Implantable medical device which may be controlled from central station

• US 20080300659A1
• Filed: 05/19/2008
• Published: 12/04/2008
• Est. Priority Date: 05/17/2007
• Status: Active Grant

• Current Assignee: Jeffrey A. Matos
• Original Assignee: Jeffrey A. Matos
• Inventors: Matos, Jeffrey A.
• Granted Patent: US 8,473,065 B2
• Time in Patent Office: Days
• US Class Current: 607/60
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

An implantable medical device (IMD) comprises a transmitting/receiving (T/R) device for transmitting medical data sensed from a patient to, and for receiving control signals from, a medical expert (a human medical professional and/or a computerized expert system) at a remote location; an electronic medical treatment device for treating the patient in response to control signals applied thereto; and a sensor circuit, having a sensor circuit output, for producing sensor circuit output signal(s) representing medical data sensed from the patient. The IMD also includes logic device which analyzes the sensor circuit output signal(s) to detect a medical abnormality which requires notification of the medical expert at the remote location, and generates notification signal(s) if required. T/R device transmits the notification signal(s) as well as signal(s) representing a medical state of said patient to the remote location. The logic device is also operative to generate local treatment device control signal(s) based on an analysis of the sensor circuit output signal(s) and to generate a remote treatment device control signal in response to real time remote control signal(s) received from the remote location. The medical treatment device of the IMD thus delivers therapy to the patient in response to either the local treatment device control signal(s) or the remote treatment device control signal(s), or both.

Claims

1. Electronic medical apparatus adapted to be implanted in a human patient, a so-called:

implantable medical device (IMD), which may be alternatively automatically self-controlled and remotely controlled by a medical expert, said apparatus comprising, in combination;

(a) a first transmitting/receiving (T/R) device for transmitting medical data sensed from said patient to, and for receiving control signals from, a remote location;

(b) an electronic medical treatment device for treating said patient in response to control signals applied thereto;

(c) a sensor circuit, having a sensor circuit output, for producing at least one sensor circuit output signal at said sensor circuit output in response to the medical data sensed from the patient; and

(d) a logic device coupled to each of

(i) said sensor circuit output,

(ii) said first T/R device, and

(iii) said treatment device,

for

(i) analysis of said at least one sensor circuit output signal,

(ii) generating a remote station notification signal, and

(iii) generating at least one treatment device control signal;

wherein;

(1) said logic device analyzes said at least one sensor circuit output signal to detect a medical abnormality which requires notification of the medical expert at the remote location, and generates a notification signal if required;

(2) said first T/R device transmits said notification signal and at least one signal representing a medical state of said patient to the remote location;

(3) said logic device is operative to generate at least one local treatment device control signal based on analysis of said at least one sensor circuit output signal; and

(4) said logic device is operative to generate at least one remote treatment device control signal in response to at least one real time remote control signal received from the remote location by said first T/R device;

whereby said IMD delivers therapy in response to at least one of said at least one local treatment device control signals and said at least one remote treatment device control signals.

2. The apparatus defined in claim 1, wherein an inhibit command of said at least one real time remote control signal prevents said electronic medical treatment device from responding to said at least one local treatment device control signal.

3. The apparatus defined in claim 1, wherein said at least one real time remote control signal causes said electronic medical treatment device to administer therapy prescribed thereby.

4. The apparatus defined in claim 1, wherein

(6) in a first operating mode said logic device generates at least one local treatment device control signal based on analysis of said at least one sensor circuit output signal;

(7) in a second operating mode, said logic device generates at least one remote treatment device control signal in response to at least one real time remote control signal received from the remote location by said first T/R device; and

(8) said logic device selects said operating mode based on at least one signal received from at least one of said first T/R device and said sensor circuit.

5. The apparatus defined in claim 4, wherein, in response to said real time remote control signal received from said remote location by said first T/R device, said logic device selects said second operating mode.

6. The apparatus defined in claim 5, wherein said second operating mode is selected following the receipt, from said medical expert at the remote location, of at least one of:

(a) a second operating state selecting signal; and

(b) a real time remote control signal.

7. The apparatus defined in claim 4, wherein, in the absence of a signal from said first T/R device, said logic device selects said first operating mode.

8. The apparatus defined in claim 1, further comprising at least one sensor, coupled to said sensor circuit, for generating at least one electrical signal that represents a medical state of said patient.

9. The apparatus defined in claim 8, wherein said sensor is selected from the group consisting of:

(a) a cardiac electrode for sensing cardiac electrical activity;

(b) a device for sensing a cardiac QT interval;

(c) a device for sensing body motion of said patient, comprising at least one of (a) an accelerometer, and (b) a piezoelectric element;

(d) a device for sensing chest ventilation of said patient, said sensor being operable to sense at least one of (1) thoracic impedance, (2) diaphragm motion of said patient, and (3) chest wall motion of said patient;

(e) a device for sensing spatial orientation of said patient.

(f) a device for sensing blood oxygen saturation;

(g) a device for sensing blood oxygen content;

(h) a device for sensing blood carbon dioxide content;

(i) a device for sensing blood pH;

(j) a device for sensing blood lactic acid content;

(k) a transducer for sensing blood pressure;

(l) a device for sensing blood sugar;

(m) a brain electrode for sensing brain electrical activity;

(n) a device for sensing a concentration of a pharmacologic agent in said patient;

(o) a device for sensing the flow rate from a circulatory heart pump;

(p) a device for sensing the rotational speed of a heart pump motor; and

(q) a device for sensing cardiac output.

10. The apparatus defined in claim 9, wherein said spatial orientation sensor (e) is operable to sense at least one of (i) whether a patient has fallen, and (ii) whether a patient is supine.

11. Apparatus comprising the apparatus (IMD) defined in claim 1, and further comprising a remote station at said remote location including:

(a) a display device for displaying medical information from said patient for evaluation by said medical expert at the remote station, in response to the receipt of said at least one signal representing a medical state of the patient transmitted by the first T/R device of at least one remotely located IMD;

(b) a first input device, responsive to said medical expert, for producing at least one real time remote control signal for controlling said IMD; and

(c) a second T/R device, coupled to said display device and said input device, for electronic communication with the first T/R device of said at least one remotely located IMD; and

wherein

(1) said medical expert observes and analyzes said at least one signal representing a medical state of said patient via said display device, following said notification signal,

(2) based on said analysis, said medical expert may cause said input device to generate at least one real time remote control signal;

(3) said real time remote control signal is transmitted via said second T/R device and said first T/R device, to the logic device of said at least one remotely located IMD; and

(4) said real time remote control signal causes said logic device to control said treatment device of said at least one remotely located IMD.

12. The apparatus defined in claim 11, wherein said medical expert is a human medical professional.

13. The apparatus defined in claim 11, wherein said real time remote control signal is a remote treatment device control signal which directs the treatment device to administer treatment.

14. The apparatus defined in claim 11, wherein

(1) in a first operating mode said logic device generates at least one local treatment device control signal based on analysis of said at least one sensor circuit output signal;

(2) in a second operating mode, said logic device generates at least one remote treatment device control signal in response to at least one real time remote control signal received from the remote location by said first T/R device; and

(3) said logic device selects said operating mode based on at least one signal received from at least one of said first T/R device and said sensor circuit.

15. The apparatus defined in claim 14, wherein said remote control signal is a mode control signal which directs the logic device to select the operating mode.

16. The apparatus defined in claim 14, wherein said second operating mode is selected following the receipt, from said medical expert at the remote location, of at least one of:

(a) a second operating state selecting signal; and

(b) a real time remote control signal.

17. The apparatus defined in claim 11, wherein said medical expert is a medical expert logic device, coupled to said second T/R device for:

(i) receipt of said notification signal;

(ii) receipt and analysis of said signals representing a medical state of a patient; and

(iii) generation of medical expert logic device real time remote control signals;

wherein

(1) said medical expert logic device analyzes said at least one signal representing a medical state of said patient, following said notification signal,

(2) based on said analysis, said medical expert logic device may generate at least one medical expert logic device real time remote control signal;

(3) said at least one medical expert logic device real time remote control signal is transmitted via said second T/R device and said first T/R device, to the logic device of said at least one IMD; and

(4) said at least one medical expert logic device real time remote control signal causes said IMD logic device to control said treatment device of said at least one IMD.

