CN102497819A - Electronic stethoscope system for telemedicine applications - Google Patents

Abstract

An electronic stethoscope includes a housing configured for hand-held manipulation, a transducer supported by the housing and configured to sense auscultation signals at a first location, and a headset coupled to the housing and configured to deliver audio corresponding to the auscultation signals through earpieces on the headset. The electronic stethoscope further includes a processor disposed in the housing and configured to convert the auscultation signals to first digital signals representative of the auscultation signals and to wirelessly transmit the first digital signals from the electronic stethoscope via a secure digital network to a second location such that the audio corresponding to the auscultation signals is provided to headsets of one or more additional electronic stethoscopes at the second location in substantial real time with the sensing of the auscultation sounds at the first location.

Description

Electronic Stethoscopes for Telemedicine Applications

technical field

The present invention relates to a telemedicine system. More particularly, the present invention relates to electronic stethoscopes for transmitting signals over a telemedicine system via a secure digital network in substantially real time.

Background technique

Various devices have been developed to detect sounds produced by the human body, such as heart 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 an essential tool for diagnosing diseases and conditions of the cardiovascular system. It serves as the most commonly used technique for diagnosing such diseases and conditions in primary healthcare and in settings where sophisticated medical equipment is unavailable, such as in remote areas.

For example, clinicians readily recognize that detecting relevant cardiac symptoms and making a diagnosis based on sounds heard through a stethoscope are skills that take years to acquire and master. The task of acoustically detecting abnormal heart activity is complicated by the fact that heart sounds often differ from each other within a short period of time, and signals indicative of cardiac disease conditions are often less audible than normal heart sounds.

Contents of the invention

In one aspect, the present invention relates to a telemedicine system comprising a first electronic stethoscope comprising: a telemedicine system configured for hand-held operation; sensing the auscultation signal at the location; and a headset that delivers audio corresponding to the auscultation signal through earpieces on the headset. The telemedicine system also includes a second electronic stethoscope including: a housing configured for hand-held operation; a transducer; and a headset that delivers audio through earpieces on the headset. The first electronic stethoscope includes: a processor that converts the auscultation signal into a digital signal representative of 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 comprises: an antenna, which receives a digital signal representing an auscultation signal at a second position via a secure digital network; The step of sensing auscultation sounds delivers audio through earpieces on the earpiece of the second electronic stethoscope substantially in real time.

In another aspect, the invention relates to an electronic stethoscope comprising: a housing configured for hand-held operation; a transducer supported by the housing and configured to sense an auscultation signal at a first position and a headset connected to the housing and configured to deliver audio corresponding to the auscultation signal through earpieces on the headset. The electronic stethoscope also includes a processor disposed in the housing and configured to convert the auscultation signal into a first digital signal representing the auscultation signal and wirelessly transmit the first digital signal from the electronic stethoscope via a secure digital network to the second location such that audio corresponding to the auscultation signal is provided to the headset of the one or more remote electronic stethoscopes at the second location substantially in real time with the step of sensing auscultation sounds at the first location.

In another aspect, the invention relates to a telemedicine system comprising a local electronic stethoscope configured to sense auscultation signals from a patient and convert the auscultation signals into digital signals representative of the auscultation signals. The telemedicine system also includes: one or more additional electronic stethoscopes; and a secure network interface connecting 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 to audio corresponding to the auscultation signal. Audio is delivered through the earpiece on the headset of each of the one or more additional electronic stethoscopes substantially in real time with the step of sensing the auscultation sounds by the local electronic stethoscope.

While a number of embodiments of the invention are disclosed, still 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. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive.

Description of drawings

FIG. 1 is a diagrammatic view of a telemedicine system according to an embodiment of the present invention.

FIG. 2 is a perspective view of an embodiment of an electronic stethoscope suitable for use in the telemedicine system shown in FIG. 1 .

3 is a front view of an embodiment of a system for interfacing with an electronic stethoscope at a patient or specialist site.

Figure 4 is a screenshot of an embodiment of a user interface at a patient site.

Figure 5 is a screenshot of an embodiment of a user interface at an expert site.

FIG. 6 is a screenshot of a graphical user interface that may be displayed on the user interfaces shown in FIGS. 4 and 5 .

7 is a perspective view of an embodiment of a wireless chestpiece for use in the telemedicine system shown in FIG. 1 .

8 is a perspective view of an embodiment of a wireless headset for use in the telemedicine system shown in FIG. 1 .

FIG. 9 is a diagrammatic view of a telemedicine system according to another embodiment of the present 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 described in detail below. However, the invention is not limited to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the scope of the invention as defined by the appended claims.

Detailed ways

1 is a diagrammatic view of an embodiment of a telemedicine system 10 including a bioacoustic sensor 12 , a patient site computer 14 , a patient site software interface 16 , a specialist site computer 22 and a specialist site software interface 24 . An optional wireless headset 25 is also shown at the expert site. Patient site bioacoustic sensor 12 communicates wirelessly with patient site computer 14 and interacts with patient site computer 14 via patient site software interface 16 . Expert site bioacoustic sensor 12 communicates wirelessly with expert site computer 22 and interacts with expert site computer 22 via expert site software interface 24 . The patient site software interface includes a wireless interface 26 and a network port interface 27 , and the specialist site software interface includes a wireless interface 28 and a network port interface 29 . Patient site computer 14 and specialist site computer 22 communicate with each other via the Internet 1. Briefly, the bioacoustic sensors 12 communicate with each other via the patient site computer 14, the specialist site computer 22, and the Internet 1 to allow a clinician or other medical professional remote from the patient site to hear in substantially real-time from the patient at the patient site. Sensed body sound. This transmission is "substantially real-time" due to any delays caused by signal processing and transmission between the patient and specialist site stethoscopes. Other sounds and information, such as voice signals, may also be transmitted between bioacoustic sensors 12 in substantially real time.

FIG. 2 is a perspective view of one embodiment of an electronic stethoscope 12 , a bioacoustic sensor suitable for use in the telemedicine system 10 . The electronic stethoscope 12 includes: earplugs 30a, 30b; ear tubes 32a, 32b; and a main tube 34. Main tube 34 is connected to a main housing or chest piece 36 that supports at least one sensor 38 (not visible in FIG. 2 ). Sensor 38 is configured to sense sounds produced by substances of biological origin, such as sounds produced by the heart, lungs, vocal cords, or other organs or tissues of the body. In some embodiments, the sensor 38 may be used to pick up speech sounds from the user of the electronic stethoscope 12 at the patient and/or specialist site. Other components that may be located within or on the main housing 36 include power supplies, microprocessors, signal processing circuits (such as digital signal processors), keyboards, graphical user interfaces, and communication devices (such as radios). Additionally, the main housing 36 may include power management circuitry, such as U.S. Patent Application Publication No. 2008/0232604 (titled "Power Management for Medical Sensing Devices Employing Multiple Sensor Signal Feature Detection" for Medical Sensing Devices Using Multiple Sensor Signal Feature Detection). Power Management for Measuring Devices)", which is hereby incorporated by reference in its entirety.

