Handheld Ultrasound Devices Making Stethoscopes Obsolete?

The stethoscope, the iconic device representing medical technology for the past two centuries, may be fading from the scene as physicians start to embrace mobile technology in the form of handheld ultrasound devices and smartphone apps.

Newer digital stethoscopes enable doctors to not only listen to heart sounds and record them, but handheld devices provide high-resolution ultrasound that can actually “see” what’s wrong with the heart.“Why do you want to still focus on these heart sounds that provide very indirect information and secondary acoustic events?” asks Eric Topol, MD, chief academic officer of Scripps Health in San Diego and a practicing cardiologist. “It’s time to move on.”

Topol also is director of the Scripps Translational Science Institute, a National Institutes of Health sponsored consortium that seeks to leverage the power of digital medicine. He says it’s been nearly six years since he has used his stethoscope to examine patients. Instead, he uses a portable echocardiogram through his smartphone. Eventually, Topol believes the stethoscope (or what he more accurately terms a stethophone) will be superseded by sound wave technology that actually scopes and is smartphone connected.

As Topol points out, several studies have compared handheld ultrasound devices with physical examination and found the devices to be significantly superior to physical examination for detecting cardiac abnormalities. In addition, he references a recent study published in the European Heart Journal that found that more than half of doctors can’t identify basic heart sounds accurately using a stethoscope, digital or otherwise. “Having a digital stethoscope isn’t going to fix that, just because you can record it,” Topol contends.

Nonetheless, the Food and Drug Administration this past fall approved the use of a digital stethoscope that can integrate heart sounds into a patient’s electronic health record. The stethoscope, called Eko Core, from startup vendor Eko Devices in San Francisco, wirelessly streams heart sounds to a HIPAA-compliant smartphone app that is available in the Apple App Store.

Because patients’ heart sounds can be integrated directly into EHRs, executives at Eko Devices contend that their mobile solution enables “more seamless cardiology referrals, documentation and cardiac monitoring.” In addition, they say Eko Core is the only stethoscope available that enables clinicians to switch between analog and digital modes.

However, Topol is not very impressed with the FDA-approved device. When Eko Core was announced, The Washington Post called it one of the biggest innovations in medicine, he says tongue in cheek. “It’s nice that, after 200 years, the stethoscope got digitized so that it actually can be recording things for the first time,” he remarks. “But, quite frankly, I think it’s too little-too late, because you can see everything with high-resolution, handheld ultrasound.”

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