The COVID-19 pandemic has led to the implementation and use of telemedicine and telehealth platforms and devices as part of current day-to-day standards of care in many hospital and healthcare systems. In this era of social distancing, doctors on our frontlines are at the most risk when diagnosing patients, and it’s therefore important to minimize exposure whenever possible. One of the devices patients immediately associate with check-ups is the stethoscope – a tool not only for assessment, but for bringing a sense of connection between doctors and patients.
Thinklabs Medical has created leading electronic stethoscope technology, which the company believes has helped mitigate the spread of COVID-19. Clive Smith, the CEO and Founder of the company, was the inventor behind designing the electronic stethoscope: Thinklabs One, the company claims, is the smallest and most powerful stethoscope in the healthcare industry with over 100X amplification, compared to a typical acoustic stethoscope. Since it has a standard headphone jack, small off-the shelf Bluetooth transmitters can be used to connect to it and beam auscultation sounds from the patient to the doctor’s headphones. During the ongoing pandemic, the two can stay at a distance from each other while the physician guides the patient where to position the puck-like stethoscope on the body, all while wearing headphones and listening to the results
Thinklabs has been imperative during biocontainment of COVID-19, Ebola, and other pandemics, by supporting doctors at Johns Hopkins Hospital, Bellevue Hospital Center in New York, the Nebraska Medical Center (center of the Ebola crisis in the U.S.), and Emory care for their isolation patients.
We interviewed Clive Smith, the about the ways that Thinklabs One is helping stop the spread of COVID-19 in hospitals across the country and the technology inside this cool digital stethoscope that makes it possible.
Alice Ferng, Medgadget: Tell me a bit about yourself and what got you interested in this space and medical technology in general.
Clive Smith, CEO and Founder of Thinklabs Medical: I’ve always been interested in medical technology. I did my senior thesis in college on electrocardiography. Years later I came across a paper in Circulation Journal that stethoscope acoustics had not improved in 200 years, and I thought it would be an interesting problem to solve, and I thought it would be clinically useful. Many of my friends are doctors who had always told me how difficult it is to hear patients on a stethoscope. I also thought it would be an easy problem to solve. I ended up spending eight years doing research and development before I had something I was satisfied with, with the acoustic performance I thought was needed to be the order of magnitude improvement I was looking for. We launched the first Thinklabs stethoscope in 2003. So, was it an easy problem to solve? No. It’s really difficult to make a good stethoscope.
Medgadget: What are your main competitors in this electronic stethoscope space, and what does your product have to offer that’s better than what’s out there? Are there key differences or innovations that others, such as the Littmann 3200, do not offer?
Smith: Our main competitor is entrenched habits. Doctors are very slow to adopt new technologies; research shows that it can take 17 years for the clinical adoption of a new idea.
Our acoustics set the standard, in terms of the ability to hear heart and lung sounds. The conventional stethoscope is almost inaudible.
There are two major advantages over other devices: One, we are absolutely fanatically focused on audio quality. I approach sound like a musician would. I am a musician, and I am always trying to get the perfect sound. It’s always been a hallmark of our technology.
Two, we play nicely with others. We make our tech as compatible with other techs in the ecosystem as possible, so our device can connect to Zoom, or American Well platforms, or almost any other platform. If a system can capture and transmit quality sound, we work with it. We don’t try to own anything. We have an open systems attitude.
In the current clinical environment, flexibility is critical. You can listen to our device through PPE with standard headphones or a loudspeaker; through walls from an adjacent room using Bluetooth; and through the Internet on telemedicine. We even give away a free audio transmission channel called thinklabs.live It’s an absolute game-changer. The only thing you can do with a conventional stethoscope is stand within two feet of a patient, with almost no protection, while you struggle to hear pathological sounds.
Medgadget: Can you give me more information about this stethoscope? It sounds like this is a wireless device that can be used from mHealth applications.
Smith: The device works with off-the-shelf Bluetooth transmitters that can pair with headphones of the doctor’s choice. It’s another example of our open-systems approach.
Medgadget: Can you talk more to the specific technical capabilities of your product? What are the frequency ranges (high vs low; bell vs diaphragm), battery life, wireless capabilities (type of Bluetooth technologies; range in ft., etc), what other devices can Thinklabs One be paired with (e.g., Bluetooth headphones or analog headphones), decibel ranges?
Smith: The technical specifications of Thinklabs One are as follows:
- Amplification: More than 100x
- Audio Filters: 5 bandpass filters
- Display: Volume, filter, battery LED scale
- Output signal level: Low impedance headphone driver, 3V p-p
- Power input: 5V DC (USB charger compatible)
- Power source: Internal lithium ion cell
- Battery Capacity: > 120 patient exams per charge (2 minutes per patient)
- Transducer: Thinklabs’ patented electromagnetic diaphragm
- Connector: 4-conductor 3.5 mm jack
- Dimensions: 46mm x 28mm
- Weight: 50 g
Headphones: Thinklabs’ high-performance earbud headphones are included with the stethoscope; it is compatible with any high-quality audio headphones.
Apps/Software: Compatible with PC/Mac/iOS/Android audio recording transmission apps, Thinklabs.live, Thinklabs Wave (iOS, Android)
The Thinklabs One can be easily used with a small Bluetooth transmitter that we offer, so that you can listen wirelessly with Bluetooth headphones or speakers.
Medgadget: How do you ensure the patient is utilizing this stethoscope correctly in order to provide the best recordings for physicians to review? I assume this can be done in real-time so that adjustments can immediately be made to correct misplacements on the patient’s chest?