18. The apparatus defined in claim 17, wherein

i) said medical expert logic device is further coupled to a first communication device for communication with a human medical expert,

ii) said medical expert logic device is operative to perform at least one of:

a) send a human notification signal to said human medical expert;

b) send said signals representing a medical state of a patient to said human medical expert;

c) send said a duplicate signal representing said at least one medical expert logic device real time remote control signal to said human medical expert; and

d) receive a human real time remote control signal;

wherein

(1) said medical expert logic device analyzes said at least one signal representing a medical state of said patient to detect a medical abnormality which requires notification of the human medical expert, and generates a human notification signal if required;

said first communication device transmits said human notification signal and at least one signal representing a medical state of said patient to said human medical expert;

(3) said medical expert logic device is operative to generate at least one first type of medical expert logic device real time remote control signal based on analysis of said at least one signal representing a medical state of said patient; and

(4) said medical expert logic device is operative to generate at least one second type of medical expert logic device real time remote control signal in response to at least one human real time remote control signal received from said human medical expert by said communication device;

whereby said IMD delivers therapy in response to at least one of;

i) said at least one local device treatment control signal;

ii) said at least one first type of medical expert logic device real time remote control signal generated by said medical expert logic device; and

iii) said at least one second type of medical expert logic device real time remote control signal, generated by said medical expert logic device in response to said at least one human real time control signal, generated by said human medical expert.

19. The apparatus defined in claim 18, wherein a human inhibit command from said human medical professional prevents said electronic medical treatment device from responding to at least one of (a) said at least one local treatment device control signal, and (b) said at least one first type of medical expert logic device real time remote control signal.

20. The apparatus defined in claim 18, wherein said at least one human real time remote control signal causes said electronic medical treatment device to administer therapy prescribed thereby.

21. A system comprising the apparatus defined in claim 18, and further comprising a human medical expert station at remote human location including:

(a) a display device for displaying medical information from said patient for evaluation by said human medical expert at said human medical expert station, in response to the receipt of said at least one signal representing a medical state of the patient communicated by said first communication device of said remote station;

(b) a human input device, responsive to said human medical expert, for producing at least one human real time remote control signal for controlling said IMD; and

(c) a second communication device, coupled to said display device and said input device, for electronic communication with the first communication device of said at least one remote station; and

wherein

(1) said human medical expert observes and analyzes said at least one signal representing a medical state of said patient via said display device, following said human notification signal;

(2) based on said analysis, said human medical expert may cause said human input device to generate at least one human real time remote control signal;

(3) said human real time remote control signal is transmitted via said second communication device, said first communication device, said second T/R device and said first T/R device, to the logic device of said at least one remotely located IMD; and

(4) said human real time remote control signal causes said logic device to control said treatment device of said at least one remotely located IMD.

22. The apparatus defined in claim 11, further comprising a plurality of implantable medical devices (IMDs) located at a plurality of sites remote from said remote station, wherein said medical expert at said remote station may control one or more of said plurality of IMDs following the receipt of a notification signal from one of said IMDs.

23. The apparatus defined in claim 22, wherein

(1) said logic device in each said IMD generates a unique IMD identification code for transmission with said notification signal;

(2) real time remote control signals are transmitted with said unique IMD identification code; and

(3) only real time remote control signals which are received by an IMD which contain the unique IMD identification code for that particular IMD will control that IMD;

thereby to assure that said medical expert remote control signals control only the particular IMD for which they were intended.

24. The apparatus defined in claim 11, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

whereby said IMD communicates with said remote station through said relay unit.

29. The apparatus defined in claim 24, wherein said relay unit includes a second input device, responsive to a person at a site of the relay unit, coupled to said fourth T/R device and operative to communicate with said first T/R device, for producing a treatment device control signal, thereby allowing control of the IMD by said on-site person.

30. The apparatus defined in claim 29, wherein said relay unit is in the vicinity of said patient, thereby allowing control of said IMD by at least one of said patient and a person near said patient.

31. The apparatus defined in claim 30, wherein said relay unit comprises a third input device, responsive to a human operator, coupled to said third T/R device and operative to communicate with said second T/R device, thereby allowing notification of said medical expert by at least one of said patient and a person near said patient.

32. The apparatus defined in claim 24, wherein said second T/R device and said third T/R device are each connected to a public telephone network.

33. The apparatus defined in claim 24, wherein said first T/R device and said fourth T/R device include means for wireless duplex transmission between them.

34. The apparatus defined in claim 24, wherein said first T/R device and said second T/R device include means for duplex communication between them through a route which includes at least one of (1) transmission through said relay unit, and (2) transmission not through said relay unit.

35. The apparatus defined in claim 34, wherein said first and said second T/R device are operative to communicate through a plurality of separate routes.

36. The apparatus defined in claim 35, further comprising means for automatically selecting one of said routes of communication.

37. The apparatus defined in claim 35, wherein said remote station further comprises a communication control device, responsive to said medical expert, for selecting the route of communication between said first and said second T/R device.

38. The apparatus defined in claim 35, wherein said routes include both a wired network and a wireless network.

39. The apparatus defined in claim 15, wherein

(1) said logic device is further operative to determine the presence and the absence of proper communication between said first T/R device and said second T/R device;

and

(2) following the transmission of said notification signal,

(i) the absence of said proper communication causes said logic device to select said first operating mode; and

(ii) the presence of said proper communication causes said logic device to select one of said first and said second operating modes, in response to said mode control signal from said remote station.

40. The apparatus defined in claim 14, wherein

(1) said logic device is further operative to determine the presence and the absence of proper communication between said first T/R device and said second T/R device;

and

(2) following the transmission of said notification signal,

(i) the absence of said proper communication causes said logic device to select said first operating mode; and

(ii) the presence of said proper communication causes said logic device to select said second operating mode.

41. The apparatus defined in claim 14, wherein said remote station further comprises a remote station handshake device, coupled to said second T/R device, for generating at least one remote station handshake signal;

and wherein;

(a) said logic device in said IMD generates an IMD handshake signal in response to receipt of a remote station handshake signal;

(b) said remote station handshake device generates a remote station handshake signal in response to receipt of a notification signal and in response to receipt of an IMD handshake signal;

whereby;

(1) receipt of said notification signal by said remote station causes said remote station handshake device to transmit a remote station handshake signal to said IMD;

(2) receipt of said remote station handshake signal by said IMD causes said IMD to transmit an IMD handshake signal to said remote station;

(3) receipt of said IMD handshake signal by said remote station causes said remote station handshake device to transmit another remote station handshake signal to said IMD; and

(4) said steps (2) and (3) continue to repeat sequentially;

thereby to allow each of (i) said IMD logic device and (ii) said remote station logic device, to determine

a presence of proper communication by the continuing timely receipt of respective handshake signals, and

an absence of proper communication by an absence of timely receipt of respective handshake signals.

42. The apparatus defined in claim 11, wherein

(a) said second T/R device includes a remote station transmitting device and a remote station receiving device;

(b) said remote station receiving device is coupled to said remote station transmitting device, and is operative, upon receipt of said notification signal, to cause said remote station transmitting device to transmit a remote station handshake signal;

(c) said first T/R device includes an IMD transmitting device and an IMD receiving device;

(d) said IMD receiving device is coupled to said IMD transmitting device, and is operative, upon receipt of said remote station handshake signal, to cause said IMD transmitting device to transmit an IMD handshake signal;

(e) said remote station receiving device is operative, upon receipt of said IMD handshake signal, to cause said remote station transmitting device to transmit another remote station handshake signal;

whereby;

(1) receipt of said notification signal by said remote station causes said remote station to transmit a remote station handshake signal;

(2) receipt of said remote station handshake signal by said IMD causes said IMD to transmit an IMD handshake signal;

(3) receipt of said IMD handshake signal by said remote station causes said remote station to transmit another remote station handshake signal; and

(4) said steps (2) and (3) continue to repeat sequentially;

thereby to allow each of (i) said IMD logic device and (ii) said remote station to determine

a presence of proper communication by the continuing timely receipt of respective handshake signals, and

an absence of proper communication by an absence of timely receipt of respective handshake signals.

