The Eko Core Stethoscope marries analog sounds with modern digital technology, bringing forth the next generation of Stethoscope.
Have you ever seen family feud? What is the most iconic symbol that represents a doctor? Would you say the white coat? Would you say glasses or books to represent learning? Would you say the caduceus or the staff of Aescleus (they are two different things)? My top answer is the stethoscope. Would you be surprised to know that we have only had the stethoscope for just at 200 years? The history of this medical device is very interesting. Doctors of antiquity would lay their ear upon the breast (chest) of the patient to auscultate (fancy doctor speak for listening to) heart sounds and lung sounds. This was often difficult based on the gender and age of the patient. A rather ingenious Frenchman named René-Théophile-Hyacinthe Laennec, a flautist, created the device in 1816 and named it from the Greek words Stethos (chest) and Skopos (to examen). Observing a simple toy/game, where children find hollow sticks and scratch the end with a pin, he grabbed a piece of paper rolled it and placed it on the chest of a patient to better hear her heart. The rest was history. Doctors did not embrace the tech until around 1850 and the first commercially made device (similar to those of today, began sale in 1852. Few small changes have occurred throughout the last 100 years from the Rapport-Sprague, to the Cardiology 3, to the Tycos Elite Harvey (my personal favorite). From hollowed out wooden tubes, to the silicone/rubberized scopes of today, this invention has drastically improved our ability to diagnose and to heal;.
Why people make fun of new things, new tech and new innovations? I would like to think that my profession would be above such petty things. Alas, we are just as guilty. They made fun of Semmelweis for suggesting doctors should wash their hands, as it was absurd that a doctor could get a patient sick. Fast forward to the idea of surgery at one time was considered a violation of the Hippocratic oath, anesthesia, Cesarean sections, forceps delivery, and now we have the same issue with analog versus digital stethoscopes. There are many blogs, many websites that deal specifically with “Best Stethoscope.” During medical school and residency (7 years) and for the 3 years I have spent in private practice, I have enjoyed my Tycos Elite Harvey stethoscope and its clear sound. What if I told you that I have a new favorite, a stethoscope that is both analog and digital and has the ability to record? Do you have students? Do you have an EMR that can save the data? The Eko Stethoscope is simply amazing.
The Eko Core stethoscope (pronounced like echo) arrived in sky blue packaging, which is elegant in its simplicity. Opening up the box, you will see a white cardboard cutout showcasing the black Eko Core. The cardboard details the functions of the core with the analog/digital switch, the volume adjustment buttons, the LED indicator and the Micro USB charging port. Additionally, you are directed to download the Eko App from the IOS App Store and the Google Play Store. The stethoscope has 1 1/2″ of tubing from the diaphragms. There is an included adult and a screw on pediatric diaphragm and a screw on bell. The Eko core measures 3 1/4″ and you have 16″ of tubing before the tubing splits. The distance from the ear tips to the split is 9″. The entire length is 32″ long and weighs 9.4 ounces.
The Eko core really is what makes the device amazing. One of the concerns that I had with a digital scope was the power supply issue. What if you have a busy clinic day and you forget to charge your device? In this instance, the unique Eko core will allow you to use either analog or digital. Using a convenient toggle, labelled “on” and “off”, you can switch between analog and digital modes. This switch occurs very quickly and is very noticeable. You can increase or decrease the sound level by using the sound up/down buttons. The device has a dynamic sound driver which provides quality audio to each of the ear pieces and can provide up to 40x amplification. With white noise reduction, background noises are reduced and not just amplified like hearing aids. Having tested other stethoscopes, this device is clearly a winner in overall sound quality. According to the website, it is the “largest self contained audio driver of any stethoscope on the market.” The best part about this technology is that it really can be quite universal. You can buy just the core for $199 and attach it to your precious cardiology grade scope (cardiology III/WelchAllyn Elite) or you can opt to purchase the entire package for $299. I love that the inline tubing provides clear, unchanged, unaltered, natural heart and lung sounds. The head of the scope is a normal stethoscope diaphragm/bell and will work completely without power. This is different than other digital devices that have digital style heads. This feature makes the Eko stethoscope so much more versatile.
