JP2013505067A - Electronic stethoscope system for telemedicine applications - Google Patents

Abstract

  An electronic stethoscope includes a housing configured for handheld operation, a transducer supported by the housing and configured to sense an auscultation signal at a first location, and coupled to the housing and auscultated through a headset earphone. A headset configured to deliver an audio signal corresponding to the signal. The electronic stethoscope senses the auscultation sound at the first location and an audio signal corresponding to the auscultation signal is provided in substantially real time to the headset of one or more additional electronic stethoscopes at the second location. The auscultation signal is disposed within the housing, converts the auscultation signal into a first digital signal representing the auscultation signal, and wirelessly transmits the first digital signal from the electronic stethoscope to the second location via a secure digital network. A processor configured to:

Description

  The present invention relates to a telemedicine system. More particularly, the present invention relates to electronic stethoscopes that transmit signals in real-time over a telemedicine system over a secure digital network.

  Various devices have been developed to detect sounds emitted by the body, such as heart sounds and lung sounds. Known devices range from primarily mechanical devices such as stethoscopes to various electronic devices such as microphones and transducers. For example, a stethoscope is a basic tool used to diagnose cardiovascular diseases and conditions. It serves as the most commonly used technique for diagnosing such diseases and conditions in primary medicine and in situations where advanced medical equipment is not available, such as in remote locations.

  For example, it may take several years to acquire and refine a technique for detecting relevant heart symptoms and making a diagnosis based on the sound heard through a stethoscope. It is easily understood by clinicians. The time period in which heart sounds are separated from each other is often very short, and the signals that characterize heart disease are often harder to hear than normal heart sounds, which detect auditory abnormal heart movements The work is complicated.

  In one aspect, the invention comprises a housing configured for handheld operation, a transducer for sensing an auscultation signal at a first location, and a headset for delivering an audio signal corresponding to the auscultation signal through an earphone of the headset. A telemedicine system including a first electronic stethoscope comprising: The telemedicine system further includes a second electronic stethoscope comprising a housing configured for handheld operation, a transducer, and a headset for delivering audio signals through the headset earphones. The first electronic stethoscope includes a processor that converts the auscultation signal into a digital signal representing the auscultation signal, and an antenna that wirelessly transmits the digital signal to a second location via a secure digital network. The second electronic stethoscope has an antenna that receives a digital signal representing an auscultation signal at a second location via a secure digital network, converts the digital signal into an audio signal corresponding to the auscultation signal, and A processor that senses the auscultation sound and distributes the audio signal substantially in real time through the headset earphone of the second electronic stethoscope.

  In another aspect, the invention comprises a housing configured for handheld operation, a transducer supported by the housing and configured to sense an auscultation signal at a first location, and a headset coupled to the housing. And a headset configured to deliver an audio signal corresponding to the auscultation signal through the earphone. The electronic stethoscope senses the auscultatory sound at the first location and an audio signal corresponding to the auscultation signal is provided in substantially real time to the headset of one or more remote electronic stethoscopes at the second location. The auscultation signal is disposed within the housing, converts the auscultation signal into a first digital signal representing the auscultation signal, and wirelessly transmits the first digital signal from the electronic stethoscope to the second location via the secure digital network. And a processor configured as described above.

  In a further aspect, the present invention relates to a telemedicine system that includes a local electronic stethoscope configured to sense a patient's auscultation signal and convert the auscultation signal into a digital signal representing the auscultation signal. The telemedicine system further includes one or more additional electronic stethoscopes and a secure network interface that connects the local electronic stethoscope to the one or more additional electronic stethoscopes via a secure digital network. Each of the one or more additional electronic stethoscopes is configured to receive a digital signal representing the auscultation signal via the secure digital network and convert the digital signal into an audio signal corresponding to the auscultation signal. The audio signal is sensed by a local electronic stethoscope and is delivered substantially in real time through the headset earphones of each of the one or more additional electronic stethoscopes.

  While several embodiments are disclosed, other embodiments of the invention will become apparent to those skilled in the art from the following Detailed Description, which illustrates and describes exemplary embodiments of the invention. Will. Accordingly, the drawings and detailed description are illustrative in nature and not restrictive.

1 is a diagram of a telemedicine system according to an embodiment of the present invention. FIG. FIG. 2 is a perspective view of an embodiment of an electronic stethoscope suitable for use in the telemedicine system shown in FIG. 1 is a front view of an embodiment of a system that works with a patient-side or specialist-side electronic stethoscope. FIG. A screen shot of an embodiment of a patient-side user interface. A screen shot of an embodiment of a user interface on the specialist side. 6 is a screenshot of a graphical user interface that can be displayed on the user interface shown in FIGS. FIG. 2 is a perspective view of an embodiment of a wireless chestpiece for use with the telemedicine system shown in FIG. 1. FIG. 2 is a perspective view of an embodiment of a wireless headset for use with the telemedicine system shown in FIG. 1. FIG. 3 is a diagram of a telemedicine system according to another embodiment of the invention.

  While the invention is susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and are described in detail below. However, it is not intended that the invention be limited to the specific embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives without departing from the scope of the invention as set forth in the appended claims.

  FIG. 1 is a diagram of an embodiment of a telemedicine system 10 that includes a bioacoustic sensor 12, a patient computer 14, a patient software interface 16, a specialist computer 22, and a specialist software interface 24. An optional wireless headset 25 is also shown to the specialist. The patient-side bioacoustic sensor 12 communicates wirelessly with the patient-side computer 14 and exchanges information with the patient-side computer 14 via the patient-side software interface 16. The specialist bioacoustic sensor 12 wirelessly communicates with the specialist computer 22 and exchanges information with the specialist computer 22 via the specialist software interface 24. The patient side software interface includes a wireless interface 26 and a network port interface 27, and the specialist side software interface includes a wireless interface 28 and a network port interface 29. The patient computer 14 and the specialist computer 22 communicate with each other over the Internet I. In short, the bioacoustic sensor 12 communicates with each other via the patient computer 14, the specialist computer 22, and the Internet I so that a clinician or other specialist away from the patient senses the patient at the patient side. Can be heard in real time. The transmission is “substantially real time” due to some delay due to signal processing and transmission between the patient stethoscope and the specialist stethoscope. Other sounds and information, such as audio signals, are also transmitted between the bioacoustic sensors 12 in substantially real time.