43. The apparatus defined in claim 41, wherein

(a) a remote station handshake signal must be received by said IMD within a first time interval following the transmission of said notification signal, in order for an IMD handshake signal to be transmitted, and

(b) in the absence of a timely receipt by said IMD of said remote station handshake signal, said IMD is operative to cause at least one of:

(i) generation of another notification signal;

(ii) generation of a first communication failure signal for transmission to said remote station;

(iii) changing the transmission mode of said first T/R device;

(iv) changing the communication route between said first T/R device and said second T/R device;

(v) increasing the power output of said first T/R device; and

(vi) maintaining said first operating mode.

44. The apparatus defined in claim 41, wherein, following the transmission of a remote station handshake signal, in the absence of receipt of an IMD handshake signal by said remote station within a second time interval, said remote station is operative to cause at least one of:

(i) generation of another remote station handshake signal;

(ii) generation of a second communication failure signal for transmission to said IMD;

(iii) changing the transmission mode of said second T/R device;

(iv) increasing the power output of said second T/R device; and

(v) changing the communication route between said second T/R device and said first T/R device.

45. The apparatus defined in claim 41, wherein, following the transmission of an IMD handshake signal, in the absence of receipt of a remote handshake signal by said IMD within a third time interval, said IMD is operative to cause at least one of:

(i) generation of another IMD handshake signal;

(ii) generation of a first communication failure signal for transmission to said remote station;

(iii) changing the transmission mode of said first T/R device;

(iv) changing the communication route between said first T/R device and said second T/R device;

(v) increasing the power output of said first T/R device; and

(vi) maintaining said first operating mode.

46. The apparatus defined in claim 44, wherein, upon receipt of said second communication failure signal, said IMD is operative to cause at least one of:

(i) generation of an IMD handshake signal;

(ii) changing the transmission mode of said first T/R device;

(iii) changing the communication route between said first T/R device and said second T/R device;

(iv) increasing the power output of said first T/R device; and

(v) maintaining said first operating state.

47. The apparatus defined in claim 43, wherein, upon receipt of said first communication failure signal, said remote station is operative to cause at least one of:

(i) generation of a remote station handshake signal;

(ii) changing the transmission mode of said second T/R device;

(iii) increasing the power output of said second T/R device; and

(iv) changing the communication route between said second T/R device and said first T/R device.

48. The apparatus defined in claim 45, wherein, upon receipt of said first communication failure signal, said remote station is operative to cause at least one of:

(i) generation of a remote station handshake signal;

(ii) changing the transmission mode of said second T/R device;

(iii) increasing the power output of said second T/R device; and

(iv) changing the communication route between said second T/R device and said first T/R device.

49. The apparatus defined in claim 11, wherein following the receipt of a first notification signal by said remote station, said medical expert may cause said input device to send a termination signal to said IMD, and wherein, upon receipt of said termination signal, said IMD causes cessation of transmission by said first T/R device until the occurrence of a further medical abnormality which requires a further notification of said medical expert.

50. The apparatus defined in claim 49, wherein, following the transmission of said termination signal, said logic device is further operative to analyze said at least one sensor circuit output signal to detect a further medical abnormality which requires a second notification of said medical expert at said remote location, and generates a second notification signal if required;

and wherein said further medical abnormality which requires said second notification differs from said medical abnormality which requires said first notification.

51. The apparatus defined in claim 50, wherein, following said termination signal:

(a) for a duration of time less than a re-notification time interval, said further medical abnormality causes said second notification; and

(b) for a duration of time equal to at least said re-notification time interval, said medical abnormality causes said first notification.

52. The apparatus defined in claim 51, wherein, said logic device further comprises a clock circuit to measure said re-notification time interval.

53. The apparatus defined in claim 50, wherein

a) said abnormality which requires a first notification is an abnormality which occurs over a first notification duration of time;

b) said abnormality which requires said second notification is an abnormality which occurs over a second notification duration of time; and

c) said first notification duration of time differs from said second notification duration of time.

54. The apparatus defined in claim 50, wherein

a) said abnormality which requires a first notification is defined by a first notification frequency of abnormal medical events;

b) said abnormality which requires said second notification is defined by a second notification frequency of abnormal medical events; and

c) said first notification frequency differs from said second notification frequency.

55. The apparatus defined in claim 50, wherein said further abnormality which requires said second notification is defined by at least one of:

a) a range of values of a medical parameter of said patient which is greater than a first notification value; and

b) a range of values of a medical parameter of said patient which is less than a second notification value;

and said abnormality which requires a first notification is defined by at least one of;

a) a range of values of a medical parameter of said patient which is greater than a third notification value; and

b) a range of values of a medical parameter of said patient which is less than a fourth notification value; and

and wherein

(i) said third notification value is greater than said first notification value; and

(ii) said fourth notification value is less than said second notification value;

whereby said further abnormality which requires said second notification is a less severe abnormality than said abnormality which requires a first notification.

56. The apparatus defined in claim 50, wherein said further abnormality which requires said second notification is defined by at least one of:

a) a range of values of a medical parameter of said patient which is greater than a fifth notification value; and

b) a range of values of a medical parameter of said patient which is less than a sixth notification value;

and said abnormality which requires a first notification is defined by at least one of;

a) a range of values of a medical parameter of said patient which is greater than a seventh notification value; and

b) a range of values of a medical parameter of said patient which is less than an eighth notification value; and

wherein

(i) said seventh notification value is less than said fifth notification value; and

(ii) said eighth notification value is greater than said sixth notification value;

whereby said further abnormality which requires said second notification is a more severe abnormality than said abnormality which requires said first notification.

57. The apparatus defined in claim 50, wherein said further abnormality which requires said second notification is defined by at least one of:

a) a range of values of a ninth function of the values of each of a fifth plurality of medical parameters of said patient which is greater than a ninth notification value; and

b) a range of values of a ninth function of the values of each of a fifth plurality of medical parameters of said patient which is less than a tenth notification value; and

and said abnormality which requires notification is defined by at least one of;

a) a range of values of a ninth function of the values of each of a fifth plurality of medical parameters of said patient which is greater than an eleventh notification value; and

b) a range of values of a ninth function of the values of each of a fifth plurality of medical parameters of said patient which is less than a twelfth notification value;

and wherein

(i) said eleventh notification value is greater than said ninth notification value; and

(ii) said twelfth notification value is less than said tenth notification value.

58. The apparatus defined in claim 50, wherein said further abnormality which requires said second notification is defined by at least one of:

a) a range of values of a tenth function of the values of each of a sixth plurality of medical parameters of said patient which is greater than a thirteenth notification value; and

b) a range of values of a tenth function of the values of each of a sixth plurality of medical parameters of said patient which is less than a fourteenth notification value;

and said abnormality which requires a first notification is defined by at least one of;

a) a range of values of a tenth function of the values of each of a sixth plurality of medical parameters of said patient which is greater than a fifteenth notification value; and

b) a range of values of a tenth function of the values of each of a sixth plurality of medical parameters of said patient which is less than a sixteenth notification value;

and wherein

(i) said fifteenth notification value is less than said thirteenth notification value; and

(ii) said sixteenth notification value is greater than said fourteenth notification value.

59. The apparatus defined in claim 50, wherein said further abnormality which requires said second notification is defined by at least one of:

a) a range of values of an eleventh function of (i) the values of each of a seventh plurality of medical parameters of said patient, and (ii) time, which is greater than a seventeenth notification value; and

b) a range of values of an eleventh function of (i) the values of each of a seventh plurality of medical parameters of said patient, and (ii) time, which is less than an eighteenth notification value;

and said abnormality which requires a first notification is defined by at least one of;

a) a range of values of an eleventh function of (i) the values of each of a seventh plurality of medical parameters of said patient, and (ii) time, which is greater than a nineteenth notification value; and

b) a range of values of an eleventh function of (i) the values of each of a seventh plurality of medical parameters of said patient, and (ii) time, which is less than a twentieth notification value;

and wherein

(i) said nineteenth notification value is greater than said seventeenth notification value; and

(ii) said twentieth notification value is less than said eighteenth notification value.

