CONTROLLING A PERSONAL MEDICAL DEVICE

• US 20100268304A1
• Filed: 04/20/2010
• Published: 10/21/2010
• Est. Priority Date: 01/13/2009
• Status: Active Grant

• Current Assignee: Jeffrey A. Matos
• Original Assignee: Jeffrey A. Matos
• Inventors: Matos, Jeffrey A.
• Granted Patent: US 8,655,450 B2
• Time in Patent Office: Days
• US Class Current: 607/60
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61M 2205/3553 remote, e.g. between patient's home and doctor's office
• CPC Class Codes: A61M 2205/3592 using telemetric means, e.g. radio or optical transmission
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/201 Glucose concentration
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/37217 characterised by the communication link, e.g. acoustic or tactile
• CPC Class Codes: A61N 1/37235 Aspects of the external programmer
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37252 Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/39622 : Pacing therapy
• CPC Class Codes: G16H 10/60 : for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/63 : for local operation
• CPC Class Codes: G16H 40/67 : for remote operation
• CPC Class Codes: H04B 17/309 : Measuring or estimating channel quality parameters
• CPC Class Codes: H04L 1/0003 : by switching between different modulation schemes
• CPC Class Codes: H04L 1/0013 : Rate matching, e.g. puncturing or repetition of code symbols
• CPC Class Codes: H04L 1/0015 : characterised by the adaptation strategy
• CPC Class Codes: H04L 1/0026 : Transmission of channel quality indication
• CPC Class Codes: H04W 24/02 : Arrangements for optimising operational condition
• CPC Class Codes: H04W 4/023 : using mutual or relative location information between multiple location based services [LBS] targets or of distance thresholds

Abstract

Medical monitoring and treatment apparatus, which is controlled by a plurality of control sources, includes a “personal medical device” (PMD) or an “implantable medical device” (IMD), respectively carried by, or implanted in, a patient. The PMD/IMD is alternatively self-controlled or controlled by one or more local external control stations, at or near the location of the patient, and/or one or more remote external control stations, remote from the patient. Either or both of the local and remote stations may be operated by a person, such as the patient, a patient facilitator and/or a medical professional, or the stations may operate automatically. Since the device is controlled by multiple sources, hierarchies are used to select the source of control.

Claims

1. Apparatus comprising an implantable medical device (IMD), which is alternatively self-controlled and remotely controlled by two control sources situated at external locations, said device comprising, in combination:

(a) a first transmitting/receiving (T/R) device for transmitting at least one signal representing an internal medical state of a patient to, and for receiving a first external control signal from a first external source and for receiving a second external control signal from a second external source;

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

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

(d) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal, and, based on the analysis, generating (A) at least one first medical information signal representing said internal medical data, and (B) an internal control signal for controlling said treatment device;

(2) generating at least one treatment device signal; and

(3) setting one of at least six operating states, each said operating state indicating a hierarchy among the sources of IMD control;

wherein;

(i) in a first operating state,

(I) said internal control signal, if any, takes priority over said first external control signal, if any, and

(II) said first external control signal, if any, takes priority over said second external control signal, if any;

(ii) in a second operating state,

(I) said internal control signal, if any, takes priority over said second external control signal, if any, and

(II) said second external control signal, if any, takes priority over said first external control signal, if any;

(iii) in a third operating state,

(I) said first external control signal, if any, takes priority over said internal control signal, if any, and

(II) said internal control signal, if any, takes priority over said second external control signal, if any;

(iv) in a fourth operating state,

(I) said first external control signal, if any, takes priority over said second external control signal, if any, and

(II) said second external control signal, if any, takes priority over said internal control signal, if any;

(v) in a fifth operating state,

(I) said second external control signal, if any, takes priority over said internal control signal, if any, and

(II) said internal control signal, if any, takes priority over said first external control signal, if any;

(vi) in a sixth operating state,

(I) said second external control signal, if any, takes priority over said first external control signal, if any, and

(II) said first external control signal, if any, takes priority over said internal control signal, if any; and

(vii) said first processor is operative to select the control signal with the highest priority among all such control signals to generate said at least one treatment device signal, in accordance with the operating state;

whereby said first processor selects the source of control of said IMD from among;

(A) said internal control signal;

(B) said first external control signal; and

(C) said second external control signal.

2. The apparatus defined in claim 1, further comprising a command station for selecting the operating state of said IMD, said command station including:

(a) a first input device, for inputting a state setting command, and for producing a command signal;

(b) a second processor coupled to said first input device, for generating a state control signal in response to said command signal;

(c) a command transmitting device, coupled to said second processor, for transmitting a state control signal to said first processor via said first T/R device;

wherein said first processor is operative to set a respective one of at least six operating states in dependence upon said received state control signal;

thereby to set the operating state of said IMD.

3. The apparatus defined in claim 1, further comprising a second command station for selecting the operating state of said IMD, said command station including:

(a) a third processor for generating a second state control signal;

(b) a second T/R device, coupled to said third processor, for transmitting said second state control signal to said first processor via said first T/R device, and for receiving said signal representing the internal medical state of said patient;

wherein;

(i) said third processor is operative to generate said second state control signal based on said signal representing the internal medical state of said patient; and

(ii) said first processor is operative to set a respective one of at least twenty four operating states in dependence upon said received second state control signal;

thereby to set the operating state of said IMD.

4. The apparatus defined in claim 1, further comprising:

(I) a first external control station for controlling said IMD, said first external control station including;

(a) a fourth processor;

(b) a first display device, coupled to said fourth processor, for displaying internal medical data of said patient;

(c) a second input device, coupled to said fourth processor, for producing a first external control signal in response to an inputted treatment choice, for inputting commands selected from a group consisting of;

(i) a patient using said IMD,

(ii) a medical professional,

(iii) an administrator,

(d) a third T/R device, coupled to said fourth processor, for receiving internal medical data of said patient, and for transmitting said first external control signal; and

(II) a second external control station for controlling said IMD, said second external control station including;

(a) a fifth processor;

(b) a second display device, coupled to said fifth processor, for displaying internal medical data of said patient;

(c) a third input device, coupled to said fifth processor, for producing a second external control signal in response to an inputted treatment choice, for inputting commands selected from another group consisting of;

(i) a patient using said IMD,

(ii) a medical professional,

(iii) an administrator,

(d) a third T/R device, coupled to said fifth processor, for receiving internal medical data of said patient, and for transmitting said second external control signal.

5. The apparatus defined in claim 1, further comprising:

(I) a third external control station for controlling said IMD, including;

(a) a sixth processor for producing a first external control signal in response to analysis by said sixth processor of said internal medical data; and

(b) a fifth T/R device, coupled to said sixth processor, for receiving internal medical data of said patient, and for transmitting said first external control signal

(II) a fourth external control station for controlling said IMD, including;

(a) a seventh processor for producing a second external control signal in response to analysis by said seventh processor of said internal medical data; and

(b) a sixth T/R device, coupled to said seventh processor, for receiving internal medical data of said patient, and for transmitting said second external control signal.

6. The apparatus defined in claim 1, further comprising:

(I) a fifth external control station for controlling said IMD, including;

(a) a eighth processor;

(b) a third display device, coupled to said eighth processor, for displaying internal medical data of said patient;

(c) a fourth input device, coupled to said eighth processor, for producing a first external control signal in response to an inputted treatment choice, for inputting commands from a member of the group consisting of;

(i) a patient using said IMD,

(ii) a medical professional,

(iii) an administrator,

(d) a seventh T/R device, coupled to said eighth processor, for receiving internal medical data of said patient, and for transmitting said first external control signal; and

(II) a sixth external control station for controlling said IMD, including;

(a) a ninth processor for producing a first external control signal in response to analysis by said ninth processor of said internal medical data; and

(b) an eighth T/R device, coupled to said ninth processor, for receiving internal medical data of said patient, and for transmitting said second external control signal.

7. The apparatus defined in claim 1, further comprising a seventh external control station for controlling said IMD, including:

(a) a tenth processor;

(b) a fourth display device, coupled to said tenth processor, for displaying internal medical data of said patient;

(c) a fifth input device, coupled to said tenth processor, for producing a first external control signal in response to an inputted treatment choice, for inputting commands from a member of the group consisting of;

(i) a patient using said IMD,

(ii) a medical professional,

(iii) an administrator,

(d) an ninth T/R device, coupled to said tenth processor, for receiving internal medical data of said patient, and for transmitting external control signals;

wherein;

(i) said tenth processor is operative to generate a second external control signal in response to analysis by said tenth processor of received internal medical data; and

(ii) said ninth T/R device is operative to transmit each of said first and said second external control signals.

8. The apparatus defined in claim 5, wherein

(I) said third external control station further comprises a database, coupled to said sixth processor, for storing information concerning at least one of:

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients;

wherein said sixth processor is operative to select a therapy choice based on analysis by said sixth processor of at least one of;

(a) information obtained from said database, and

(b) said received internal medical data; and

(II) said fourth external control station further comprises a second sensor circuit, having a second sensor circuit output coupled to said seventh processor, for producing at least one second sensor circuit output signal at said second sensor circuit output in response to external medical data sensed from the patient by said second sensor circuit;

wherein said seventh processor is operative to select a therapy choice based on analysis by said seventh processor of at least one of;

(a) said second sensor circuit output signal, and

(b) said received internal medical data.

9. The apparatus defined in claim 6, wherein said sixth external control station further comprises at least one of

(I) a database, coupled to said ninth processor, for storing information concerning at least one of:

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

(II) a third sensor circuit, having a third sensor circuit output coupled to said ninth processor, for producing at least one third sensor circuit output signal at said third sensor circuit output in response to external medical data sensed from the patient by said third sensor circuit;

wherein;

(i) said ninth processor is operative to select a therapy choice based on analysis by said ninth processor of at least one of;

(a) information obtained from said database, and

(b) said third sensor circuit output signal, and

(c) said received internal medical data; and

(ii) said ninth processor is operative to generate a second external control signal based on said analysis.

10. The apparatus defined in claim 7, wherein said seventh external control station further comprises at least one of

(I) a database, coupled to said tenth processor, for storing information concerning at least one of:

(i) patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients;

(II) a fourth sensor circuit, having a fourth sensor circuit output coupled to said tenth processor, for producing at least one fourth sensor circuit output signal at said fourth sensor circuit output in response to external medical data sensed from the patient by said fourth sensor circuit;

wherein;

(i) said tenth processor is operative to select a therapy choice based on analysis by said tenth processor of at least one of;

(a) information obtained from said database, and

(b) said fourth sensor circuit output signal, and

(c) said received internal medical data; and

(ii) said tenth processor is operative to generate a second external control signal based on said analysis.

