Do you remember your first cell phone? I looked at the device with a fair amount of awe and considered it to be borderline magic that I could call someone without being anchored to the wall by a 15-footlong curly cord. I’m sure you had a similar experience, and you can also recall several phones you’ve had through the years. At the time, they all seemed like such technological miracles, but they are antiquated compared to what you carry in your pocket today.



Just like cell phone technology has evolved rapidly through the years, so has patient electronic signature solutions for hospitals. For the past 20 years, we’ve helped hospitals move away from paper-based consent forms to paperless eConsent solutions, and we’ve seen our fair share of electronic signature capture device evolution through the years. In this blog, I want to take you on a walk down memory lane, showing you where patient electronic signature has been, where patient eSignature is today, and where it’s headed in the near future.

Patient Electronic Signature | Past

Electronic signature technology is not exclusive to healthcare. As consumers, we’ve used electronic signature for credit card purchases and other legal documents for years. However, remaining true to the healthcare’s overall theme of being a laggard in technology adoption, industry acceptance of applying electronic signature solutions to capture patient’s signatures for hospital consent forms was slow. This was in part due to patient and consumer wariness of such technologies being applied to a healthcare encounter where personal privacy is paramount. In other words, just as hospitals were hesitant to relinquish the comfort of paper-based consent forms, patients were equally hesitant. To that end, the first iteration of patient electronic signature was a paper/electronic hybrid approach used with our eSignature Clipboard.

The eClipboard
Manufacture/Model: Topaz ClipGem
Active Dates: 1999 - 2005


With the eSignature Clipboard, the patient would be registered in the EHR (MEDITECH, Epic, Cerner, etc.) and paper consents and electronic consents would be produced concurrently. The paper was then placed upon the electronic clipboard and presented to the patient where they would sign directly on the paper with a specialized pen, capturing the signature on the paper and electronically. For all its benefits, the major drawback was that the paper consent form was given to the patient and all too often discarded in a way that was not HIPAA compliant 

Simple LCD eSignature Pad 

Manufacture/Model: Topaz SigLite 

Active Dates: 2002 – Present 


As it became evident that a hybrid paper/electronic eConsent process was not ideal, demand grew for fully electronic consent solutions. The first products to meet this need were simple in their design and application. The patient would be registered in the EHR system, and eConsents were produced. The patient was told to electronically sign-off on the eConsents using small LCD devices. While this was a paperless process, it did not provide the best patient experience. Many patients were not happy to electronically sign a form that they could not see. Yet many of these devices are still in use and are a prominent part of the patient electronic signature solution offered by Epic Systems. 


Advanced LCD eSignature Pads 

Manufacture/Model: Wacom STU Series & Topaz SigGem 

Active Dates: 2004 – Present 


Once patients and hospitals became more comfortable with a truly paperless electronic consent and signature experience, the demand increased for more advanced and economical LCD eSignature capture devices. These devices offered advantages over the more simplistic LCD eSignature capture devices in that they could display partial form content directly on the screen, and, in some cases, hospitals could display marketing images directly on the LCD screens. 


Hospitals across the US, Canada, UK, EU, and beyond still use these devices to create paperless registration processes. Unfortunately, however, these devices are tethered to a workstation, presenting logistical challenges for the application of capturing patient electronic signatures at the bedside. 


Patient Electronic Signature | Present 

For the past two years, there have been two primary drivers shaping the current evolution of patient electronic signature technology: 

  1. EHR User Interface Integration
  2. Mobility | Bed-Side Capability 
EHR User Interface Integration 

For registration clerks to clinicians, the EHR has become the center of their world when it comes to documentation and interacting with patient records. To that end, the last thing these users want is to be forced to leave their EHR to deal with a 3rd party application. In response to that concern, we have integrated the software component of patient electronic signatures directly within the EHR user interfaces of Epic, MEDITECH, Cerner, and Allscripts, dramatically improving the end-user adoption and experience. 

Mobility | Bed-Side Capability 

As patient electronic signature technology became more heavily adopted across registration departments of hospitals, the next eSignature frontier became apparent: bedside Using LCD devices to capture patient electronic signature was not a good option bedside, so hospitals continued to use paper-based consents. The solution was to incorporate tablets at the bedside, allowing for the capture of patient electronic signature on much more complicated forms, such as Informed Consents regarding surgical procedures.  


Patient Electronic Signature | Future 

What does the future of patient electronic signature look like for hospitals? To find the answer, one only needs to consider our current situation with the global COVID-19 pandemic and the age-old saying, “necessity is the mother of invention” to find the answer. 


The waiting room of a hospital is about the last place you want to be during a pandemic, and hospitals are working diligently to find innovative solutions in this area. Telehealth visits have exploded and will continue to do so, and in keeping true to the concept of remote care with telehealth, patients are being sent electronic consent forms that can be securely and legally signed on their own devices (see our Impression solution). The goal is to provide a contactless and rapid check-in process once the patient arrives at the hospital.  


This is clearly the future of patient electronic signature technology, and the bring-your-own-device (BYOD) strategy can effectively reduce the spread of COVID and other disease agents. This makes for a strong infection control strategy with eSignature that has a strong place in healthcare, pandemic or not. 


Cody Strate

Written by Cody Strate

For more than 15 years, Cody has provided sales and marketing leadership with the goal of providing the smoothest, easiest, and most pleasurable customer experience imaginable. Cody is a Forbes Communication Council member and lives in Colorado with his wife, two kids, and two dogs.