In the field when using the DUO function I have noticed that each position produces a unique heart sound as well as ECG tracing. I find it somewhat difficult in obtaining a clean ECG pattern without noise which causes distortion on the Eko DUO E5 App display on the IPAD or Phone. I also think that dry skin, body fat, or hair can restrict the quality of the ECG. Despite placing the diaphragm at an inward facing 45 degree angle at the upper left pectoral below the clavicle. For now we have been avoiding using the ECG feature in the field and Have been using a Colin BP-S510 Unit. The Eko DUO E5 is outstanding for in house patient care. We are using the PCG feature out in the field mostly, making sure that the patient does not have a Pacer.