong)(zhong)的(de)(de)作用(yong)可想而知。

　　不過(guo)，電子病歷的(de)推廣(guang)還面臨一些新的(de)問題(ti)，主(zhu)要集中在安全性、患(huan)者(zhe)隱私保障和合法(fa)(fa)性等(deng)方(fang)面。下面，我(wo)們就來簡單分(fen)析一下電子簽名法(fa)(fa)實(shi)施后電子病歷在我(wo)國的(de)合法(fa)(fa)性和安全性問題(ti)。

　　首先(xian)，電(dian)子(zi)病歷整體上(shang)屬(shu)于數據電(dian)文，即(ji)我(wo)國電(dian)子(zi)簽名法第二條規定的“以電(dian)子(zi)、磁、光學或(huo)者類似手段(duan)生成、發送(song)或(huo)者儲(chu)存的信(xin)息”。

　　第二(er)，根據(ju)我國(guo)電(dian)子(zi)簽名法(fa)第三條的規定：“民事(shi)(shi)活動中的合(he)同或者其他(ta)文(wen)件、單證(zheng)等(deng)文(wen)書，當(dang)事(shi)(shi)人可以約定使用或者不使用電(dian)子(zi)簽名、數據(ju)電(dian)文(wen)”，也就是說(shuo)，使用電(dian)子(zi)病歷應征得當(dang)事(shi)(shi)人的同意(yi)，以自(zi)愿為前提。

　　第(di)三，我國電子(zi)(zi)簽(qian)名法(fa)(fa)第(di)三條還規(gui)定，電子(zi)(zi)簽(qian)名、數據電文(wen)不(bu)適(shi)(shi)用(yong)于以下文(wen)書：“（一）涉(she)及婚姻(yin)、收養、繼(ji)承等人(ren)身關系(xi)的(de)(de)(de)(de)；（二）涉(she)及土地、房屋等不(bu)動產(chan)權益轉(zhuan)讓的(de)(de)(de)(de)；（三）涉(she)及停止供(gong)水(shui)、供(gong)熱、供(gong)氣、供(gong)電等公用(yong)事業服務的(de)(de)(de)(de)；（四）法(fa)(fa)律、行政法(fa)(fa)規(gui)規(gui)定的(de)(de)(de)(de)不(bu)適(shi)(shi)用(yong)電子(zi)(zi)文(wen)書的(de)(de)(de)(de)其他情(qing)形”，也就(jiu)是說(shuo)，電子(zi)(zi)病(bing)歷(li)(li)如(ru)涉(she)及這(zhe)些內容的(de)(de)(de)(de)，如(ru)與遺囑有(you)關的(de)(de)(de)(de)電子(zi)(zi)病(bing)歷(li)(li)等，法(fa)(fa)律并不(bu)支(zhi)持這(zhe)部(bu)分的(de)(de)(de)(de)效(xiao)力。

　　第四，電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)應(ying)(ying)得到妥善的保(bao)存(cun)(cun)，否則(ze)今后難以(yi)(yi)作為(wei)相關證(zheng)據(ju)使用。根據(ju)我(wo)國電(dian)(dian)子(zi)(zi)(zi)簽(qian)名(ming)法(fa)第六條的規(gui)(gui)定(ding)：“符合下列(lie)條件的數(shu)據(ju)電(dian)(dian)文，視為(wei)滿足法(fa)律、法(fa)規(gui)(gui)規(gui)(gui)定(ding)的文件保(bao)存(cun)(cun)要求：（一）能(neng)夠(gou)(gou)有(you)效(xiao)地(di)表現(xian)所載內容(rong)并可供隨時調取(qu)查用；（二(er)）數(shu)據(ju)電(dian)(dian)文的格(ge)(ge)(ge)式(shi)與(yu)其生(sheng)成、發(fa)送或(huo)者(zhe)接收(shou)時的格(ge)(ge)(ge)式(shi)相同，或(huo)者(zhe)格(ge)(ge)(ge)式(shi)不(bu)相同但(dan)是能(neng)夠(gou)(gou)準確(que)表現(xian)原來生(sheng)成、發(fa)送或(huo)者(zhe)接收(shou)的內容(rong)；（三）能(neng)夠(gou)(gou)識別數(shu)據(ju)電(dian)(dian)文的發(fa)件人、收(shou)件人以(yi)(yi)及(ji)發(fa)送、接收(shou)的時間”。怎么理解呢，其一，電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)應(ying)(ying)得到“固(gu)定(ding)”——即儲(chu)存(cun)(cun)在硬盤或(huo)其他(ta)設(she)備中(zhong)，不(bu)可以(yi)(yi)只存(cun)(cun)儲(chu)在緩存(cun)(cun)中(zhong)，而且(qie)儲(chu)存(cun)(cun)在硬盤或(huo)其他(ta)設(she)備中(zhong)后應(ying)(ying)可以(yi)(yi)隨時調取(qu)，不(bu)發(fa)生(sheng)信(xin)(xin)息失真；其二(er)，如根據(ju)儲(chu)存(cun)(cun)需要，對電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)進行壓縮(suo)、轉換、加密導(dao)致信(xin)(xin)息存(cun)(cun)在形式(shi)發(fa)生(sheng)改變(bian)的，只要能(neng)夠(gou)(gou)還原，不(bu)影(ying)響其法(fa)律效(xiao)力；其三，電(dian)(dian)子(zi)(zi)(zi)病(bing)(bing)歷(li)的生(sheng)成時間應(ying)(ying)和書寫人的簽(qian)名(ming)——即醫生(sheng)的電(dian)(dian)子(zi)(zi)(zi)簽(qian)名(ming)一起(qi)儲(chu)存(cun)(cun)，并且(qie)這些信(xin)(xin)息是真實可靠的。