11. The apparatus defined in claim 1, wherein:

(i) said first T/R device is operative to receive at least three external control signals from a first plurality of locations;

(ii) said first processor is operative to generate at least one treatment device signal in response to the internal control signal and to the receipt of a second plurality of external control signals;

(iii) said first processor is operative to set one of a third plurality of operating states indicating a unique hierarchy among the sources of IMD control;

(iv) the number of said third plurality of operating states, being the number of possible unique hierarchies among the sources of IMD control, is equal to a factorial of the number of said second plurality of control signals;

whereby said first processor selects the source of control of said IMD from among;

(A) said internal control signal; and

(B) each of said external control signals.

12. The apparatus defined in claim 1, wherein said first sensor circuit is coupled to said first T/R device, for receipt of at least one of:

(1) said internal medical data; and

(2) medical data representing at least one value of a physiologic parameter of said patient observable from outside of a body of the patient.

13. The apparatus defined in claim 1, further comprising a sensor, implanted inside of a body of the patient, for sensing said internal medical data;

and wherein said first sensor circuit further comprises a sensor circuit input, adapted to be coupled to said sensor;

whereby said IMD is operative to sense said internal medical data.

14. An implantable medical device (IMD), which is alternatively self-controlled and remotely controlled by three control sources situated at external locations, said device comprising, in combination:

(a) a first transmitting/receiving (T/R) device for transmitting at least one signal representing an internal medical state of a patient to, and for receiving a first external control signal from a first external location, a second external control signal from a second external location, and a third external control signal from a third external location;

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

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

(d) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal, and, based on the analysis, generating (A) at least one first medical information signal representing said internal medical data, and (B) an internal control signal for controlling said treatment device,

(2) generating at least one treatment device signal; and

(3) setting one of at least twenty four operating states, each said operating state indicating a hierarchy among the sources of IMD control;

wherein;

(i) in a first operating state,

(I) said internal control signal, if any, takes priority over said first external control signal, if any,

(II) said first external control signal, if any, takes priority over said second external control signal, if any, and

(III) said second external control signal, if any, takes priority over said third external control signal;

(ii) in a second operating state,

(I) said internal control signal, if any, takes priority over said first external control signal, if any,

(II) said first external control signal, if any, takes priority over said third external control signal, if any, and

(III) said third external control signal, if any, takes priority over said second external control signal;

(iii) in a third operating state,

(I) said internal control signal, if any, takes priority over said second external control signal, if any,

(II) said second external control signal, if any, takes priority over said first external control signal, if any, and

(III) said first external control signal, if any, takes priority over said third external control signal;

(iv) in a fourth operating state,

(I) said internal control signal, if any, takes priority over said second external control signal, if any,

(II) said second external control signal, if any, takes priority over said third external control signal, if any, and

(III) said third external control signal, if any, takes priority over said first external control signal;

(v) in a fifth operating state,

(I) said internal control signal, if any, takes priority over said third external control signal, if any,

(II) said third external control signal, if any, takes priority over said first external control signal, if any, and

(III) said first external control signal, if any, takes priority over said second external control signal;

(vi) in a sixth operating state,

(I) said internal control signal, if any, takes priority over said third external control signal, if any,

(II) said third external control signal, if any, takes priority over said second external control signal, if any, and

(III) said second external control signal, if any, takes priority over said first external control signal;

(vii) in a seventh operating state,

(I) said first external control signal, if any, takes priority over said internal control signal, if any,

(II) said internal control signal, if any, takes priority over said second external control signal, if any, and

(III) said second external control signal, if any, takes priority over said third external control signal;

(viii) in an eighth operating state,

(I) said first external control signal, if any, takes priority over said internal control signal, if any,

(II) said internal control signal, if any, takes priority over said third external control signal, if any, and

(III) said third external control signal, if any, takes priority over said second external control signal;

(ix) in a ninth operating state,

(I) said first external control signal, if any, takes priority over said second external control signal, if any,

(II) said second external control signal, if any, takes priority over said internal control signal, if any, and

(III) said internal control signal, if any, takes priority over said third external control signal;

(x) in a tenth operating state,

(I) said first external control signal, if any, takes priority over said second external control signal, if any,

(II) said second external control signal, if any, takes priority over said third external control signal, if any, and

(III) said third external control signal, if any, takes priority over said internal control signal;

(xi) in an eleventh operating state,

(I) said first external control signal, if any, takes priority over said third external control signal, if any,

(II) said third external control signal, if any, takes priority over said internal control signal, if any, and

(III) said internal control signal, if any, takes priority over said second external control signal;

(xii) in a twelfth operating state,

(I) said first external control signal, if any, takes priority over said third external control signal, if any,

(II) said third external control signal, if any, takes priority over said second external control signal, if any, and

(III) said second external control signal, if any, takes priority over said internal control signal;

(xiii) in a thirteenth operating state,

(I) said second external control signal, if any, takes priority over said internal control signal, if any,

(II) said internal control signal, if any, takes priority over said first external control signal, if any, and

(III) said first external control signal, if any, takes priority over said third external control signal;

(xiv) in a fourteenth operating state,

(I) said second external control signal, if any, takes priority over said internal control signal, if any,

(II) said internal control signal, if any, takes priority over said third external control signal, if any, and

(III) said third external control signal, if any, takes priority over said first external control signal;

(xv) in a fifteenth operating state,

(I) said second external control signal, if any, takes priority over said first external control signal, if any,

(II) said first external control signal, if any, takes priority over said internal control signal, if any, and

(III) said internal control signal, if any, takes priority over said third external control signal;

(xvi) in a sixteenth operating state,

(I) said second external control signal, if any, takes priority over said first external control signal, if any,

(II) said first external control signal, if any, takes priority over said third external control signal, if any, and

(III) said third external control signal, if any, takes priority over said internal control signal;

(xvii) in a seventeenth operating state,

(I) said second external control signal, if any, takes priority over said third external control signal, if any,

(II) said third external control signal, if any, takes priority over said internal control signal, if any, and

(III) said internal control signal, if any, takes priority over said first external control signal;

(xviii) in an eighteenth operating state,

(I) said second external control signal, if any, takes priority over said third external control signal, if any,

(II) said third external control signal, if any, takes priority over said first external control signal, if any, and

(III) said first external control signal, if any, takes priority over said internal control signal;

(xix) in a nineteenth operating state,

(I) said third external control signal, if any, takes priority over said internal control signal, if any,

(II) said internal control signal, if any, takes priority over said first external control signal, if any, and

(III) said first external control signal, if any, takes priority over said second external control signal;

(xx) in a twentieth operating state,

(I) said third external control signal, if any, takes priority over said internal control signal, if any,

(II) said internal control signal, if any, takes priority over said second external control signal, if any, and

(III) said second external control signal, if any, takes priority over said first external control signal;

(xxi) in a twenty first operating state,

(I) said third external control signal, if any, takes priority over said first external control signal, if any,

(II) said first external control signal, if any, takes priority over said internal control signal, if any, and

(III) said internal control signal, if any, takes priority over said second external control signal;

(xxii) in a twenty second operating state,

(I) said third external control signal, if any, takes priority over said first external control signal, if any,

(II) said first external control signal, if any, takes priority over said second external control signal, if any, and

(III) said second external control signal, if any, takes priority over said internal control signal;

(xxiii) in a twenty third operating state,

(I) said third external control signal, if any, takes priority over said second external control signal, if any,

(II) said second external control signal, if any, takes priority over said internal control signal, if any, and

(III) said internal control signal, if any, takes priority over said first external control signal;

(xxiv) in a twenty fourth operating state,

(I) said third external control signal, if any, takes priority over said second external control signal, if any,

(II) said second external control signal, if any, takes priority over said first external control signal, if any, and

(III) said first external control signal, if any, takes priority over said internal control signal;

(xxv) said first processor is operative to select the control signal with the highest priority among all such control signals to generate said at least one treatment device signal, in accordance with the operating state;

whereby said first processor selects the source of control of said IMD from among;

(A) said internal control signal;

(B) said first external control signal;

(C) said second external control signal; and

(D) said third external control signal.

15. The apparatus defined in claim 14, further comprising a first command station for selecting the operating state of said IMD, said first command station including:

(a) a first input device, for inputting a state setting command, and for producing a command signal;

(b) a second processor coupled to said first input device, for generating a first state control signal in response to said command signal;

(c) a command transmitting device, coupled to said second processor, for transmitting said first state control signal to said first processor via said first T/R device;

wherein said first processor is operative to set a respective one of at least twenty four operating states in dependence upon said received first state control signal;

thereby to set the operating state of said IMD.

16. The apparatus defined in claim 14, further comprising a second command station for selecting the operating state of said IMD, said command station including:

(a) a third processor for generating a second state control signal;

(b) a second T/R device, coupled to said third processor, for transmitting said second state control signal to said first processor via said first T/R device, and for receiving said signal representing the internal medical state of said patient;

wherein;

(i) said third processor is operative to generate said second state control signal based on said signal representing the internal medical state of said patient; and

(ii) said first processor is operative to set a respective one of at least twenty four operating states in dependence upon said received second state control signal;

thereby to set the operating state of said IMD.

17. The apparatus defined in claim 14, further comprising:

(I) a first external control station for controlling said IMD, including;

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

(b) a third T/R device, for receiving internal medical data of said patient, and for transmitting said first external control signal and said second external control signal;

(c) a fourth processor coupled to said second sensor circuit output and to said third T/R device for analysis of at least one of (1) said external medical data and (2) said internal medical data, and for generation of a therapy choice based on said analysis; and

(d) a first display device, coupled to said fourth processor, for displaying at least one of (1) internal medical data of said patient, and (2) external medical data of said patient; and

(e) a second input device, coupled to said fourth processor, for producing a first patient choice signal in response to a first inputted treatment choice by said patient;

wherein said fourth processor is operative to;

(1) generate a first external control signal based on the therapy choice of said fourth processor;

(2) generate a second external control based on said first patient choice signal; and

(II) a second external control station for controlling said IMD, including;

(a) a fifth processor;

(b) a second display device, coupled to said fifth processor, for displaying internal medical data of said patient;

(c) a third input device, coupled to said fifth processor, for producing a first medical professional choice signal in response to an inputted treatment choice from a medical professional;

(d) a fourth T/R device, coupled to said fifth processor, for receiving internal medical data of said patient, and for transmitting said third external control signal; and

wherein said fifth processor is operative to generate said third external control signal based on the therapy choice indicated by said first medical professional choice signal;

thereby to control said IMD in response to;

(1) the analysis by said first processor;

(2) the analysis by said fourth processor;

(3) a treatment choice by the patient; and

(4) a treatment choice by the medical professional.