The signal processing circuitry of electronic stethoscope 12 may be configured to perform a variety of functions ranging from simple to complex. For example, the signal processing circuitry may be configured to perform relatively complex analyzes of the bioacoustic signals received from the sensors 38, such as body sound signature matching. Signal processing circuitry may perform various forms of statistical analysis on the signals generated by sensors 38 . In such configurations, the signal processing circuitry may include a digital signal processor (DSP). As another example, the signal processing circuitry may perform selective frequency filtering to enhance different types of body sounds sensed by electronic stethoscope 12 . The signal processing circuitry is also configured to convert the signal generated by the transducer 38 into an acoustic signal for transmission through the ear tubes 32a, 32b for accurate and realistic reproduction of body sound through the earplugs 30a, 30b. In some embodiments, electronic stethoscope 12 is configured to produce acoustic signals, such as US Patent No. 6,134,331 (titled "Electronic Stethoscope (electronic stethoscope)"), US Patent No. 7,006,638 (titled "Electronic Stethoscope (electronic stethoscope) ”) and/or U.S. Patent No. 7,130,429 (entitled “Method and an Apparatus for Processing Auscultation Signals (method and apparatus for processing auscultation signals)”), each of which is incorporated by reference in its entirety and enter.

In some embodiments, the sensor 38 of the electronic stethoscope is configured to modulate or generate an electrical signal in response to deformation of the transducer. Suitable transducers are modulated in combination with piezoelectric materials (organic and/or inorganic piezoelectric materials) (e.g. piezoelectric films), piezoresistive materials, strain gauges, capacitive or inductive elements, linear variable differential transformers, and responsive deformation or those transducers of other materials or elements that produce electrical signals. Sensor 38 may be planar or non-planar, such as in the case of a curved or corrugated configuration. Suitable piezoelectric materials include polymer films, polymer foams, ceramics, composites, or combinations thereof. Sensor 38 may incorporate transducer arrays of the same or different transducer types and/or different transducer materials, all of which may be connected in series, individually, or in a multilayer configuration. Suitable transducers incorporating multiple sensing elements with different characteristics and/or sensors with customizable sensing characteristics are disclosed in commonly owned U.S. Patent Application Nos. 2007/0113649 and 2007/0113654, both of which Each of the applications is hereby incorporated by reference in its entirety.

Sensor 38 may be implemented using technologies other than those employing electromagnetic energy or piezoelectric materials. For example, the sound to be translated can move a cantilever with a highly reflective surface, and a laser or beam of light shining on the surface can be modulated. The intensity or other characteristic of the modulated light can be received by a photodetector, which outputs an electrical signal for analysis. As another example, one or more accelerometers may be used to sense sound signals and generate electrical signals corresponding to the sound signals.

The electronic stethoscope 12 also includes a user interface 40 . User interface 40 may include a number of mode and/or status indicators and mode and/or control switches. Switches may include, for example, volume or gain control switches and mode selection switches. Indicators may provide an indication of the selected filter mode or other information such as battery and communication link status. Such communication link status indications may be based on error detection (CRC and other methods as described below) performed by the computer 14, 22 and/or electronic stethoscope 12 at the patient or specialist site. In a preferred embodiment, only the occurrence of errors is recorded and not their absence. For example, if the specialist site computer 22 and/or the specialist site electronic stethoscope 12 identify an error, the specialist site electronic stethoscope 12 may send a signal to the specialist site computer 22 that the data received by the specialist site electronic stethoscope 12 is different from that of the patient site electronic stethoscope. 12 sent data. An indication may then be provided through the user interface 40 that shows the clinician at the specialist site that the sound heard through the specialist site electronic stethoscope 12 is not a true reproduction of the body sound signal sensed by the patient site electronic stethoscope 12. As used herein, the term "true reproduction" refers to a digitally exact reproduction.

The electronic stethoscope 12 also includes an integrated communication system for wireless transmission of signals with the patient site computer 14 or the specialist site computer 22 . For example, information obtained by the electronic stethoscope 12 during auscultation may be transmitted to the computer 14,22. Computers 14, 22 may process information to obtain various output data, such as visual, graphical and/or audible representations of information (e.g., heart rate indications, S1-S4 heart sounds) and/or diagnostic information related to abnormalities Cardiac, pulmonary, or other organ function (eg, phonocardiogram, spectrogram, cardiac murmurs (eg, those due to valvular regurgitation or stenosis), respiratory disturbances (eg, pneumonia or pulmonary edema)) or other organ pathology.

The communication system may be used to establish a radio frequency (RF) communication link between the electronic stethoscope 12 and the computer 14 or 22 or other external device (such as a personal computer, personal digital assistant (PDA), cell phone, netbook, etc.), as will be described more below. described in detail. The communication link may be implemented using a short-range wireless communication interface, such as conforming to a known communication standard (such as the Bluetooth standard, IEEE 802 standard (such as IEEE 802.11), ZigBee or similar specifications (such as those according to IEEE 802.15.4 standard), or other public or proprietary wireless protocol) interface. For example, in some embodiments, the communication system is a Class 1 or Class 2 Bluetooth radio. Wireless communication can be accomplished in a manner that utilizes one or several of the following forms of energy: electromagnetic radiation, optical (including near-infrared), and acoustic (including high frequencies beyond the limit of average hearing). In some embodiments, a communication system is used to establish a secure communication link between the electronic stethoscope 12 and the computer.

In some embodiments, an antenna (not shown) for the wireless communication system is integrated into the main housing 36 . To improve the communication link with the electronic stethoscope 12, an aperture 42 may be formed in the metal main housing 36 and covered with a more electromagnetically transmissive material. For example, the aperture 42 may be covered with a polymeric member. A flashing light source, such as an LED, may be mounted in the aperture to indicate that the connection between the electronic stethoscope 12 and the computer is active, and to alert the user of the electronic stethoscope 12 not to cover the aperture 42 . A return signal strength indicator may be included on the user interface 40 to provide the user with the strength of the communication link when establishing a connection with the computer. In some embodiments, a small parabolic reflector is placed below the antenna to reflect signals transmitted from the antenna that are normally lost in the patient's tissue, and to gather signals received from the computer that are captured by the antenna. In an alternative embodiment, the antenna is mounted in one of the ear tubes 32a, 32b or main tube 34 to position the antenna higher and improve line of sight to the computer. The antenna may include multiple branches that may be mounted on either side of the ear tubes 32a, 32b to allow unobstructed signal communication in different body positions.