60. The apparatus defined in claim 50, wherein said further abnormality which requires said second notification is defined by at least one of:

a) a range of values of a twelfth function of (i) the values of each of an eighth plurality of medical parameters of said patient, and (ii) time, which is greater than a twenty first notification value; and

b) a range of values of a twelfth function of (i) the values of each of an eighth plurality of medical parameters of said patient, and (ii) time, which is less than a twenty second notification value;

and said abnormality which require a first notification is defined by at least one of;

a) a range of values of a twelfth function of (i) the values of each of an eighth plurality of medical parameters of said patient, and (ii) time, which is greater than a twenty third notification value; and

b) a range of values of a twelfth function of (i) the values of each of an eighth plurality of medical parameters of said patient, and (ii) time, which is less than a twenty fourth notification value;

and wherein

(i) said twenty third notification value is less than said twenty first notification critical value; and

(ii) said twenty fourth notification value is greater than said twenty second notification critical value.

61. The apparatus defined in claim 11, wherein said medical expert may cause said input device to send a first programming signal, via said second T/R device and said first T/R device, to said logic device to change a definition of said abnormality which requires notification.

62. The apparatus defined in claim 50, wherein said medical expert may cause said input device to send a second programming signal, via said second T/R device and said first T/R device, to said logic device to change a definition of said abnormality which requires said second notification.

63. The apparatus defined in claim 51, wherein said medical expert may cause said input device to send a third programming signal, via said second T/R device and said first T/R device, to said logic device to change the duration of said re-notification time interval.

64. The apparatus defined in claim 11, wherein,

(a) said electronic medical treatment device is operative to provide a plurality of possible treatments;

and

(b) following receipt of said notification signal, said medical expert may cause said input device to send a fourth programming signal, via said second T/R device and said first T/R device, to said logic device to change at least one of said plurality of possible treatments.

65. The apparatus defined in claim 64, wherein said treatment change consists of at least one of:

(a) selecting an alternate type of treatment;

(b) causing a repetitive treatment;

(c) changing a sequence of treatment steps; and

(d) changing a parameter of said treatment.

66. The apparatus defined by claim 65, wherein said parameter is selected from the group consisting of (1) a stimulating voltage, (2) a stimulating pulse width, (3) a stimulating waveform, (4) a stimulating electrical energy, (5) a rate of stimulation, (6) a choice of a stimulating electrode, (7) a flow rate of a pump, (8) a flow pressure of a pump, (9) an amount of a drug delivered by a pump, and (10) the rate of drug delivery by a pump.

67. The apparatus defined by claim 65, wherein said type of treatment is selected from the group consisting of a shock, electrical pacing, an administration a drug and a choice of a drug.

68. The apparatus defined by claim 11, wherein, following receipt of said notification signal, said medical expert may cause said input device to send a fifth programming signal, via said second T/R device and said first T/R device, to said logic device to change the criteria by which said logic device defines a medical abnormality.

69. The apparatus defined by claim 11, wherein,

(a) said logic device includes a microprocessor capable of running a plurality of algorithms for analysis of said sensor circuit output signals, and

(b) following receipt of said notification signal, said medical expert may cause said input device to send a sixth programming signal, via said second T/R device and said first T/R device, to said logic device to change the algorithm by which said logic device analyzes said at least one sensor circuit output signal.

70. The apparatus defined in claim 11, wherein following the receipt of said notification signal by said remote station, and following the expiration of a fourth time interval following at least one of:

the last received handshake signal, and

the last received control signal,

said logic device causes cessation of transmission by said first T/R device until the occurrence of a further medical abnormality which requires notification.

71. The apparatus defined in claim 41, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, in the absence of proper communication between said first T/R device and said second T/R device, at least one of;

a) said first T/R device and said fourth T/R device are operative to change communication modes;

b) said first T/R device and said fourth T/R device are operative to change communication routes;

c) said second T/R device and said third T/R device are operative to change communication modes;

d) said second T/R device and said third T/R device are operative to change communication routes;

e) said third T/R device is operative to increase transmitter power output; and

f) said fourth T/R device is operative to increase transmitter power output.

72. The apparatus defined in claim 43, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, in the absence of a timely receipt by said IMD of said remote station handshake signal, said IMD is further operative to change at least one of;

a) the communication mode between said first T/R device and said fourth T/R device;

b) the communication route between said first T/R device and said fourth T/R device;

c) the communication mode between said second T/R device and said third T/R device;

d) the communication route between said second T/R device and said third T/R device;

e) the power output of said third T/R device; and

f) the power output of said fourth T/R device.

73. The apparatus defined in claim 44, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, in the absence of a timely receipt by said remote station of said IMD handshake signal, said remote station is further operative to change at least one of;

a) the communication mode between said first T/R device and said fourth T/R device;

b) the communication route between said first T/R device and said fourth T/R device;

c) the communication mode between said second T/R device and said third T/R device;

d) the communication route between said second T/R device and said third T/R device;

e) the power output of said third T/R device; and

f) the power output of said fourth T/R device.

74. The apparatus defined in claim 45, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, in the absence of a timely receipt by said IMD of said remote station handshake signal, said IMD is further operative to change at least one of;

a) the communication mode between said first T/R device and said fourth T/R device;

b) the communication route between said first T/R device and said fourth T/R device;

c) the communication mode between said second T/R device and said third T/R device;

d) the communication route between said second T/R device and said third T/R device;

e) the power output of said third T/R device; and

f) the power output of said fourth T/R device.

75. The apparatus defined in claim 46, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, upon receipt of said second communication failure signal, said IMD is further operative to change at least one of;

a) the communication mode between said first T/R device and said fourth T/R device;

b) the communication route between said first T/R device and said fourth T/R device;

c) the communication mode between said second T/R device and said third T/R device;

d) the communication route between said second T/R device and said third T/R device;

e) the power output of said third T/R device; and

f) the power output of said fourth T/R device.

76. The apparatus defined in claim 47, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, upon receipt of said first communication failure signal, said remote station is further operative to change at least one of;

a) the communication mode between said first T/R device and said fourth T/R device;

b) the communication route between said first T/R device and said fourth T/R device;

c) the communication mode between said second T/R device and said third T/R device;

d) the communication route between said second T/R device and said third T/R device;

e) the power output of said third T/R device; and

f) the power output of said fourth T/R device.

77. The apparatus defined in claim 48, further comprising a communication relay unit including:

(1) a third transmitting/receiving (T/R) device for electronic communication with said second T/R device of said remote station; and

(2) a fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said first T/R device of said IMD;

wherein said IMD communicates with said remote station through said relay unit; and

wherein, upon receipt of said first communication failure signal, said remote station is further operative to change at least one of;

a) the communication mode between said first T/R device and said fourth T/R device;

b) the communication route between said first T/R device and said fourth T/R device;

c) the communication mode between said second T/R device and said third T/R device;

d) the communication route between said second T/R device and said third T/R device;

e) the power output of said third T/R device; and

f) the power output of said fourth T/R device.

78. The apparatus defined in claim 11, wherein said treatment device is operative to generate a treatment confirmation signal after administration of treatment to said patient, and wherein said treatment confirmation signal is transmitted to said remote station by said first T/R device.

79. The apparatus defined in claim 41, wherein, in the absence of a signal from said first T/R device, said logic device selects said first operating mode.

80. The apparatus defined in claim 11, wherein said logic device is operative to generate at least one logic device analysis signal representing a result of said analysis of said at least one sensor circuit output signal, and wherein said at least one logic device analysis signal is transmitted to said remote station by said first T/R device.

81. The apparatus defined in claim 1, wherein said at least one local treatment device control signal is transmitted to said remote station by said first T/R device.

82. The apparatus defined in claim 1, wherein

(a) said logic device is operative to analyze said at least one sensor circuit output signal to detect a medical abnormality which may require treatment;

and

(b) said abnormality which requires notification is the same as said abnormality which may require treatment.