18. The apparatus defined in claim 14, further comprising:

(I) a third external control station for controlling said IMD, including;

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

(b) a fifth T/R device, for receiving internal medical data of said patient, and for transmitting said first external control signal and said second external control signal;

(c) a sixth processor coupled to said third sensor circuit output and to said fifth T/R device for analysis of at least one of (1) said external medical data and (2) said internal medical data, and for generation of a therapy choice based on said analysis; and

(d) a third display device, coupled to said sixth processor, for displaying at least one of (1) internal medical data of said patient, and (2) external medical data of said patient; and

(e) a fourth input device, coupled to said sixth processor, for producing a second patient choice signal in response to a second inputted treatment choice by said patient;

wherein said sixth processor is operative to;

(1) generate a first external control signal based on the therapy choice of said sixth processor;

(2) generate a second external control based on said second patient choice signal;

and

(II) a fourth external control station for controlling said IMD, including;

(a) a sixth T/R device, for receiving internal medical data of said patient, and for transmitting said third external control signal;

(b) a first database, for storing information concerning at least one of;

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

(c) a seventh processor, coupled to said sixth T/R device and to said first database, for producing a third external control signal in response to analysis by said seventh processor of at least one of (1) said internal medical data, and (2) information obtained from said first database;

thereby to control said IMD in response to;

(1) the analysis by said first processor;

(2) the analysis by said sixth processor;

(3) the analysis by said seventh processor; and

(4) a treatment choice by the patient.

19. The apparatus defined in claim 14, further comprising:

(I) a fifth external control station for controlling said IMD, including;

(a) a seventh T/R device, for receiving internal medical data of said patient, and for transmitting said first external control signal;

(b) a fourth display device, for displaying internal medical data of said patient;

(c) a fifth input device, for producing a third patient choice signal in response to a third inputted treatment choice by said patient; and

(d) an eighth processor coupled to (a) said seventh T/R device, (b) said fourth display device, and (c) said fifth input device, for generating said first external control based on the therapy choice indicated by said third patient choice signal;

(II) a sixth external control station for controlling said IMD, including;

(a) a eighth T/R device, for receiving internal medical data of said patient, and for transmitting said second external control signal;

(b) a second database, for storing information concerning at least one of;

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

(c) a ninth processor, coupled to said eighth T/R device and to said second database, for producing said second external control signal in response to analysis by said ninth processor of at least one of (1) said internal medical data, and (2) information obtained from said second database; and

(III) a seventh external control station for controlling said IMD, including;

(a) a ninth T/R device, for receiving internal medical data of said patient, and for transmitting said third external control signal;

(b) a fifth display device, for displaying internal medical data of said patient;

(c) a sixth input device, for producing a second medical professional choice signal in response to a second inputted treatment choice by a medical professional; and

(d) an tenth processor coupled to (i) said ninth T/R device, (ii) said fifth display device, and (iii) said sixth input device, for generating said third external control based on the therapy choice indicated by said second medical professional choice signal;

thereby to control said IMD in response to;

(1) the analysis by said first processor;

(2) the treatment choice by the patient;

(3) the analysis by said ninth processor; and

(4) the treatment choice by the medical professional.

20. The apparatus defined in claim 14, further comprising:

(I) an eighth external control station for controlling said IMD, including;

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

(b) a tenth T/R device, for receiving internal medical data of said patient, and for transmitting said first external control signal;

(c) an eleventh processor coupled to said fourth sensor circuit output and to said tenth T/R device for analysis of at least one of (1) said external medical data and (2) said internal medical data, and for generation of a therapy choice based on said analysis;

wherein said eleventh processor is operative to generate said first external control signal based on the therapy choice of said eleventh processor;

(II) a ninth external control station for controlling said IMD, including;

(a) an eleventh T/R device, for receiving internal medical data of said patient, and for transmitting said second external control signal;

(b) a third database, for storing information concerning at least one of;

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

(c) a twelfth processor, coupled to said eleventh T/R device and to said third database, for producing said second external control signal in response to analysis by said twelfth processor of at least one of (1) said internal medical data, and (2) information obtained from said third database; and

(III) a tenth external control station for controlling said IMD, including;

(a) a twelfth T/R device, for receiving internal medical data of said patient, and for transmitting said third external control signal;

(b) a sixth display device, for displaying internal medical data of said patient;

(c) a seventh input device, for producing a third medical professional choice signal in response to a third inputted treatment choice by a medical professional; and

(d) a thirteenth processor coupled to (i) said twelfth T/R device, (ii) said sixth display device, and (iii) said seventh input device, for generating said third external control based on the therapy choice indicated by said third medical professional choice signal;

thereby to control said IMD in response to;

(1) the analysis by said first processor;

(2) the analysis by said eleventh processor;

(3) the analysis by said twelfth processor; and

(4) the treatment choice by the medical professional.

21. The apparatus defined in claim 14, further comprising:

(I) an eleventh external control station for controlling said IMD, including;

(a) a thirteenth T/R device, for receiving internal medical data of said patient, and for transmitting said first external control signal;

(b) a seventh display device, for displaying internal medical data of said patient;

(c) an eighth input device, for producing a fourth patient choice signal in response to a fourth inputted treatment choice by said patient; and

(d) a fourteenth processor coupled to (i) said thirteenth T/R device, (ii) said seventh display device, and (iii) said eighth input device, for generating said first external control based on the therapy choice indicated by said fourth patient choice signal;

(II) a twelfth external control station for controlling said IMD, including;

(a) a fourteenth T/R device, for receiving internal medical data of said patient, and for transmitting said second external control signal and said third external control signal;

(b) a fourth database, for storing information concerning at least one of;

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

(c) an eighth display device, for displaying internal medical data of said patient;

(d) a ninth input device, for producing a fourth medical professional choice signal in response to a fourth inputted treatment choice by a medical professional; and

(e) a fifteenth processor, coupled to said fourteenth T/R device and to said fourth database, and operative to;

(i) generate said second external control signal in response to analysis by said fifteenth processor of at least one of (1) said internal medical data, and (2) information obtained from said fourth database; and

(ii) generate said third external control based on the therapy choice indicated by said fourth medical professional choice signal;

thereby to control said IMD in response to;

(1) the analysis by said first processor;

(2) the treatment choice by the patient;

(3) the analysis by said fifteenth processor; and

(4) the treatment choice by the medical professional.

22. The apparatus defined in claim 14, further comprising:

(I) a thirteenth external control station for controlling said IMD, including;

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

(b) a fifteenth T/R device, for receiving internal medical data of said patient, and for transmitting said first external control signal;

(c) a sixteenth processor coupled to said fifth sensor circuit output and to said fifteenth T/R device for analysis of at least one of (1) said external medical data and (2) said internal medical data, and for generation of a therapy choice based on said analysis;

wherein said sixteenth processor is operative to generate said first external control signal based on the therapy choice of said sixteenth processor;

(II) a fourteenth external control station for controlling said IMD, including;

(a) a sixteenth T/R device, for receiving internal medical data of said patient, and for transmitting said second external control signal and said third external control signal;

(b) a fifth database, for storing information concerning at least one of;

(i) a patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

(c) an ninth display device, for displaying internal medical data of said patient;

(d) a tenth input device, for producing a fifth medical professional choice signal in response to a fifth inputted treatment choice by a medical professional; and

(e) a seventeenth processor, coupled to said sixteenth T/R device and to said fifth database, and operative to;

(i) generate said second external control signal in response to analysis by said seventeenth processor of at least one of (1) said internal medical data, and (2) information obtained from said fifth database; and

(ii) generate said third external control based on the therapy choice indicated by said fifth medical professional choice signal;

thereby to control said IMD in response to;

(1) the analysis by said first processor;

(2) the analysis by said sixteenth processor;

(3) the analysis by said seventeenth processor; and

(4) the treatment choice by the medical professional.

23. The apparatus defined in claim 14 wherein:

(i) said first T/R device is operative to receive at least four external control signals from a first plurality of locations;

(ii) said first processor is operative to generate at least one treatment device signal in response to the internal control signal and in response to the receipt of a second plurality of external control signals;

(iii) said first processor is operative to set one of a third plurality of operating states indicating a unique hierarchy among the sources of IMD control;

(iv) the number of said third plurality of operating states, being the number of possible unique hierarchies among the sources of IMD control, is equal to a factorial of the number of said second plurality of control signals;

whereby said first processor selects the source of control of said IMD from among;

(A) said internal control signal; and

(B) each of said external control signals.

24. The apparatus defined in claim 14, wherein said first sensor circuit is coupled to said first T/R device, for receipt of at least one of:

(1) said internal medical data; and

(2) medical data representing at least one value of a physiologic parameter of said patient observable from outside of a body of the patient.

25. The apparatus defined in claim 14, further comprising a sensor, implanted inside of a body of the patient, for sensing said internal medical data;

and wherein said first sensor circuit further comprises a sensor circuit input, adapted to be coupled to said sensor;

whereby said IMD is operative to sense said internal medical data.

26. Apparatus comprising an implantable medical device (IMD) which is alternatively self-controlled and remotely controlled by at least one external control source situated at an external location, said IMD comprising, in combination:

(a) a first transmitting/receiving (T/R) device for transmitting at least one signal representing an internal medical state of a patient to, and for receiving a first external control signal from a first external control source;

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

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

(d) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal, and, based on the analysis, generating (A) at least one first medical information signal representing said internal medical data, and (B) an internal control signal for controlling said treatment device,

(2) generating at least one treatment device signal; and

(3) selecting one of at least three operating states in response to a received state control signal;

wherein;

(i) in a first operating state,

the therapy choice indicated by said internal control signal, if any, takes priority over the therapy choice indicated by said first external control signal, if any, for determining the treatment;

(ii) in a second operating state,

the therapy choice indicated by said first external control signal, if any, takes priority over the therapy choice indicated by said internal control signal, if any, for determining the treatment;

(iii) in a third operating state,

both the therapy choice indicated by said first external control signals and the therapy choice indicated by said internal control signal determine the treatment;

whereby said first processor selects the source of control of said IMD from among;

(A) said internal control signal; and

(B) said first external control signal.

27. The apparatus defined in claim 26, wherein said first processor is operative in said third operating state to select a therapy choice form the group consisting of:

(a) causing said treatment device to deliver therapy only if both of said internal and said first external control signal indicate the delivery of therapy;

(b) causing said treatment device to deliver therapy if either one of said internal and said first external control signal indicate the delivery of therapy;

(c) causing said treatment device to deliver a first intermediate amount of therapy, if

(i) said internal control signal indicates a first amount of therapy to be delivered, and

(ii) said first external control signal indicates a second amount of therapy to be delivered;

wherein said first intermediate amount of therapy is an amount which ranges from said first amount to said second amount of therapy.