The stethoscope has a good weight, yet is a little lopsided if worn around the neck. It is perfect for pocket carry and for the belt hanging attachment, that some medical school book stores try to get students to purchase. The battery is listed as having 9 hours continuous recording capability. I really had no idea how much I used my stethoscope, in my family medicine practice, until I owned this device. Seeing 20-30 patients per day, averaging 2 minutes of auscultation (heart, lungs, abdomen) on just about ever patient, I found I used about 1 hour per day of the device. I purposefully did not charge the device for an entire week to see if it would last the week. I was pleasantly surprised that I was able to complete an entire M-F clinic and nearly an entire remainder of the next week. Wednesday the following week, I started to get a solid Red LED, suggesting battery <25% and then red flashing LED, suggesting battery is <10%. You cannot use the device while charging, but remember you do not need power to use the device in analog mode. The LED indicators will flash yellow while off and charging and will remain solid yellow once fully charged. I am not certain how long this takes to charge, but it appeared to be fully charged between 4-6 hours.
If I was just reviewing the stethoscope alone, I would give it a 5/5 star rating. This device can stand shoulder to shoulder with the heavyweight Cardiology III and WelchAllyn Elite devices, which is no small undertaking. Comparing weight, the Eko is about 3 ounces more than the 6.4 ounce Cardiology III and 5-6 ounces less than the WelchAllyn DLX. Additionally, you can augment the WelchAllyn and Cardiology III with a core. The overall beauty of this device is the ease of app pairing. The stethoscope, when turned on simply works. The app connects and you can start seeing and hearing the sounds immediately. You to select body position, sitting, standing, supine and you can select the location of auscultation along the anterior chest (aortic, pulmonary, tricuspid, mitral). Turn the toggle to on and the app is ready to use. Select the record button and save this to your device. It is HIPPA compliant, which is a must for any device storing patient information. You can choose to log in with a PIN or with your email. It is important to note that you will need to Initially create an account.
Once you download the application, you will need to enter your first name, last name, email, password and then confirm the password. It will then ask you to create a pin for quick login. This pin is a 4 digit numeric code that you will input x2. Once completed, it asks you to turn on the device and it will pair immediately. Once paired, you will be taken to a short tutorial. You will see the blue parallel lines across the top left, representing the control center. You will see a head/shoulder icon for patients, which will allow you to access stored data/recordings. It will then show you an example of the phonocardiogram, Once you have set up and paired the device, you will only need to turn the device on and open the application. On the iPhone 6s Plus, I do not think that this could be much easier. The application is listed to work with iPhone 4 and above. I do not have an Android device to test. The free version is enhanced further by the pro version, which adds MP3 recording download and live streaming. The Enterprise edition also adds library features, and discounted prices. The free app will allow you to save to some EMR, to have unlimited recordings, to share with other providers.
Once logged into the application, you simply need to turn on the Eko and you will notice that there is a blue circle record button along the bottom. Across the top of the application you will notice 2 parallel bars, “Position,” “Posture,” and a head icon. Tapping the word position icon will allow you to choose heart/lung/other and the posture standing/sitting/supine. The head icon will take you to your saved patient list. To record, press the circle and then save to the patient file. This device/application is listed as HIPAA compliant. Tap the 2 parallel bars along the top left and you will notice that this brings up a menu bar. You will see the remaining battery reserve, you can alter the volume, change playback from the headphones (Eko stethoscope), to the phone, you can enter account settings and help. The playback through the phone is not that great, but the playback through the stethoscope is fantastic. If you try to change the audio to the phone icon, you will get a cautionary warning that the sound is not an actual auscultation. Selecting help will take you to a list of helpful options, which includes video tutorials.
I want you to know that this is not a product first look, nor is this simply a how-to or Unboxing. I have been utilizing the Eko in my personal practice now for the last 30 days, M-F 8-10 hours at a time and during two Saturday shifts. I have a medical student with me currently. I will allow them to listen, I will then record and I will ask them questions about the sounds. I will ask them what they hear and ask them to describe it. Personally, this is superior to the training I received. I had to guess at sounds, I had to rely on online sounds and guess more often than not. It was nice when an upper level would tell me what to listen for. The recording feature is very helpful for this type of training. Y