System and method for automated collection and analysis of patient information retreived from an implantable medical device for remote patient care

• US 20010007053A1
• Filed: 02/20/2001
• Published: 07/05/2001
• Est. Priority Date: 06/03/1999
• Status: Active Grant

• Current Assignee: Cardiac Intelligence Corp (Boston Scientific Corporation)
• Original Assignee: Cardiac Intelligence Corp (Boston Scientific Corporation)
• Inventors: Bardy, Gust H.
• Granted Patent: US 6,358,203 B2
• Time in Patent Office: Days
• US Class Current: 600/300
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/4803 Speech analysis specially adapted for diagnostic purposes
• CPC Class Codes: A61B 5/7465 Arrangements for interactive communication between patient and care services, e.g. by using a telephone network telemetry of measured physiological signal A61B5/0002
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics

Abstract

A system and method for automated collection and analysis of patient information retrieved from a medical device adapted to be implanted in a patient for remote patient care is described. A set of collected measures is periodically received from the medical device adapted to be implanted over a communications link which is interfaced to a network server. The collected measures set includes individual measures which each relate to patient information recorded by the medical device adapted to be implanted for an individual patient. The collected measures set is stored into a patient care record for the individual patient within a database server organized to store one or more patient care records. Each patient care record includes a plurality of the collected measures sets. One or more of the collected measures sets in the patient care record for the individual patient is analyzed relative to one or more other collected measures sets stored in the database server to determine a patient status indicator.

Claims

1. A system for automated collection and analysis of patient information retrieved from a medical device adapted to be implanted in a patient for remote patient care, comprising:

a network server interfaced to a communications link over which is periodically received a set of collected measures from the medical device adapted to be implanted, the collected measures set comprising individual measures which each relate to patient information recorded by the medical device adapted to be implanted for an individual patient;

a database server coupled to the network server and storing the collected measures set into a patient care record for the individual patient, the database server being organized to store one or more patient care records which each comprise a plurality of the collected measures sets; and

an application server coupled to the database server and analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in the database server to determine a patient status indicator.

2. A system according to

claim 1

, the application server further comprising:

a comparison module comparing an initial measure selected from the one or more collected measures sets to a sibling measure selected from the one or more other collected measures sets, the initial measure and the sibling measure both relating to the same type of patient information.

3. A system according to

claim 1

, the application server further comprising:

a derivation module determining an initial derived measure using at least one measure selected from the one or more collected measures sets and determining a sibling derived measure using at least one measure selected from the one or more other collected measures sets, the initial derived measure and the sibling derived measure both relating to the same type of derived patient information; and

a comparison module comparing the initial derived measure to the sibling derived measure.

4. A system according to

claim 1

, the application server further comprising:

a comparison module comparing an initial measure selected from the one or more collected measures sets to a peer measure selected from the one or more other collected measures sets, the initial measure relating to a different type of patient information than the peer measure.

5. A system according to

claim 1

, the application server further comprising:

a derivation module determining a peer derived measure using at least one measure selected from the one or more other collected measures sets; and

a comparison module comparing an initial measure selected from the one or more collected measures sets to the peer derived measure, the initial measure relating to a different type of patient information than the derived patient information to which the peer derived measure relates.

6. A system according to

claim 1

, the application server further comprising:

a derivation module determining an initial derived measure using at least one measure selected from the one or more collected measures sets; and

a comparison module comparing the initial derived measure to a peer measure selected from the one or more other collected measures sets, the initial derived measure relating to a different type of derived patient information than the patient information to which the peer measure relates.

7. A system according to

claim 1

, the application server further comprising:

a derivation module determining an initial derived measure using at least one measure selected from the one or more collected measures sets and determining a peer derived measure using at least one measure selected from the one or more other collected measures sets; and

a comparison module comparing the initial derived measure to the peer derived measure, the initial derived measure relating to a different type of derived patient information than the derived patient information to which the peer derived measure relates.

8. A system according to

claim 1

, wherein the one or more other collected measures sets are stored in the patient care record for the individual patient for whom the patient care indicator has been determined.

9. A system according to

claim 1

, wherein the one or more other collected measures sets are stored in the patient care records for a group of one or more other individual patients.

10. A system according to

claim 1

, further comprising:

a collection client communicatively interposed between the medical device adapted to be implanted and the communications link, the collection client retrieving the collected measures set and downloading the collected measures set from the collection client into the network server over the communications link.