83. The apparatus defined in claim 1, wherein

(a) said logic device is operative to analyze said at least one sensor circuit output signal to detect a medical abnormality which may require treatment;

and

(b) said abnormality which requires notification is different than said abnormality which may require treatment.

84. The apparatus defined in claim 83, wherein

a) said abnormality which requires notification is an abnormality which occurs over a first duration of time;

b) said abnormality which may require treatment is an abnormality which occurs over a second duration of time; and

c) said first duration of time differs from said second duration of time.

85. The apparatus defined in claim 83, wherein

a) said abnormality which requires notification is defined by a first frequency of abnormal medical events;

b) said abnormality which may require treatment is defined by a second frequency of abnormal medical events; and

c) said first frequency differs from said second frequency.

86. The apparatus defined in claim 83, wherein each said abnormality is determined based on medical data representing at least two medical parameters of said patient.

87. The apparatus defined in claim 83, wherein said abnormality which requires notification is defined by at least one of:

a) a range of values of a medical parameter of said patient which is greater than a first critical value; and

b) a range of values of a medical parameter of said patient which is less than a second critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a medical parameter of said patient which is greater than a third critical value; and

b) a range of values of a medical parameter of said patient which is less than a fourth critical value;

and wherein

(i) said third critical value is greater than said first critical value; and

(ii) said fourth critical value is less than said second critical value;

whereby said abnormality which requires notification is a less severe abnormality than said abnormality which may require treatment.

88. The apparatus defined in claim 83, wherein said abnormality which requires notification is defined by at least one of:

a) a range of values of a medical parameter of said patient which is greater than a fifth critical value; and

b) a range of values of a medical parameter of said patient which is less than a sixth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a medical parameter of said patient which is greater than a seventh critical value; and

b) a range of values of a medical parameter of said patient which is less than an eighth critical value;

and wherein

(i) said seventh critical value is less than said fifth critical value; and

(ii) said eighth critical value is greater than said sixth critical value;

whereby said abnormality which requires notification is a more severe abnormality than said abnormality which may require treatment.

89. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a first function of the value of a medical parameter of said patient which is greater than a ninth critical value; and

b) a range of values of a first function of the value of a medical parameter of said patient which is less than a tenth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a first function of the value of a medical parameter of said patient which is greater than an eleventh critical value; and

b) a range of values of a first function of the value of a medical parameter of said patient which is less than a twelfth critical value;

and wherein

(i) said eleventh critical value is greater than said ninth critical value; and

(ii) said twelfth critical value is less than said tenth critical value.

90. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a second function of the value of a medical parameter of said patient which is greater than a thirteenth critical value; and

b) a range of values of a second function of the value of a medical parameter of said patient which is less than a fourteenth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a second function of the value of a medical parameter of said patient which is greater than an fifteenth critical value; and

b) a range of values of a second function of the value of a medical parameter of said patient which is less than a sixteenth critical value;

and wherein

(i) said fifteenth critical value is less than said thirteenth critical value; and

(ii) said sixteenth critical value is greater than said fourteenth critical value.

91. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a third function of (i) the value of a medical parameter of said patient, and (ii) time, which is greater than a seventeenth critical value; and

b) a range of values of a third function of (i) the value of a medical parameter of said patient, and (ii) time which is less than an eighteenth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a third function of (i) the value of a medical parameter of said patient, and (ii) time, which is greater than a nineteenth critical value; and

b) a range of values of a third function of (i) the value of a medical parameter of said patient, and (ii) time, which is less than a twentieth critical value;

and wherein

(i) said nineteenth critical value is greater than said seventeenth critical value; and

(ii) said twentieth critical value is less than said eighteenth critical value.

92. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a fourth function of (i) the value of a medical parameter of said patient, and (ii) time, which is greater than a twenty first critical value; and

b) a range of values of a fourth function of (i) the value of a medical parameter of said patient, and (ii) time which is less than a twenty second critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a fourth function of (i) the value of a medical parameter of said patient, and (ii) time, which is greater than a twenty third critical value; and

b) a range of values of a fourth function of (i) the value of a medical parameter of said patient, and (ii) time, which is less than a twenty fourth critical value;

and wherein

(i) said twenty third critical value is less than said twenty first critical value; and

(ii) said twenty fourth critical value is greater than said twenty second critical value.

93. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a fifth function of the values of each of a first plurality of medical parameters of said patient which is greater than a twenty fifth critical value; and

b) a range of values of a fifth function of the values of each of a first plurality of medical parameters of said patient which is less than a twenty sixth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a fifth function of the values of each of a first plurality of medical parameters of said patient which is greater than a twenty seventh critical value; and

b) a range of values of a fifth function of the values of each of a first plurality of medical parameters of said patient which is less than a twenty eighth critical value;

and wherein

(i) said twenty seventh critical value is greater than said twenty fifth critical value; and

(ii) said twenty eighth critical value is less than said twenty sixth critical value.

94. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a sixth function of the values of each of a second plurality of medical parameters of said patient which is greater than a twenty ninth critical value; and

b) a range of values of a sixth function of the values of each of a second plurality of medical parameters of said patient which is less than a thirtieth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a sixth function of the values of each of a second plurality of medical parameters of said patient which is greater than a thirty first critical value; and

b) a range of values of a sixth function of the values of each of a second plurality of medical parameters of said patient which is less than a thirty second critical value;

and wherein

(i) said thirty first critical value is less than said twenty ninth critical value; and

(ii) said thirty second critical value is greater than said thirtieth critical value.

95. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of a seventh function of (i) the values of each of a third plurality of medical parameters of said patient, and (ii) time, which is greater than a thirty third critical value; and

b) a range of values of a seventh function of (i) the values of each of a third plurality of medical parameters of said patient, and (ii) time, which is less than a thirty fourth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of a seventh function of (i) the values of each of a third plurality of medical parameters of said patient, and (ii) time, which is greater than a thirty fifth critical value; and

b) a range of values of a seventh function of (i) the values of each of a third plurality of medical parameters of said patient, and (ii) time, which is less than a thirty sixth critical value;

and wherein

(i) said thirty fifth critical value is greater than said thirty third critical value; and

(ii) said thirty sixth critical value is less than said thirty fourth critical value.

96. The apparatus defined in claim 83, wherein

said abnormality which requires notification is defined by at least one of:

a) a range of values of an eighth function of (i) the values of each of a fourth plurality of medical parameters of said patient, and (ii) time, which is greater than a thirty seventh critical value; and

b) a range of values of an eighth function of (i) the values of each of a fourth plurality of medical parameters of said patient, and (ii) time, which is less than a thirty eighth critical value;

and said abnormality which may require treatment is defined by at least one of;

a) a range of values of an eighth function of (i) the values of each of a fourth plurality of medical parameters of said patient, and (ii) time, which is greater than a thirty ninth critical value; and

b) a range of values of an eighth function of (i) the values of each of a fourth plurality of medical parameters of said patient, and (ii) time, which is less than a fortieth critical value;

and wherein

(i) said thirty ninth critical value is less than said thirty seventh critical value; and

(ii) said fortieth critical value is greater than said thirty eighth critical value.

97. The apparatus defined in claim 1, wherein said logic device is operative to pass said at least one sensor circuit output signal to said first T/R device for transmission of said at least one sensor circuit output signal to the remote location in addition to said notification signal.

98. The apparatus defined in claim 1, wherein said sensor circuit output is further coupled to said first T/R device for transmission of said at least one sensor circuit output signal to the remote location in addition to said notification signal.

99. The apparatus defined in claim 1, further comprising a power supply coupled to a transmitter in said first T/R device, for powering said transmitter, and wherein said logic device is operable to power up said transmitter at the time a notification signal is to be sent, thereby to conserve power during periods when no transmission is required.

100. The apparatus defined in claim 99, wherein said logic device is operable to power down said transmitter upon the occurrence of an event selected from the group consisting of (i) a specified time following the last transmission, and (ii) receipt of a signal from the remote location.

101. The apparatus defined in claim 100, further comprising a supplementary power supply coupled to said treatment device, said sensor circuit, said logic device and a receiver in said first T/R device.

