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Originating Site Guidance - iOS/Android

Logging in and Pairing (Android/iOS):

  1. Login to the Eko app and use the credentials provided. At the login screen, tap “clinicians” to use your own login or a designated site login provided by the Eko administrator at your institution. Tap “Telemedicine” if you have been issued an 8 digit number and 4 digit pin.
  2. Ensure that the Bluetooth is active on your device, then turn on your Eko device.

DUO (left): Turn on by pressing and holding the action button for two seconds, the LED will blink which means that the device is searching for a Bluetooth Connection.

CORE (right): Turn on by moving the toggle to ON- the light will flash WHITE

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Once the device you want to use appears in the menu, tap it to pair. After a successful connection The DUO LED will turn from flashing to solid and the light on the CORE will turn solid WHITE

Activating Live Playback 

Live Playback allows you to listen to the stethoscope audio using standard headphones connected to your mobile device. 

  1. After logging in and pairing your Eko device, tap “Record” on the Home Screen to begin a Quick Recording.
  2. From here, you can tap “Audio” to enable Play from Headphones. This setting allows you to stream sounds to headphones or earbuds that are connected to your phone or tablet. Please adjust your phone’s audio settings to find a suitable volume. You have the option to enable Volume Boost, which will further amplify the sounds.
    to the right (to activate it)
    • mceclip0.png
  3. Once the switch is toggled on, the sounds will play from your headphones connected to your mobile device. 
    • For best sound quality, we recommend using wired headphones plugged into your phone        

You can playback a recording that you have made using either your stethoscope earpieces or using headphones plugged into your iOS. When your CORE/DUO is ON and paired, your mobile app will default to playing back your recording through the stethoscope. When the CORE/DUO is OFF, your mobile app will default to playing back your recording through the iOS device.

If using CORE, an Android device will work as outlined above. If using DUO, your playback output will always default to the Android device.  *Note: Please disable this feature to reduce noise from coming out of your phone/tablet if the same device is being used as the originating device.

Initiating a Live stream

Initiating a Live stream (if applicable to your plan) *iOS screenshots below, names and direction same for Android.

  • You can also tap “Live Stream” to initiate a Live Stream session if you have an Enterprise Software Plan.
  • Make sure to click “Live Stream” and toggle the feature to “on” to unlock the Live Stream URL
  • If your workflow involves sharing the Live Stream link, users will need to click the “Live Stream” icon and select “Email Live Stream link’ or “Share Live Stream link” from the pop-up.

Note that when you launch the Eko Clinic application, it will default to your last used screen. If you are utilizing the Eko application primarily for Live Stream, you will remain on the “Record” tab where Live Stream lives unless someone clicks away.
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Ending a Live Stream Session

Simply turn your Eko device off or navigate back to the settings panel and switch the Live Stream toggle ‘OFF’. The Live Stream can be left ON if several patients are scheduled to be seen throughout the day. Collaborators will be able to use the same URL you shared previously, which can be saved as a “favorite” within their internet browser.

Running AI Analysis with Spot Check

Spot Check lets you quickly check for signs of cardiovascular disease from a single recording. Eko’s FDA-cleared, clinically-validated, automated disease detection will automatically check for potential heart murmurs or atrial fibrillation with every Spot Check or full Cardiac Exam. If you are interested in walking through a full cardiac exam, please visit our Cardiac Exam Walkthrough to learn more.  

Step 1: Connecting your Eko stethoscope. 

Make sure Bluetooth is enabled on your mobile device. Log in to the Eko App and power on your digital stethoscope. Connect_Device_1.png

 

Select the stethoscope you want to set up from the screen. If you’re using the same stethoscope from your last pairing, Eko will automatically reconnect with that stethoscope. Connect_Device_2.png

 

The app will indicate when the stethoscope is paired successfully.