  FIG. 2 is a perspective view of one embodiment of an electronic stethoscope 12 that is a bioacoustic sensor suitable for use in the telemedicine system 10. The electronic stethoscope 12 includes ear tips 30 a and 30 b, ear tubes 32 a and 32 b, and a main tube 34. The main pipe 34 is coupled to the main housing or chestpiece 36 and supports at least one sensor 38 (not visible in FIG. 2). The sensor 38 is configured to sense sounds emitted by causes originating from the living body, such as sounds emitted by the heart, lungs, vocal cords, or other organs or tissues of the body. In some embodiments, the sensor 38 can be used to pick up the voice of the user of the electronic stethoscope 12 at the patient and / or specialist side. Other components that may be located in or on the main housing 36 include power supplies, microprocessors, signal processing circuitry (eg, digital signal processors), keypads, graphical user interfaces, and communication devices (eg, wireless devices) ). Further, the main housing 36 is described in US Patent Application Publication No. 2008/0232604, entitled “Power Management for Medical Sensing Devices Multiple Sensor Signal Detection,” which is incorporated herein by reference in its entirety. A simple power management circuit may be provided.

  The signal processing circuit configuration of the electronic stethoscope 12 may be configured to perform various functions from simple to complex. For example, the signal processing circuitry may be configured to perform a relatively advanced analysis of the bioacoustic signal received from the sensor 38, such as body sound profile matching. The signal processing circuitry may perform various forms of statistical analysis on the signal generated by the sensor 38. In such a configuration, the signal processing circuitry may include a digital signal processor (DSP). As a further example, the signal processing circuitry may perform selective frequency filtering to enhance different types of body sounds that the electronic stethoscope 12 senses. The signal processing circuitry is further configured to convert the signal produced by the sensor 38 into an acoustic signal for transmission through the ear canals 32a, 32b and for accurate and faithful reproduction of body sounds via the ear tips 30a, 30b. . In some embodiments, the electronic stethoscope 12 is made up of US Pat. No. 6,134,331, titled “Electronic Stethoscope”, US Pat. No. 7,006, each of which is hereby incorporated by reference in its entirety. 638, name “Electronic Stethoscope”, and / or US Pat. No. 7,130,429, name “Method and an Apparatus for Processing Audit Signals”, configured to generate acoustic signals .

  In some embodiments, the electronic stethoscope sensor 38 is configured to modulate or generate an electrical signal in response to transducer deformation. Suitable transducers include piezoelectric materials (organic) such as piezoelectric films, piezoresistive materials, strain gauges, capacitive or inductive elements, linear variable actuation transformers, and other materials or elements that modulate or generate electrical signals in response to deformation. And / or an inorganic piezoelectric material). The sensor 38 may be planar or non-planar, such as in a curved or corrugated configuration. Suitable piezoelectric materials may include polymer films, polymer foams, ceramics, composite materials, or combinations thereof. The sensor 38 may incorporate an array of different transducers of the same or different types of transducers and / or transducer materials, all of which are connected in series, individually or in a multilayer structure. Also good. Suitable transducers incorporating multiple sensing elements having different characteristics and / or sensors with adjustable sensing characteristics are disclosed in U.S. Patent Application Publication Nos. 2007/0113649 and 2007/0113654 by the same owner. Each of which is incorporated herein by reference in its entirety.

  The sensor 38 may be implemented using techniques other than those using electromagnetic energy or piezoelectric materials. For example, the sound to be converted may move a cantilever having a highly reflective surface, and a laser or light beam that illuminates on this surface may be modulated. The intensity or other characteristic of the modulated light may be received by a photodetector that outputs an electrical signal for analysis. As a further example, one or more accelerometers may be used to sense a sound signal and generate an electrical signal corresponding to the sound signal.

  The electronic stethoscope 12 may also include a user interface 40. User interface 40 may include a number of mode and / or status indicators and mode and / or control switches. The switches may include, for example, a volume or gain control switch and a mode selection switch. The indicator may display other information such as the selected filter mode or battery and communication link status. Such an indication of the status of the communication link may be based on error detection (eg, CRC and other methods described below) performed by the computer 14, 22 and / or the electronic stethoscope 12 at the patient or specialist side. . In the preferred embodiment, there is only an error reported, not no error. For example, if the error is identified by either the specialist computer 22 and / or the specialist electronic stethoscope 12, the specialist electronic stethoscope 12 will receive data from the specialist electronic stethoscope 12 as the patient electronic stethoscope. A signal that 12 is not the same as the data to be transmitted may be sent to the specialist computer 22. The user interface 40 can then provide a display to indicate to the specialist clinician that the sound heard from the specialist electronic stethoscope 12 is not a faithful reproduction of the body sound signal sensed by the patient electronic stethoscope 12. As used herein, the term “faithful reproduction” means digitally exact reproduction.

  The electronic stethoscope 12 also includes an integrated communication system that wirelessly communicates signals with the patient computer 14 or the specialist computer 22. For example, information acquired by the electronic stethoscope 12 during auscultation may be transmitted to the computers 14, 22. The computers 14, 22 process the information to provide information (eg, heart rate instructions, S1-S4 heart sounds) and / or diagnostic information regarding abnormal heart function, lung function, or other organ function (eg, Various such as visual display, graphic display, and / or auditory display of heart sounds, frequency spectrogram, heart failure such as due to respiratory failure such as pneumonia or pulmonary edema), or other organ lesions Output data may be provided.

  As will be described in detail below, using a communication system, the electronic stethoscope 12 and the computer 14 or 22, or other external device (eg, personal computer, personal digital assistant (PDA), mobile phone, netbook, etc.) A radio frequency (RF) communication link between the two may be established. The communication link can be a known communication such as the Bluetooth standard, IEEE 802 standard (eg IEEE 802.11), similar specifications based on ZigBee or IEEE 802.15.4 standard, or other public or proprietary wireless protocols. It may be implemented using a short-range wireless communication interface such as an interface that conforms to the standard. For example, in some embodiments, the communication system is a Class 1 or Class 2 Bluetooth wireless device. Wireless communication is performed in a manner that utilizes one or more of the following forms of energy: electromagnetic radiation, light (including near infrared), and sound (including high frequencies above the average hearing limit). May be. In some embodiments, a communication system may be used to establish a secure communication link between the electronic stethoscope 12 and the computer.

  In some embodiments, an antenna (not shown) for a wireless communication system may be integrated into the main housing 36. In order to improve the communication link with the electronic stethoscope 12, the opening 42 may be formed in the metal main housing 36 and covered with a more electromagnetic and transparent material. For example, the opening 42 can be covered with a polymer member. A flashing light source (eg, LED) is attached to the opening, indicating that the connection between the electronic stethoscope 12 and the computer is active, and reminding the user of the electronic stethoscope 12 not to cover the opening 42 Good. A feedback signal strength indicator may be provided on the user interface 40 to provide the user with the strength of the communication link while the connection to the computer is established. In some embodiments, a small parabolic reflector is placed at the bottom of the antenna to reflect signals transmitted from the antenna that are normally lost in the patient's tissue and received from a computer captured by the antenna. Concentrate the signal. In another embodiment, the antenna is attached to one of the ear tubes 32a, 32b or main tube 34 and the antenna is placed higher to improve the line-of-sight distance to the computer. The antenna may include a plurality of branches that can be attached to both sides of the ear canals 32a, 32b to allow unhindered signal communication in various body directions.