102. The apparatus defined in claim 11, further comprising a power supply coupled to a transmitter in said first T/R device for powering said transmitter, and wherein said transmitter is powered up in response to an activation signal received from at least one of said remote station and said logic device, thereby to conserve power during periods when no transmission is required.

103. The apparatus defined in claim 102, wherein said transmitter is powered down by at least one of:

(a) a remote transmitter power reduction signal received from said remote station; and

(b) a local transmitter power reduction signal received from said logic device;

thereby to reduce the power consumption when said transmitter is not in use.

104. The apparatus defined in claim 1, wherein said electronic medical treatment device is selected from the group consisting of:

(a) a cardioverter-defibrillator device comprising;

(i) a defibrillator circuit, having a defibrillator circuit output, for producing at least one defibrillation pulse at said defibrillator circuit output;

(ii) at least one electrode for application of said defibrillator pulse to said patient; and

(iii) a connecting circuit coupling said defibrillator circuit output to said at least one electrode;

(b) a pacemaker device comprising;

(i) a pacemaker circuit, having a pacemaker circuit output, for producing at least one pacemaker pulse at said pacemaker circuit output;

(ii) at least one electrode for application of said pacemaker pulse to said patient; and

(iii) a connecting circuit coupling said pacemaker circuit output to said at least one electrode;

(c) a carotid receptor stimulator;

(d) a brain stimulator;

(e) a nerve stimulator;

(f) a muscle stimulator;

(g) a drug infusion pump; and

(h) a circulatory heart pump for pumping the blood of said patient.

105. The apparatus defined in claim 1, wherein said electronic medical treatment device comprises:

(a) a defibrillator circuit, having a defibrillator circuit output, for producing at least one defibrillation pulse at said defibrillator circuit output;

(b) a pacemaker circuit, having a pacemaker circuit output, for producing at least one pacemaker pulse at said pacemaker circuit output;

(c) at least one electrode for application of at least one of (i) said defibrillator pulse; and

(ii) said pacemaker pulse to said patient;

(d) a first connecting circuit coupling said defibrillator circuit output to at least one said electrode; and

(e) a second connecting circuit coupling said pacemaker circuit output to at least one said electrode.

106. The apparatus defined in claim 105, wherein at least one of said at least one electrode is selectively coupled to said defibrillator circuit output and said pacing circuit output, thereby serving as both a defibrillator electrode and a pacing electrode.

107. The apparatus defined in claim 104, wherein said nerve stimulator is operative to stimulate at least one of:

(1) at least one branch of the vagus nerve; and

(2) at least one nerve which conveys nerve signals from a carotid artery baroreceptor.

108. The apparatus defined in claim 104, wherein said drug infusion pump is selected from the group consisting of:

(i) a pump which supplies insulin;

(ii) a pump which supplies a chemotherapeutic agent;

(iii) a pump which supplies an antibiotic;

(iv) a pump which supplies an anesthetic agent; and

(v) a pump which supplies an analgesic agent,

to said patient.

109. The apparatus defined in claim 11, wherein the IMD comprises a data storage device, coupled to said logic device, for storage of data, said data including at least one of:

(a) medical data received from said sensor circuit;

(b) data representing logic device analysis of medical data;

(c) data representing logic device control signals for application to said electronic medical treatment device;

(c) data representing notification signals for transmission to said remote station; and

(d) data representing control signals received from said remote station.

110. The apparatus defined in claim 109, wherein said data storage device is further coupled to said sensor circuit output for storage of sensor output signal data.

111. The apparatus defined in claim 109, where said data storage device is operative to provide said stored medical data to said logic device for transmission to said remote station upon receipt of at least one of:

(1) a command received from said remote station; and

(2) a notification signal received from said logic device.

112. The apparatus defined in claim 11, further comprising:

(a) at least one battery, coupled to each of said first T/R device, said medical treatment device, said sensor circuit and said logic device, for supplying electrical power thereto;

(b) battery monitoring apparatus, coupled to said battery and to said first T/R device, for monitoring battery information selected from the group consisting of (i) battery voltage, (ii) battery current drain, (iii) battery impedance, and (iv) remaining battery energy;

wherein said battery monitoring apparatus is operative to send said battery information to said remote station via said first T/R device.

113. The apparatus defined in claim 112, wherein said first T/R device includes a transmitting device and a receiving device and wherein said transmitting device is operative to reduce its power output in response to a first power reduction signal received by said receiving device from said remote station,

whereby said medical expert may cause said reduction in transmission power output of said transmitting device to conserve battery function in response to receipt of battery information indicating that battery capacity has declined below a first critical value.

114. The apparatus defined in claim 112, wherein said first T/R device includes a transmitting device and a receiving device and wherein said transmitting device is operative to switch off, in response to a second power reduction signal received by said receiving device from said remote station,

whereby said medical expert may cause a cessation of transmission by said transmitting device in response to receipt of battery information indicating that battery capacity has declined below a second critical value.

115. The apparatus defined in claim 1, further comprising at least one battery, coupled to each of said first T/R device, said medical treatment device, said sensor circuit and said logic device, for supplying electrical power thereto;

wherein

(a) said first T/R device includes a transmitting device and a receiving device and said transmitting device is operative to reduce its power output in response to a power reduction signal from said logic device; and

(b) said logic device is operative to monitor battery information selected from the group consisting of (i) battery voltage, (ii) battery current drain, (iii) battery impedance, and (iv) remaining battery energy;

whereby said logic device causes said transmitting device to reduce power output to conserve battery function in response to battery information indicating that battery capacity has declined below a first prescribed value.

116. The apparatus defined in claim 1, further comprising at least one battery, coupled to each of said first T/R device, said medical treatment device, said sensor circuit and said logic device, for supplying electrical power thereto;

wherein

(a) said first T/R device includes a transmitting device and a receiving device and said transmitting device is operative to switch off its power output in response to a power off signal from said logic device; and

(b) said logic device is operative to monitor battery information selected from the group consisting of (i) battery voltage, (ii) battery current drain, (iii) battery impedance, and (iv) remaining battery energy;

whereby said logic device causes said transmitting device to switch off, to conserve battery function, in response to battery information indicating that battery capacity has declined below a second prescribed value.

117. The apparatus defined in claim 11, further comprising:

(a) at least one first battery, coupled to said first T/R device, for supplying power to said first T/R device;

(b) at least one second battery coupled to each of said medical treatment device, said sensor circuit and said logic device, for supplying electrical power thereto; and

(c) first battery capacity monitoring apparatus, coupled to said first battery and to said first T/R device, for monitoring first battery information selected from the group consisting of (i) first battery voltage, (ii) first battery current drain, (iii) first battery impedance, and (iv) remaining first battery energy;

wherein said first battery monitoring apparatus is operative to send said first battery information to said remote station via said first T/R device.

118. The apparatus defined in claim 117, wherein at least one of said first and second battery is rechargeable.

119. The apparatus defined in claim 117, wherein said first T/R device includes a transmitting device and a receiving device and wherein said transmitting device is operative to reduce its power output in response to a first power reduction signal received by said receiving device from said remote station,

whereby said medical expert may cause said reduction in transmission power output of said transmitting device to conserve battery function in response to receipt of battery information indicating that the first battery capacity has declined below a first critical value.

120. The apparatus defined in claim 118, wherein said first T/R device includes a transmitting device and a receiving device and wherein said transmitting device is operative to switch off, in response to a second power reduction signal received by said receiving device from said remote station,

whereby said medical expert may cause a cessation of transmission by said transmitting device in response to receipt of battery information indicating that the first battery capacity has declined below a second critical value.

121. The apparatus defined in claim 117, wherein said first battery is further coupled to each of said medical treatment device, said sensor circuit and said logic device, for selectively supplying electrical power thereto in response to a battery control signal received by said receiving device from said remote station.

122. The apparatus defined in claim 117, wherein said second battery is further coupled to said first T/R device, for selectively supplying electrical power thereto in response to a battery control signal received by said receiving device from said remote station.

