A Forensic Breakdown

SECOND IN A SERIES – PART 2 OF 5

Electronic dental records have surpassed the paper chart as primary medium for patient documentation.

Back in the day, when a paper note was contested in court, handwriting experts and ink analysts were called in to assess whether the chart additions were late or fraudulent.

Nowadays, digital forensics is used to evaluate the data and meta data surrounding the chart note to detect late or false entries.

So, it’s no surprise when a legal dispute arises, many attorneys engage digital forensic experts look at the data first, rather than witness statements or depositions.

Every click, entry, and image in a dental system becomes part of a factual timeline that courts rely on to determine what truly happened.

This post breaks down how ordinary electronic dental records become powerful legal evidence.

Clinical Notes: The First Line of Defense

Clinical notes are often the most scrutinized component of a dental chart.

Digital forensic experts examine:

  • Timestamps (determine creation, modification, and deletion dates and times)
  • User IDs tied to each entry.
  • Addendum vs. overwrite behavior
  • Consistency between imaging and treatment events

A note that appears to be written days after treatment — or edited after a complaint — can dramatically shift the legal narrative.

Imaging Files and Metadata

Radiographs, CBCT scans, and intraoral photos contain hidden metadata that can confirm or contradict clinical claims. Analysts look for:

  • Capture date and time
  • Device identifiers
  • Software version
  • Modification history
  • Missing or overwritten images

If a patient alleges a missed diagnosis, metadata can prove whether the dentist had the relevant image at the time of treatment.

Billing and Insurance Records

Billing logs often reveal intent, timing, and workflow patterns. Forensic experts  focuses on:

  • Code changes after treatment
  • Deleted or reversed claims
  • User‑level billing activity
  • Timing of submissions relative to chart entries

In fraud or upcoding allegations, these logs can become central evidence.

Access (Audit) Logs and User Activity Trails

Practice management systems can quietly record every login, logout, and chart access. These logs can help answer questions such as:

  • Who viewed the chart
  • Whether unauthorized chart access occurred
  • If a staff member altered a record
  • Whether a dentist was logged in at the time of an alleged entry

These digital event trails often resolve “he said, she said” disputes.

Device and Network Logs

Servers, firewalls, and workstations generate logs that can reveal:

  • Remote access attempts
  • USB device usage
  • Data transfers

These are especially relevant in privacy breach cases or allegations of intentional (malicious) data destruction.

Why This Matters

Courts increasingly rely on digital evidence because it is:

  • Objective
  • Timestamped
  • Hard to manipulate without leaving traces
  • Consistent across systems

For dental professionals, this means that your digital footprint is your legal shield — or your liability.

Related Posts:

If you have questions, or need help, do not hesitate contact me for assistance.

William Hiltz, CEO Hiltz & Associates
Contact by Email or Phone
Schedule a 30 minute consult