 

Connect_Device_3.png

Step 2: Entering Spot Check

On the Cardiac Exam Home Screen, tap “Spot Check” to begin. (On your first visit to the new version of the clinic app, Spot Check will be the only selectable option, as shown on the left. Spot_Check_1st_Time.png

 

Once you complete your first recording, you’ll have the option to perform a Spot Check or Full Cardiac Exam for any future assessment, as shown on the right.) Returning_User_Screen.png

Step 3: Learning about heart sound and ECG analysis

If this is your first time using the new Eko app, a series of screens explaining the possible results and indications for use of the Eko Analysis Software will automatically appear before starting your Spot Check. Murmur_AI.png

 

Tap “Continue” to proceed through each screen.  AFib_AI.png

 

Be sure to check the acknowledge box after reading the Indications for Use and before tapping “Continue.”  EAS_IFU.png

Step 4: Taking a recording

Spot Check mode is set to record at the Left Upper Sternal Border (LUSB) by default. Once the Eko app hears a sound, it will start recording automatically. You will see the recording and analysis progress on the mobile device screen, as shown on the screenshots below. Note that in Spot Check mode, only one recording will be taken. 

Use the included visual to help guide you through placement. If you’re using a CORE device, hold the chestpiece in position as you normally would.

DUO_Placement.png

 

If you’re using a DUO, we recommend positioning the device at an angle toward the left shoulder, ensuring both electrodes are in direct contact with the patient’s skin CORE_Placement.png

 

Have your patient remain still and quiet to capture a high quality recording. The app will listen for a good signal. Listening_LUSB.png

 

When a good signal is found, a 15-second recording will start automatically. Audio_Settings.png

 

Hold your stethoscope steady for the next 15 seconds. Eko will automatically check for heart murmurs and/or atrial fibrillation (when using DUO). Placement_Tips.png

 

Tap on “Audio” on the lower left of the screen to enable audio playback through headphones. As shown below on the left, you can initiate headphone playback by sliding the toggle until it is blue. You can also engage Volume Boost by moving the slider right or left. Recording.png

 

Tap on “Placement” on the lower right of the screen to pull up the placement reference image, as shown below on the right. Recording.png

Step 5: Viewing the results

Once you have finished the recording, the algorithm analysis results will be displayed on the Spot Check Summary screen. From here, you can assign the recording to a patient by tapping “Assign” on the top right corner.  Summary_1.png

 

If you’re assigning the recording to a patient you’ve already created, you can find and select them using the search bar or by scrolling through the patient list. Assign.png

 

You can also create a new patient profile directly from the recording. If you close the “Assign Patient” tray or select “I’ll Assign Later,” your recording will be automatically saved under “Unassigned.” Create_New.png

Tap “Share” in the lower left corner to generate and share a report with the full waveform, a secure link to access the audio clip, and any included annotations (this is explained in more detail below).  Tap “Notes” to enter freeform notes about this patient and/or recording (this is also explained in more detail below).

Tap “Playback” to see the recorded phonocardiogram and hear the recorded sounds. Select_Playback.png

 

Tap “Delete” to delete the recording; you will be asked for confirmation before deletion takes place.  Delete_Recording.png

Step 6: Select a stance

(Optional) Indicating the stance your patient was in during the recording by selecting: “Standing, Sitting, or Supine.” Select_Stance.png

Step 7: Entering notes and details

Tap “Notes” to further annotate this exam with freeform text. Select_Notes.png

 

Fill in any additional detail by typing into the text field. Keep in mind that any notes or comments you add will be included when sharing this recording. Therefore, we strongly recommend omitting any personally identifiable patient information or protected health information. Select “Done” to save the note. Draft_Note.png

 

From the Summary Notes screen, you can edit or delete the note by swiping left on the note and tapping on either “Edit” or “Delete”. You will be asked to confirm any deletion before the record is actually deleted. 