11. A system according to

claim 10

, wherein the collection client is selected from the group consisting of a programmer, interrogator, recorder, monitor, telemetered signals transceiver, personal computer, digital data processor, and combinations thereof.

12. A system according to

claim 1

, the application server being interfaced to a feedback communications link and further comprising:

a feedback client interfaced to the feedback communications link over which automated feedback based on the patient status indicator is provided to the individual patient from the application server.

13. A system according to

claim 12

, the application server further comprising:

a feedback module providing tiered feedback comprising;

at a first level of feedback, communicating an interpretation of the patient status indicator to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the patient status indicator to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the patient status indicator to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on the patient status indicator to the implantable medical device over the feedback communications link.

14. A system according to

claim 12

, wherein the automated feedback comprises at least one of the group consisting of a peer group status indicator, a historical status indicator, a trend indicator, a medicinal efficacy indicator, and a wellness indicator.

15. A system according to

claim 12

, wherein the feedback communications link comprises at least one of the following:

internetwork link, internetwork link, serial link, data telephone link, satellite link, radio-frequency link, infrared link, fiber optic link, coaxial cable link, television link, and combinations thereof.

16. A system according to

claim 12

, wherein the feedback client is selected from the group consisting of a personal computer, facsimile machine, telephone instrument, network computer, wireless computer, personal data assistant, television, digital data processor, and combinations thereof.

17. A system according to

claim 1

, the application server further comprising:

an analysis module dynamically analyzing the one or more of the collected measures sets in the patient care record for the individual patient.

18. A system according to

claim 1

, the application server further comprising:

an analysis module analyzing the one or more of the collected measures sets in the patient care record for the individual patient in a batch comprising the one or more of the collected measures sets in patient care records for a plurality of individual patients.

19. A system according to

claim 1

, wherein the communications link comprises at least one of the following:

internetwork link, internetwork link, serial link, data telephone link, satellite link, radio-frequency link, infrared link, fiber optic link, coaxial cable link, television link, and combinations thereof.

20. A system according to

claim 1

, wherein the database server comprises at least one of the following:

volatile storage, non-volatile storage, removable storage, fixed storage, random access storage, sequential access storage, permanent storage, erasable storage, and combinations thereof.

21. A system according to

claim 1

, wherein the organization of the database server comprises at least one of the following:

flat file, hierarchical database server, relational database server, distributed database server, and combinations thereof.

22. A system according to

claim 1

, wherein the network server and the application server are each selected from the group consisting of a personal computer, minicomputer, mainframe computer, supercomputer, parallel computer, workstation, digital data processor, and combinations thereof.

23. A system according to

claim 1

, wherein the medical device is selected from the group consisting of a pacemaker, implantable cardioverter defibrillator, implantable heart failure monitor, implantable event monitor, implantable cardiopulmonary monitor, implantable metabolic monitor or device, endocrinology monitor or device, hematology monitor or device, implantable neuromuscular monitor or device, implantable gastrointestinal monitor or device, genitourinary monitor or device, and combinations thereof.

24. A system according to

claim 1

, wherein the set of collected measures comprises at least one of the following:

atrial electrical activity, ventricular electrical activity, time of day, activity level, cardiac output, oxygen level, cardiovascular pressure measures, pulmonary measures, interventions made, and combinations thereof.

25. A system according to

claim 24

, the set of collected measures further comprising derived measures selected from the group consisting of linear measures derived from the set of collected measures, non-linear measures derived from the set of collected measures, and combinations thereof.

26. A method for automated collection and analysis of patient information retrieved from a medical device adapted to be implanted in a patient for remote patient care, comprising:

periodically receiving a set of collected measures from the medical device adapted to be implanted over a communications link which is interfaced to a network server, the collected measures set comprising individual measures which each relate to patient information recorded by the medical device adapted to be implanted for an individual patient;

storing the collected measures set into a patient care record for the individual patient within a database server organized to store one or more patient care records which each comprise a plurality of the collected measures sets; and

analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in the database server to determine a patient status indicator.

27. A method according to

claim 26

, the operation of analyzing the one or more collected measures sets further comprising:

comparing an initial measure selected from the one or more collected measures sets to a sibling measure selected from the one or more other collected measures sets, the initial measure and the sibling measure both relating to the same type of patient information.