28. The apparatus defined in claim 27, wherein said first intermediate amount of therapy is selected from the group consisting of:

(i) the arithmetic average of said first amount of therapy and said second amount of therapy; and

(ii) a polynomial function, of at least the first degree, of at least one of (i) said first amount of therapy and (ii) said second amount of therapy.

29. The apparatus defined in claim 26, further comprising a command station for setting the operating state of said IMD, said command station including:

(a) a command input device, for inputting a state setting command and for producing a command signal;

(b) a second processor, coupled to said command input device, for generating a state control signal in response to said command signal;

(c) a command transmitting device, coupled to said second processor, for transmitting said state control signal to said first processor via said first T/R device;

thereby to set the operating state of said IMD.

30. The apparatus defined in claim 26, further comprising a first external control station for controlling said IMD, said first external control station including:

(a) a third processor;

(b) a display device, coupled to said third processor, for displaying internal medical data of said patient;

(c) an input device, coupled to said third processor, for producing a first external control signal in response to an inputted treatment choice, for inputting commands from at least one of;

(i) a patient using said IMD,

(ii) a medical professional,

(iii) an administrator,

(d) a second T/R device, coupled to said third processor, for receiving internal medical data of said patient, and for transmitting said first external control signal to said IMD.

31. The apparatus defined in claim 26, further comprising a second external control station for controlling said IMD, said second external control station including:

(a) a fourth processor for producing a second external control signal in response to analysis by said fourth processor of said internal medical data; and

(b) a third T/R device, coupled to said fourth processor, for receiving internal medical data of said patient, and for transmitting said second external control signal.

32. The apparatus defined in claim 31, wherein said second external control station further comprises a database, for storing information concerning at least one of:

(i) the patient,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients;

wherein said fourth processor is operative to select a therapy choice based on analysis by said fourth processor of at least one of;

(a) information obtained from said database, and

(b) said received internal medical data.

33. The apparatus defined in claim 31, wherein:

(i) said second external control station further comprises a second sensor circuit, having a second sensor circuit output coupled to said fourth processor, for producing at least one second sensor circuit output signal at said second sensor circuit output in response to external medical data sensed from the patient by said second sensor circuit;

(ii) said fourth processor is operative to select a therapy choice based on analysis by said fourth processor of at least one of;

(a) analysis of said second sensor circuit output signal, and

(b) said received internal medical data.

34. The apparatus defined in claim 30, further comprising a first identifier signal source, coupled to said second T/R device, for providing a first identifier signal for transmission to said first T/R device;

wherein, in the absence of the receipt of at least one of (i) said first identifier signal and (ii) said first external control signal, said first processor is operative to cause said internal control signal to control said IMD;

whereby said first processor detects the absence of proper communications between said first external control station and said IMD, and remedies said absence;

thereby to control said IMD in the absence of proper communications with said first external control station.

35. The apparatus defined in claim 31, further comprising a second identifier signal source, coupled to said third T/R device, for providing a second identifier signal for transmission to said first T/R device;

wherein, in the absence of the receipt of at least one of (i) said second identifier signal and (ii) said second external control signal, said first processor is operative to cause said internal control signal to control said IMD;

whereby said first processor detects the absence of proper communications between said second external control station and said IMD, and remedies said absence;

thereby to control of said IMD in the absence of proper communications with said second external control station.

36. The apparatus defined in claim 26, wherein:

(i) said first T/R device is operative to transmit at least one signal representing a medical state of said patient to, and to receive a second external control signal from, a second external control source situated at an external location;

(ii) said first processor is operative to select an operating state from among the group of operating states consisting of (a) said three operating states, and (b) at least one additional operating state selected from the group consisting of;

(I) a first additional operating state in which said treatment device delivers therapy only if all three of said internal, first external and second external control signals indicate the delivery of therapy;

(II) a second additional operating state in which said treatment device delivers therapy if any two of said internal, first external and second external control signals indicate the delivery of therapy;

(III) a third additional operating state in which said treatment device delivers therapy if any of one of said internal, first external and second external control signals indicate the delivery of therapy; and

(IV) a fourth additional operating state in which said treatment device delivers a second intermediate amount of therapy, if

(i) said internal control signal indicates a first amount of therapy to be delivered,

(ii) said first external control signal indicates a second amount of therapy to be delivered, and

(iii) said second external control signal indicates a third amount of therapy to be delivered;

wherein said second intermediate amount of therapy is an amount which ranges between the smallest and the largest of such amounts of therapy.

37. The apparatus defined in claim 36, wherein said second intermediate amount of therapy is selected from the group consisting of:

(i) the arithmetic average of said first, second and third amounts of therapy;

(ii) the amount of therapy which is neither the largest nor the smallest of said first, second and third amounts of therapy;

(iii) a polynomial function, of at least the first degree, of at least one of (i) said first amount of therapy, (ii) said second amount of therapy, and (iii) said third amount of therapy;

(iv) a pair of identical therapy amounts, if any, from among said first, second and third amounts of therapy;

(v) an arithmetic average of the two amounts of therapy with the smallest difference between their respective values; and

(vi) a polynomial function, of at least the first degree, of at least one of the two amounts of therapy with the smallest difference between their respective values.

38. The apparatus defined in claim 26, wherein:

(i) said first T/R device is operative to transmit at least one signal representing a medical state of said patient to, and to receive a plurality of external control signals from, each of a plurality of external control sources situated at external locations;

(ii) said first processor is operative to select an operating state from among the group of operating states consisting of (a) said three operating states, and (b) at least one additional operating state selected from the group consisting of;

(I) a first additional operating state in which said treatment device delivers therapy only if all of said internal and external control signals indicate the delivery of therapy;

(II) a second additional operating state in which said treatment device delivers therapy if any of said internal and external control signals indicate the delivery of therapy;

(III) a third additional operating state in which said treatment device delivers a third intermediate amount of therapy, if

(i) said internal control signal indicates a first amount of therapy to be delivered, and

(ii) said external control signals indicate amounts of therapy to be delivered;

wherein said third intermediate amount of therapy is an amount which ranges between the smallest and the largest of such amounts of therapy.

39. The apparatus defined in claim 38, wherein said third intermediate amount of therapy is selected from the group consisting of:

(i) the arithmetic average of each of said amounts of therapy;

(ii) the amount of therapy which corresponds to the median value, among all of the amounts of therapy;

(iii) the amount of therapy which corresponds to the value of the mode, among all of the amounts of therapy; and

(iv) a polynomial function, of at least the first degree, of at least one of (i) any one of the amounts of therapy, and (ii) a plurality of the amounts of therapy.

40. Apparatus comprising an implantable medical device (IMD) which is alternatively self-controlled and remotely controlled by at least one control source situated at an external location, said IMD comprising, in combination:

(a) a first transmitting/receiving (T/R) device for transmitting a signal representing internal medical data of a patient to, and for receiving an external control signal and a state control signal from, at least one external location;

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

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

(d) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal, and, based on the analysis, generating (A) at least one medical information signal representing said internal medical data, and (B) an internal control signal for controlling said treatment device,

(2) generating at least one treatment device signal; and

(3) selecting one of four operating states, in response to a received state control signal;

wherein;

(i) in a first operating state, said treatment device signals are produced only in response to said internal control signal;

(ii) in a second operating state, said treatment device control signals are produced only in response to said external control signal;

(iii) in a third operating state, said internal control signal, if any, controls said treatment device, unless an external control signal is received; and

if said external control signal is received, it takes priority over said internal control signal for determining the choice of treatment, if any, administered by said electronic medical treatment device;

(iv) in a fourth operating state, said external control signal, if any, controls said treatment device, unless an internal control signal is produced; and

if said internal control signal is produced, it takes priority over said external control signal, if any, for determining the choice of treatment administered by said electronic medical treatment device; and

(v) said first processor selects one of said four operating states in response to a received first state control signal;

whereby;

(i) in said first operating state, only said internal control signal controls said IMD,

(ii) in said second operating state, only said external control signal controls said IMD,

(iii) in said third operating state, said external control signal takes priority over said internal control signal, and

(iv) in said fourth operating state, said internal control signal takes priority over said external control signal;

thereby to cause said first processor to select the source of control of said IMD from among (A) said internal control signal, and (B) said external control signal, in response to said state control signal.

41. The apparatus defined in claim 40, further comprising a command station for setting the operating state of said IMD, said command station including:

(a) a command input device, for inputting a state setting command and for producing a command signal;

(b) a second processor, coupled to said command input device, for generating a state control signal in response to said command signal;

(c) a command transmitting device, coupled to said second processor, for transmitting said state control signal to said first processor via said first T/R device;

thereby to set the operating state of said IMD.

42. The apparatus defined in claim 40, further comprising a first external control station for controlling said IMD, said first external control station including:

(a) a third processor;

(b) a display device, coupled to said third processor, for displaying internal medical data of said patient;

(c) an input device, coupled to said third processor, for producing a first external control signal in response to an inputted treatment choice, for inputting commands from at least one of;

(i) a patient using said IMD,

(ii) a medical professional, and

(iii) an administrator,

(d) a second T/R device, coupled to said third processor, for receiving internal medical data of said patient, and for transmitting said first external control signal to said IMD

43. The apparatus defined in claim 40, further comprising a second external control station for controlling said IMD, said second external control station including:

(a) a fourth processor for producing a second external control signal in response to analysis by said fourth processor of said internal medical data; and

(b) a third T/R device, coupled to said fourth processor, for receiving internal medical data of said patient, and for transmitting said second external control signal.

44. The apparatus defined in claim 43, wherein said second external control station further comprises a database, for storing information concerning at least one of:

(i) the patient,

(ii) the IMD,

(iii) the prior use of the IMD by the patient,

(iv) the prior use of other implanted medical devices (IMDs) by the patient,

(v) the prior use of a substantially similar IMD by other patients, and

(vi) the prior use of different IMDs by other patients;

wherein said fourth processor is operative to select a therapy choice based on analysis by said fourth processor of at least one of;

(a) information obtained from said database, and

(b) said received internal medical data.

45. The apparatus defined in claim 43, wherein:

(i) said second external control station further comprises a second sensor circuit, having a second sensor circuit output coupled to said fourth processor, for producing at least one second sensor circuit output signal at said second sensor circuit output in response to external medical data sensed from the patient by said second sensor circuit;

(ii) said fourth processor is operative to select a therapy choice based on analysis by said fourth processor of at least one of;

(a) analysis of said second sensor circuit output signal, and

(b) said received internal medical data.