123. The apparatus defined in claim 11, further comprising:

(a) at least one first battery, coupled to said first T/R device, for supplying power to said first T/R device and coupled to said logic device for supplying battery information to said logic device;

(b) at least one second battery coupled to each of said medical treatment device, said sensor circuit and said logic device, for supplying electrical power thereto;

wherein said logic device is operative to monitor said first battery information selected from the group consisting of (i) first battery voltage, (ii) first battery current drain, (iii) first battery impedance, and (iv) remaining first battery energy;

wherein said logic device is operative to cause said transmitting device to reduce power output in response to first battery information indicating that first battery capacity has declined below a first critical value, thereby to conserve first battery function.

124. The apparatus defined in claim 123, wherein said first T/R device includes a transmitting device and a receiving device and wherein said transmitting device is operative to reduce its power output in response to a first power reduction signal received from said logic device,

whereby said logic device may cause said reduction in transmission power output of said transmitting device to conserve battery function in response to receipt of battery information indicating that the first battery capacity has declined below said first critical value.

125. The apparatus defined in claim 123, wherein said first T/R device includes a transmitting device and a receiving device and wherein said transmitting device is operative to switch off, in response to a second power reduction signal received from said logic device,

whereby said logic device may cause a cessation of transmission by said transmitting device in response to receipt of battery information indicating that the first battery capacity has declined below a second critical value.

126. The apparatus defined in claim 1, expert wherein said logic device is operative to analyze said sensor circuit output signals to determine whether to send a notification signal to said remote location and to generate and send said notification signal to said remote location via said first T/R device for consideration by said medical expert when the analysis reveals a medical abnormality.

127. The apparatus defined in claim 1, wherein said logic device is operative to detect faults in the operation of at least one of said first T/R device, said treatment device, said sensor circuit and said logic device itself, and to generate and send a fault detection signal to said remote location via said first T/R device upon detection of a fault.

128. The apparatus defined in claim 127, wherein said fault detection signal identifies the detected fault.

129. The apparatus defined in claim 127, further comprising at least one battery and wherein the logic device is operative to determine an unfavorable value of at least one of:

a) a battery voltage;

b) a battery impedance; and

c) a charge time

and to generate and send said fault detection signal when said unfavorable value is determined.

25. The apparatus defined in 24, further comprising a plurality (x) of communication relay units, each including:

(1) a (y)th transmitting/receiving (T/R) device;

(2) a (y+1)th transmitting/receiving T/R device;

wherein

(a) y=2z+1;

(b) z is an integer which is at least the number 1 and at most the number x;

(c) said first T/R device and said second T/R device are linked by x+1 separate communication links serially connected through said x communication relay units, as follows;

(i) a (p)th one of said T/R device, where p equals one of the possible values of y, belonging to the [(p−

1)/2]th communication relay unit, communicates with said second T/R device;

(ii) said (p+1)th T/R device, belonging to said [(p−

1)/2]th communication relay unit, communicates with one said (qth) T/R device, belonging to said [(q−

1)/2]th communication relay unit, where q equals one of the possible values of y except p;

(iii) step (ii) is repeated, with each successive step utilizing a remaining communication relay unit, until all of said communication relay units are utilized, and all but one of said possible values of y are assigned;

(iv) in a final step, said (k+1)th T/R device, where k is the last possible value of y to be assigned, communicates with said first T/R device;

thereby to cause said first T/R device and said second T/R device to communicate through a plurality of communication relay units.

26. The apparatus defined in claim 25, wherein at least one of said plurality of communication relay units is not utilized for the communication between said first T/R device and said second T/R device.

27. The apparatus defined in claim 26, wherein said relay unit further comprises a telecommunication control unit for selecting a mode of communication between said second T/R device and said third T/R device.

28. The apparatus defined in claim 27, wherein the mode of communication includes a mode selected from the group consisting of an Internet, a public telephone network and a private communications network.

130. Electronic medical apparatus adapted to be implanted in a human patient, a so-called implantable medical device (IMD), which may be alternatively automatically self-controlled and remotely controlled by a medical expert, said apparatus comprising, in combination:

(a) a first transmitting/receiving (T/R) device for transmitting medical data sensed from said patient to, and for receiving control signals from, a remote location;

(b) an electronic medical treatment device for treating said patient in response to control signals applied thereto;

(c) a sensor circuit, having a sensor circuit output, for producing at least one sensor output signal at said sensor circuit output in response to the medical data sensed from the patient; and

(d) a logic device coupled to each of

(i) said sensor circuit output,

(ii) said first T/R device, and

(iii) said treatment device,

for

(i) analysis of said at least one sensor circuit output signal,

(ii) generating a remote station notification signal, and

(iii) generating at least one local treatment device control signal;

wherein;

(1) said logic device analyzes said at least one sensor circuit output signal to detect a medical abnormality which requires notification of the medical expert at the remote location, and generates a notification signal if required;

(2) said first T/R device transmits said notification signal and at least one signal representing a medical state of said patient to the remote location;

(3) in a first operating mode said logic device generates at least one local treatment device control signal based on analysis of said at least one sensor circuit output signal;

(4) in a second operating mode, said logic device generates at least one remote treatment device control signal in response to at least one real time remote control signal received from the remote location by said first T/R device; and

(5) said logic device selects said operating mode based on at least one signal received from at least one of said first T/R device and said sensor circuit.

131. A method of controlling an electronic medical apparatus adapted to be implanted in a human patient, a so-called implantable medical device (IMD), which may treat a medical condition in a patient following the detection by said device of an abnormality, which may be alternatively automatically self-controlled and remotely controlled by a medical expert at a remote location, said method comprising the steps of:

(1) monitoring signals which contain information about at least one medical state in a patient and producing medical condition signals representative of said state;

(2) detecting a medical abnormality which may require treatment, based on said signals;

(3) upon detection of said medical abnormality, determining locally whether said treatment is to be administered automatically by said IMD or remotely by a medical expert;

(4) if said local determination is for automatic treatment, automatically selecting and administering said treatment;

(5) if said local determination is for remote determination of treatment;

(a) transmitting information concerning said medical abnormality to said medical expert;

(b) receiving said information for review by a medical expert;

(c) said medical expert selecting the treatment of said medical abnormality, if treatment is warranted;

(d) said medical expert transmitting at least one real time treatment control signal to said IMD, if treatment is warranted; and

(e) said IMD administering said medical treatment in real time, in response to said at least one treatment control signal.

132. The method defined in claim 131, wherein a medical abnormality which results in said automatic treatment is different than a medical abnormality which results in said remote determination of treatment.

133. The method defined in claim 132, wherein

a) said medical abnormality which results in said remote determination of treatment is an abnormality which occurs over a first duration of time;

b) said medical abnormality which results in said automatic treatment is an abnormality which occurs over a second duration of time; and

c) said first duration of time differs from said second duration of time.

134. The method defined in claim 132, wherein

a) said medical abnormality which results in said remote determination of treatment is defined by a first frequency of abnormal medical events;

b) said medical abnormality which results in said automatic treatment is defined by a second frequency of abnormal medical events; and

c) said first frequency differs from said second frequency.

135. The method defined in claim 132, wherein each said medical abnormality is determined based on medical data representing at least two medical parameters of said patient.

136. The method defined in claim 132, wherein

said medical abnormality which results in said remote determination of treatment is defined by at least one of:

a) a range of values of a medical parameter of said patient which is greater than a first critical value; and

b) a range of values of a medical parameter of said patient which is less than a second critical value;

and said medical abnormality which results in said automatic treatment is defined by at least one of;

a) a range of values of a medical parameter of said patient which is greater than a third critical value; and

b) a range of values of a medical parameter of said patient which is less than a fourth critical value;

and wherein

(i) said third critical value is greater than said first critical value; and

(ii) said fourth critical value is less than said second critical value;

whereby said medical abnormality which results in said remote determination is a less severe medical abnormality than said medical abnormality which results in said automatic treatment.

137. The method defined in claim 132, wherein said medical abnormality which results in said remote determination is defined by at least one of:

a) a range of values of a medical parameter of said patient which is greater than a fifth critical value; and

b) a range of values of a medical parameter of said patient which is less than a sixth critical value;

and said medical abnormality which results in said automatic treatment is defined by at least one of;

a) a range of values of a medical parameter of said patient which is greater than a seventh critical value; and

b) a range of values of a medical parameter of said patient which is less than an eighth critical value;

and wherein

(i) said seventh critical value is less than said fifth critical value; and

(ii) said eighth critical value is greater than said sixth critical value;

whereby said medical abnormality which results in said remote determination is a more severe medical abnormality than said medical abnormality which results in said automatic treatment.

