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Blunders and Wonders: Home Medical Care & Digital Stethoscopes


As care moves out of the hospital, healthcare must grapple with a number of issues.

Hello I’m Dr. Nick the Incrementalist and here today to talk about Blunders and Wonders.

This Week’s Blunder: Home Medical Care Device User Design

Care is moving out of the hospital and into the home and that’s a good thing. Just ask anyone where they would like to spend their life and especially their twilight years. I know I’d like to end my days at home. You’ll never hear a response “the hospital.”

To achieve this safely we have been on a steady march to equipping the medical home with technology that can help monitor our health using technology that keeps tabs on key body systems.

But some devices used in the home are designed for use in hospitals, and more importantly, by trained professionals. And handing these over to elderly patients and their family care givers can be a recipe for disaster. Even when they do come with manuals and labels, oftentimes in print so small as to be illegible to anyone with eye sight affected by presbyopia — you know that frustrating experience that occurs with age that means you now need reading glasses.

This is as much about user design as it is care giver knowledge, and it is made worse by the unpredictable nature of the varied environments that we find in our homes.

The push to the medical home demands a new found focus on user design and designing systems that cater to all levels of knowledge and experience, and remove the potential for failure or mistakes by designing systems that fail safely and elegantly. User focused design is spotty at best in healthcare, and the failures have been balanced by training of users, but that’s not scalable nor is it appropriate in the home setting. So, for the new digital home age, let’s focus on delivering a great, perfect experience for those home-based users.

This Week’s Wonder: A New Digital Stethoscope

I know, a little bit of a surprise to some given that some in the digital health space have declared the stethoscope dead. But this is a new take on the stethoscope.

My father was an engineer. His ear was tuned to listen to machines and engines, and he could tell something was wrong by the change of the sounds he heard. Same was true in the stethoscope and the experienced clinicians who I would watch in awe as they’d listen to a patient’s heart and correctly determine the disease just by observing the patient and listening to the sounds.

But stethoscope design has changed little since its invention in 1816 by Rene Laennec. So, it was about time it received a makeover, and the team from the Rochester Institute of Technology used innovative digital signal processing techniques. They included digital signal filtering, advanced beat-based rejection, algorithms and ensemble averaging. They combined precision sensors, electrocardiogram technology and machine learning applications into one piece of equipment to better detect heart ailments and beyond. The new systems improve the acoustic diagnostics with spectral analysis and taps into machine learning techniques using automated neural networks to learn and recognize defects. This was the same pattern recognition that the consultants of yesteryear were famous for. They developed and used them to treat their patients with characteristic flair. Now we are starting to develop technology to provide access to those insights to the junior clinicians who lacked the personal experience to develop that in the early part of their career.

Until next time, I’m Dr. Nick, the Incrementalist — don’t let perfection stand in the way of progress.

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