46. The apparatus defined in claim 42 further comprising a first identifier signal source, coupled to said second T/R device, for providing a first identifier signal for transmission to said first T/R device;

wherein, in the absence of the receipt of at least one of (i) said first identifier signal and (ii) said external control signal, said first processor is operative to cause said internal control signal to control said IMD;

whereby said first processor detects the absence of proper communications between said first external control station and said IMD, and remedies said absence;

thereby to control said IMD in the absence of proper communications with said first external control station.

47. The apparatus defined in claim 43 further comprising a second identifier signal source, coupled to said third T/R device, for providing a second identifier signal for transmission to said first T/R device;

wherein, in the absence of the receipt of at least one of (i) said second identifier signal and (ii) said external control signal, said first processor is operative to cause said internal control signal to control said IMD;

whereby said first processor detects the absence of proper communications between said second external control station and said IMD, and remedies said absence;

thereby to control of said IMD in the absence of proper communications with said second external control station.

48. The apparatus defined in claim 40, wherein:

(i) said first T/R device is adapted to transmit at least one signal representing a medical state of said patient to, and to receive N additional external control signals from, external locations;

(ii) said first processor is further adapted to select an operating state from among (a) said four operating states and (b) 3N additional operating states;

(iii) X is an integer ranging from the integer “

1”

to the integer “

N”

;

(iv) in the (3X+2)^th operating state, said treatment device control signals are produced only in response to an X^th additional external control signal;

(v) in the (3X+3)^th operating state, said internal control signal, if any, controls said treatment device, unless said X^th additional external control signal is received; and

if said X^th additional external control signal is received, it takes priority over said internal control signal for determining the choice of treatment, if any, administered by said electronic medical treatment device;

(vi) in the (3X+4)^th operating state, said X^th additional external control signal, if any, controls said treatment device, unless an internal control signal is produced; and

if said internal control signal is produced, it takes priority over said X^th additional external control signal, if any, for determining the choice of treatment administered by said electronic medical treatment device;

whereby;

(i) in said (3X+2)^th operating state, only said X^th additional external control signal controls said IMD,

(ii) in said (3X+3)^th operating state, said X^th additional external control signal takes priority over said internal control signal, and

(iii) in said (3X+4)^th operating state, said internal control signal takes priority over said X^th additional external control signal;

thereby to cause said first processor to select the source of control of said IMD from among (A) said internal control signal, (B) said external control signal, and (C) said N additional external control signals in response to said state control signal.

49. The apparatus defined in claim 40, wherein:

(i) said first T/R device is adapted to transmit at least one signal representing a medical state of said patient to, and to receive a plurality of additional external control signals from, external locations;

(ii) said first processor is further adapted to select an operating state from among (a) said four operating states and (b) at least three additional operating states;

(iii) in response to a second state control signal, said first processor is operative to assign a unique priority level to each of any received external control signals, wherein the values of said assigned priority levels indicate a control hierarchy among all such control signals and their sources;

(iv) a control signal assigned a given priority level overrides a treatment command represented by a control signal assigned a lower priority level;

(v) in a fifth operating state, said first processor is operative to select the received external control signal with the highest priority level for control of said IMD;

(vi) in a sixth operating state, said internal control signal, if any, controls said treatment device, unless a plurality of external control signals are received; and

if said plurality of external control signals are received, the received external control signal which has been assigned the highest priority, takes priority over said internal control signal for determining the choice of treatment, if any, administered by said electronic medical treatment device;

(vii) in a seventh operating state, the external control signal with the highest assigned priority controls said treatment device, unless an internal control signal is produced; and

if said internal control signal is produced, it takes priority over said received external control signal which has been assigned the highest priority, for determining the choice of treatment administered by said electronic medical treatment device;

whereby;

(i) in said fifth operating state, only the highest priority received external control signal controls said IMD,

(ii) in said sixth operating state, the highest priority received external control signal takes priority over said internal control signal, and

(iii) in said seventh operating state, said internal control signal takes priority over the highest priority received external control signal;

thereby to cause said first processor to select the source of control of said IMD from among (A) said internal control signal, (B) said external control signal, and (C) said plurality of additional external control signals in response to said second state control signal.

50. A medical monitoring and treatment system which may be controlled by a plurality of control sources, said system comprising, in combination:

(a) an implantable medical device (IMD), which is alternatively self-controlled and remotely controlled, said device comprising, in combination;

(i) a first transmitting/receiving (T/R) device for transmitting at least one signal representing internal medical data of a patient to, and for receiving external control signals from, external command and control stations;

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

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

(iv) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal and, based on the analysis, generating (A) at least one first medical information signal representing said internal medical data, and (B) an internal control signal for controlling said treatment device,

(2) receiving at least one external control signal;

(3) generating at least one treatment device signal; and

(4) receiving at least one command-hierarchy setting signal;

(b) at least one external control station, each comprising, in combination;

(i) a P^th transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD; and

(ii) a P^th processor, coupled to said P^th T/R device, for producing at least one external control signal for controlling said IMD; and

(c) at least one external command station, each comprising, in combination;

(i) a Q^th transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD;

(ii) a Q^th processor, coupled to said Q^th T/R device, for producing at least one hierarchy-setting signal for setting the hierarchy among the control station processors, for controlling said IMD; and

(iii) a Q^th input device, coupled to said Q^th processor, for inputting at least one hierarchy-setting command;

wherein;

(1) said first T/R device transmits at least one first medical information signal to at least one of said external control stations;

(2) said first processor is operative to generate at least one treatment device signal in response to at least one of (a) said internal control signal, and (b) at least one external control signal received from at least one of said external control stations by said first T/R device;

(3) said first processor is operative to receive said hierarchy-setting signal received from at least one of said external command stations by said first T/R device;

(4) in response to said hierarchy-setting signal said first processor is operative to assign a unique priority level to each of said internal and external control signals, wherein the values of said assigned priority levels indicate a control hierarchy among all such control signals and their sources, wherein;

a treatment device signal represented by a control signal assigned a given priority level overrides a treatment device signal represented by a control signal assigned a lower priority level;

whereby said IMD delivers the therapy represented by the control signal which has been assigned the highest priority level;

thereby to establish and maintain a hierarchy among the sources of control of said IMD.

51. The system defined in claim 50, wherein said first processor is operative to permanently assign at least one of said priority levels indicating said control hierarchy.

52. The system defined in claim 50, wherein:

(i) at least one of said input devices is operative to input a password prior to inputting of said at least one hierarchy-setting command, for transmission by said respective T/R device to said first processor,

(ii) said first processor is operative to store at least one password; and

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received password matches the stored password;

whereby access to setting the control hierarchy is restricted to at least one designated person.

53. The system defined in claim 50, wherein:

(i) at least one of said input devices is operative to input a biologic identifier prior to the inputting of said at least one hierarchy-setting command, for transmission by said respective T/R device to said first processor,

(ii) said first processor is operative to store at least one biologic identifier;

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received biologic identifier matches the stored biologic identifier.

54. The system defined in claim 53, wherein said biologic identifier is at least one of:

(i) a fingerprint image,

(ii) an image of a face,

(iii) an image of a retinal,

(iv) an image of an iris,

(v) a voiceprint, and

(vi) a sample of DNA.

55. The system defined in claim 50, wherein said internal control signal is assigned the highest priority;

thereby to give said internal control signal the highest priority for controlling said IMD.

56. The system defined in claim 50, wherein said internal control signal is assigned a priority selected from the group consisting of:

(i) second highest priority,

(ii) third highest priority,

(iii) fourth highest priority, and

(iv) fifth highest priority.

57. The system defined in claim 50, wherein one external control station further comprises at least one first patient input device, coupled to the respective processor, for inputting therapy commands from said patient;

and wherein the inputted patient therapy command causes the processor of the respective external control station to produce a patient external control signal which indicates the therapy choice of said patient.

58. The system defined in claim 57, wherein said external control station further comprises a display device, for displaying medical information to said patient.

59. The system defined in claim 58, wherein the T/R device of said respective external control station is operative to receive at least one medical information signal for consideration by said patient, in selecting said therapy choice.

60. The system defined in claim 57, wherein said patient external control signal is assigned the highest priority;

thereby to give the highest priority to said patient, for controlling said IMD.

61. The system defined in claim 57, wherein said patient external control signal is assigned a priority selected from the group consisting of:

(i) second highest priority,

(ii) third highest priority,

(iii) fourth highest priority, and

(iv) fifth highest priority.

62. The system defined in claim 50, wherein:

(i) one external control station further comprises a second sensor circuit, having a second sensor circuit output, for producing at least one second sensor circuit output signal at said second sensor circuit output in response to the external medical data sensed from the patient by said second sensor circuit; and

(ii) the respective processor of said external control station is operative to analyze said at least one second sensor output signal to produce a patient device external control signal which indicates the therapy choice of said respective processor, for controlling said IMD.

63. The system defined in claim 62, wherein:

(i) the processor of said respective external control station is operative to generate at least one second medical information signal representing said external medical data; and

(ii) the respective T/R device of said external control station is operative to transmit said second medical information signal to at least one of;

(1) said first T/R device, for analysis by said first processor, and

(2) the T/R device of another external control station;

whereby said external medical data is available for use by at least one of (a) said IMD, and (b) at least one other external control unit.

64. The system defined in claim 62, wherein:

(i) the Pth T/R device of a respective external control station is operative to receive at least one additional medical information signal;

(ii) the Pth processor of said respective external control station is further operative to analyze said at least one additional medical information signal received by the respective T/R device of said external control station to produce a patient device external control signal which indicates the therapy choice of said respective processor;

whereby said respective processor of said external control station analyzes at least;

(a) said at least one second sensor output signal, and

(b) said at least one additional received medical information signal,

to produce said patient device external control signal for controlling said IMD.

65. The system defined in claim 62, wherein said patient device external control signal is assigned the highest priority;

thereby to give the highest priority to the therapy choice of the processor of said external medical data sensed from the patient, for controlling said IMD.

66. The system defined in claim 62, wherein said patient device external control signal is assigned a priority selected from the group consisting of:

(i) second highest priority,

(ii) third highest priority,

(iii) fourth highest priority, and

(iv) fifth highest priority.

67. The system defined in claim 62, wherein said one external control station further comprises at least one sensor, placed external to and in proximity to said patient, and coupled to said sensor circuit, for providing physiologic data about said patient.

68. The system defined in claim 67, wherein said sensor is selected from the group consisting of:

(i) an electrocardiogram electrode,

(ii) a blood pressure cuff,

(iii) an oxygen saturation sensor,

(iv) a carbon dioxide detector,

(v) an accelerometer,

(vi) a detector of body attitude,

(vii) a ketone detector,

(viii) a respiration detector,

(ix) an electroencephalogram electrode,

(x) an electrode for measuring skin resistance,

(xi) a video camera, and

(xii) a microphone.