138. The method defined in claim 132, wherein

said medical abnormality which results in said remote determination is defined by at least one of:

a) a range of values of a first function of the value of a medical parameter of said patient which is greater than a ninth critical value; and

b) a range of values of a first function of the value of a medical parameter of said patient which is less than a tenth critical value;

and said medical abnormality which results in said automatic treatment is defined by at least one of;

a) a range of values of a first function of the value of a medical parameter of said patient which is greater than an eleventh critical value; and

b) a range of values of a first function of the value of a medical parameter of said patient which is less than a twelfth critical value;

and wherein

(i) said eleventh critical value is greater than said ninth critical value; and

(ii) said twelfth critical value is less than said tenth critical value.

139. The apparatus method in claim 132, wherein

said medical abnormality which results in said remote determination is defined by at least one of:

a) a range of values of a second function of the value of a medical parameter of said patient which is greater than a thirteenth critical value; and

b) a range of values of a second function of the value of a medical parameter of said patient which is less than a fourteenth critical value;

and said medical abnormality which results in said automatic treatment is defined by at least one of;

a) a range of values of a second function of the value of a medical parameter of said patient which is greater than an fifteenth critical value; and

b) a range of values of a second function of the value of a medical parameter of said patient which is less than a sixteenth critical value;

and wherein

(i) said fifteenth critical value is less than said thirteenth critical value; and

(ii) said sixteenth critical value is greater than said fourteenth critical value.

140. The method defined in claim 131, further comprising the step of transmitting at least one abnormality detection control signal from the remote location to the IMD to change the criteria for detection of at least one of

(a) said medical abnormality which results in said automatic treatment;

and

(b) said medical abnormality which results in said remote determination.

141. The method defined in claim 131, wherein said medical abnormality which results in automatic treatment requires the presence of at least two abnormal conditions of said patient.

142. The method defined in claim 131, wherein

(1) said implantable medical device is at least one of a pacemaker, a cardioverter and a defibrillator;

(2) said medical abnormality is a heart rhythm abnormality; and

(3) the step of administering said medical treatment includes at least one of;

(a) applying at least one shock to the patient, and

(b) applying at least one pacing pulse to the patient.

143. The method defined in claim 142, wherein at least one of (a) said at least one shock and (b) said at least one pacing pulse has programmed parameters, and wherein said method further comprises the step of the medical expert transmitting at least one treatment control signal to the IMD to change the programmed parameters.

144. The method defined in claim 131, further comprising the steps of:

(6) transmitting program control signals to the IMD from the remote location to change the criteria for detecting said medical abnormality.

145. The method defined in claim 131, further comprising the steps of:

(6) transmitting a reminder control signal to the IMD from the remote location instructing the IMD to transmit further medical condition signals after a prescribed interval of time.

146. The method defined in claim 145, wherein the reminder control signal instructs the IMD to repeatedly transmit further medical condition signals at prescribed intervals of time.

147. The method defined in claim 146, wherein the IMD automatically ceases to transmit medical condition signals when the apparent abnormality is satisfactorily corrected.

148. The method defined in claim 131, further comprising the steps of:

(6) transmitting to the remote location, for evaluation by the medical expert, at least one of

(a) signals representing the automatic treatment; and

(b) said monitoring signals.

149. A method of controlling an electronic medical apparatus adapted to be implanted in a human patient, a so-called implantable medical device (IMD), which may treat a medical condition in a patient following the detection by said device of an abnormality, which may be alternatively automatically self-controlled and remotely controlled by a medical expert at a remote location, said method comprising the steps of:

(1) monitoring signals which contain information about at least one medical state in a patient and producing medical condition signals representative of said state;

(2) detecting a medical abnormality which may require treatment, based on said signals;

(3) upon detection of said medical abnormality, determining locally whether said treatment is to be administered automatically by said IMD or remotely by a medical expert;

(4) if said local determination is for automatic treatment, automatically selecting and administering said treatment;

(5) if said local determination is for remote determination of treatment;

(a) transmitting information concerning said medical abnormality to said medical expert;

(b) receiving said information for review by a medical expert;

(c) said medical expert selecting the treatment of said medical abnormality, if treatment is warranted;

(d) said medical expert transmitting at least one real time treatment control signal to said IMD, if treatment is warranted; and

(e) said IMD administering said medical treatment in real time, in response to said at least one treatment control signal.

(6) if the requirement for treatment cannot be determined, due to the presence of artifacts in said medical condition signals, transmitting at least one repair control signal to the IMD from the remote location, in an attempt to remove the artifacts from the medical condition signals;

(7) transmitting further medical condition signals to said medical expert at said remote location; and

(8) at said remote location, determining whether said artifacts have been removed from said medical condition signals.

150. The method defined in claim 149, wherein said repair control signal is a command to inhibit a particular function of the IMD.

151. The method defined in claim 149, wherein said implantable medical device is at least one of a pacemaker, a cardioverter and a defibrillator which includes a plurality of electrodes, selectively coupled to a sensing circuit, for sensing cardiac activity, and wherein said repair control signal is a command to couple a different electrode to said sensing circuit, thereby to remove artifacts caused by a particular electrode.

152. A method of controlling an electronic medical apparatus adapted to be implanted in a human patient, a so-called implantable medical device (IMD), which may treat a medical condition in a patient following the detection by said device of an abnormality, under remote control of a medical expert, said method comprising the steps of:

(1) monitoring information about at least one medical state in a patient and producing medical condition signals representative of said medical state;

(2) detecting an apparent medical abnormality which may require treatment, based on said medical condition signals;

(3) upon detection of said apparent medical abnormality, transmitting said medical condition signals to a medical expert at a remote location;

(4) at said remote location, determining whether said treatment is warranted based on said medical condition signals;

(5) if treatment is warranted, transmitting real time treatment control signals to the IMD from the remote location;

(6) administering treatment to said patient in real time based on said treatment control signals;

(7) monitoring further said information about said at least one medical state in a patient and producing medical condition signals representative of said medical state;

(8) transmitting said medical condition signals to said medical expert at said remote location;

(9) at said remote location, determining whether said treatment was successful.

153. A method of controlling an electronic medical apparatus adapted to be implanted in a human patient, a so-called implantable medical device (IMD), which may treat a medical condition in a patient following the detection by said device of an abnormality, under remote control of a medical expert, said method comprising the steps of:

(1) monitoring information about at least one medical state in a patient and producing medical condition signals representative of said medical state;

(2) detecting an apparent medical abnormality which may require treatment, based on said medical condition signals;

(3) upon detection of said apparent medical abnormality, transmitting said medical condition signals to a medical expert at a remote location;

(4) at said remote location, receiving said medical condition signals and determining whether said treatment is warranted based on said medical condition signals;

(5) determining whether said treatment is to be administered automatically by said IMD or remotely by a medical expert;

(6) if said determination is for automatic treatment, automatically selecting and administering said automatic treatment to said patient;

(7) if said determination is for remote treatment by said medical expert;

(a) said medical expert selecting the treatment of said medical abnormality;

(b) said medical expert transmitting at least one real time treatment control signal to said IMD; and

(c) said IMD administering said medical treatment in real time, in response to said at least one treatment control signal.

154. The method defined in claim 153, further comprising the steps of:

(8) monitoring further said information about said at least one medical state in said patient and producing medical condition signals representative of said medical state;

(9) transmitting said medical condition signals to said medical expert at said remote location;

(10) at said remote location, determining whether said treatment was successful;

(11) if said treatment is not successful, repeating said steps (7)-(10), until at least one of;

(a) said treatment is successful; and

(b) a prescribed number of said treatments has been administered.

155. The method defined in claim 153, further comprising the steps of:

(8) transmitting program control signals to the IMD from the remote location to change the criteria for at least one of;

(a) detecting said apparent medical abnormality;

(b);

automatically selecting treatment; and

(c) automatically administering treatment.