　　第(di)五，醫生的(de)(de)(de)(de)(de)(de)(de)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)是(shi)(shi)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)病(bing)(bing)歷必不可(ke)少的(de)(de)(de)(de)(de)(de)(de)一(yi)個環節(jie)，而電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)病(bing)(bing)歷只(zhi)能(neng)與(yu)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)相(xiang)匹(pi)配，所以根據(ju)(ju)我(wo)國電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)法(fa)(fa)第(di)十四條(tiao)的(de)(de)(de)(de)(de)(de)(de)規(gui)定(ding)(ding)：“可(ke)靠的(de)(de)(de)(de)(de)(de)(de)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)與(yu)手寫簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)或者(zhe)蓋(gai)章具(ju)有(you)同等(deng)的(de)(de)(de)(de)(de)(de)(de)法(fa)(fa)律(lv)效力”，那么什么是(shi)(shi)“可(ke)靠的(de)(de)(de)(de)(de)(de)(de)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)”呢？電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)法(fa)(fa)第(di)十三(san)條(tiao)規(gui)定(ding)(ding)：“電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)同時符合下列條(tiao)件的(de)(de)(de)(de)(de)(de)(de)，視為可(ke)靠的(de)(de)(de)(de)(de)(de)(de)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)：（一(yi)）電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)制(zhi)作數(shu)據(ju)(ju)用(yong)(yong)于(yu)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)時，屬于(yu)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)人(ren)專有(you)；（二(er)）簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)署時電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)制(zhi)作數(shu)據(ju)(ju)僅由電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)人(ren)控制(zhi)；（三(san)）簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)署后對(dui)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)的(de)(de)(de)(de)(de)(de)(de)任何改(gai)(gai)動(dong)能(neng)夠被(bei)(bei)(bei)發現；（四）簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)署后對(dui)數(shu)據(ju)(ju)電(dian)(dian)(dian)(dian)文內容和形式的(de)(de)(de)(de)(de)(de)(de)任何改(gai)(gai)動(dong)能(neng)夠被(bei)(bei)(bei)發現。當事人(ren)也可(ke)以選擇使用(yong)(yong)符合其約定(ding)(ding)的(de)(de)(de)(de)(de)(de)(de)可(ke)靠條(tiao)件的(de)(de)(de)(de)(de)(de)(de)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)”。又(you)怎么理解？其一(yi)，電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)在發放(fang)時應(ying)(ying)是(shi)(shi)經過身份(fen)核實的(de)(de)(de)(de)(de)(de)(de)，與(yu)特定(ding)(ding)主體(ti)一(yi)一(yi)對(dui)應(ying)(ying)；其二(er)，電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)只(zhi)能(neng)被(bei)(bei)(bei)它(ta)的(de)(de)(de)(de)(de)(de)(de)所有(you)者(zhe)使用(yong)(yong)，他人(ren)如果使用(yong)(yong)，必須有(you)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)所有(you)者(zhe)的(de)(de)(de)(de)(de)(de)(de)明確授權才有(you)效；其三(san)，電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)本身和它(ta)附著的(de)(de)(de)(de)(de)(de)(de)數(shu)據(ju)(ju)電(dian)(dian)(dian)(dian)文應(ying)(ying)是(shi)(shi)有(you)相(xiang)應(ying)(ying)的(de)(de)(de)(de)(de)(de)(de)技術保障其不能(neng)任意改(gai)(gai)動(dong)的(de)(de)(de)(de)(de)(de)(de)。簡單地(di)說(shuo)，如果一(yi)個電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)是(shi)(shi)現在國家認可(ke)的(de)(de)(de)(de)(de)(de)(de)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)認證(zheng)服(fu)務機構(gou)(gou)（CA認證(zheng)機構(gou)(gou)）所發放(fang)的(de)(de)(de)(de)(de)(de)(de)數(shu)字簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)，而對(dui)這(zhe)個電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)的(de)(de)(de)(de)(de)(de)(de)操作是(shi)(shi)完全(quan)規(gui)范的(de)(de)(de)(de)(de)(de)(de)話（包括電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)認證(zheng)服(fu)務機構(gou)(gou)、電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)人(ren)、電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)依賴方），那么這(zhe)個電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)就(jiu)是(shi)(shi)我(wo)國法(fa)(fa)律(lv)所認可(ke)的(de)(de)(de)(de)(de)(de)(de)電(dian)(dian)(dian)(dian)子(zi)(zi)(zi)(zi)(zi)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)，就(jiu)與(yu)簽(qian)(qian)(qian)(qian)(qian)(qian)(qian)名(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)(ming)蓋(gai)章具(ju)有(you)同等(deng)的(de)(de)(de)(de)(de)(de)(de)法(fa)(fa)律(lv)效力。