  The electronic stethoscope 12 also includes a wired connection port 44 between the electronic stethoscope 12 and the computer 14 or 22 or other external device (eg, personal computer, personal digital assistant (PDA), mobile phone, netbook, etc.). Wired connection between them may be possible. A conductor (electrical or optical) may connect between the wired connection port 44 of the electronic stethoscope 12 and a suitable connector on the external device. The wired connection port 44 of the electronic stethoscope 12, and any necessary interface circuitry, to communicate information according to a variety of protocols, such as FireWire ™ (IEEE 1394), USB, mini USB, or other communication protocols. It may be configured. Further, the connection port 44 may be configured to connect to a docking station that links the electronic stethoscope 12 with the computer 14 or 22. The connection of the electronic stethoscope 12 to the cable or docking station may trigger the control / application software on the computer 14 or 22 to automatically start and / or a sound file stored on the electronic stethoscope 12 or Data files may be uploaded or synchronized to the computer 14 or 22. Once connected, recharge power may be supplied to the electronic stethoscope 12 via the wired connection port 44.

  An acoustic transducer or microphone 48 may also be integrated on the upper side of the main housing 36 (ie, the side away from the sensor 38). Using the microphone 48, ambient sounds can be received from around the microphone 48. For example, the microphone 48 can be used in addition to or instead of the sensor 38 to pick up the voice of the user of the electronic stethoscope 12 at the patient and / or specialist side.

  In some embodiments, the electronic stethoscope 12 comprises an integrated electronic storage medium that allows the user to save audio tracks, body sounds, or other recordings on the electronic stethoscope 12 for later review. The electronic storage medium includes voice recognition data for recognizing the user or owner of the stethoscope, and voice commands so that certain settings (eg, output, volume) of the electronic stethoscope 12 can be changed in response to the voice commands. It may further include conversation recognition data for recognition. A speech recognition voice command may also be used to transfer voice tracks, body sounds, or other records or files to the patient medical record database. In some embodiments, as described, for example, in US Pat. No. 7,444,285 (Forbes), an electronic stethoscope records the contents of audio signals or other data files (eg, patient medical records). Configured to post to In addition, the sound track may be stored together with a sound track related to the sensed body sound so that the body sound and the sound track can be reproduced simultaneously through the ear tips 30a and 30b. In some embodiments, the user interface 40 allows a user to scroll through body sound and audio tracks stored in an electronic storage medium for selection and playback. Further, the active ambient noise reducing microphone 48 may be used to remove unnecessary ambient environmental noise from the recorded body signal and voice signal.

  Referring back to FIG. 1, the patient-side electronic stethoscope 12 is connected or combined with the patient-side computer 14 via a secure wireless interface 26 to secure the patient-side electronic stethoscope 12 and the patient-side computer 14. A network connection may be established. Similarly, the specialist's electronic stethoscope 12 connects to or combines with the specialist's computer 22 via a secure wireless interface 28 to establish a secure network connection between the specialist's electronic stethoscope 12 and the specialist's computer 22. You can do it. Although a single electronic stethoscope 12 is shown on each of the patient side and the specialist side, it will be appreciated that a plurality of electronic stethoscopes 12 can be connected to the patient side computer 14 and / or the specialist side computer 22. In some embodiments, the electronic stethoscope 12 is combined with a respective computer 14, 22 via a personal area network (PAN). An example of a PAN is a Bluetooth network in which a pairing code is set in one of the electronic stethoscope 12 and the computer 14 or 22 and is input to the other of the electronic stethoscope 12 and the computer 14 or 22. In some embodiments, an optional wireless headset 26 is also connected or combined with the specialist computer 22 via the secure wireless interface 28.

  Also, a secure connection via the Internet I is established between the network port interface 27 of the computer 14 and the network port interface 29 of the computer 22 so that the electronic stethoscope 12 can communicate with each other using a secure network connection. . For example, the network port interfaces 27, 29 may exchange certificates, require authentication, or define a secure network key and establish a secure connection. Further, the data may be encrypted by the computers 14 and 22 before the data is transmitted over the Internet I. Subsequently, the data may be decrypted upon reception using the secure network key. In some embodiments, the network port interfaces 27, 29 allow applications on the computers 14 and 22 to operate remotely over the Internet I with the wireless interfaces 26, 28.

  In another embodiment, the electronic stethoscope 12 is configured to communicate with each other directly (ie, not connected to the computers 14 and 22) via a secure connection. For example, each electronic stethoscope 12 may be configured with a unique Internet Protocol (IP) address, and the electronic stethoscope 12 establishes a secure connection directly to each other using a wireless fidelity (WiFi) connection or other wireless connection. You can do it. As another example, a plurality of electronic stethoscopes 12 that communicate with each other locally may be provided on the patient side and / or the specialist side.

  When the electronic stethoscope 12 is connected via a secure network connection, signals may be transmitted substantially in real time between the electronic stethoscope 12 or between the electronic stethoscope 12 and the computers 14, 22. For example, body sounds may be transmitted substantially in real time from an electronic stethoscope on the patient side to the ear tips 30a, 30b on the specialist side. Further, speakers connected to the computers 14 and 22 may reproduce body sounds substantially in real time. In some embodiments, the patient-side and specialist-side electronic stethoscope 12 is such that body sounds and other sounds are reproduced in substantially the same way on the patient-side and specialist-side ear tips 30a, 30b. Are substantially the same. In addition, the sound may be recorded and stored with one of the electronic stethoscopes 12 and then substantially simultaneously with all networked electronic stethoscopes 12 (from memory in the electronic stethoscope 12 or from the computer 14). , One of 22). In some embodiments, the signals transmitted by the patient electronic stethoscope 12 to the patient computer 14 via the Internet I are packetized and enumerated by the patient electronic stethoscope 12 for error checking by the specialist. In order to ensure faithful sound quality and reliable playback on the specialist's electronic stethoscope 12. In order to further ensure accurate data transmission from the patient electronic stethoscope 12, each element of the telemedicine system 10 (ie, the patient computer 14, the specialist computer 22, and the specialist electronic stethoscope 12) is in error. You can check. Error checking may use any suitable data transmission inspection technique, including but not limited to cyclic redundancy check (CRC), checksum, horizontal and vertical redundancy check, hash function, repetition code, and the like. The system may also incorporate, for example, sample throughput measurements that are made to determine excess data or data starvation in the communication link. In short, voice packets from the patient-side electronic stethoscope 12 are directly relayed (ie, mirrored) to the specialist-side electronic stethoscope 12 via the Internet I.

