About 200 years ago a French physician rolled a sheet of paper into a cylinder and held it up to the chest of a patient. The creation was crude and simple, but it worked. Rene Laenneac could better hear his patient’s heartbeat, and the stethoscope was born.
Today, the stethoscope remains a fixture in medicine, draped around the shoulders of doctors. It’s also overdue for a makeover.
Now Eko Devices, a Silicon Valley start-up, has received FDA approval for its digital stethoscope, which brings the power of modern technology to an already essential device. The implications could be huge for patient care. It’s also a reminder of the enormous potential for modern technology to improve health care, which still relies on dated technology such as fax machines to play critical roles.
The stethoscope, called the Eko Core, records the sounds of a patient’s heart and transmits them to an iPhone app. This opens the potential for heart sounds to be stored in the cloud, for clinicians to reference or analyze the data en masse to heighten their understanding of the human heart. High-quality care could be provided at a lower cost. Unnecessary tests could be avoided.
“If we can bring the expert cardiologists from Johns Hopkins to the patient in rural Nebraska or the rural village in India, that opens up the opportunity to save lives,” said Jason Bellet, the chief operating officer at Eko Devices. “What we’re seeing with the age of telemedicine is now we can take a heart sound from a rural, underserved community and send that to a cardiologist for an instant second opinion.”
It’s been difficult for cardiologists to seize the full power of the Internet. Being in a patient’s presence has been essential in order to hear the heart. But with a digital stethoscope that’s connected to the Internet, a cardiologist could sit in her office and review heart sounds sent from around the world. This data could be gathered by someone who would need only a basic knowledge of how to operate a medical device.
“How do you provide state of the art care in the areas where patients live?” asked Ami Bhatt, director of cardiology and an affiliate of the health-care transformation lab at Massachusetts General Hospital. “Both with travel, work time that is lost, having families, and then even insurance in and out of state, et cetera, it is a challenge oftentimes to get to a big academic medical center generally in a city far away from you.”
While other electronic stethoscopes exist, Eko’s is the first to have a HIPAA-compliant smartphone app and integration into the electronic health record. For digital stethoscopes to become the norm, they will have to integrate seamlessly into physicians’ lives and patients’ medical records.
For physicians who want to keep their existing stethoscope, Eko sells a $199 attachment for analog stethoscopes. Eko also has a $299 version that filters out ambient noise so that physicians can focus on the sound of the heart. Use of the related app is free for small practices, but Eko will be charging larger operations. It’s already partnered with drchrono, a platform for electronic health records, to get its data to flow into those records. This week it plans to begin selling the devices to physicians.
The Silicon Valley start-up also has much broader aspirations. It’s developing an algorithm that it hopes will recognize heart conditions.
“Our goal is to have the doctor put the stethoscope on the patient’s chest, click ‘analyze’ much like you would click ‘identify’ a song within the Shazam app and have it say this is a midsystolic ejection murmur,” Bellet said.
A professor at California-San Francisco is testing the algorithm, to see how it stacks up against an echocardiogram, a trusted but expensive machine used to monitor the heart.
The professor, John Chorboa, met Eko chief executive Connor Landgraf through a university class, and was struck by the promise of what Landgraf proposed.
“Maybe it can do it in a better way than the human ear can, and maybe it can tell us something about the human heart that we didn’t really know before,” Chorboa told me.
Analyzing huge data sets has proved immensely valuable elsewhere, so it follows that there’s much to be gained from studying a wealth of data about the human heart and its sounds.
“I hope that someday we will be able to use big data, a set of algorithms to say ‘When your murmur is changing at this rate, that will predict that you could need a valve surgery for this reason in this much time,’ ” Bhatt said. “That’s the ideal, that’s the Holy Grail with these kind of things. It will take time to get here. These are the first steps, these are the building blocks for eventually getting to that kind of personalized medicine.”