　　第六，由(you)于電(dian)(dian)子病歷本身會涉及一(yi)些(xie)事關健康甚至性命的重大糾(jiu)紛(fen)，所以(yi)其(qi)不可隨(sui)意更改性十(shi)(shi)分(fen)重要(yao)，也(ye)就是簽(qian)名者可以(yi)為其(qi)簽(qian)署(shu)的文件承(cheng)擔相應(ying)的責(ze)任，其(qi)被(bei)篡改的可能性應(ying)該是幾乎沒(mei)有的。如數字簽(qian)名的使用就可以(yi)確保電(dian)(dian)子病歷本身的完整性和不可否認(ren)性，這(zhe)一(yi)點對于電(dian)(dian)子病歷十(shi)(shi)分(fen)重要(yao)。

　　總之，電(dian)(dian)(dian)(dian)子(zi)簽名法是(shi)(shi)電(dian)(dian)(dian)(dian)子(zi)病(bing)歷在(zai)我(wo)(wo)國(guo)(guo)得以推廣應用的(de)(de)基礎，沒有電(dian)(dian)(dian)(dian)子(zi)簽名法保障的(de)(de)電(dian)(dian)(dian)(dian)子(zi)病(bing)歷是(shi)(shi)不可(ke)想象(xiang)的(de)(de)，而電(dian)(dian)(dian)(dian)子(zi)簽名法出臺實施后，電(dian)(dian)(dian)(dian)子(zi)病(bing)歷必將(jiang)有所(suo)(suo)(suo)作為(wei)，推進我(wo)(wo)國(guo)(guo)的(de)(de)醫(yi)療(liao)衛生信(xin)(xin)息化(hua)(hua)(hua)、為(wei)廣大患者及(ji)所(suo)(suo)(suo)有公眾造福。當然，電(dian)(dian)(dian)(dian)子(zi)病(bing)歷還面臨技術安(an)全問(wen)(wen)(wen)題(ti)(ti)、標準統一問(wen)(wen)(wen)題(ti)(ti)、資金(jin)投(tou)入問(wen)(wen)(wen)題(ti)(ti)、患者隱私權保障等問(wen)(wen)(wen)題(ti)(ti)，但這些就不是(shi)(shi)電(dian)(dian)(dian)(dian)子(zi)簽名法所(suo)(suo)(suo)能解決(jue)的(de)(de)了。我(wo)(wo)們相信(xin)(xin)，隨著我(wo)(wo)國(guo)(guo)信(xin)(xin)息化(hua)(hua)(hua)法制(zhi)環境的(de)(de)完善、信(xin)(xin)息安(an)全的(de)(de)提(ti)高(gao)以及(ji)醫(yi)療(liao)衛生信(xin)(xin)息化(hua)(hua)(hua)的(de)(de)發展，問(wen)(wen)(wen)題(ti)(ti)都會(hui)很快冰釋，一個(ge)全面信(xin)(xin)息化(hua)(hua)(hua)與法制(zhi)化(hua)(hua)(hua)的(de)(de)社會(hui)將(jiang)會(hui)到來！