  In the preferred embodiment, telemedicine system 10 includes error checking and verification independent of the underlying communication system or network (eg, Bluetooth, TCP / IP) protocol. To further ensure that the signal is a faithful reproduction of the auscultatory sound of the patient-side electronic stethoscope 12, error checking may be performed independently in any component of the telemedicine system 10. In certain preferred embodiments, service interruptions in the underlying system are categorized by their duration and severity, and all errors indicate that the signal is not faithfully reproduced (one or more components of the telemedicine system). Communication with the user). For example, the patient-side component can send packetized or other signals to the specialist-side system component every 500 milliseconds. If the underlying communication system or network is interrupted for more than 500 milliseconds, the packet / signal is dropped, resulting in an indication of poor audio quality (for example, by changing the color of the indicator) on the specialist side It may be.

  Furthermore, ambient sounds, such as audio signals, can be received by the sensor 38 and transmitted between the electronic stethoscopes 12 in substantially real time, simultaneously or alternately with body sounds. In another embodiment, the electronic stethoscope 12 can receive voice communications and other ambient sounds through the microphone 48 that are processed and transmitted to a remote location. Body sound information is continuously streamed from the patient-side electronic stethoscope 12 to the specialist-side electronic stethoscope 12, while ambient sounds are streamed in both directions between the patient-side and specialist-side electronic stethoscope 12. The patient side electronic stethoscope 12, the specialist side electronic stethoscope 12, the patient side computer 14, and the specialist side computer 22 each include one or more ring buffers to ensure continuous streaming of information between the electronic stethoscopes 12. It may be done. In some embodiments, ambient sounds are μ-law encoded and superimposed on body sounds generated by the patient's electronic stethoscope 12. Accordingly, the clinician on the patient side can hear the body sound from the patient while receiving voice instructions from the specialist on the specialist side, for example. As a result, the specialist on the specialist side can practically experience working with the patient. Since the clinician on the patient side receives the sound through the ear tips 30a and 30b, the clinician on the patient side and the specialist side of the patient side rather than performing communication output on the side of the specialist through the speaker attached to the patient side computer 14, for example. Specialists can consult privately. Using signal processing, the sound quality of the audio signal provided through the ear tips 30a, 30b can be optimized.

  The sound and auscultation sounds reproduced through the ear tips 30 a, 30 b of the patient-side and specialist-side electronic stethoscope 12 may be controlled locally at each electronic stethoscope 12. Auscultation and audio signals may be provided simultaneously to the ear tips 30a, 30b, but separate channels allow the clinician to control the volume of auscultation sounds and audio communications separately. This allows the clinician to optimize the relative volume of the auscultation and ambient sounds, providing the clinician with a balanced output of the ear tips 30a, 30b tailored to the clinician's preference. Each electronic stethoscope 12 may further comprise a selectable audio amplification filter that, for example, amplifies a particular frequency band of the audio signal to support ambient noise reduction.

  In some embodiments, transmission of the audio signal is selectably controlled while the stethoscope is coupled via a secure network connection. For example, when connected, body sounds may be constantly transmitted from the patient side to the specialist side, while audio signals and other ambient sounds are only between sites when the clinician chooses to transmit audio signals. Is transmitted. For example, in some embodiments, the electronic stethoscope 12 utilizes selective frequency filtering during auscultation to suppress frequency bands typical of audio signals. In such an embodiment, the clinician essentially cancels frequency filtering or changes the filter settings (i.e., allows playback and transmission of only specific frequency bands typical of audio signals), Audio signal transmission may begin. In some embodiments, transmission of the audio signal is initiated when the clinician presses a button on the user interface 40. Electronic stethoscope 12 may be configured to transmit an audio signal when a button on user interface 40 remains depressed (similar to a handheld transceiver or walkie-talkie). Alternatively, the electronic stethoscope 12 may be set such that when the button is pressed and released, the audio signal transmission mode is activated, and when the button is subsequently pressed and released again, the audio signal transmission mode is canceled.

  The electronic stethoscope 12 may include an integrated software memory that initially stores software for the patient side software interface 16 and / or the specialist side software interface 24. For example, software may be provided with each electronic stethoscope 12 as the electronic stethoscope 12 is sold to consumers. When the electronic stethoscope 12 is combined with the computer 14 or 22, the electronic stethoscope 12 may be configured to automatically load software stored in the software memory into the computer 14 or 22. When the software is installed on the computers 14, 22, for example, the software sends information and signals from the electronic stethoscope 12 to the computers 14, 22 and provides control signals from the computers 14, 22 to the electronic stethoscope 12. This allows the electronic stethoscope 12 to communicate with the computers 14, 22.

  Also shown in FIG. 1 are a patient-side televideo application 56 and a server-side televideo application 58. In some embodiments, a video camera is connected to the patient computer 14 and / or the specialist computer 22 to enable image communication between the patient side and the specialist side via televideo applications 56 and 58. Thereby, for example, the specialist on the specialist side can confirm the position of the sensor 38 with respect to the patient on the patient side, and can provide the patient with an opinion on the position of the sensor 38. As another example, a video camera may be used with each microphone 48 of the electronic stethoscope 12 to provide a video conference between the patient side and the specialist side.

  FIG. 3 is a front perspective view of an embodiment of a computer 60 suitable for use as the patient computer 14 and / or the specialist computer 22. The computer 60 includes a processor 62, a display 64, a camera 66, a keyboard 68, a mouse 70, and a communication adapter 72. The processor 62 is also configured to connect to the Internet, facilitating communication between the patient side and the specialist side. Although processor 62 is shown as a laptop computer, the processor may be a desktop computer or may have any other form. In addition, although a single display 64 is shown, a laptop computer display can also be used. In addition, other input devices (eg, trackballs, joysticks, etc.) may be incorporated into the computer 60 used in the telemedicine system 10.

  The processor 62 receives input control signals from the keyboard 68 and mouse 70 and provides video signals to the display 64. Further, the processor 62 sends a signal to the electronic stethoscope 12 via the communication adapter 72 and receives a signal from the electronic stethoscope 12. In some embodiments, the communication adapter 72 is a Bluetooth dongle suitable for secure communication over short distances (eg, up to 10 meters) and medium distances (eg, up to 100 meters). In order to start a secure connection with the electronic stethoscope 12 using the keyboard 68 and the mouse 70, a security code or the like may be set. As shown, the communication adapter 72 can be placed high on the wall to improve the line-of-sight distance and communication link between the electronic stethoscope 12 and the communication adapter 72.

