Ausculo

India's healthcare system has a major gap between rural and urban areas. While about 70% of the population lives in rural regions, around 80% of doctors work in cities. This results in a doctor–patient ratio of 1:1,500 nationwide, which is much lower than the WHO’s recommended ratio of 1:1,000. In rural areas, the situation is even worse, with one doctor for every 2,500 people. Rural patients often have to travel over 100 km to get basic medical care.

To address these challenges, telemedicine has become an important solution. In 2020, India introduced the eSanjeevani platform, which connects village-level Health & Wellness Centres (HWCs) or Sub-centres with specialist hubs. It works through two models: one for healthcare provider-to-provider interactions and another for doctor-to-patient consultations. Within a few months, this platform facilitated millions of remote consultations.

Digital stethoscopes, like the 3M Littmann CORE and the Eko stethoscope, can record, process, and wirelessly transmit heart and lung sounds for remote diagnosis (Seah & Zhao, 2023). During teleconsultations, a healthcare worker can use the device on a patient while a clinician listens live or reviews the recordings later. This technology can help improve diagnostic accuracy. However, despite their potential, digital stethoscopes are not widely used in rural India. The main barriers are high costs and limited availability in low-resource areas.

Although it’s known that digital stethoscopes are not widely adopted, the specific reasons—like usability issues, infrastructure challenges, and perceptions among healthcare workers—have not been thoroughly explored in rural India. This paper aims to understand how to design a digital stethoscope specifically for rural telemedicine, focusing on the technical, human, and infrastructure-related factors that influence its usability and acceptance.