28. A method according to

claim 26

, the operation of analyzing the one or more collected measures sets further comprising:

determining an initial derived measure using at least one measure selected from the one or more collected measures sets;

determining a sibling derived measure using at least one measure selected from the one or more other collected measures sets, the initial derived measure and the sibling derived measure both relating to the same type of derived patient information; and

comparing the initial derived measure to the sibling derived measure.

29. A method according to

claim 26

, the operation of analyzing the one or more collected measures sets further comprising:

comparing an initial measure selected from the one or more collected measures sets to a peer measure selected from the one or more other collected measures sets, the initial measure relating to a different type of patient information than the peer measure.

30. A method according to

claim 26

, the operation of analyzing the one or more collected measures sets further comprising:

determining a peer derived measure using at least one measure selected from the one or more other collected measures sets; and

comparing an initial measure selected from the one or more collected measures sets to the peer derived measure, the initial measure relating to a different type of patient information than the derived patient information to which the peer derived measure relates.

31. A method according to

claim 26

, the operation of analyzing the one or more collected measures sets further comprising:

determining an initial derived measure using at least one measure selected from the one or more collected measures sets; and

comparing the initial derived measure to a peer measure selected from the one or more other collected measures sets, the initial derived measure relating to a different type of derived patient information than the patient information to which the peer measure relates.

32. A method according to

claim 26

, the operation of analyzing the one or more collected measures sets further comprising:

determining an initial derived measure using at least one measure selected from the one or more collected measures sets;

determining a peer derived measure using at least one measure selected from the one or more other collected measures sets; and

comparing the initial derived measure to the peer derived measure, the initial derived measure relating to a different type of derived patient information than the derived patient information to which the peer derived measure relates.

33. A method according to

claim 26

, wherein the one or more other collected measures sets are stored in the patient care record for the individual patient for whom the patient care indicator has been determined.

34. A method according to

claim 26

, wherein the one or more other collected measures sets are stored in the patient care records for a group of one or more other individual patients.

35. A method according to

claim 26

, further comprising:

retrieving the collected measures set into a collection client communicatively interposed between the medical device adapted to be implanted and the communications link; and

downloading the collected measures set from the collection client into the network server over the communications link.

36. A method according to

claim 35

, wherein the collection client is selected from the group consisting of a programmer, interrogator, recorder, monitor, telemetered signals transceiver, personal computer, digital data processor, and combinations thereof.

37. A method according to

claim 26

, further comprising:

providing automated feedback based on the patient status indicator to the individual patient over a feedback communications link configured between the network server and a feedback client.

38. A method according to

claim 37

, further comprising:

providing tiered feedback comprising;

at a first level of feedback, communicating an interpretation of the patient status indicator to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the patient status indicator to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the patient status indicator to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on the patient status indicator to the implantable medical device over the feedback communications link.

39. A method according to

claim 37

, wherein the automated feedback comprises at least one of the group consisting of a peer group status indicator, a historical status indicator, a trend indicator, a medicinal efficacy indicator, and a wellness indicator.

40. A method according to

claim 37

, wherein the feedback communications link comprises at least one of the following:

internetwork link, internetwork link, serial link, data telephone link, satellite link, radio-frequency link, infrared link, fiber optic link, coaxial cable link, television link, and combinations thereof.

41. A method according to

claim 37

, wherein the feedback client is selected from the group consisting of a personal computer, facsimile machine, telephone instrument, network computer, wireless computer, personal data assistant, television, digital data processor, and combinations thereof.

42. A method according to

claim 26

, further comprising:

dynamically analyzing the one or more of the collected measures sets in the patient care record for the individual patient.

43. A method according to

claim 26

, further comprising:

analyzing the one or more of the collected measures sets in the patient care record for the individual patient in a batch comprising the one or more of the collected measures sets in patient care records for a plurality of individual patients.

44. A method according to

claim 26

, wherein the communications link comprises at least one of the following:

internetwork link, internetwork link, serial link, data telephone link, satellite link, radio-frequency link, infrared link, fiber optic link, coaxial cable link, television link, and combinations thereof.

45. A method according to

claim 26

, wherein the database server comprises at least one of the following:

volatile storage, non-volatile storage, removable storage, fixed storage, random access storage, sequential access storage, permanent storage, erasable storage, and combinations thereof.

46. A method according to

claim 45

, wherein the organization of the database server comprises at least one of the following:

flat file, hierarchical database server, relational database server, distributed database server, and combinations thereof.

