Using the Eko DUO with the Eko Android Application
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Introduction to Guide
The purpose of this guide is to provide a step-by-step walkthrough of the Eko Android Application and how it interfaces with the Eko DUO.
The guide is meant to complement the official Eko DUO User Manual, available for download under ‘DUO Resources’ at the following link:
1. Getting started with the Eko Android App
1.1. Download the Eko Mobile Application
The Eko DUO pairs with an Android application available for download from the Google Play Store. Search for the Eko: Digital Stethoscope + ECG app and initiate the download.
Please note Indications for Use:
The Eko Model E5 System is intended to be used by healthcare professionals to electronically amplify, filter, and transfer body sounds and single-channel electrocardiogram (ECG) waveforms. The Eko Model E5 System also displays ECG waveforms and phonocardiogram waveforms on the accompanying mobile application for storage and sharing (when prescribed or used under the care of a physician). It can be used to record heart sounds and cardiac murmurs, bruits, respiratory sounds, and abdominal sounds during physical examination in normal patients or those with suspected diseases of the cardiac, vascular, pulmonary, or abdominal organ systems. The device can be used on adults and pediatrics.
The data offered by the device is only significant when used in conjunction with physician over read as well as consideration of other relevant patient data.
The device should not be used on infants weighing less than 10kg.
1.2. Sign up for an Eko Account (New Customers Only)
If you are new to Eko, you will need to sign-up for an Eko Account. Open the Eko Mobile Application, click Sign Up, and enter your first name, last name, preferred email address and password (Figures 1 and 2).
Existing Eko customers can click Log In.
1.3. Create a 4-Digit PIN
Once logged in, you will see two horizontal lines in the upper left corner of the screen. Click on those to enter the Settings Menu (Figure 3). We recommend creating a 4-digit PIN by clicking “Change PIN.” The 4-digit PIN can be used to quickly re-enter the application if you need to navigate away at any point.
1.4. Pair Your DUO
You are now ready to connect your DUO. Please turn ON the DUO by holding down the center button for 3 seconds. The ring of LED lights around the button will illuminate when the DUO has been turned ON. The top LED light will remain illuminated to illustrate the device is turned on in the Diaphragm stethoscope filter mode (Figure 5). Click Connect Device.
You will see the word ‘Eko DUO’ appear on the screen. Please click on the word ‘DUO’ to complete the pairing process with the iOS device. (Figure 6).
2. Using the Eko Android App
2.1. Start a recording
When the DUO is paired, you will see the PCG (phonocardiogram) and 1-lead ECG (electrocardiogram) waveforms appear on the Home Screen (Figure 7). The PCG will appear on the bottom of the screen and the ECG will appear on the top of the screen.
To begin a recording, tap the blue circle on the main recording screen (Figure 7). By default, the recording length is set to 15-seconds. Recording length can be changed in the Settings Menu (See Section 4). A recording can be stopped at any time by tapping the blue rectangle (Figure 8).
2.2. Add Recording Position to A Recording
To annotate a recording with a recording position, click on “Position” or “Posture” at the top of the screen (Figure 9). Tap on the Heart, Lung, or Other to reveal common recording positions. Scroll to select the desired position and select “Save and Close” (Figure 10).
2.3. Adding Notes to a Recording
To annotate a recording with notes, select the desired recording and then click on the note symbol in the bottom left-hand side of the screen (Figure 11). Click on “Add Note” and type in any notes you wish to associate with the recording (Figure 12).
2.4. Saving a recording
After associating a recording position and any notes, you are now ready to save the recording. Click SAVE to save the recording (Figure 12). You can save a recording to an existing patient or create a new patient (Figure 13). If this is your first time using the Eko Application, you will need to create a new patient (see section 2.5 below).
2.5. Creating a new patient
To create a new patient, click on Add New in the top navigation bar (see Figure 13 above). You will be required to enter a unique Patient ID (such as a medical record number) and have the option to write in First Name, Last Name, Birthdate, Gender, and a Description about the patient (Figure 14).
2.6. Saving a recording to a patient
When you are ready to save a recording to your new or existing patient, search for the desired patient and press Save. Your recording will now be associated with that patient.
2.7. Sharing a patient record
A patient record can be securely shared with a clinical colleague. To share a patient record, click on the patient’s name and tap the three dots in the top right of the patient record screen (Figure 17). Click Share Patient and enter your colleagues email (Figure 18). Your colleague will receive an invitation to log into Eko’s secure web dashboard (Section 4) to review the patient record and any associated recordings.
