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The Promise and Peril of
Software Designed for
Forensic Odontology
JOHN MELVILLE, MS, MD
SITE DIRECTOR, CHILD ADVOCACY CENTER AT AKRON CHILDREN’S HOSPITAL,
MAHONING VALLEY.
SOFTWARE ARCHITECT, BUSINESS CASUAL SOFTWARE
Disclosures
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I am a Software Architect for Business Casual Software.
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We created PhotoDocumentor.
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I want to sell it to every one of you.
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I have worked as a paid expert witness in child abuse
cases.
Agenda
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Describe the development of PhotoDocumentor, an electronic
medical record designed for medical forensics.
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Avoid the urge to give a 30 minute infomercial for my software.
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Determine a software product’s metaphor.
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Discuss and demonstrate checklists as a clinical quality tool.
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Evaluate opportunities to integrate complicated mathematics
into forensic odontology.
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Evaluate and criticize the incorporation of “negative” features in
forensic software.
How to solve a problem with a
computer.
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Get lucky – Find exactly the software you were looking for.
(www.google.com)
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Create custom templates, files, and practices in existing software.
(Word, WordPress)
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Create macros or plug-ins for existing software. (Access, Sharepoint,
Drupal)
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Write you own software
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Use a general purpose language. (C#)
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Beware of products that advertise programming without programming.
My Approach: PhotoDoc
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X
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Custom Software Application
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C#, WPF, Xaml, C++, HLSL
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42,830 lines of computer code.
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1,260 pages as a trade
paperback.
It’s a lot of work
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I started in 2006.
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I work on PhotoDoc most
evenings and weekends.
People look at me funny when
I say you relax by
programming computers.
Software’s Metaphor
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What does the software think that it does
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Correlate antemortem and postmortem dental findings.
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Enhance and modify pictures.
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Organize, analyze, and present digital forensic evidence.
Signs that your software has the wrong metaphor.
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There are settings or features you have to never use.
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Every time you start out you have to change a lot of things.
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Common or fundamental operations just seem hard.
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Simple mistakes have serious consequences.
Checklists in Medicine (or
Dentistry)
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X
1
Medicine is hard
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People are stupid.
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Checklists make you smarter
A surgical checklist1
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Reduced 30 day morality 46%
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Reduced complications 36%
Haynes AB, Wieser TG, Berry WR, et al. “A surgical safety
checklist to reduce mortality and morbidity in a global
population.” NEJM 2009; 360: 491-499
Computerized Documentation
Promise
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Faster to write.
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Faster to read.
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Consistency
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Coders get you lots of $$$$!
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Can guide practitioner into
best practices.
Peril
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Can be more difficult to
read.
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Makes imprecise, or worse
incorrect documentation
the easy path.
X
Sometimes the form is going
to be incorrect.
Negative Features
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Sometimes, what a program will not do can be a
feature.
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After a note is signed it cannot be changed.
X
The program will not let you delete evidence pictures.
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Money in a bank account can only get spent once.
X
The problem is that the negative features you put in
V1 and up being your biggest requests for V2.
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It turns out that the world is messier than we would
like it to be.
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Back in the paper and pen world, we could break
the rules when we needed to.
Features come in groups
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Programmers refer to the CRUD operations
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Create
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Read
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Update
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Delete (And Undelete.)
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If your software has a negative feature, make sure
you have a way to make it look like you did the
forbidden thing.
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Alternatively, consider a compensatory operation.
In Conclusion
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Custom software is an expensive but flexible method to
control your work.
X
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Expensive for me may become very inexpensive for you.
All software has a metaphor.
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Using software against its metaphor is a recipe for ongoing
frustration.
X
Custom software can guide professionals into best
practices.
X
Custom software provides space for genuinely innovative
mathematics.
X
Negative features may be helpful, But look that gift horse
in the mouth.