47. A method according to

claim 26

, wherein the network server and the application server are each selected from the group consisting of a personal computer, minicomputer, mainframe computer, supercomputer, parallel computer, workstation, digital data processor, and combinations thereof.

48. A method according to

claim 26

, wherein the medical device is selected from the group consisting of a pacemaker, implantable cardioverter defibrillator, implantable heart failure monitor, implantable event monitor, implantable cardiopulmonary monitor, implantable metabolic monitor or device, endocrinology monitor or device, hematological monitor or device, implantable neuromuscular monitor or device, implantable gastrointestinal monitor or device, genitourinary monitor or device, and combinations thereof.

49. A method according to

claim 26

, wherein the set of collected measures comprises at least one of the following:

atrial electrical activity, ventricular electrical activity, time of day, activity level, cardiac output, oxygen level, cardiovascular pressure measures, pulmonary measures, interventions made, and combinations thereof.

50. A method according to

claim 49

, the set of collected measures further comprising derived measures selected from the group consisting of linear measures derived from the set of collected measures, non-linear measures derived from the set of collected measures, and combinations thereof.

51. A computer-readable storage medium holding code for automated collection and analysis of patient information retrieved from a medical device adapted to be implanted in a patient for remote patient care, comprising:

a network server interfaced to a communications link over which is periodically received a set of collected measures from the medical device adapted to be implanted, the collected measures set comprising individual measures which each relate to patient information recorded by the medical device adapted to be implanted for an individual patient;

a database server coupled to the network server and storing the collected measures set into a patient care record for the individual patient, the database server being organized to store one or more patient care records which each comprise a plurality of the collected measures sets; and

an application server coupled to the database server and analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in the database server to determine a patient status indicator.

52. A storage medium according to

claim 51

, the application server further comprising:

a comparison module comparing an initial measure selected from the one or more collected measures sets to a sibling measure selected from the one or more other collected measures sets, the initial measure and the sibling measure both relating to the same type of patient information.

53. A storage medium according to

claim 51

, the application server farther comprising:

a derivation module determining an initial derived measure using at least one measure selected from the one or more collected measures sets and determining a sibling derived measure using at least one measure selected from the one or more other collected measures sets, the initial derived measure and the sibling derived measure both relating to the same type of derived patient information; and

a comparison module comparing the initial derived measure to the sibling derived measure.

54. A storage medium according to

claim 51

, the application server further comprising:

a comparison module comparing an initial measure selected from the one or more collected measures sets to a peer measure selected from the one or more other collected measures sets, the initial measure relating to a different type of patient information than the peer measure.

55. A storage medium according to

claim 51

, the application server further comprising:

a derivation module determining a peer derived measure using at least one measure selected from the one or more other collected measures sets; and

a comparison module comparing an initial measure selected from the one or more collected measures sets to the peer derived measure, the initial measure relating to a different type of patient information than the derived patient information to which the peer derived measure relates.

56. A storage medium according to

claim 51

, the application server further comprising:

a derivation module determining an initial derived measure using at least one measure selected from the one or more collected measures sets; and

a comparison module comparing the initial derived measure to a peer measure selected from the one or more other collected measures sets, the initial derived measure relating to a different type of derived patient information than the patient information to which the peer measure relates.

57. A storage medium according to

claim 51

, the application server further comprising:

a derivation module determining an initial derived measure using at least one measure selected from the one or more collected measures sets and determining a peer derived measure using at least one measure selected from the one or more other collected measures sets; and

a comparison module comparing the initial derived measure to the peer derived measure, the initial derived measure relating to a different type of derived patient information than the derived patient information to which the peer derived measure relates.

58. A storage medium according to

claim 51

, further comprising:

a collection client communicatively interposed between the medical device adapted to be implanted and the communications link, the collection client retrieving the collected measures set and downloading the collected measures set from the collection client into the network server over the communications link.

59. A storage medium according to

claim 51

, the application server being interfaced to a feedback communications link and further comprising:

a feedback client interfaced to the feedback communications link over which automated feedback based on the patient status indicator is provided to the individual patient from the application server.

60. A storage medium according to

claim 59

, the application server further comprising:

a feedback module providing tiered feedback comprising;

at a first level of feedback, communicating an interpretation of the patient status indicator to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the patient status indicator to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the patient status indicator to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on the patient status indicator to the implantable medical device over the feedback communications link.