Left_Swipe.png

 

You can also add separate, additional notes by tapping, “Add Note” at the bottom of the screen. Edited_Note.png

Step 8: Sharing a recording

After you tap “Share”, you’ll see a pop-up miniature version of the generated report. Select_Share.png

 

You now have the option to use a number of common media including text messaging, email, or any frequently used messaging apps. Your recipient will be able to access the audio clip directly from the report without any login.  Share_Report.png

[Important] If this recording is assigned to a patient, any personally identifiable information (PII) from that patient will be present and visible on the report. This may violate HIPAA provisions if you are sharing. YOU ARE RESPONSIBLE FOR ENSURING HIPAA COMPLIANCE WHEN YOU ARE SHARING PATIENT RECORDS.

After you tap on your chosen method (medium) for sharing, tap “End Spot Check” to return to the Cardiac Exam Home Screen. You also have the option to add the three other cardiac recording positions to this Spot Check exam by tapping “Continue with Full Exam.” That will take you to Cardiac Exam Mode. For more information on Cardiac Exam Mode, visit here

Remember, once you’ve completed your first recording, you’ll be able to choose between performing a Spot Check or full Cardiac Exam on any future login.  Home_Screen_Returning_User.png

Patient Recordings

Navigate to Patients by tapping on the “Patients” tab in the bottom right corner.

Returning_User_Screen.png

“Assigned” recordings will display by default.  You can search for a patient by entering their name into the search bar (as shown on the left). Tap on the found patient’s name to view a list of recordings assigned to that patient (as shown in the middle). A list of all of that patient’s recordings will come up by default. 

Murmur_AI.png

You can quickly filter that list by tapping either “Cardiac Exam” or “Quick Record”. (Spot Check recordings will be listed as a “Cardiac Exam” with one recording.)

AFib_AI.png

Tap the recording you’d like to review (as shown on the right). While reviewing, you can add notes to the recording, reassign it, or delete it. You can also scroll through the full list of assigned patients and tap on the patient you want to view.


EAS_IFU.png

Back on the Recordings list, you can also take quick actions by swiping left on the recording and tapping “Reassign” or “Delete.” 

DUO_Placement.png
If you want to edit or delete that patient’s profile, tap “Edit” on the top right corner. AFib_AI.png

If you want to see unassigned patient records, go back to the search screen and tap “Unassigned”. Quickly filter your recordings by “Cardiac Exam” or “Quick Record”. (Spot Check recordings will appear under the “Cardiac Exam” filter.) Tap the recording you’d like to review. 

Audio_Settings.png

 

If you’d like to assign that recording to a patient, tap “Assign” on the top right corner to assign this recording to a new or existing patient. You will be given the option of assigning the recording to an existing patient (as on the left) or creating a new patient (as on the right).

Placement_Tips.png

 

If you change your mind, and decide not to assign the recording after all, just tap “I’ll Assign Later”.

 

Assign.png

 

You can also take quick actions on a single recording by swiping left on the recording and selecting “Assign” or “Delete”, or by tapping “Edit” at the top right corner to assign or delete multiple recordings at a time.

 

 

 

Select_Stance.png

Once you tap “Edit”, you will see empty circles appear next to the recordings. Tap on the circles corresponding to the recordings you want to assign or delete, and then tap on the appropriate action at the bottom of the screen. 

Playback.png

 

 

You may cancel this action at any time by tapping on “Cancel” at the top right of the screen.

 

 

Select_Notes.png

Assigning a recording

 

 

From the Unassigned Patient Recordings screen, swipe left on the recording you’d like to assign.

 

 

Draft_Note.png

 

 

Tap “Assign” and select a patient to assign the recording to.

 

 

Assign.png

 

 

Or create a new patient.

 

 

Create_New.png

 

 

Tap “Edit” at the top right corner of the “Unassigned” Patient Recordings screen.

 

 

Select_Stance.png

From here, you can select and assign multiple recordings at a time.