  The camera 66 communicates with the processor 62 and captures images of the patient side or the specialist side. The processor 62 is then connected to the Internet I via the televideo application 56 or 58 to provide live video images to the patient or specialist side. As shown, the camera 66 is attached to the top of the display 64 and can provide image communication between the patient and the specialist as described above. The camera 66 may also be configured for wireless communication with the processor 62, allowing the camera 66 to move on the patient side or specialist side (eg, to capture an image of the position of the sensor 38 on the patient). In some embodiments, the keyboard 68 and / or mouse 70 can be used on one side to control the operation (eg, zoom, focus, position, etc.) of the camera 66 on the other side. Thereby, for example, a specialist on the specialist side can control an image captured on the patient side.

  FIG. 4 is a screen shot of an embodiment of a user interface 80 that may be displayed on the patient-side display 64 during telemedicine time. The user interface 80 includes a data display module 82, a video conference module 84, and a stethoscope control module 86. The user of the patient computer 14 interacts with the user interface on the display 64 using the keyboard 68, mouse 70, and / or other input devices. For example, the user may use the mouse 70 to select a button or pull-down menu element on the user interface 80.

  The data display module 82 is a graphical display of periodic body sounds emitted by the patient and sensed by the patient-side sensor 38. The signal generated by sensor 38 is processed by an electronic stethoscope processor and supplied to patient computer 14 via an integrated antenna. The processor 62 then processes these signals and converts them into a form suitable for display on the data display module 82. This graph can be updated periodically or substantially in real time while the clinician applies the electronic stethoscope 12 to the patient's body. The scale or axis used in the graph can be manipulated using radio buttons 88 on the data display module.

  In some embodiments, the electronic stethoscope processor divides the signal generated by sensor 38 into a plurality of channels. For example, the electronic stethoscope processor may convert the sensed body sound into a data signal representative of the sensed body sound and send the data signal to the patient computer 14 on the first channel, and the sensed body sound into an acoustic signal. The sound signal may be sent to the ear tips 30a and 30b through the second channel. Alternatively, the signal generated by sensor 38 may be sent directly to patient computer 14 for conversion to a display data signal to processor 62.

  The video conference module 84 displays an image captured by the camera 66 on the specialist side. This allows the patient-side clinician to be shown to the specialist-side specialist who can actually show the preferred positioning of the sensor 38 relative to the patient-side patient, for example. The video conference module 84 also includes a toolbar 90 that includes various video conference controllers. For example, the toolbar 90 may include buttons for adjusting the volume received from the specialist and the placement of the video conference on the user interface 80. The toolbar 90 may also include interfaces and tools for starting and ending a video conference.

  Stethoscope control module 86 may include various selectable controls and settings for patient-side electronic stethoscope 12. These settings may be selected to control the mode, volume, power state, recording settings, etc. of the patient-side electronic stethoscope 12. In some embodiments, these settings can also be selected via the user interface 40 of the electronic stethoscope 12. Stethoscope control module 86 also provides options to control other modules on user interface 80. The stethoscope control module 86 may further include selectable options regarding communication settings between the electronic stethoscope 12 and the patient computer 14. For example, the stethoscope control module 86 may allow adjustment of the packetization settings of the electronic stethoscope 12 or verification and repair of connection settings between the electronic stethoscope 12 and the patient computer 14.

  FIG. 5 is a screen shot of an embodiment of the user interface 100 that may be displayed on the specialist's display 64 during telemedicine hours. Similar to the user interface 80, the user interface 100 includes a data display module 102, a video conference module 104, and a stethoscope control module 106. The user of the specialist computer 22 exchanges information with the user interface on the display 64 using the keyboard 68, the mouse 70, and / or other input devices. For example, the user may use the mouse 70 to select a button or pull-down menu element on the user interface 100.

  The data display module 102 is a graphical display of periodic body sounds emitted by the patient and sensed by the patient-side sensor 38. The signal generated by the sensor 38 is processed by an electronic stethoscope processor, supplied to the patient computer 14 and sent to the specialist computer 22. The processor 62 of the specialist computer processes these signals and converts them into a form suitable for display on the data display module 102. This graph can be updated periodically or substantially in real time while the patient clinician places the electronic stethoscope 12 on the patient's body. The scale or axis used in the graph can be manipulated using radio buttons 108 on the data display module.

  The video conference module 104 displays an image captured by the patient-side camera 66. Thereby, the specialist on the specialist side can confirm the position of the sensor 38 with respect to the patient on the patient side, for example. The video conference module 104 also includes a toolbar 110 that includes various video conference controllers. For example, the toolbar 110 may include buttons for adjusting the volume received from the patient and the placement of the video conference on the user interface 100. Toolbar 110 may also include interfaces and tools for starting and ending a video conference. The toolbar 110 may also include a controller for adjusting the camera position on the patient side.

  The stethoscope control module 106 may include various selectable controls and settings for the patient-side and / or specialist-side electronic stethoscope 12. These settings may be selected to control the mode, volume, power status, recording settings, etc. of the patient and / or specialist electronic stethoscope 12. For example, the stethoscope control module 106 may include an interface that controls the mode and filter settings of the patient-side electronic stethoscope 12. The stethoscope control module 106 may also be configured to control some settings on the patient-side electronic stethoscope 12 while leaving other settings controlled only locally. For example, the stethoscope control module 106 can provide volume control for the specialist electronic stethoscope 12 only, while the volume of the patient electronic stethoscope 12 is (eg, on the stethoscope control module 86 or the patient electronic stethoscope 12). It can only be adjusted on the patient side (via the user interface 40). In some embodiments, the specialist electronic stethoscope 12 is also configured such that the user interface 40 on the specialist electronic stethoscope 12 controls the settings of the patient electronic stethoscope 12 when connected to a secure network. May be. The specialist electronic stethoscope 12 also controls substantially all settings of the patient electronic stethoscope 12 while allowing volume adjustment on the patient side (ie, local control on the patient side is essentially disabled). Be configured). Such local control ensures that the volume can be adjusted according to the preference of the user at each location.

  In another embodiment, the specialist clinician sets the specialist electronic stethoscope 12 to the desired setting, and then sets the specialist electronic stethoscope 12 setting to the patient electronic stethoscope 12 in a single transmission. Send (e.g., via the specialist computer 22 and the patient computer 14), the settings of the patient electronic stethoscope 12 may be updated.

  The stethoscope control module 106 may further include selectable options in the communication settings between the patient-side electronic stethoscope 12 and the patient-side computer 14 and / or the specialist-side electronic stethoscope 12 and the specialist-side computer 22. For example, the stethoscope control module 106 may allow adjustment of the packetization settings of the electronic stethoscope 12 or confirmation and repair of connection settings between the electronic stethoscope 12 and the specialist computer 22.