61. A storage medium according to

claim 51

, the application server further comprising:

an analysis module dynamically analyzing the one or more of the collected measures sets in the patient care record for the individual patient.

62. A storage medium according to

claim 51

, the application server further comprising:

an analysis module analyzing the one or more of the collected measures sets in the patient care record for the individual patient in a batch comprising the one or more of the collected measures sets in patient care records for a plurality of individual patients.

63. A system for automated remote patient care using patient information retrieved from a medical device adapted to be implanted in a patient, comprising:

a medical device adapted to be implanted in an individual patient and being interfaced to a communications link, the implantable medical device periodically sending a set of collected measures for the individual patient over the communications link;

a database organized into one or more patient care records with each patient care record comprising a plurality of the collected measures sets, each collected measures set comprising individual measures which each relate to patient information recorded by the implantable medical device; and

a server coupled to the database and interfaced to the communications link and a feedback communications link, the server comprising;

a database module storing the collected measures set received from the implantable medical device over the communications link into the patient care record in the database for the individual patient;

an analysis module analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in the patient care record of the individual patient; and

a feedback module sending feedback based on the analysis of the one or more collected measures sets to the individual patient over the feedback communications link.

64. A system according to

claim 63

, the analysis module further comprising:

a comparison module comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to the same type of patient information.

65. A system according to

claim 63

, the analysis module further comprising:

a comparison module comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to different types of patient information.

66. A system according to

claim 63

, the analysis module further comprising:

a derivation module determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

a comparison module comparing the at least one derived measure to at least one measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets.

67. A system according to

claim 63

, the analysis module further comprising:

a derivation module determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets and determining at least one other derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

a comparison module comparing the at least one derived measure to the at least one other derived measure.

68. A system according to

claim 63

, the feedback module further comprising providing tiered feedback comprising:

at a first level of feedback, communicating an interpretation of the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on analysis of the one or more collected measures sets to the implantable medical device over the feedback communications link.

69. A method for automated remote patient care using patient information retrieved from a medical device adapted to be implanted in a patient, comprising:

organizing one or more patient care records in a database with each patient care record comprising a plurality of the collected measures sets, each collected measures set comprising individual measures which each relate to patient information recorded by a medical device adapted to be implanted for an individual patient;

receiving a set of the collected measures periodically sent from the implantable medical device over a communications link;

storing the collected measures set into the patient care record in the database for the individual patient;

analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in the patient care record of the individual patient; and

sending feedback based on the analysis of the one or more collected measures sets to the individual patient over a feedback communications link.

70. A method according to

claim 69

, the operation of analyzing further comprising:

comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to the same type of patient information.

71. A method according to

claim 69

, the operation of analyzing further comprising:

comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to different types of patient information.

72. A method according to

claim 69

, the operation of analyzing further comprising:

determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

comparing the at least one derived measure to at least one measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets.

73. A method according to

claim 69

, the operation of analyzing further comprising:

determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets;

determining at least one other derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

comparing the at least one derived measure to the at least one other derived measure.

74. A method according to

claim 69

, the operation of sending feedback further comprising:

providing tiered feedback comprising;

at a first level of feedback, communicating an interpretation of the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on analysis of the one or more collected measures sets to the implantable medical device over the feedback communications link.

75. A system for automated remote patient care using patient information retrieved from a medical device adapted to be implanted in a patient, comprising:

a medical device adapted to be implanted in an individual patient and being interfaced to a communications link, the implantable medical device periodically sending a set of collected measures for the individual patient over the communications link;

a database organized into a plurality of patient care records with each patient care record comprising a plurality of the collected measures sets, each collected measures set comprising individual measures which each relate to patient information recorded by the implantable medical device; and

a server coupled to the database and interfaced to the communications link and a feedback communications link, the server comprising;

a database module storing the collected measures set received from the implantable medical device over the communications link into the patient care record in the database for the individual patient;

an analysis module analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in other patient care records in the database; and

a feedback module sending feedback based on the analysis of the one or more collected measures sets to the individual patient over the feedback communications link.

76. A system according to

claim 75

, the analysis module further comprising:

a comparison module comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to the same type of patient information.

77. A system according to

claim 75

, the analysis module further comprising:

a comparison module comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to different types of patient information.

78. A system according to

claim 75

, the analysis module further comprising:

a derivation module determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

a comparison module comparing the at least one derived measure to at least one measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets.