The electronic stethoscope 12 may also include a wired connection port 44 to allow a wired connection between the electronic stethoscope 12 and a computer 14 or 22 or other external device (such as a personal computer, personal digital assistant (PDA), cell phone, netbook, etc.). Conductors (either electrical or optical) may be connected between the wired connection port 44 of the electronic stethoscope 12 and an appropriate connector on the external device. The wired connection port 44 of the electronic stethoscope 12, as well as any necessary interface circuitry, may be configured to communicate information according to a number of protocols, such as FireWire ^™ (IEEE 1394), USB, Mini USB, or other communication protocols. Additionally, the connection port 44 may be configured to connect to a docking station that interfaces the electronic stethoscope 12 with the computer 14 or 22 . Attachment of the electronic stethoscope 12 to the cable or docking station can trigger the automatic launch of control/application software on the computer 14 or 22 and/or allow sound or data files stored on the electronic stethoscope 12 to be uploaded or synchronized to the computer 14 or 22. When connected, recharging energy may also be delivered to the electronic stethoscope 12 via the wired connection port 44 .

An acoustic transducer or microphone 48 may also be integrated into the top side of the main housing 36 (ie the side facing away from the sensor 38 ). The microphone 48 may be used to receive ambient sound from an area surrounding the microphone 48 . For example, microphone 48 may be used in addition to or instead of sensor 38 to pick up speech sounds from a user of electronic stethoscope 12 at the patient and/or specialist site.

In some embodiments, electronic stethoscope 12 includes an integrated electronic storage medium that allows a user to store vocal tracks, body sounds, or other recordings in electronic stethoscope 12 for later listening. The electronic storage medium may also include voice recognition data for identifying the user or owner of the stethoscope and language recognition data for recognizing voice commands so that the electronic stethoscope 12 may be modified in response to the voice commands. certain settings (such as power, volume). Speech recognition voice commands can also be used to transfer voice, body, or other records or files to a patient medical records database. In some embodiments, the electronic stethoscope is configured to transcribe the content of the speech signal into a file or other data file (eg, a patient medical file), as described, for example, in US Patent No. 7,444,285 (Forbes). The soundtrack may also be stored with the soundtrack relating to the sensed body sounds, so that the body sounds and the soundtrack can be played simultaneously through the earbuds 30a, 30b. In some embodiments, user interface 40 allows a user to scroll through body sounds and tracks stored on electronic storage media for selection and playback. Microphone 48 may also be used for effective ambient noise reduction to remove unwanted ambient noise from recorded body and speech signals.

Referring back to FIG. 1 , the electronic stethoscope 12 at the patient site can be connected or paired with the patient site computer 14 via a secure wireless interface 26 to establish a secure network connection between the patient site electronic stethoscope 12 and the patient site computer 14 . Similarly, the electronic stethoscope 12 at the specialist site may be connected to or paired with the specialist site computer 22 via a secure wireless interface 28 to establish a secure network connection between the specialist site electronic stethoscope 12 and the specialist site computer 22 . Although a single electronic stethoscope 12 is shown at each of the patient site and the specialist site, it should be understood that multiple electronic stethoscopes 12 may be connected to the patient site computer 14 and/or the specialist site computer 22 . In some embodiments, the electronic stethoscope 12 is paired with its respective computer 14, 22 via a personal area network (PAN). An example of a PAN is a Bluetooth network where a pairing code is established on one of the electronic stethoscope 12 and computer 14 or 22 and entered on the other of the electronic stethoscope 12 and computer 14 or 22 . In some embodiments, an optional wireless headset 26 is also connected to or paired with the expert site computer 22 via a secure wireless interface 28 .

In addition, a secure connection is established between the network port interfaces 27, 29 of the computers 14, 22 respectively via the Internet 1, so that the electronic stethoscopes 12 can communicate with each other via the secure network connection. For example, the network port interfaces 27, 29 may exchange certificates, obtain authentication, or establish secure network keys to establish a secure connection. Additionally, the data may be encrypted by the computers 14, 22 prior to sending the data over the Internet 1. When data is received, it can be decrypted using the secure network key. In some embodiments, network port interfaces 27, 29 allow application software on computers 14 and 22 to interface with wireless interfaces 26, 28 located remotely across the Internet I.

In an alternative embodiment, electronic stethoscopes 12 are configured to communicate directly with each other (ie, without interfacing with computers 14 and 22 ) via a secure connection. For example, electronic stethoscopes 12 may each be configured with a unique Internet Protocol (IP) address, and electronic stethoscopes 12 may directly establish a secure connection with each other using a wireless fidelity (WiFi) connection or other wireless connection. As another example, a patient site and/or a specialist site may include multiple electronic stethoscopes 12 that communicate with each other locally.

When the electronic stethoscopes 12 are connected over the secure network connection, signals may be sent between the electronic stethoscopes 12 or between the electronic stethoscopes 12 and the computers 14, 22 in substantially real time. For example, body sounds may be transmitted in substantially real time from an electronic stethoscope at the patient site to earbuds 30a, 30b at the specialist site. Additionally, body sounds can be reproduced substantially in real time through microphones connected to the computers 14,22. In some embodiments, the electronic stethoscope 12 at the patient site and the specialist site are substantially identical such that body and other sounds are reproduced substantially identically in the earbuds 30a, 30b at the patient site and the specialist site. Additionally, sound may be recorded and stored by one of the electronic stethoscopes 12 and then played (either from memory in the electronic stethoscope 12 or from one of the computers 14, 22) to all networked electronic stethoscopes 12 substantially simultaneously. In some embodiments, signals transmitted by the patient site electronic stethoscope 12 to the patient site computer 14 and over the Internet 1 are packetized and enumerated by the patient site electronic stethoscope 12 and error checked at the specialist site to ensure that Authentic sound quality and reliable reproduction at expert site electronic stethoscope 12. Error checking may be performed by each element in telemedicine system 10 (ie, patient site computer 14, specialist site computer 22, and specialist site electronic stethoscope 12) to further ensure that data from patient site electronic stethoscope 12 is transmitted accurately. Error checking may be any applicable data transmission checking technique including, but not limited to, cyclic redundancy checking (CRC), checksum, horizontal and vertical redundancy checking, hash functions, repetition codes, and the like. The system may also incorporate, for example, a sample throughput measurement by performing the sample throughput measurement to determine excess or insufficient data in a communication link. In short, the sound packet from the electronic stethoscope 12 at the patient site is directly forwarded (ie, mirrored) to the electronic stethoscope 12 at the expert site through the Internet 1 .