Select_Notes.png

 

Following a Cardiac Exam or Quick Record, tap “Assign” in the top right corner of the “Results” screen and select a patient to assign the recording to or create a new patient. Note that ending the Spot Check or Cardiac Exam without assigning will save the recording as “Unassigned”

iPhone_UI_51.png

Editing a Patient Profile

Navigate to the Patient Recordings screen by tapping the “Patients” tab. Under “Assigned,” tap on the patient name that you’d like to edit. Tap “Edit” at the top right corner. Fill in or edit the patient’s information.

Murmur_AI.png

You can also share the patient profile with another Eko user by tapping “Share Patient.” Add your recipient’s contact information and tap “Save”. (Important: Your recipient needs to have an Eko account tied to the indicated email address to access the shared patient information.) 

Select_Notes.png

Tap “Save” to save all changes and return to the patient’s list of recordings.

CORE_Placement.png

Sharing a recording

From a patient’s profile:

Select a recording from the patient’s list of recordings.

AFib_AI.png 

Tap “Share” at the bottom left corner from the recording screen.

iPhone_UI_59.png

Select the medium for sharing and input your recipient’s contact information. (Make sure there’s no identifiable patient information in your annotations for this recording)

iPhone_UI_93.png 

Following a spot check:

 Tap “Share” at the bottom left corner from the Summary screen

Select_Share.png 

Select the medium for sharing and input your recipient’s contact information. (Make sure there’s no identifiable patient information in your annotations for this recording)

iPhone_UI_93.png 

A single position following a full Cardiac Exam:

Select a single position from the Exam Summary screen.

EAS_IFU.png 

Tap “Share” at the bottom left corner of that position’s recording/playback screen.

iPhone_UI_77.png

Select the medium for sharing and input your recipient’s contact information. (Make sure there’s no identifiable patient information in your annotations for this recording)

 

iPhone_UI_93.png

Bluetooth Range / Connection

Bluetooth connection: The Eko CORE and DUO all connect to compatible software programs via Bluetooth and are subject to the limitations of most other Bluetooth devices. If users are experiencing poor connectivity (frequent disconnections, latency, or disruptions in transmission of the wave forms) attempt the following:

  •  Check that Bluetooth has been turned On for that device.
  •  Ensure that there is a clear line of sight between the stethoscope and the device the user is attempting to connect and stream from. 
    • Even a human hand or body may disrupt the connection
  • Limit the physical distance between the stethoscope and the device the user is attempting to connect and stream from. 

Poor waveforms: If users are experiencing waveforms within the app that have artifact or are smaller than desired, Eko advises: 

  • Alter the positioning of the device. Certain anatomical locations or positioning may provide better waveforms and ECG tracings. 
  • Follow the steps to improve Bluetooth connectivity. If the Bluetooth connection is disrupted that will affect graphing of the waveforms.

Best practices

  • Ensure that the Live Stream feature has been toggled “On” in the Eko app and that you have solid waveforms coming through on your screen to confirm successful pairing. If the feature is “OFF”, the provider will not be able to listen to your device.
  • Adjusting your local volume from the device or the app will not impact the listening provider’s experience, only yours. The listening provider should adjust the volume from their browser or on their local machine as needed.
  • The stethoscope can be turned “OFF” during the assessment as needed to confer with the listening provider over the video platform used. *Please note that turning the stethoscope “OFF” will end the data transmission; if the stethoscope is turned back “ON” it should auto-pair with the Eko mobile applications (users of the Eko Windows software may need to connect the device again directly) and restart the Eko Live Stream session.
  • If you are experiencing audio feedback, it could be helpful to briefly mute the video conference microphone during auscultation. That way, the listening provider can continue to instruct on stethoscope placement as needed. When bi-directional conversation is needed again, remember to unmute.
  • Always ensure there is a clear line of sight between the stethoscope and the device it is paired to, this will decrease the chances of potential Bluetooth interference.
  • If using the Eko app on iOS or Android, the clinician may send the app to the background and continue the live streaming session while utilizing another video conference app.
  • Once the assessment is concluded, the provider can turn the Eko stethoscope OFF and close the Eko app until the next visit. 

 

LBL 270, Rev C, March 16, 2022

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