  The user interface 100 shown and described is merely exemplary, and there can be other configurations for the user interface. In one exemplary alternative configuration shown in FIG. 6, the user interface 100 has a control unit 114 that includes buttons and other interfaces on the user interface 40 of the specialist electronic stethoscope 12. A first graphical user interface 112, which is an image highlighting the features of the upper housing 36, may be provided. Each button on the controller 114 may be selectable to cause the same function of the specialist electronic stethoscope 12 as if the corresponding button on the user interface 40 was pressed. A user interface similar to the user interface 112 may also be displayed on the user interface 80 to provide an on-screen function controller for the patient electronic stethoscope 12.

  When the specialist electronic stethoscope 12 is connected to and synchronized with the patient electronic stethoscope 12, the user interface 100 includes patient buttons and other interfaces on the user interface 40 of the patient electronic stethoscope 12. A single graphical user interface may be displayed that is an image highlighting features of the housing 36 on the stethoscope 12. This same graphical user interface 112 may also be displayed on the user interface 80. When the patient-side and specialist-side electronic stethoscope 12 is connected, each button on the graphical user interface 112 is displayed on the patient-side electronic stethoscope 12 as if the corresponding button on the user-side stethoscope user interface 40 was pressed. May be selectable either on the patient side or on the specialist side to cause the same function. The graphical user interface 112 provides a specialist clinician with an interface that can control certain settings (eg, modes, filters, etc.) of the patient electronic stethoscope 12.

  The graphical user interface 112 may also include a plurality of connection buttons 116 that may be used to control the connection between the specialist computer and the connected electronic stethoscope 12. For example, in the embodiment shown in FIG. 6, the connect button 116 is a “scope disconnect” button that disconnects the local specialist electronic stethoscope 12 from the specialist computer 22, and disconnects the specialist computer 22 from the patient electronic stethoscope 12. A “remote disconnect” button that activates (and desynchronizes the specialist's electronic stethoscope 12) and a “remote conversation” button that activates voice communication between the specialist and patient's electronic stethoscope 12. When the specialist electronic stethoscope 12 is not connected to the patient electronic stethoscope 12, the “Remote Disconnect” and “Remote Conversation” buttons may be deactivated or hidden on the graphical user interface 112.

  In addition, the graphical user interface 112 may include an options menu 117 that allows the user to control various options related to the connected electronic stethoscope 12. For example, in the embodiment shown in FIG. 6, the options menu 117 includes a pull-down menu that allows the clinician to scroll between stethoscopes connected to the specialist computer 22. This allows the active electronic stethoscope 12 to be switched active on the graphical user interface 112 and the clinician to change each setting of the connected stethoscope.

  The graphical user interface 112 further includes a visual and / or audible indication that the sound heard by the clinician at the specialist electronic stethoscope 12 is a faithful reproduction of the sound of the patient electronic stethoscope 12. Good. In the embodiment shown in FIG. 6, the graphical user interface 112 includes a fidelity gauge 118 labeled “Stream Integrity” that includes a fidelity indicator 119. The fidelity indicator 119 changes color to indicate whether faithful sound reproduction is occurring at the specialist electronic stethoscope 12. For example, the fidelity indicator 119 may indicate green when the sound is reproduced faithfully and red when the sound is not reproduced faithfully. This display may be based on error detection (eg, CRC) performed by the specialist computer 22 and / or the specialist electronic stethoscope 12. Error detection may be performed by the patient computer 14 and / or the patient electronic stethoscope 12. For example, if the error is identified by either the specialist computer 22 and / or the specialist electronic stethoscope 12, the specialist electronic stethoscope 12 will receive data from the specialist electronic stethoscope 12 as the patient electronic stethoscope. A signal that 12 is not the same as the data to be transmitted may be sent to the specialist computer 22. The user interface 100 can then provide a display, indicating to the specialist clinician that the sound audible from the specialist electronic stethoscope 12 is not a faithful reproduction of the body sound signal sensed by the patient electronic stethoscope 12. The specialist electronic stethoscope 12, the patient electronic stethoscope 12, and / or the user interface 80 may also provide a faithful sound reproduction display. In another embodiment, no errors are reported to the system component.

  Although the electronic stethoscope 12 has been described with respect to a stethoscope having a chestpiece, a main tube, and a binaural tube connected to an ear tip, the electronic stethoscope used in the telemedicine system 10 may have other configurations. For example, FIG. 7 shows a wireless chestpiece 120 and FIG. 8 shows a wireless headset 122 that can be used with the telemedicine system 10.

  Wireless chestpiece 120 is configured in substantially the same manner as chestpiece 36 described above with respect to FIG. 2 and interacts with elements of telemedicine system 10 in substantially the same manner as electronic stethoscope 12. In particular, the wireless chestpiece 120 is configured to connect to the computers 14, 22 via a secure network connection. Components that may be placed in the chestpiece 120 include a power supply, a signal processing circuit configuration, and a communication interface. A sensor 124 (not shown) is supported on one end of the wireless chestpiece 120, and an antenna 126 is attached to the end of the wireless chestpiece 120 opposite to the sensor 124. In some embodiments (not shown), the antenna is integrated into the housing, as described above. Sensor 124 may have characteristics and configurations similar to those described above for sensor 38. In the embodiment shown, the antenna 126 is configured to swivel or rotate with respect to the pivot 128 and the antenna 126 can be positioned to maximize signal coupling during use. The antenna 126 can also be positioned to minimize clearance during storage. In some embodiments, the antenna 126 is a high performance antenna for a wide signal range (eg, greater than 100 m), thereby maximizing the mobility of the wireless chestpiece 120.

  The wireless headset 122 is configured to receive signals from the wireless chestpiece 120 via a secure connection. In some embodiments, the chestpiece 120 and the headset 122 are combined together with a Bluetooth connection. The wireless headset 122 may also be configured to communicate with the computer 14 or 22, similar to the headset 26 shown in FIG. The wireless headset 122 may have various configurations including over-ear and inner-ear designs. In the illustrated embodiment, the wireless headset 122 includes ear tips 130a, 130b for the inner ear. In some embodiments, the ear tips 130a, 130b are substantially the same as the ear tips 30a, 30b of FIG. To do.

  The wireless headset 122 may also include a microphone 132 that receives the user's voice. The microphone 132 is coupled to an adjustable support 134 that can change the position of the microphone 132 relative to the user. As described above, the signal received by the microphone 132 may be superimposed on the body sound sensed by the wireless headset 120 and sent over the Internet I.