In a preferred embodiment, the telemedicine system 10 includes error checking and authentication independent of the underlying communication system or network (eg, Bluetooth, TCP/IP) protocol. Independent error checking may be performed at any component of the telemedicine system 10 to further ensure that the signal is a true reproduction of the auscultation sounds from the electronic stethoscope 12 at the patient site. In certain preferred embodiments, outages serving the underlying system are categorized by duration and severity, with all errors resulting in the following communication being sent to the user (via one or more components of the telemedicine system): The signal is not for real reproduction. For example, the patient site component may send packets or other signals to the specialist site system component every 500 milliseconds. An interruption in the underlying communication system or network of more than 500 milliseconds can result in dropped packets/signals and a resulting indication (eg, via a color change of the indicator) of degraded audio quality at the expert site.

Additionally, ambient sound (eg, speech signals) may also be received by the transducer 38 and may be transmitted between the electronic stethoscopes 12 in substantially real-time, simultaneously with, or alternately with body sounds. In an alternative embodiment, electronic stethoscope 12 may receive voice communications and other ambient sounds through microphone 48 for processing and transmission to a remote site. Body sound information flows continuously from the patient site electronic stethoscope 12 to the specialist site electronic stethoscope 12 , while ambient sound flows bi-directionally between the patient and specialist site electronic stethoscopes 12 . Patient site electronic stethoscope 12 , specialist site electronic stethoscope 12 , patient site computer 14 , and specialist site computer 22 may each include one or more ring buffers to ensure a continuous flow of information between electronic stethoscopes 12 . In some embodiments, the ambient sound is μ-law encoded and superimposed on the body sounds produced by the electronic stethoscope 12 at the patient site. Thus, a clinician at a patient site can, for example, hear body sounds from the patient while receiving voice instructions from a specialist at the specialist site. This allows the specialist at the specialist site to have a substantially hands-on experience with the patient. Because the clinician at the patient site receives the sound through the earbuds 30a, 30b, the clinician at the patient site and the specialist at the specialist site can consult privately rather than having a session via a computer attached to the patient site computer 14, for example. Expert site communication output for microphone. Signal processing may be employed to optimize the sound quality of speech signals provided through the earbuds 30a, 30b.

The speech and auscultation sounds reproduced by the earbuds 30a, 30b of the electronic stethoscope 12 at the patient site and the specialist site can be controlled locally at each electronic stethoscope 12 . Auscultation and voice signals may be provided to the earbuds 30a, 30b simultaneously but on separate channels, allowing the clinician to independently control the volume of auscultation sounds and voice communications. This allows the clinician to optimize the relative volume of auscultation and ambient sounds, thereby providing a balanced output to the clinician's earbuds 30a, 30b that is customized to the clinician's preferences. Each electronic stethoscope 12 may also include a selective speech enhancement filter that, for example, enhances specific frequency bands of the speech signal to help reduce ambient noise.

In some embodiments, the transmission of voice signals can be selectively controlled when the stethoscope is connected through a secure network connection. For example, when connected, body sounds can be continuously transmitted from the patient site to the specialist site, while voice signals and other ambient sounds are only transmitted between sites when the clinician chooses to transmit voice signals. For example, in some embodiments, electronic stethoscope 12 utilizes selective frequency filtering to suppress frequency bands that characterize speech signals during auscultation. In such an embodiment, the clinician may initiate transmission of the speech signal by substantially disabling frequency filtering or modifying filter settings (ie, allowing reproduction and transmission of certain frequency bands that characterize only the speech signal). In some embodiments, when a clinician presses a button on user interface 40, voice signal transmission is initiated. Electronic stethoscope 12 may be configured such that a voice signal is transmitted when a button on user interface 40 is pressed and held (similar to a hand-held transceiver or walkie-talkie). Alternatively, electronic stethoscope 12 may be configured such that the voice signal transmission mode is activated when the button is pressed and released, and deactivated when the button is subsequently pressed and released again.

Electronic stethoscope 12 may include integrated software memory that initially stores software for patient site software interface 16 and/or specialist site software interface 24 . For example, software may be included with each electronic stethoscope 12 when the electronic stethoscopes 12 are sold to consumers. When electronic stethoscope 12 is paired with computer 14 or 22 , electronic stethoscope 12 may be configured to automatically download software stored in software memory to computer 14 or 22 . When the software is installed on the computer 14, 22, the software allows the electronic stethoscope 12 to interact with the computer 14, 22, for example, by sending information and signals from the electronic stethoscope 12 to the computer 14, 22 and by The control signals of 14 and 22 are provided to the electronic stethoscope 12 .

Patient site remote video application software 56 and server site remote video application software 58 are also shown in FIG. 1 . In some embodiments, video cameras are connected to patient site computer 14 and/or specialist site computer 22 to allow video communication between the patient site and specialist site via remote video application software 56 and 58 . This allows, for example, a specialist at the specialist site to see the positioning of the sensor 38 relative to the patient at the patient site and to provide the patient site with feedback on the positioning of the sensor 38 . As another example, a video camera may be used in conjunction with the microphone 48 on each of the electronic stethoscopes 12 to allow for a video session between the patient site and the specialist site.

FIG. 3 is a front perspective view of an embodiment of a computer 60 suitable for use as patient site computer 14 and/or specialist site computer 22 . Computer 60 includes processor 62 , display 64 , camera 66 , keyboard 68 , mouse 70 and communications adapter 72 . Processor 62 is also configured to connect to the Internet to facilitate communication between the patient site and the specialist site. Processor 62 is shown as a laptop computer, but alternatively the processor may be a desktop computer or may have any other form. Additionally, although a separate display 64 is shown, a laptop computer display could also be used. Additionally, other input devices (eg, trackballs, joysticks, etc.) may be integrated into the computer 60 used in the telemedicine system 10 .

Processor 62 receives input control signals from keyboard 68 and mouse 70 and provides video signals to display 64 . In addition, processor 62 also sends signals to and receives signals from electronic stethoscope 12 via communications adapter 72 . In some embodiments, communication adapter 72 is a Bluetooth adapter suitable for short-range (eg, up to 10m) and medium-range (eg, up to 100m) secure communications. The keyboard 68 and mouse 70 can be used to establish security codes etc. to initiate a secure connection with the electronic stethoscope 12 described above. The communication adapter 72 may be positioned high on the wall, as shown, to improve the line of sight and communication link between the electronic stethoscope 12 and the communication adapter 72 .