3. The Settings Page
3.1. Navigating to the Settings Menu
To find the Settings Menu, navigate to the home screen of the Eko Mobile App and tap on the ‘=’ symbol in the top left of the screen. The Settings Menu will allow you to customize your app experience to best fit your needs.
3.2. The Settings Menu Overview
The Settings menu is divided into four sections: 1. Devices, 2. Live Streaming, 3. Account, and 4. Support. Your DUO must be paired with the Eko Application to adjust the device settings.
3.3. Settings > Devices > Connection Status (‘Not Connected’ or ‘Connected’)
The first item on the device menu is the current connection status of the device. It will either say ‘Not Connected’ or ‘Connected’ if a device is paired.
If the status reads ‘Not Connected’, click on the word ‘Connect’ and follow instructions outlined in Section 2.2 of this guide to pair your DUO.
‘Connected to DUO’:
If the status reads ‘Connected’, you have successfully paired the Eko DUO with the Eko Mobile Application. A battery status indicator will show the current battery level on the device. You can disconnect the DUO from your iOS at any time by selecting ‘Disconnect’.
*TIP*: Pairing one time per Device to initiate Auto-pair: After connecting a DUO to your Android device once, your DUO should consistently auto-pair with the device moving forward provided you have not connected with another Bluetooth device in between sessions. Simply turn the device on to begin pairing.
3.4. Settings > Devices > Volume
A DUO device must be paired with the Eko Mobile App to reveal the volume toggle under the ‘Devices’ section of the settings menu. This volume toggle represents the volume of the audio playing out of the DUO. The DUO output volume can be adjusted by either pressing the volume toggle on the side of the device or adjusting the volume in the mobile app.
3.5. Settings > Devices > Audio Filter
A DUO device must be paired with the Eko Mobile App to reveal the Audio Filter section. You can change the audio filter on the DUO between the following modes: Diaphragm, Bellmode, Midrange, and Extended. The frequency ranges for each mode are outlined in the Getting Started Guide that is included in your device package and the complete User Guide that is available online.
3.6. Settings > Devices > Recording Length
The default recording length for our devices is set at 15 seconds. You can only change the recording length when the DUO is paired with your device. Do so by going to settings and looking under the Devices section for ‘Recording Length’. Use the toggle to adjust the maximum recording length between 15 and 120 seconds. You can stop the recording at any time during the session by pressing the blue rectangle.
3.7. Settings > Devices > Quick Record
You have the ability to start recording directly from your DUO if your Android device is out of reach. After connecting your DUO, click on settings and look under Devices to make sure the ‘Quick Record’ switch is turned to the right and green. You can now quick record directly from your DUO by double-tapping the center button. To stop the recording, double tap the center button again.
3.8. Settings > Devices > ECG Mains Filter
Depending on your preference, you can toggle the main filters on your DUO between 50 Hz and 60 Hz. Go to settings, look under devices and scroll down until you see ‘ECG Main Filter’. The switch will always be green, but when it is switched to the left it will say 50 Hz indicating that it is set to 50 Hz and when it is switched to the right it will say ‘60 Hz’ indicating it is set to 60 Hz.
3.9. Settings > Account
If you want to make changes to your account information, you can do so at any time within the Eko App. Go to settings and scroll down to the ‘Account’ section.
By selecting the word ‘Edit,’ you can change the first name and last name name associated with your account.
To change your password, select ‘Change Password’. Type in your existing password once and your new password twice. After pressing the blue check mark, your changes will be made.
By selecting ‘Change Login Pin’ you can change the login pin for your account.
3.10. Settings > Support
If you are having any issues with your DUO, working the app or any other questions, the Eko App can point you in the right direction.
When on the settings page, scroll down to the Support section. By pressing “Help” you will be redirected to our Resources and FAQs. From here you can also access our customer support email address if you cannot find answers to any of the questions online.
4. The Eko Web Dashboard
4.1. Accessing the Eko Web Dashboard
From our website you can access all of the patient data you recorded and saved to your Eko account. Simply go to our website https://ekohealth.com/, and select login at the top of the screen.
From here login to the Eko dashboard by using the username and password you created on your phone or tablet.
After pressing sign in you now have access to all the patient data that you saved to the Eko App from the Eko Dashboard!
4.2. Accessing a patient recording
When opening up the Eko Dashboard, it will default to showing you a list of all of your patients. If you are not at this view or you want to filter the list of patients you have, select the ‘All Patients’ tab on the side of the screen. If you want to filter the patients by ones that are shared with you or ones from your EHR, select the tab on the side that indicates that group. Another way to effectively find a patient is by typing in their name, or patient ID into the search bar at the top of the screen.