  In addition to the electronic stethoscope used in the telemedicine system 10 having another configuration, the connection between the electronic stethoscopes may have another configuration. For example, FIG. 9 is a diagram of a telemedicine system 150 according to another embodiment. The telemedicine system 150 includes a sensing electronic stethoscope 12a, a plurality of networked electronic stethoscopes 12b, 12c,. . . , 12n, and a network interface or hub 152. The electronic stethoscopes 12a to 12n communicate wirelessly with the network interface 152. The electronic stethoscopes 12a-12n may be configured substantially similar to the electronic stethoscope 12 described above in FIG. 2 and may have substantially similar characteristics. Of course, the electronic stethoscope 12n represents the nth networked electronic stethoscope 12, which limits or defines the number of networked electronic stethoscopes 12 connected to the network interface 152. Not interpreted. In some embodiments, the network interface 152 is configured as a wearable, handheld, or portable device.

  The network interface 152 is configured to establish a secure connection with the electronic stethoscopes 12a-12n. In some embodiments, electronic stethoscopes 12a-12n are combined with network interface 152 via a personal area network (PAN). An example of a PAN is a Bluetooth network in which a pairing code is set in the network interface 152 and input to each of the electronic stethoscopes 12a to 12n for secure connection to the network interface 152. Once connected, the patient's body sound can be sensed using the sensing electronic stethoscope 12a, while the patient's body sound sensed by the sensing electronic stethoscope 12a can be networked using the electronic stethoscopes 12b-12n. Can be heard in real time. In addition, other sounds, such as voice prompts, may be received by one of the sensors 38a-12n of the electronic stethoscopes 12a-12n or the microphone 48 and delivered to each of the networked electronic stethoscopes 12a-12n. In another embodiment, the electronic stethoscopes 12a-12n are directly networked with each other (ie, not associated with the intermediary network interface 152).

  In one implementation, the teacher's electronic stethoscope 12 and one or more student electronic stethoscopes 12 may be networked via the network interface 152. A doctor or student is selected to sense the patient's body sound, while other networked users can hear the patient's body sound from their respective electronic stethoscopes 12. In addition, sounds stored on the teacher's electronic stethoscope 12 (or another networked storage device) may be played on all networked electronic stethoscopes 12 at substantially the same time. The physician may also provide voice instructions or prompts that are provided through the earphones of the student's electronic stethoscope 12 simultaneously with the sensed body sounds via the sensor 38 or microphone 48 of the main housing 36. Thus, if a doctor's electronic stethoscope is used to sense body sounds, the doctor will actually show the positioning and usage of the electronic stethoscope 12a while the student will be connected to the networked electronic stethoscopes 12b-12n. Can be heard at. If the student's electronic stethoscope is being used to sense body sounds, the physician can provide instructions and advice to each student through sensor 38 or microphone 48. In addition, each student with an electronic stethoscope 12 networked to the network interface 152 senses body sounds in turn, while the physician can provide individual advice to the students.

  In other embodiments, a networked scope is connected to a computer or other external device (eg, mobile phone, PDA) as described above. The auscultation sounds and audio signals of networked scopes can be reproduced in substantially real time by speakers connected to a computer or other external device. In some embodiments, body sounds are downloaded from an electronic storage medium or other online database (e.g., website) via a network connection to a computer or external device, streamed with a networked stethoscope, and / or It may be reproduced in real time from the speaker.

  In summary, certain embodiments disclosed herein include a housing configured to be manipulated by a clinician in a hand-held manner relative to a patient, and a housing that is supported by the housing and that receives the patient's auscultation signal at a first location. A first electronic stethoscope comprising: a transducer configured to sense; and a headset coupled to the housing and configured to deliver an audio signal corresponding to the auscultation signal through the headset earphone. It relates to a telemedicine system. The telemedicine system further includes a second electronic stethoscope that includes a housing, transducer, and headset substantially similar to the housing, transducer, and headset of the first electronic stethoscope. The first electronic stethoscope is configured to convert the auscultation signal into a digital signal representing the auscultation signal and wirelessly transmit the digital signal to the second location via the secure digital network. The second electronic stethoscope receives the digital signal representing the auscultation signal at the second location via the secure digital network, converts the digital signal into an audio signal corresponding to the auscultation signal, and auscultation sound at the first location. And delivering the audio signal substantially in real time through the headset earphone of the second electronic stethoscope.

  Various modifications and additions may be made to the exemplary embodiments described without departing from the scope of the present invention. For example, although the embodiments described above refer to particular features, the scope of the invention includes embodiments having different combinations of features and embodiments that do not include all of the features described above. Accordingly, the scope of the invention is intended to embrace all such alternatives, modifications and variations that fall within the scope of the appended claims, along with all equivalents thereof.

Claims (42)