Camera 66 communicates with processor 62 to capture video of the patient or specialist site. The processor 62 then interfaces via the remote video application software 56 or 58 over the Internet 1 to provide live video feed to the patient or specialist site. As shown, a camera 66 may be mounted on top of the display 64 to allow for video communication between the patient site and the specialist site. Camera 66 may also be configured for wireless communication with processor 62 to allow camera 66 to be moved around the patient or specialist site (eg, to capture video of the location of sensor 38 on the patient). In some embodiments, keyboard 68 and/or mouse 70 may be used at one site to control the operation (eg, zoom in, focus, position, etc.) of camera 66 at another site. This allows, for example, a specialist at the specialist site to control the video being captured at the patient site.

FIG. 4 is a screenshot of an embodiment of a user interface 80 that may be displayed on a display 64 at a patient site during a telemedicine procedure. The user interface 80 includes a data display module 82 , a video session module 84 and a stethoscope control module 86 . A user of patient site computer 14 may interact with the user interface on display 64 using keyboard 68, mouse 70, and/or other input devices. For example, a user may use mouse 70 to select a button or drop-down menu element on user interface 80 .

The data display module 82 is a graphical representation of periodic body sounds produced by the patient and sensed by the sensor 38 at the patient site. Signals generated by sensor 38 are processed by an electronic stethoscope processor and provided to patient site computer 14 via an integrated antenna. Processor 62 then processes these signals and converts them into an appropriate form for display on data display module 82 . The graph may be updated periodically or substantially in real time as the clinician holds electronic stethoscope 12 against the patient's body. The scale used or axes in the graph can be manipulated using the radio buttons 88 on the data display module.

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

Video session module 84 displays the video being captured by camera 66 at the specialist site. For example, this allows the clinician at the patient site to see the specialist at the specialist site, and allows the specialist to indicate the preferred positioning of the sensor 38 relative to the patient at the patient site. The video session module 84 also includes a toolbar 90 having a plurality of video session controls. For example, toolbar 90 may include buttons to control the volume of sounds received from the expert site and the positioning of video sessions on user interface 80 . Toolbar 90 may also include interfaces and tools for starting and ending video sessions.

The stethoscope control module 86 may include a number of selectable controls and settings for the electronic stethoscope 12 at the patient site. These settings can be selected to control the patient site electronic stethoscope 12 mode, volume, power status, recording settings, and the like. In some embodiments, these setting items may also be selected via the user interface 40 on the electronic stethoscope 12 . The stethoscope control module 86 may also include options for controlling other modules on the user interface 80 . The stethoscope control module 86 may also include optional options for communication settings between the electronic stethoscope 12 and the patient site computer 14 . For example, the stethoscope control module 86 may allow adjustment of packet settings for the electronic stethoscope 12 or check and repair of connection settings between the electronic stethoscope 12 and the patient site computer 14 .

FIG. 5 is a screenshot of an embodiment of a user interface 100 that may be displayed on a display 64 at a specialist site during a telemedicine procedure. Similar to the user interface 80 , the user interface 100 includes a data display module 102 , a video session module 104 and a stethoscope control module 106 . A user of expert site computer 22 may interact with the user interface on display 64 using keyboard 68, mouse 70, and/or other input devices. For example, a user may use mouse 70 to select a button or drop-down menu element on user interface 100 .

The data display module 102 is a graphical representation of periodic body sounds produced by the patient and sensed by the sensor 38 at the patient site. Signals generated by sensor 38 are processed by an electronic stethoscope processor, provided to patient site computer 14 and sent to specialist site computer 22 . The expert site computer processor 62 then processes these signals and converts them into an appropriate form for display on the data display module 102 . The graph may be updated periodically or substantially in real time as a clinician at the patient site holds the electronic stethoscope 12 against the patient's body. The scale used or axes in the graph can be manipulated using the radio buttons 108 on the data display module.

Video session module 104 displays video being captured by camera 66 at the patient site. For example, this allows a specialist at the specialist site to see the positioning of the sensor 38 relative to the patient at the patient site. The video session module 104 also includes a toolbar 110 having a plurality of video session controls. For example, toolbar 110 may include buttons that control the volume of sounds received from the patient site and the positioning of video sessions on user interface 100 . Toolbar 110 may also include interfaces and tools for starting and ending video sessions. The toolbar 110 may also include controls to adjust the camera position at the patient site.

The stethoscope control module 106 may include a number of selectable controls and settings for the electronic stethoscope 12 at the patient site and/or specialist site. These settings can be selected to control patient and/or specialist site electronic stethoscope 12 modes, filtering, volume, power status, recording settings, and the like. For example, the stethoscope control module 106 may include an interface to control mode and filter settings on the electronic stethoscope 12 at the patient site. The stethoscope control module 106 may also be configured to allow control of certain settings on the patient site electronic stethoscope 12, while reserving other settings for local control only. For example, the stethoscope control module 106 may provide volume control for the specialist site electronic stethoscope 12 only, while the volume of the patient site electronic stethoscope 12 may only be controlled at the patient site (such as via the stethoscope control module 86 or on the patient site electronic stethoscope 12 user interface 40). In some embodiments, the specialist site electronic stethoscope 12 may also be configured such that the user interface 40 on the specialist site electronic stethoscope 12 controls settings of the patient site electronic stethoscope 12 when connected over a secure network. The specialist site electronic stethoscope 12 can also be configured to control substantially all settings on the patient site electronic stethoscope 12 (ie, substantially disable local controls at the patient site), while still allowing the patient site to control the volume. This local control ensures that the volume can be adjusted according to the user's preferences at each location.

In an alternative embodiment, the clinician at the specialist site can set the specialist site electronic stethoscope 12 to the required settings and then send the specialist site electronic stethoscope 12 settings to the patient site electronically in one transmission. stethoscope 12 (eg, via specialist site computer 22 and patient site computer 14 ) to update settings on patient site electronic stethoscope 12 .

Stethoscope control module 106 may also include optional options for communication settings between patient site electronic stethoscope 12 and patient site computer 14 and/or specialist site electronic stethoscope 12 and specialist site computer 22 . For example, the stethoscope control module 106 may allow adjustment of subpackage settings of the electronic stethoscope 12 or check and repair of connection settings between the electronic stethoscope 12 and the specialist site computer 22 .