Smith: In a live telemedicine encounter, the provider can see where the stethoscope is placed and can guide the patient. The device itself is fairly easy to use. When recording, our app provides a visual display that shows the waveform. It’s easy to see when a clean recording is being captured.
Medgadget: Please discuss how doctors and patients are leveraging new technology for remote medicine, and what technologies they are deploying.
Smith: The telemedicine era has finally arrived. About 80-percent of doctor-patient encounters can be done remotely. We now have remote stethoscopes to listen to the heart and lungs, pulse oximeters to measure blood oxygen, which is especially important for monitoring COVID-19 patients, and blood pressure devices. Electronic blood pressure measurement, albeit inaccurate, has been in the home for years. Scales have been in the home for a century, and good-quality cameras are ubiquitous. AliveCor and Apple Watch have made ECG and heart rhythm analysis available, as well. So, almost all the equipment that’s available in a primary care practice are now available in the home.
Medgadget: Please describe how Thinklabs One is being used by hospitals, including Johns Hopkins, Mount Sinai, Harvard University Medical, and Dallas Children’s Hospital. What kinds of feedback and support are these hospitals providing? Do you have any industry partners for hardware or software collaborations? Or is that all in-house expertise?
Smith: Johns Hopkins Hospital has been using Thinklabs devices from the time we released our first product. They used our first stethoscopes in projects with the Gates Foundation to capture lung sounds in high altitude pediatric pulmonology research and, since the Ebola outbreak in 2014, they’ve been using the Thinklabs One in biocontainment and in their Infectious Disease units, which was recently shown on 60 Minutes.
Mt. Sinai hospital in New York was discharging chronic patients with heart failure and COPD recently, in order to make space for the anticipated onslaught of Covid-19 patients. Homecare nurses managing these patients are using the Thinklabs One for telemedicine to care for those patients.
Dallas Children’s uses our device exclusively for telemedicine with school nurses across the state of Texas.
Our device is used in bedside teaching at Harvard University.
St Jude’s Children’s Research Hospital is using our device for remote pediatric cancer care for kids who come from across the globe and need follow-up care at home.
Physicians have become really creative in the COVID-19 crisis. We’ve helped them craft multiple approaches to Safe Distance Auscultation. Some groups are using an extension cable to listen to patients in their cars in drive-through exam stations; others are using loudspeakers or headphones through PPE or to the next room; and we have others who are using telemedicine within the hospital or from a remote location. Early on, some physicians were quarantined at home, but could still practice in their hospitals through telemedicine, which was an unusual reversal, where the doctor is in the home, and the patient is in the hospital.
We’ve sent stethoscopes around the world, not only in the US, to Europe, Asia and Australia. In the early days, the geography and urgency of our orders, was almost a metric of where the outbreak was occurring.
Medgadget: How is similar medical equipment being used to help doctors stay safe and protected from COVID spread in the hospitals? How is data being provided without one-to-one contact? How is this data protected?
Smith: It does not apply to us. Our device does not store private health information. Better for you to talk to an EMR provider.
Medgadget: How are remote doctors leveraging other technologies through other technologies like Zoom, etc. With the known security issues of technologies of Zoom, are you making sure that the platforms chosen are secure enough for healthcare privacy (such as Microsoft Teams, which has a focus on secure, encrypted healthcare conversations)?
Smith: Our device is part of a larger ecosystem. It connects to other platforms. Because of the compatibility of our device, we can connect to any system and our customers determine the level of privacy. There are no security issues related to our device specifically. When it connects to other systems, we leave it to the IT and data security teams in the hospitals to select secure systems.
Medgadget: It sounds like you have integral knowledge of how the COVID crisis stands in comparison to the Ebola crisis, can you please elaborate on this? What are your thoughts on this Covid-19 pandemic?
Smith: Ground zero for the Ebola crisis was West Africa. A limited number of leading biocontainment centers were the primary treatment centers for those patients in the US: Emory in Atlanta, the NIH Clinical Center, Bellevue Hospital in New York. These super-specialized centers had deep expertise and skills in managing highly infectious patients, and the number of patients in the United States was extremely limited, mostly clinicians who had been in Africa. We were supporting teams on the ground in Africa and we provided stethoscopes to all the hospitals who were dealing with patients in the U.S. The situation was very well contained in the U.S. and in Europe.
Ground zero for the COVID pandemic is Planet Earth. Every hospital in the U.S., regardless of their experience with infectious disease management, has had to learn in real-time how to manage infectious patients. The scale is orders of magnitude greater than Ebola in the U.S.
Three. We are in mitigation now, not containment.
And lastly, as someone who grew up in South Africa, I’m hoping that this time, Africa will get a pass as their winter approaches.
Medgadget: Are you working with other companies to actually look at recordings in terms of predictive algorithms for conditions, etc.?
Smith: Yes, we are. There’s a lot of work being done in that area. We are very involved. But we don’t like to predict the performance of algorithms before they perform. A number of AI algorithms in our space are based on very limited studies.
Medgadget: Any other things to highlight about your company, upcoming innovations or other products, or the Thinklabs One that hasn’t been asked yet?
- Instantaneous increase in demand and production during Covid-19
- Lightning-speed innovation in production technologies to meet demand
- Daily conversations with frontline hospitals and healthcare workers, to establish best practices in auscultation through PPE in Emergency Departments and ICUs
- Launched Safe Distance Auscultation initiative
After the acute crisis subsides, you will see a lot of innovation in telemedicine, which is likely to be the enduring legacy of this pandemic.