A first electronic comprising: a housing configured for handheld operation; a transducer for sensing an auscultation signal at a first location; and a headset for delivering an audio signal corresponding to the auscultation signal through an earphone of the headset. A stethoscope, further comprising: a processor that converts the auscultation signal into a digital signal representing the auscultation signal; and an antenna that wirelessly transmits the digital signal to a second location via a secure digital network. With an electronic stethoscope,
A second electronic stethoscope comprising a housing configured for handheld operation, a transducer, and a headset for delivering audio signals through the headset's earphones, the second electronic stethoscope via the secure digital network An antenna that receives the digital signal representative of the auscultation signal at a location; converts the digital signal into an audio signal corresponding to the auscultation signal; senses the auscultation sound at the first location; A telemedicine system comprising: a second electronic stethoscope further comprising a processor for delivering the audio signal substantially in real time through an earphone of a stethoscope headset.   The telemedicine system of claim 1, wherein the second location is remote from the first location.   The telemedicine system of claim 1, wherein the audio signal delivered to the headset of the second electronic stethoscope is a faithful reproduction of the auscultatory sound at the first location.   The transducer of the first electronic stethoscope further receives an ambient audio signal at the first location; the transducer of the second electronic stethoscope further receives an ambient audio signal at the second location; The telemedicine system of claim 1, wherein the ambient audio signal is wirelessly transmitted between the first location and the second location via the secure digital network.   The first electronic stethoscope further comprises a first microphone that receives ambient audio signals at the first location, and the second electronic stethoscope receives second ambient audio signals at the second location. The telemedicine system according to claim 1, further comprising a microphone, wherein the ambient audio signal is transmitted wirelessly between the first location and the second location via a secure digital network.   When the transducer activates a user interface element of the first electronic stethoscope, the transducer is activated to receive an ambient audio signal at the first location, and the second transducer is in the second electronic auscultation. The telemedicine system of claim 4, wherein activating a user interface element of the device is activated to receive an ambient audio signal at the second location.   The telemedicine system of claim 6, wherein the processor of the first electronic stethoscope comprises a frequency filter, and the setting of the frequency filter is changed by operation of a user interface element of the first electronic stethoscope.   The first electronic stethoscope communicates with a first computer at the first location via a first secure personal area network, and the second electronic stethoscope communicates via a second secure personal area network. The telemedicine system of claim 1, wherein the telemedicine system is in communication with a second computer at the second location, and the first computer transmits a digital signal representing an auscultation signal to the second computer via a secure digital connection. .   When the audio signal delivered through the headset earphone of the second electronic stethoscope is a faithful reproduction of the auscultation signal sensed by the first electronic stethoscope, the first stethoscope, the second 9. The telemedicine system of claim 8, wherein at least one of a stethoscope, the first computer, and the second computer provides an audible and / or visual display.   The telemedicine system of claim 1, wherein the respective antennas of the first and second electronic stethoscopes are at least partially disposed on the headset.   The telemedicine system of claim 1, wherein the first electronic stethoscope is further configured to wirelessly receive signals from the second electronic stethoscope via a secure digital network.   2. The first electronic stethoscope is configured to receive a control signal over a secure digital network so that settings of the first electronic stethoscope can be changed from the second location. Telemedicine system.   The telemedicine system of claim 12, wherein the control signal prevents a change in a particular setting of the first electronic stethoscope at the first location.   The telemedicine system of claim 13, wherein the control signal does not prevent a change in volume setting of the first electronic stethoscope at the first location.   The telemedicine system of claim 1, wherein at least one of the first and second electronic stethoscopes comprises a wireless chestpiece and a wireless headset. A housing configured for handheld operation;
A transducer supported by the housing and sensing an auscultation signal at a first location;
A headset coupled to the housing and configured to deliver an audio signal corresponding to the auscultation signal through an earphone of the headset;
Sensing the auscultatory sound at the first location so that a sound signal corresponding to the auscultation signal is provided in substantially real time to a headset of one or more remote electronic stethoscopes at the second location. Disposed in the housing, configured to convert to a first digital signal representative of the auscultation signal and wirelessly transmit the first digital signal from the electronic stethoscope to a second location via a secure digital network. An electronic stethoscope comprising a processor.   The electronic stethoscope of claim 16, wherein the second location is remote from the first location.   The electronic stethoscope of claim 16, wherein the audio signal corresponding to the auscultation signal is a faithful reproduction of an auscultation sound sensed at the first location.   The converter receives an ambient audio signal at the first location, and the processor converts the ambient audio signal into a second digital signal representative of the ambient audio signal, and the second signal via the secure digital network. The electronic stethoscope of claim 16, further configured to wirelessly transmit two digital signals along with the first digital signal to the second location.   A microphone disposed in a housing for receiving an ambient audio signal at the first location, wherein the processor converts the ambient audio signal into a second digital signal representative of the ambient audio signal; The electronic stethoscope of claim 16, further configured to wirelessly transmit the second digital signal along with the first digital signal to the second location via a secure digital network.   20. The electronic stethoscope of claim 19, wherein actuating a user interface element on the housing activates the transducer to receive an ambient audio signal at the first location.   20. The electronic stethoscope of claim 19, wherein the processor further comprises a frequency filter, and the setting of the frequency filter is changed by operation of the user interface element.   21. The electronic stethoscope of claim 20, wherein the microphone is disposed on the housing opposite the transducer.   17. The electronic stethoscope of claim 16, wherein the processor communicates with a computer via a secure personal area network, and the computer transmits the first digital signal to the second location.   25. The electronic stethoscope of claim 24, wherein the processor communicates over a secure personal area network via a radio frequency signal.   The computer further comprises a memory for storing executable software, and further configured to automatically transfer the software from the software memory to the computer when the processor is connected to the computer via the secure personal area network 25. The electronic stethoscope of claim 24.   The electronic stethoscope of claim 16, further comprising an antenna configured to wirelessly transmit the first digital signal from the electronic stethoscope via a secure digital connection.   28. The electronic stethoscope of claim 27, wherein the antenna is disposed within the headset.   The electronic stethoscope of claim 16, wherein the processor is further configured to wirelessly receive a signal from the second location via the secure digital network.   30. The electronic stethoscope of claim 29, wherein the signal comprises a signal emitted by one or more remote electronic stethoscopes at the second location.   The electronic stethoscope of claim 16, wherein the housing comprises a wireless chestpiece. A local electronic stethoscope configured to sense a patient's auscultation signal and convert the auscultation signal into a digital signal representing the auscultation signal;
One or more additional electronic stethoscopes;
A secure network interface connecting the local electronic stethoscope to one or more remote electronic stethoscopes via a secure digital network, each of the one or more additional electronic stethoscopes via the secure digital network Receiving the digital signal representing the auscultation signal, and converting the digital signal into an audio signal corresponding to the auscultation signal, the auscultation sound being sensed by the local electronic stethoscope, A telemedicine system that is delivered in substantially real-time through each headset earphone of one or more additional electronic stethoscopes.   36. The telemedicine system of claim 32, wherein the audio signal delivered to each headset of the one or more additional electronic stethoscopes is a faithful reproduction of the auscultatory sound sensed by the local electronic stethoscope.   The local electronic stethoscope and the one or more additional electronic stethoscopes are each configured to receive an ambient audio signal and wirelessly transmit the ambient audio signal over the secure digital network. The telemedicine system according to 32.   Each of the local electronic stethoscope and the one or more additional electronic stethoscopes further comprises a microphone that receives an ambient audio signal, each transmitting the ambient audio signal wirelessly via the secure digital network. The telemedicine system of claim 32, wherein the telemedicine system is configured.   35. The telemedicine system of claim 34, wherein activation of a user interface element activates respective transducers of the local electronic stethoscope and one or more additional electronic stethoscopes to receive ambient audio signals.   35. The telemedicine system of claim 32, wherein the local electronic stethoscope is further configured to wirelessly receive signals from the one or more additional electronic stethoscopes via the secure network interface.   The secure network interface is a personal area network hub, and each of the local electronic stethoscope and one or more additional electronic stethoscopes connects to the personal area network hub via a secure personal area network connection. The telemedicine system according to 32.   40. The telemedicine system of claim 38, wherein the personal area network hub is wearable.   36. The telemedicine system of claim 32, wherein the one or more additional electronic stethoscopes are remote from the local electronic stethoscope.   40. The telemedicine system of claim 38, wherein the personal area network hub is selected from the group consisting of a personal computer, a personal digital assistant, a mobile phone, and a netbook. A housing configured for handheld operation;
A transducer supported by the housing and sensing an auscultation signal at a first location;
A headset coupled to the housing and configured to deliver an audio signal corresponding to the auscultation signal through an earphone of the headset;
Disposed within the housing to sense the auscultation sound at the first location and to provide a sound signal corresponding to the auscultation signal in substantially real time to the headset at the second location; A processor configured to convert the auscultation signal into a first digital signal representing an auscultation signal and wirelessly transmit the first digital signal from a bioacoustic sensor to the second location via a secure digital network; A bioacoustic sensor.

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