The user interface 100 shown and described is exemplary only and other configurations of user interfaces may be used. In an exemplary alternative configuration shown in FIG. 6 , the user interface 100 may include a first graphical user interface 112 that is a feature enhancement of the housing 36 on the electronic stethoscope 12 at the specialist site. An image that has a control portion 114 that includes each of the buttons and other interfaces on the user interface 40 of the specialist site electronic stethoscope 12 . Each button on control section 114 is selectable to produce the same function on expert site electronic stethoscope 12 as pressing the corresponding button on user interface 40 . A user interface similar to user interface 112 may also be displayed on user interface 80 for on-screen function control of electronic stethoscope 12 at the patient site.

When the specialist site electronic stethoscope 12 is connected and synchronized with the patient site electronic stethoscope 12, the user interface 100 may display a single graphical user interface that is a feature-enhanced image of the housing 36 on the patient site electronic stethoscope 12, including Each of the buttons and other interfaces on the user interface 40 of the electronic stethoscope 12 at the patient site. This same graphical user interface 112 may also be displayed on user interface 80 . When the patient and specialist site electronic stethoscopes 12 are connected, each button on the graphical user interface 112 is selectable at either the patient or specialist site, resulting in the same functionality on the patient site electronic stethoscope 12 as if pressing the user on the patient site stethoscope The corresponding buttons on the interface 40 are the same. Graphical user interface 112 provides the clinician at the specialist site with an interface through which certain settings of electronic stethoscope 12 at the patient site can be controlled (eg, modes, filters, etc.).

The graphical user interface 112 may also include a plurality of connect buttons 116 that may be used to control the connection between the specialist site computer and the electronic stethoscope 12 to which it is connected. For example, in the embodiment shown in FIG. 6, the connection buttons 116 include: a "disconnect stethoscope" button that allows the local expert site electronic stethoscope 12 to be disconnected from the expert site computer 22; a "remote disconnect" button that allows the expert Disconnection of site computer 22 from patient site electronic stethoscope 12 (and desynchronization of patient site electronic stethoscope 12 and specialist site electronic stethoscope 12); and a "remote talk" button which initiates voice communication between the specialist and patient site electronic stethoscope 12 . The “Remote Disconnect” and “Remote Talk” buttons may be disabled or may not appear on the graphical user interface 112 when the specialist site electronic stethoscope 12 is not connected to the patient site electronic stethoscope 12 .

Additionally, 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 drop-down menu that allows the clinician to scroll through stethoscopes connected to the specialist site computer 22 . This triggers activation of the active electronic stethoscope 12 on the graphical user interface 112, allowing the clinician to modify settings for each of the connected stethoscopes.

The graphical user interface 112 may also include visual and/or audio indications to indicate that the sounds heard by the clinician at the specialist site electronic stethoscope 12 are true reproductions of the sounds from the patient site electronic stethoscope 12 . In the embodiment shown in FIG. 6 , the graphical user interface 112 includes a fidelity meter 118 labeled "Signal Flow Integrity" that includes a fidelity indicator 119 . The fidelity indicator 119 changes color to indicate whether a realistic sound reproduction is produced at the specialist site electronic stethoscope 12 . For example, the fidelity indicator 119 is displayed in green when the sound is a true reproduction and in red when the sound is not a true reproduction. The indication may be based on error detection (eg, CRC) performed by the specialist site computer 22 and/or the specialist site electronic stethoscope 12 . Error detection may also be performed by patient site computer 14 and/or patient site electronic stethoscope 12 . For example, if the specialist site computer 22 and/or the specialist site electronic stethoscope 12 identify an error, the specialist site electronic stethoscope 12 may send a signal to the specialist site computer 22 that the data received by the specialist site electronic stethoscope 12 is different from that of the patient site electronic stethoscope. 12 sent data. This indication may then be provided through the user interface 100 to show the clinician at the specialist site that the sound heard through the specialist site electronic stethoscope 12 is not a true reproduction of the body sound signal sensed by the patient site electronic stethoscope 12. The specialist site electronic stethoscope 12, the patient site electronic stethoscope 12, and/or the user interface 80 may also provide an indication of realistic sound reproduction. In an alternative embodiment, false absences are reported to system components.

Although electronic stethoscope 12 has been described with reference to a stethoscope having a chestpiece, main tube, and binaural pieces connected to ear tips, electronic stethoscopes for use in 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 may be used in connection with the telemedicine system 10 .

Wireless chestpiece 120 is constructed substantially similar to chestpiece 36 described above with reference 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 interface with the computers 14, 22 via a secure network connection. Components that may be provided in chestpiece 120 include power supplies, signal processing circuits, and communication interfaces. A sensor 124 (not shown) is supported at one end of the wireless chest piece 120 , and an antenna 126 is mounted at an end of the wireless chest piece 120 opposite the sensor 124 . In some embodiments (not shown), the antenna is integrated into the housing described above. Sensor 124 may have characteristics and configurations similar to those described above with reference to sensor 38 . In the illustrated embodiment, the antenna 126 is configured to pivot or rotate about a pivot 128 to allow the antenna 126 to be set for maximum signal coupling during use. The antenna 126 may also be configured to minimize headroom during storage. In some embodiments, the antenna 126 is a high performance antenna for a large signal range (eg, greater than 100m), thereby maximizing the mobility of the wireless chestpiece 120 .

Wireless headset 122 is configured to receive signals from wireless chestpiece 120 via a secure connection. In some embodiments, the chestpiece 120 and headphones 122 are paired with each other via a Bluetooth connection. Wireless headset 122 may also be configured to communicate with computer 14 or 22 , similar to headset 26 shown in FIG. 1 . Wireless headphones 122 may have various configurations, including on-ear and in-ear designs. In the illustrated embodiment, the wireless headset 122 includes earbuds 130a, 130b for in-ear use. In some embodiments, earbuds 130a, 130b are substantially identical to earbuds 30a, 30b in FIG.

The wireless headset 122 may also include a microphone 132 for receiving speech sounds from the user. The microphone 132 is connected to an adjustable support 134 which allows the microphone 132 to be positioned relative to the user. The signal received by the microphone 132 may be superimposed on the body sound sensed by the wireless headset 120 and transmitted over the Internet I, as described above.

In addition to having alternative configurations for electronic stethoscopes used in telemedicine system 10, connections between electronic stethoscopes may also have alternative configurations. For example, FIG. 9 is a diagrammatic view of a telemedicine system 150 according to an alternative embodiment. The telemedicine system 150 includes a sensing electronic stethoscope 12 a , a plurality of networked electronic stethoscopes 12 b , 12 c , . . . , 12 n , and a network interface or hub 152 . Electronic stethoscopes 12a-12n communicate with network interface 152 wirelessly. Electronic stethoscopes 12a-12n may be constructed substantially similarly and may have substantially similar characteristics to electronic stethoscope 12 described above in FIG. 2 . It should be understood that electronic stethoscope 12n represents the nth networked electronic stethoscope 12 and should not be construed as limiting or limiting the number of networked electronic stethoscopes 12 connected to network interface 152 . In some embodiments, network interface 152 is configured as a durable, handheld or portable device.