69. The system defined in claim 62 further comprising:

(a) an output device, coupled to said respective processor of said external control station, for providing at least one question to said patient, and

(b) a patient response input device, coupled to said respective processor of said external control station, for inputting at least one response from said patient;

wherein;

(i) said response, if any, to said at least one question indicates a degree of necessity of therapy for said patient;

(ii) said respective processor is operative to determine said degree of necessity from the inputted response, if any;

(iii) said respective processor utilizes the determination of said degree of necessity to select a therapy choice; and

(iv) said respective processor produces a patient device external control signal which indicates said therapy choice of said external device based on said determination, for transmission to said first processor.

70. The system defined in claim 69, wherein:

(i) the processor of said respective external control station is operative to generate at least one third medical information signal representing said degree of necessity; and

(ii) the respective T/R device of said external control station is operative to transmit said third medical information signal to at least one of;

(1) said first T/R device, for analysis by said first processor, and

(2) the T/R device of another external control station;

whereby said information indicating said degree of necessity is available for use by at least one of (a) said IMD, and (b) at least one other external control unit.

71. The system defined in claim 50, wherein one external control station further comprises (a) a display device for displaying medical information to a medical professional, and (b) a medical professional input device, coupled to the respective processor, for inputting therapy choices from the medical professional;

and wherein an inputted medical professional therapy command causes the processor of the respective external control station to produce a medical professional external control signal.

72. The system defined in claim 71, wherein the T/R device of said respective external control station is operative to receive at least one medical information signal for consideration by said medical professional in selecting said therapy choice.

73. The system defined in claim 71, wherein said medical professional external control signal is assigned the highest priority;

thereby to give the highest priority to said medical professional, for controlling said IMD.

74. The system defined in claim 71, wherein said medical professional external control signal is assigned a priority selected from the group consisting of:

(i) second highest priority,

(ii) third highest priority,

(iii) fourth highest priority, and

(iv) fifth highest priority.

75. The system defined in claim 50, wherein one external control station further comprises a database, coupled to the respective processor, for storing information about at least one of:

(i) the patient,

(ii) the IMD,

(iii) the prior use of the IMD by the patient,

(iv) the prior use of other implanted medical devices (IMDs) by the patient,

(v) the prior use of a substantially similar IMD by other patients, and

(vi) the prior use of different IMDs by other patients;

wherein said respective processor of said external control station is operative to select a therapy choice based on analysis by said respective processor of;

(a) at least a portion of said information stored in said database, and

(b) said at least one first medical information signal; and

wherein said respective processor produces a medical expert external control signal which indicates the therapy choice of said external device based on said analysis, for transmission to said first processor.

76. The system defined in claim 75, wherein:

(i) the processor of said one external control station is operative to generate at least one fourth medical information signal representing information stored in said database; and

(ii) the respective T/R device of said one external control station is operative to transmit said fourth medical information signal to at least one of;

(1) said first T/R device, for analysis by said first processor, and

(2) the T/R device of another external control station;

whereby said database information is available for use by at least one of (a) said IMD, and (b) at least one other external control station.

77. The system defined in claim 75, wherein:

(i) the T/R device of said one external control station is operative to receive at least one additional medical information signal;

(ii) said respective processor of said one external control station is further operative to analyze said at least one additional medical information signal received by the respective T/R device of said external control station to produce a medical expert external control signal which indicates the therapy choice of said respective processor;

whereby said respective processor of said external control station analyzes at least;

(a) said database information, and

(b) said at least one additional received medical information signal, to produce said medical expert external control signal for controlling said IMD.

78. The system defined in claim 75, wherein said medical expert external control signal is assigned the highest priority;

thereby to give the highest priority to the therapy choice selected by the processor performing the analysis of the database information, for controlling said IMD.

79. The system defined in claim 75, wherein said medical expert external control signal is assigned a priority selected from the group consisting of:

(i) second highest priority,

(ii) third highest priority,

(iii) fourth highest priority, and

(iv) fifth highest priority.

80. The system defined in claim 75, wherein said analysis comprises at least one of:

(i) analyzing the results of the prior use of the IMD by the patient, at a time when internal medical data sensed from the patient was substantially similar to the current patient internal medical data;

(ii) analyzing the results of the prior use of the IMD by the patient, at a time when internal medical data sensed from the patient was substantially different from the current patient internal medical data;

(iii) analyzing the results of the prior use of another IMD by the patient, at a time when internal medical data sensed from the patient was substantially similar to the current patient internal medical data;

(iv) analyzing the results of the prior use of another IMD by the patient, at a time when internal medical data sensed from the patient was substantially different from the current patient internal medical data;

(v) analyzing the results of the prior use of substantially similar IMDs by other patients, at a time when internal medical data sensed from said other patients was substantially similar to the current patient internal medical data;

(vi) analyzing the results of the prior use of substantially similar IMDs by other patients, at times when internal medical data sensed from said other patients was substantially different from the current patient internal medical data;

(vii) analyzing the results of the prior use of different IMDs by other patients, at times when internal medical data sensed from said other patients was substantially similar to the current patient internal medical data; and

(viii) analyzing the results of the prior use of different IMDs by other patients, at a time when internal medical data sensed from said other patients was substantially different from the current patient internal medical data;

thereby to determine an optimal medical treatment based on information in said database.

81. The system defined in claim 50, wherein:

(i) said first T/R device is operative to receive at least one medical information signal transmitted by the T/R device of an external control station, and

(ii) said first processor is further operative to generate said internal control signal based on the analysis of both;

(a) said received medical information signal, and

(b) said first medical information.

82. Medical monitoring and treatment apparatus which may be controlled by a plurality of control sources, said apparatus comprising, in combination:

(a) a personal medical device (PMD) adapted to be carried by a patient, either internally or externally, which PMD is alternatively self-controlled and remotely controlled, said device comprising, in combination;

(i) a first transmitting/receiving (T/R) device for transmitting at least one signal representing medical data of the patient to, and for receiving external control signals from external control stations;

(ii) an electronic medical treatment device for treating the patient in response to treatment device signals applied thereto;

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

(iv) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal and, based on the analysis, generating (A) at least one first medical information signal representing said medical data, and (B) an internal control signal for controlling said treatment device,

(2) receiving at least one external control signal;

(3) generating at least one treatment device signal; and

(4) receiving at least one command-hierarchy setting signal; and

(b) at least two external control stations, each comprising, in combination;

(i) a P^th transmitting/receiving (T/R) device for electronic communication with said first T/R device of said PMD; and

(ii) a P^th processor, coupled to said P^th T/R device, for producing at least one external control signal for controlling said PMD;

wherein;

(1) said first T/R device transmits at least one first medical information signal to at least one of said external control stations;

(2) said first processor is operative to generate at least one treatment device signal in response to at least one of (a) said internal control signal, and (b) an external control signal received from at least one of a plurality of said external control stations by said first T/R device;

(3) in response to said command-hierarchy setting signal, said first processor is operative to assign a unique priority level to each of said internal and external control signals, wherein the values of said assigned priority levels indicate a control hierarchy among all such control signals and their sources,

wherein;

a treatment device signal represented by a control signal assigned a given priority level overrides a treatment device signal represented by a control signal assigned a lower priority level;

whereby said PMD delivers the therapy represented by the control signal which has been assigned the highest priority level;

thereby to establish and maintain a hierarchy among the sources of control of said PMD.

83. The apparatus defined in claim 82, further comprising a command station for setting the operating state of said PMD, said command station including:

(a) a command input device, for inputting a state setting command and for producing a command signal;

(b) a second processor, coupled to said command input device, for generating a state control signal in response to said command signal;

(c) a command transmitting device, coupled to said second processor, for transmitting a command-hierarchy setting signal to said first processor via said first T/R device, in response to said state control signal from said second processor;

thereby to set the operating state of said PMD.

84. The apparatus defined in claim 82, wherein said PMD is an implanted medical device (IMD), implanted in a body of said patient.

85. The apparatus defined in claim 82, wherein said PMD is an external medical device (EMD), located external to the body of said patient.

86. The apparatus defined in claim 84, wherein said medical data is internal medical data, acquired within a body of said patient.

87. The apparatus defined in claim 86, further comprising a first sensor, implanted inside of said body, for sensing said internal medical data;

and wherein said first sensor circuit further comprises a sensor circuit input, adapted to be coupled to said first sensor;

whereby said IMD is operative to sense said internal medical data.

88. The apparatus defined in claim 86, further comprising a first sensing device, implanted inside of said body, comprising:

(a) a second sensor, for sensing internal medical data of said patient;

(b) a third processor, coupled to said second sensor, for producing a first sensing signal representing said internal medical data; and

(c) a first sensor transmitting device, coupled to said third processor, for transmitting a first sensing output signal, representing said internal medical data, to said first T/R device;

wherein said first sensor circuit is coupled to said first T/R device, for receipt of information representing said internal medical state, received by said first T/R device;

whereby said IMD is operative to sense a representation of said internal medical data transmitted by said implanted first sensing device.

89. The apparatus defined in claim 84, further comprising a second sensing device, located outside of said body, comprising:

(a) a third sensor, for sensing external medical data of said patient;

(b) a fourth processor, coupled to said third sensor, for producing a second sensing signal representing said external medical data;

and

(c) a second sensor transmitting device, coupled to said fourth processor, for transmitting a second sensing signal, representing said external medical data, to said first T/R device;

wherein said first sensor circuit is coupled to said first T/R device, for receipt of information representing said external medical data, received by said first T/R device;

whereby said IMD is operative to sense a representation of said external medical data transmitted by said external second sensing device.

90. The apparatus defined in claim 85, further comprising a third sensing device, located inside of said body, comprising:

(a) a fourth sensor, for sensing internal medical data of said patient;

(b) a fifth processor, coupled to said fourth sensor, for producing a third sensing signal representing said internal medical data;

and

(c) a third sensor transmitting device, coupled to said fifth processor, for transmitting a third sensing signal, representing said internal medical data, to said first T/R device;

wherein said first sensor circuit is coupled to said first T/R device, for receipt of information representing said internal medical data, received by said first T/R device;

whereby said EMD is operative to sense a representation of said internal medical data transmitted by said internal third sensing device.

91. The apparatus defined in claim 85, wherein said medical data is external medical data, acquired outside of a body of said patient.

92. The apparatus defined in claim 91, further comprising a fourth sensing device, located outside of said body, comprising:

(a) a fifth sensor, for sensing external medical data of said patient;

(b) a sixth processor, coupled to said fifth sensor, for producing a fourth sensing signal representing said external medical data; and

(c) a fourth sensor transmitting device, coupled to said sixth processor, for transmitting a fourth sensing signal, representing said external medical data, to said first T/R device;

wherein said first sensor circuit is coupled to said first T/R device, for receipt of information representing said external medical state, received by said first T/R device;

whereby said EMD is operative to sense a representation of said external medical data transmitted by said external fourth sensing device.