79. A system according to

claim 75

, the analysis module further comprising:

a derivation module determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets and determining at least one other derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

a comparison module comparing the at least one derived measure to the at least one other derived measure.

80. A system according to

claim 75

, the feedback module further comprising providing tiered feedback comprising:

at a first level of feedback, communicating an interpretation of the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on analysis of the one or more collected measures sets to the implantable medical device over the feedback communications link.

81. A method for automated remote patient care using patient information retrieved from a medical device adapted to be implanted in a patient, comprising:

organizing a plurality of patient care records in a database with each patient care record comprising a plurality of the collected measures sets, each collected measures set comprising individual measures which each relate to patient information recorded by a medical device adapted to be implanted for an individual patient;

receiving a set of the collected measures periodically sent from the implantable medical device over a communications link;

storing the collected measures set into the patient care record in the database for the individual patient;

analyzing one or more of the collected measures sets in the patient care record for the individual patient relative to one or more other collected measures sets stored in other patient care records in the database; and

sending feedback based on the analysis of the one or more collected measures sets to the individual patient over a feedback communications link.

82. A method according to

claim 81

, the operation of analyzing further comprising:

comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to the same type of patient information.

83. A method according to

claim 81

, the operation of analyzing further comprising:

comparing at least one collected measure selected from the one or more collected measures sets to at least one other collected measure selected from the one or more other collected measures sets, the at least one collected measure and the at least one other collected measure both relating to different types of patient information.

84. A method according to

claim 81

, the operation of analyzing further comprising:

determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

comparing the at least one derived measure to at least one measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets.

85. A method according to

claim 81

, the operation of analyzing further comprising:

determining at least one derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets;

determining at least one other derived measure using at least one collected measure selected from at least one of the one or more collected measures sets and the one or more other collected measures sets; and

comparing the at least one derived measure to the at least one other derived measure.

86. A method according to

claim 81

, the operation of sending feedback further comprising:

providing tiered feedback comprising;

at a first level of feedback, communicating an interpretation of the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a second level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to the individual patient over the feedback communications link;

at a third level of feedback, communicating a notification of potential medical concern based on the analysis of the one or more collected measures sets to medical personnel in local proximity to the individual patient over the feedback communications link; and

at a fourth level of feedback, communicating a set of reprogramming instructions based on analysis of the one or more collected measures sets to the implantable medical device over the feedback communications link.

87. A system for automated remote cardiovascular patient care using cardiovascular patient information retrieved from a cardiovascular monitoring device adapted to be implanted in a patient, comprising:

a telemetry transceiver retrieving on a substantially regular basis a set of collected cardiovascular measures recorded by and stored in the cardiovascular monitoring device adapted to be implanted and periodically communicating the collected cardiovascular measures set over a communications link to a centralized server; and

a centralized server comprising;

a database storing the collected cardiovascular measures set into a patient care record for the individual patient, the database being organized into a plurality of patient care records with each patient care record comprising a plurality of the collected cardiovascular measures sets, each collected cardiovascular measures set comprising individual cardiovascular measures which each relate to patient information recorded by a implantable cardiovascular monitoring device for an individual patient;

an analysis module analyzing one or more of the collected cardiovascular measures sets in the patient care record for the individual patient relative to one or more other collected cardiovascular measures sets stored in the patient care records in the database; and

a feedback module sending feedback based on the analysis of the one or more collected cardiovascular measures sets to the individual patient over a feedback communications link.

88. A method for automated remote cardiovascular patient care using cardiovascular patient information retrieved from a cardiovascular monitoring device adapted to be implanted in a patient, comprising:

retrieving on a substantially regular basis a set of collected cardiovascular measures recorded by and stored in the cardiovascular monitoring device adapted to be implanted;

periodically communicating the collected cardiovascular measures set over a communications link to a centralized server;

storing the collected cardiovascular measures set into a patient care record for the individual patient in a database coupled to the centralized server;

organizing a plurality of patient care records in the database with each patient care record comprising a plurality of the collected cardiovascular measures sets, each collected cardiovascular measures set comprising individual cardiovascular measures which each relate to patient information recorded by the cardiovascular monitoring device for an individual patient;

analyzing one or more of the collected cardiovascular measures sets in the patient care record for the individual patient relative to one or more other collected cardiovascular measures sets stored in the patient care records in the database; and

sending feedback based on the analysis of the one or more collected cardiovascular measures sets to the individual patient over a feedback communications link.