Network interface 152 is designed to establish a secure connection with electronic stethoscopes 12a-12n. In some embodiments, electronic stethoscopes 12a-12n are paired with network interface 152 via a personal area network (PAN). An example of a PAN is a Bluetooth network, where a pairing code is established on the network interface 152 and entered into each electronic stethoscope 12a-12n to securely connect to the network interface 152. When connected, the sensing electronic stethoscope 12a can be used to sense patient body sounds, and the networked stethoscopes 12b-12n can be used to listen to patient body sounds sensed by the sensing electronic stethoscope 12a in substantially real time. Additionally, other sounds (eg, voice prompts) may be received on the sensor 38 or microphone 48 of one of the electronic stethoscopes 12a-12n and delivered to each of the networked electronic stethoscopes 12a-12n. In an alternative embodiment, the electronic stethoscopes 12a-12n are networked directly with each other (ie, without interfacing the intervening network interface 152).

In one example embodiment, the teacher's electronic stethoscope 12 and one or more students' electronic stethoscopes 12 may be networked via network interface 152 . A doctor or student may be selected to sense patient body sounds while other networked users listen to the patient's body sounds via their respective electronic stethoscopes 12 . Additionally, the sounds stored in the teacher's electronic stethoscope 12 (or another networked storage device) can be played back to all networked electronic stethoscopes 12 substantially simultaneously. The physician may also provide voice instructions or prompts via the sensor 38 or microphone 48 on the main housing 36 , which are provided through the earpieces of the student's electronic stethoscope 12 simultaneously with the sensed body sounds. Thus, if a doctor's electronic stethoscope is being used to sense body sounds, the doctor can demonstrate the positioning and use of electronic stethoscope 12a while students listen to networked electronic stethoscopes 12b-12n. If the students' electronic stethoscopes are being used to sense body sounds, the doctor can provide instructions and guidance to each of the students via the sensor 38 or the microphone 48 . Additionally, each of the students with an electronic stethoscope 12 networked to the network interface 152 can take turns sensing body sounds while the physician provides them with individual instruction.

In other embodiments, a networked stethoscope is connected to a computer or other external device (eg, cell phone, PDA), as described above. Auscultation tones and voice signals of the networked stethoscope can be reproduced in substantially real time by a microphone connected to a computer or other external device. In some embodiments, body sounds may be downloaded from an electronic storage medium or other online database (such as a website) to a computer or external device via a network connection and streamed to a networked stethoscope, and/or reproduced through a microphone in substantially real time.

In summary, certain embodiments disclosed herein relate to a telemedicine system that includes a first electronic stethoscope that includes a housing configured to be viewed by a clinician. Hand-held operation on the patient; a transducer supported by the housing and configured to sense an auscultation signal from the patient at a first position; and a headset connected to the The housing is configured to deliver audio corresponding to the auscultation signal through earpieces on the headset. The telemedicine system also includes a second electronic stethoscope, the second electronic stethoscope includes a housing, a transducer and earphones, the housing, the transducer and the earphones are the same as the housing, the transducer and the first electronic stethoscope. Transducers are basically similar to headphones. The first electronic stethoscope is configured to: convert the auscultation signal into a digital signal representative of the auscultation signal; and wirelessly transmit the digital signal to the second location via the secure digital network. The second electronic stethoscope is constructed to: receive a digital signal representing the auscultation signal at a second location via a secure digital network; convert the digital signal into an audio frequency corresponding to the auscultation signal; and sense the auscultation sound at the first location The step delivers audio through earpieces on a headset of a second electronic stethoscope in substantially real time.

Various modifications and additions may be made to the exemplary embodiments discussed without departing from the scope of the present invention. For example, while the above-described embodiments refer to specific features, the scope of the invention also includes embodiments having different combinations of features and embodiments that do not contain all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications and variations that come within the scope of the claims and all equivalents thereof.

Claims (42)