93. The apparatus defined in claim 91, further comprising a sixth sensor, located outside of said body, for sensing external medical data;

and wherein said first sensor circuit further comprises a sensor circuit input, adapted to be coupled to said sixth sensor;

whereby said EMD is operative to sense said external medical data.

94. The apparatus defined in claim 86, wherein:

(A) one of said external control stations is a local external control station, located in the vicinity of said IMD, comprising, in combination;

(i) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD; and

(ii) a seventh processor, coupled to said second T/R device, for producing at least one local external control signal for controlling said IMD;

(B) another one of said external control stations is a remote external control station comprising, in combination;

(i) a third transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD; and

(ii) an eighth processor, coupled to said third T/R device, for producing at least one remote external control signal for controlling said IMD; and

wherein;

(1) said first T/R device transmits at least one signal representing an internal medical state of said patient to at least one of said local and said remote external control stations;

(2) said first processor is operative to generate at least one treatment device control signal in response to at least one of (a) said internal control signal, and (b) an external control signal received from at least one of said local and said remote external control stations by said first T/R device;

(3) said first processor is operative to assign a priority level to each of (i) said internal control signal, (ii) said local external control signal and (iii) said remote external control signal,

thereby to establish and maintain a hierarchy among the sources of control of said IMD.

95. The apparatus defined in claim 94, wherein:

(i) said local external control station further comprises a first input device, coupled to said seventh processor, for inputting hierarchy-setting commands by at least one of (a) said patient, and (b) a medical professional;

(ii) said seventh processor is operative to produce a hierarchy-setting signal in response to an inputted hierarchy-setting command; and

(iii) said second T/R transmits said hierarchy setting signal to said first processor via said first T/R device;

thereby to allow at least one of said patient and a medical professional to set the control hierarchy of said apparatus, from said local external control station.

96. The apparatus defined in claim 94, wherein:

(i) said remote external control station further comprises a second input device, coupled to said eighth processor, for inputting hierarchy-setting commands by a medical professional;

(ii) said eighth processor is operative to produce said hierarchy-setting signal in response to an inputted hierarchy-setting command; and

(iii) said third T/R transmits said hierarchy-setting signal to said first processor via said first T/R device;

thereby to allow a medical professional to set the control hierarchy of said apparatus, from said remote external control station.

97. The apparatus defined in claim 82, wherein said first processor is operative to permanently assign at least one of said priority levels indicating said control hierarchy.

98. The apparatus defined in claim 95, wherein:

(i) said first input device is operative to input a password prior to inputting of said at least one hierarchy-setting command, for transmission by said seventh T/R device to said first processor,

(ii) said first processor is operative to store at least one password; and

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received password matches the stored password;

whereby access to setting the control hierarchy is password restricted.

99. The apparatus defined in claim 96, wherein:

(i) said second input device is operative to input a password prior to inputting of said at least one hierarchy-setting command, for transmission by said eighth T/R device to said first processor,

(ii) said first processor is operative to store at least one password; and

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received password matches the stored password;

whereby access to setting the control hierarchy is password restricted.

100. The apparatus defined in claim 83, wherein:

(i) said command input device is operative to input a password prior to inputting of said at least one hierarchy-setting command, for transmission by said command transmitting device to said first processor,

(ii) said first processor is operative to store at least one password; and

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received password matches the stored password;

whereby access to setting the control hierarchy is password restricted.

101. The apparatus defined in claim 95, wherein:

(i) said first input device is operative to input a biologic identifier prior to the inputting of said at least one hierarchy-setting command, for transmission by said seventh T/R device to said first processor,

(ii) said first processor is operative to store at least one biologic identifier;

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received biologic identifier matches the stored biologic identifier.

102. The apparatus defined in claim 96, wherein:

(i) said second input device is operative to input a biologic identifier prior to the inputting of said at least one hierarchy-setting command, for transmission by said eighth T/R device to said first processor,

(ii) said first processor is operative to store at least one biologic identifier;

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received biologic identifier matches the stored biologic identifier.

103. The apparatus defined in claim 83, wherein:

(i) said command input device is operative to input a biologic identifier prior to the inputting of said at least one hierarchy-setting command, for transmission by said command transmitting device to said first processor,

(ii) said first processor is operative to store at least one biologic identifier;

(iii) said first processor is operative to assign said priority levels indicating said control hierarchy only if said received biologic identifier matches the stored biologic identifier.

104. The apparatus defined in claim 94, wherein said internal control signal is assigned the highest priority;

thereby to give said internal control signal the highest priority for controlling said IMD.

105. The apparatus defined in claim 94, wherein said local external control station further comprises at least one first patient input device, coupled to the seventh processor, for inputting therapy commands from said patient;

and wherein the inputted patient therapy command causes said seventh processor to produce a patient external control signal which indicates the therapy choice of said patient for controlling the IMD.

106. The apparatus defined in claim 105, wherein said patient external control signal is assigned the highest priority;

thereby to give the highest priority to said patient, for controlling the IMD.

107. The apparatus defined in claim 94, wherein:

(i) said local external control station further comprises a second sensor circuit, having a second sensor circuit output, for producing at least one second sensor circuit output signal at said second sensor circuit output in response to external medical data sensed from the patient by said second sensor circuit; and

(ii) the seventh processor is operative to analyze said at least one second sensor output signal to produce a patient device external control signal which indicates the therapy choice of said seventh processor, for controlling said IMD.

108. The apparatus defined in claim 107, wherein:

(i) said seventh processor is further operative to generate a first urgent command-hierarchy setting signal, in response to the analysis of at least one of (A) said at least one second sensor output signal, and (B) said signal representing medical data of the patient; and

(ii) said second T/R device is operative to transmit said first urgent hierarchy-setting signal to said first processor, via said first T/R device;

whereby the processor of said local external control station may reset the control hierarchy upon the detection of an urgent patient condition.

109. The apparatus defined in claim 108, wherein:

(i) said seventh processor is further operative to generate a first non-urgent command-hierarchy setting signal, in response to the analysis of at least one of (A) said at least one second sensor output signal, and (B) said signal representing medical data of the patient; and

(ii) said second T/R device is operative to transmit said first non-urgent hierarchy-setting signal to said first processor, via said first T/R device;

whereby the processor of said local external control station may further reset the control hierarchy upon the detection of a stable patient condition, after an urgent patient condition.

110. The apparatus defined in claim 107, wherein said patient device external control signal is assigned the highest priority;

thereby to give the highest priority to the therapy choice of the seventh processor, making therapy choices based on said external medical data sensed from the patient, for controlling said IMD.

111. The apparatus defined in claim 107, wherein said local external control station further comprises at least one seventh sensor, placed external to and in proximity to said patient, and coupled to said second sensor circuit, for providing physiologic data about said patient.

112. The apparatus defined in claim 111, wherein said seventh sensor is selected from the group consisting of:

(i) an electrocardiogram electrode,

(ii) a blood pressure cuff,

(iii) an oxygen saturation sensor,

(iv) a carbon dioxide detector,

(v) an accelerometer,

(vi) a detector of body attitude,

(vii) a ketone detector,

(viii) a respiration detector,

(ix) an electroencephalogram electrode,

(x) an electrode for measuring skin resistance,

(xi) a video camera, and

(xii) a microphone.

113. The apparatus defined in claim 107 further comprising:

(a) an output device, coupled to said seventh processor, for providing at least one question to said patient, and

(b) a second input device, coupled to said seventh processor, for inputting at least one response from said patient;

wherein;

(i) said response, if any, to said at least one question indicates a degree of necessity of therapy for said patient;

(ii) said seventh processor is operative to determine said degree of necessity from the inputted response, if any;

(iii) said seventh processor utilizes the determination of said degree of necessity to select a therapy choice; and

(iv) said seventh processor produces a patient device external control signal which indicates said therapy choice of said local external control station based on said determination, for transmission to said first processor.

114. The apparatus defined in claim 94, wherein said remote external control station further comprises a medical professional input device, coupled to the eighth processor, for inputting therapy choices from a medical professional;

and wherein an inputted medical professional therapy command causes the eighth processor to produce a medical professional external control signal which indicates the therapy choice of said medical professional for controlling the IMD.

115. The apparatus defined in claim 114, wherein said medical professional external control signal is assigned the highest priority;

thereby to give the highest priority to said medical professional, for controlling said IMD.

116. The apparatus defined in claim 94, wherein said remote external control station further comprises a database, coupled to said eighth processor, for storing information about at least one of:

(i) the patient,

(ii) the IMD,

(iii) the prior use of the IMD by the patient,

(iv) the prior use of other implanted medical devices (IMDs) by the patient,

(v) the prior use of the IMD by other patients, and

(vi) the prior use of other IMDs by other patients;

wherein said eighth processor is operative to select a therapy choice based on analysis by said eighth processor of;

(a) information obtained from said database, and

(b) said at least one signal representing an internal medical state of a patient; and

wherein said eighth processor produces a medical expert external control signal which indicates the therapy choice of said remote external control station based on said analysis, for transmission to said first processor.

117. The apparatus defined in claim 116, wherein:

(i) said eighth processor is further operative to generate a second urgent command-hierarchy setting signal, in response to the analysis of at least one of (A) the information obtained from said database, and (B) said signal representing medical data of the patient; and

(ii) said third T/R device is operative to transmit said second urgent hierarchy-setting signal to said first processor, via said first T/R device;

whereby the processor of said remote external control station may reset the control hierarchy upon the detection of an urgent patient condition.

118. The apparatus defined in claim 117, wherein:

(i) said eighth processor is further operative to generate a second non-urgent command-hierarchy setting signal, in response to the analysis of at least one of (A) the information obtained from said database, and (B) said signal representing medical data of the patient; and

(ii) said third T/R device is operative to transmit said second non-urgent hierarchy-setting signal to said first processor, via said first T/R device;

whereby the processor of said remote external control station may further reset the control hierarchy upon the detection of a stable patient condition, after an urgent patient condition.

119. The apparatus defined in claim 116, wherein said medical expert external control signal is assigned the highest priority;

thereby to give the highest priority to the therapy choice selected by the third processor performing the analysis which includes the database information, for controlling said IMD.