Select the patient's name whose recordings you want to open up. A list of all the recordings you have saved by that patient will appear as their date and time.
You now have access to your patients recording!
4.3. Playing back a patient recording
If you want to listen back to a patient's auscultation, select the one that you want to listen back to and the audio file will appear. To listen to the recording, just press the play button in the bottom left corner.
4.4. Adding notes to a patient recording
If you want to add notes to an auscultation, open up the recording that you want to make notes on. In the bottom bar, type in the notes that you wish to add to the recording. After you are done editing them, press enter and they will show up.
If you want to mark a note in a specific section of the recording, select the spot in the recording that you want to mark and drag until you have covered the whole section. The bottom bar will now have that sections time marked. Write any notes that you want to leave in the bar and press enter.
4.5. Sharing a patient file
To share a patients data, first select the patient whose file you wish to share. There are three tabs at the top below the patient's name; ‘Recordings’, ‘Sharing’ and ‘Activity’. select the one labeled ‘Sharing’.
Select the button in the bottom right corner of the screen that says ‘Share Patient’. By pressing ‘Share Patient’ you can give another person access to all of a patients data. Type in the email address of the person you would like to share this data with and press ‘Send Sharing Link’ to give them access.
4.6. Exporting audio and ECG from a patient file
To export the sound of your auscultation, select the recording you wish to download and press the green button labeled ‘Data’ in the top right corner.
If you would like a PDF rhythm strip, return to the patient recording and select the blue PDF button in the top right corner of the recording.
From here you can save the document using the download button. The .pdf also includes access to the recorded audio from the auscultation. Simply select the ‘download data’ button in the top right corner and it will download the wav. file.
4.7. Upgrading to Eko Telemedicine or an enterprise account
If you want to use your DUO to livestream an auscultation in real time to as many people as you want, you can do so by upgrading your account to a ‘Telemedicine Account’. The Telemedicine upgrade has a $480 annual fee. If you are a health system or group looking to create a customized Eko Dashboard and (insert more details) you can upgrade your account to an ‘Eko Enterprise’ account.
Go to your Eko Dashboard and select the account Icon in the top right corner of the screen. Under here click on the tab that says ‘Upgrade’.
From here there are two options you can select from, ‘Eko Telemedicine’ and ‘Eko Enterprise’. For Eko Telemedicine, select the ‘Set Up 2-Week Free Trial’ button and enter your credit card information. As indicated, you will receive a two week free trial of the ‘Telemedicine’ service to see if it is a good fit for your needs.
For the Eko Enterprise service, select the ‘Contact Us’ button under the Eko Enterprise tab. This will redirect to your email so you can let us know your exact needs for an enterprise account and we can negotiate pricing with you.
5. Eko LiveStream
5.1. Starting & Sharing a LiveStream Session
Navigate to your Settings panel under the LiveStreaming section. Tap the “Live Stream” toggle to ‘ON’. You will see a bar at the top of the screen indicating that Live Stream is going.
5.2. Sharing a LiveStream Session
You can share a live stream URL with someone by:
- Entering their email address where it says “Email live stream link”
- Selecting the “Share live stream link” option and sending the URL through one of your communication apps (e.g. text message, email)
- Copying the livestream Live Stream URL by going to “Share live stream link” > select the “copy” icon and paste the livestream URL in an app outside of the Eko mobile app
Best practices for sharing a livestream session with a group
- Share the livestream session with yourself (enter your email address in the “Collaborator’s Email Address”) and forward the email to the group you wish to share it with.
- Share the livestream link in a group text message.
5.3. Ending a LiveStream Session
You can end a live streaming session by navigating back to the settings panel and switching the Live Stream toggle ‘OFF’. This will allow you to re-start the live streaming session at anytime and have collaborators tune in using the same URL. We recommend this URL be saved as a “favorite” within the internet browser.
If you select “Reset URL,” the URL you shared will no longer be active. To start another live stream session, you will need to re-share the new URL with your collaborators.
5.4. Tuning into (listening) to a LiveStream Session
Collaborator will receive an email notifying them they have been invited to join a live stream session. They can join livestream in their web browser using Chrome, Safari (Mac only), Firefox, or Microsoft Edge (PC only). They can also join livestream from their mobile phone web browser using Safari. They will see the waveform moving across the screen and can listen to the audio. We recommend using headphones* to listen.
* Heart/lung sounds are low frequency. Phone/computer speakers are optimized for high frequency sounds.
Step 1: Collaborator will receive email and should click “Listen Now.”
Step 2: They will see dark waveforms moving across screen and should listen to the audio using headphones.
Step 3: They will see this screen when the session has not begun, has ended or if the connection is lost.