With information technology progress, many high-level hospitals have already built or use electronic medical records system to record the patient's medical condition. It is necessary for data security protection of the medical records that electronic medical records have not only the mandatory of law, but also the user's privacy. The traditional digital signature technology used to protect the authenticity, integrity and non-repudiation of electronic medical record is that treat medical record as a whole file to a digital signature, we must obtain the entire medical record documentation in order to verify the authenticity of documents, then it will easily reveal user's privacy and causing unnecessary waste of communication bandwidth. XML digital signature has the smaller size in a signature, but it can not prevent the document's reordering attacksThis article first introduce digital signature as a more comprehensive technology, then give a digital signature scheme for electronic medical records combined with the ideological content extraction signatures aiming at the large signature size and easy to leakage of user privacy and other issues. The fine-grained digital signature scheme enables electronic medical records in the node-level signatures and have a finer granularity and lower communication bandwidth compared with the existing program.It can significantly improve system efficiency and the use of electronic medical records flexibility. At last, the digital signature prototype system of electronic medical record is designed and developed and signature can be extracted with a visual features.The main work of this paper is as follows:(1) It extended the structure of XML digital signature .The signing sub-messages of electronic medical records document is defined used additional features of