1. A telemedicine system comprising: A first electronic stethoscope, the first electronic stethoscope includes a housing, a transducer and headphones, the housing is configured for hand-held operation, the transducer senses an auscultation signal at a first position, the The headset delivers audio corresponding to the auscultation signal through earpieces on the headset, the first electronic stethoscope also includes a processor and an antenna, the processor converts the auscultation signal into a signal representing the a digital signal of said auscultation signal, said antenna for wirelessly transmitting said digital signal to a second location via a secure digital network; and A second electronic stethoscope comprising a housing, a transducer, and a headset configured for hand-held operation, the headset being delivered through earpieces on the headset audio, the second electronic stethoscope further comprising an antenna for receiving the digital signal representing the auscultation signal at the second location via the secure digital network and a processor for converting said digital signal into an audio frequency corresponding to said auscultation signal and passing over said headset of said second electronic stethoscope substantially in real time with the step of sensing said auscultation sound at said first location The earpieces deliver the audio. 2. The telemedicine system of claim 1, wherein the second location is remote from the first location. 3. The telemedicine system of claim 1, wherein the audio delivered to the headset of the second electronic stethoscope is a true reproduction of the auscultation sounds at the first location. 4. The telemedicine system of claim 1 , wherein the transducer on the first electronic stethoscope also receives ambient audio at the first location, and the transducer on the second electronic stethoscope The transducer also receives ambient audio at the second location, and wherein the ambient audio is wirelessly transmitted between the first location and the second location via the secure digital network. 5. The telemedicine system of claim 1 , wherein the first electronic stethoscope further comprises a first microphone that receives ambient audio at the first location, and the second electronic stethoscope further includes comprising a second microphone that receives ambient audio at the second location, and wherein the ambient audio is wirelessly transmitted between the first location and the second location via the secure digital network . 6. The telemedicine system of claim 4, wherein upon activation of a user interface element on the first electronic stethoscope, the transducer is activated to receive ambient audio at the first location, and Wherein upon activation of a user interface element on the second electronic stethoscope, the second transducer is activated to receive ambient audio at the second location. 7. The telemedicine system according to claim 6, wherein said processor of said first electronic stethoscope includes a frequency filter, and wherein the step of activating said user interface elements of said first electronic stethoscope modifies said Frequency filter settings. 8. The telemedicine system of claim 1 , wherein the first electronic stethoscope communicates with the first computer at the first location via a first secure personal area network, and the second electronic stethoscope communicates via a second A secure personal area network is in communication with a second computer at the second location, and wherein the first computer transmits the digital signal representing the auscultation signal to the second computer via a secure digital connection. 9. The telemedicine system of claim 8, wherein when the audio delivered through the earpiece on the headset of the second electronic stethoscope is sensed by the first electronic stethoscope At least one of the first electronic stethoscope, the second electronic stethoscope, the first computer and the second computer provides audio and/or visual indications of the true reproduction of the auscultation signal. 10. The telemedicine system of claim 1, wherein the antenna of each of the first electronic stethoscope and the second electronic stethoscope is disposed at least partially within the headset. 11. The telemedicine system of claim 1, wherein the first electronic stethoscope is further configured to wirelessly receive signals from the second electronic stethoscope via the secure digital network. 12. The telemedicine system of claim 1, wherein the first electronic stethoscope is configured to receive control signals via the secure digital network to allow modification of settings of the first electronic stethoscope from the second location . 13. The telemedicine system of claim 12, wherein the control signal inhibits modification of certain settings of the first electronic stethoscope at the first location. 14. The telemedicine system of claim 13, wherein the control signal does not inhibit modification of a volume setting of the first electronic stethoscope at the first location. 15. The telemedicine system of claim 1, wherein at least one of the first electronic stethoscope and the second electronic stethoscope comprises a wireless chest piece and a wireless headset. 16. An electronic stethoscope comprising: a housing configured for hand-held operation; a transducer supported by the housing and sensing an auscultation signal at a first position; a headset connected to the housing and configured to deliver audio corresponding to the auscultation signal through earpieces on the headset; and a processor disposed in the housing and configured to convert the auscultation signal into a first digital signal representing the auscultation signal and transfer the first digital signal from the The electronic stethoscope is wirelessly transmitted to a second location such that the audio corresponding to the auscultation signal is provided to the second location substantially in real time with the step of sensing the auscultation sound at the first location. Headphones for one or more remote electronic stethoscopes at the location. 17. The electronic stethoscope of claim 16, wherein the second location is remote from the first location. 18. The electronic stethoscope of claim 16, wherein the audio corresponding to the auscultation signal is a true reproduction of the auscultation sounds sensed at the first location. 19. The electronic stethoscope of claim 16, wherein the transducer receives ambient audio at the first location, and wherein the processor is further configured to convert the ambient audio into A second digital signal of ambient audio, and wirelessly transmitting the second digital signal along with the first digital signal to the second location via the secure digital network. 20. The electronic stethoscope of claim 16, further comprising: a microphone disposed in the housing to receive ambient audio at the first location, wherein the processor is further configured to convert the ambient audio into a first and wirelessly transmit the second digital signal together with the first digital signal to the second location via the secure digital network. 21. The electronic stethoscope of claim 19, wherein upon activation of a user interface element on the housing, the transducer is activated to receive ambient audio at the first location. 22. The electronic stethoscope of claim 19, wherein the processor further includes a frequency filter, and wherein the step of activating the user interface element modifies a setting of the frequency filter. 23. The electronic stethoscope of claim 20, wherein the microphone is disposed on a side of the housing opposite the transducer. 24. The electronic stethoscope of claim 16, wherein the processor communicates with a computer via the secure personal area network, and wherein the computer transmits the first digital signal to the second location. 25. The electronic stethoscope of claim 24, wherein the processor communicates via radio frequency signals over the secure personal area network. 26. The electronic stethoscope of claim 24, further comprising: memory for storing software executable by the computer, wherein the processor is further configured to automatically download the software from the computer when the processor is connected to the computer via the secure personal area network The software memory is transferred to the computer. 27. The electronic stethoscope of claim 16, further comprising: an antenna configured to wirelessly transmit the first digital signal from the electronic stethoscope via the secure digital connection. 28. The electronic stethoscope of claim 27, wherein the antenna is disposed in the headset. 29. 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 generated by one or more remote electronic stethoscopes at the second location. 31. The electronic stethoscope of claim 16, wherein the housing comprises a wireless chest piece. 32. A telemedicine system comprising: a local electronic stethoscope configured to sense an auscultation signal from the patient and convert the auscultation signal into a digital signal representative of the auscultation signal; One or more additional electronic stethoscopes; and a secure network interface connecting the local electronic stethoscope to the one or more remote electronic stethoscopes via a secure digital network, wherein each of the one or more additional electronic stethoscopes is configured as receiving the digital signal representing the auscultation signal via the secure digital network, and converting the digital signal into an audio frequency corresponding to the auscultation signal, wherein the auscultation sound is sensed by the local electronic stethoscope The step of delivering the audio through earpieces on headphones of each of the one or more additional electronic stethoscopes in substantially real time. 33. The telemedicine system of claim 32, wherein the audio delivered to the headset of each of the one or more additional electronic stethoscopes is sensed by the local electronic stethoscope Realistic reproduction of the auscultation sounds. 34. The telemedicine system of claim 32, wherein the local electronic stethoscope and the one or more additional electronic stethoscopes are each configured to receive ambient audio and wirelessly transmit the audio via the secure digital network. ambient audio. 35. The telemedicine system of claim 32, wherein the local electronic stethoscope and the one or more additional electronic stethoscopes each further include a microphone for receiving ambient audio, and are each configured to communicate via the secure digital network to transmit the ambient audio wirelessly. 36. The telemedicine system of claim 34, wherein upon activation of a user interface element, the transducers on each of the local electronic stethoscope and the one or more additional electronic stethoscopes are activated by Activate to receive ambient audio. 37. 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. 38. The telemedicine system of claim 32, wherein the secure network interface is a personal area network hub, and wherein each of the local electronic stethoscope and the one or more additional electronic stethoscopes are connected via a secure personal area network hub. A LAN connection is connected to the personal area network hub. 39. The telemedicine system of claim 38, wherein the personal area network hub is a durable hub. 40. The telemedicine system of claim 32, wherein the one or more additional electronic stethoscopes are remote from the local electronic stethoscope. 41. The telemedicine system of claim 38, wherein said personal area network hub is selected from a personal computer, a personal digital assistant, a cell phone, and a netbook. 42. A bioacoustic sensor comprising: a housing configured for hand-held operation; a transducer supported by the housing and sensing an auscultation signal at a first position; a headset connected to the housing and configured to deliver audio corresponding to the auscultation signal through earpieces on the headset; and a processor disposed in the housing and configured to convert the auscultation signal into a first digital signal representing the auscultation signal and transfer the first digital signal from the The bioacoustic sensor is wirelessly transmitted to a second location such that the audio corresponding to the auscultation signal is provided to the second location substantially in real time with the step of sensing the auscultation sound at the first location. Headphones at the second position.

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