120. The apparatus defined in claim 116, wherein said analysis by said eighth processor comprises at least one of:

(i) analyzing the results of the prior use of the IMD by the patient, at a time when internal medical data sensed from the patient was substantially similar to the current patient internal medical data;

(ii) analyzing the results of the prior use of the IMD by the patient, at a time when internal medical data sensed from the patient was substantially different from the current patient internal medical data;

(iii) analyzing the results of the prior use of another IMD by the patient, at a time when internal medical data sensed from the patient was substantially similar to the current patient internal medical data;

(iv) analyzing the results of the prior use of another IMD by the patient, at a time when internal medical data sensed from the patient was substantially different from the current patient internal medical data;

(v) analyzing the results of the prior use of substantially similar IMDs by other patients, at times when internal medical data sensed from said other patients was substantially similar to the current patient internal medical data;

(vi) analyzing the results of the prior use of substantially similar IMDs by other patients, at times when internal medical data sensed from the other patients was substantially different from the current patient internal medical data;

(vii) analyzing the results of the prior use of different IMDs by other patients, at times when internal medical data sensed from said other patients was substantially similar to the current patient internal medical data; and

(viii) analyzing the results of the prior use of different IMDs by other patients, at a time when internal medical data sensed from said other patients was substantially different from the current patient internal medical data;

thereby to determine an optimal medical treatment based on information in said database.

121. Medical monitoring and treatment apparatus which is controlled by a plurality of control sources, said system comprising, in combination:

(a) an implantable medical device (IMD), which is alternatively self-controlled and remotely controlled, said device comprising, in combination;

(i) a first transmitting/receiving (T/R) device for transmitting at least one signal representing an internal medical state of a patient to, and for receiving external control signals from, external locations;

(ii) a medical treatment device for treating said patient in response to treatment device control signals applied thereto;

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

(iv) a first processor, coupled to each of

(1) said first sensor circuit output,

(2) said first T/R device, and

(3) said treatment device,

for

(1) analyzing said at least one first sensor circuit output signal;

(2) generating an internal control signal, in response to said analysis, for controlling said treatment device; and

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

(b) a local external control station comprising, in combination;

(i) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD; and

(ii) a second processor, coupled to said second T/R device, for producing at least one local external control signal for controlling said IMD; and

(c) a remote external control station comprising, in combination;

(i) a third transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD; and

(ii) a third processor, coupled to said third T/R device, for producing at least one remote external control signal for controlling said IMD;

wherein;

(1) said first T/R device transmits at least one signal representing an internal medical state of said patient to at least one of said local and said remote external control stations; and

(2) said first processor is operative to generate at least one treatment device control signal in response to at least one of;

(a) said internal control signal, and

(b) at least one external control signal received from at least one of;

(i) said local external control station, and

(ii) said remote external control station by said first T/R device;

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

(i) the analysis of said at least one first sensor circuit output signal by said first processor,

(ii) said at least one local external control signal, and

(iii) said at least one remote external control signal.

122. The apparatus defined in claim 121, wherein, when both (i) a local external control signal is received by said first T/R device, and (ii) an internal control signal is generated, the response of said first processor to both signals is selected from the group consisting of:

(a) the therapy choice indicated by said local external control signal takes priority over the therapy choice indicated by said internal control signal, for determining the treatment;

(b) the therapy choice indicated by said internal control signal takes priority over the therapy choice indicated by said local external control signal, for determining the treatment; and

(c) both of the therapy choices indicated by said local external control signal and said internal control signal determine the treatment.

123. The apparatus defined in claim 121, wherein, when both (i) a remote external control signal is received by said first T/R device, and (ii) an internal control signal is generated, the response of said first processor to both signals is selected from the group consisting of:

(a) the therapy choice indicated by said remote external control signal takes priority over the therapy choice indicated by said internal control signal, for determining the treatment;

(b) the therapy choice indicated by said internal control signal takes priority over the therapy choice indicated by said remote external control signal, for determining the treatment; and

(c) both of the therapy choices indicated by said remote external control signal and said internal control signal determine the treatment.

124. The apparatus defined in claim 121, wherein, when both (i) a local external control signal is received by said first T/R device, and (ii) a remote external control signal is received by said first T/R device, the response of said first processor to both signals is selected from the group consisting of:

(a) the therapy choice indicated by said local external control signal takes priority over the therapy choice indicated by said remote external control signal, for determining the treatment;

(b) the therapy choice indicated by said remote external control signal takes priority over the therapy choice indicated by said local external control signal, for determining the treatment; and

(c) both of the therapy choices indicated by said local external control signal and said remote external control signal determine the treatment.

125. The apparatus defined in claim 121, wherein, when:

(i) a remote external control signal is received by said first T/R device,

(ii) a local external control signal is received by said first T/R device, and

(iii) an internal control signal is generated;

the response of said first processor to both signals is selected from the group consisting of;

(a) the therapy choice indicated by said remote external control signal takes priority over both (1) the therapy choice indicated by said local external control signal, and (2) the therapy choice indicated by said internal control signal, for determining the treatment;

(b) the therapy choice indicated by said local external control signal takes priority over both (1) the therapy choice indicated by said remote external control signal, and (2) the therapy choice indicated by said internal control signal, for determining the treatment;

(c) the therapy choice indicated by said internal control signal takes priority over both (1) the therapy choice indicated by said local external control signal, and (2) the therapy choice indicated by said remote external control signal, for determining the treatment;

(d) both of the therapy choices indicated by said local external control signal and said internal control signal determine the treatment;

(e) both of the therapy choices indicated by said remote external control signal and said internal control signal determine the treatment;

(f) both of the therapy choices indicated by said local external control signal and said remote external control signal determine the treatment; and

(g) all three of the therapy choices indicated by said remote external control signal, said local external control signal, and said internal control signal determine the treatment.

126. The system defined in claim 121, wherein said local external control station further comprises a patient assessment device, coupled to said second processor, for assessing the physiologic state of said patient, and for generating an assessment signal in response thereto, and wherein:

(i) said second processor is operative to analyze said assessment signal and, based on the analysis, to generate a first local processor signal indicating a therapy choice for said medical treatment device, and

(ii) in response to said first local processor signal, said second T/R device is operative to transmit a local external control signal, indicating the therapy choice of said second processor, to said first T/R device;

whereby said local external control station controls the therapy choice of said IMD.

127. The system defined in claim 126, wherein said patient assessment device is operative to analyze said signal representing an internal medical state of a patient and, based on the analysis, to cause said second processor to generate said first local processor signal indicating a therapy choice for said medical treatment device.

128. The system defined in claim 126, further comprising a patient communication device, coupled to said patient assessment device for exchanging information with the patient,

wherein:

(a) said patient communication device is operative to ask at least one question of said patient, and to receive a respective response, if any, inputted to said patient communication device;

(b) said patient assessment device is operative to assess the response to said at least one question, and to generate a patient fitness signal, representing the physiologic state of said patient as assessed by said at least one question;

(c) said second processor is operative to utilize said at least one response for additional analysis for the determination of the first local processor signal indicating a therapy choice for said medical treatment device.

129. The system defined in claim 126, wherein:

(i) said local external control station further comprises a second sensor circuit, having a second sensor circuit output, for producing at least one second sensor circuit output signal at said second sensor circuit output in response to the external medical data sensed from the patient by said second sensor circuit; and

(ii) said patient assessment device is coupled to said second sensor circuit output and is operative to utilize said at least one second sensor output signal for analysis of said external medical data, for the generation of an assessment signal representing the physiologic state of said patient as observed externally;

thereby to utilize the signal representing the external medical state of the patient, in the therapy decision of said second processor.

130. The system defined in claim 129, wherein said patient assessment device is further operative to provide said second sensor output signal to said second processor, and wherein said second processor is operative to cause said second T/R device to transmit a representation of said second sensor output signal to at least one of:

(a) said first T/R device, and

(b) said third T/R device;

thereby to allow for the use of information based on the second sensor output signal by at least one said first processor and said third processor.

131. The system defined in claim 126, wherein said second processor is further operative to cause said second T/R device to transmit a signal representing at least one of (i) the information in said assessment signal, and (ii) the analysis by said second processor of said assessment signal to at least one of:

(a) said first T/R device, and

(b) said third T/R device;

thereby to allow for the use of information based on the patient assessment signal by at least one said first processor and said third processor.

132. The system defined in claim 121, wherein:

(i) said local external control station further comprises a first input device, coupled to said second processor, for inputting a medical treatment device therapy selection by said patient;

(ii) in response to said selection, said second processor is operative to generate a second local processor signal indicating a therapy choice of said patient, and

(iii) in response to said second local processor signal, said second T/R device is operative to transmit a local external control signal representing the patient choice to said first T/R device;

whereby said patient controls the therapy choice of said medical treatment device.

133. The system defined in claim 132, wherein said local external control station further comprises a first display device, coupled to said second processor, for display of information representing the medical state of said patient, based on said signal representing an internal medical state of a patient;

thereby to provide internal medical information to the patient for patient decisions.

134. The system defined in claim 126, further comprising a second input device, coupled to said second processor, for inputting a medical treatment device therapy selection, if any, by the patient;

wherein;

(i) if said patient does not input a medical therapy selection to said second input device, said first local processor signal, if any, causes said second T/R device to transmit a local external control signal representing the therapy choice indicated by said first local processor signal to said first T/R device, and

(iii) if said patient does input a medical therapy selection to said second input device, said second processor causes said second T/R device to transmit a local external control signal representing the therapy choice indicated by said second input device to said first T/R device;

thereby to establish a control hierarchy for treatment selection source in which the treatment selection by said patient takes priority over a treatment selection based on the analysis of said patient assessment signal.

135. The system defined in claim 126, further comprising a third input device, coupled to said second processor, for inputting a medical treatment device therapy selection, if any, by the patient;

wherein;

(i) if said second processor generates said first local processor signal, a local external control signal representing the therapy choice resulting from said second processor analysis is transmitted to said first T/R device, and

(iii) if said second processor does not generate said first local processor signal, and if said patient does input a medical therapy selection to said third input device, a local external control signal representing the therapy choice indicated by said third input device is transmitted to said first T/R device;

thereby to establish a control hierarchy for treatment selection source in which the treatment selection based on the analysis of said patient assessment signal takes priority over a treatment selection of said patient.

136. The system defined in claim 126, further comprising a fourth input device, coupled to said second processor, for inputting a medical treatment device therapy selection, if any, by the patient;

wherein;

(i) if said second processor generates said first local processor signal, and if said patient does not input a medical treatment device therapy selection to said fourth input device, a local external control signal representing the therapy choice resulting from said second processor analysis of said patient assessment signal is transmitted to said first T/R device, and

(ii) if said second processor does not generate said first local processor signal, and if said patient does input a medical treatment device therapy selection to said fourth input device, a local external control signal representing the therapy choice of said patient is transmitted to said first T/R device, and

(iii) if said second processor generates said first local processor signal, and if said patient does input a medical treatment device therapy selection to said fourth input device, a local external control signal representing both (1) the therapy choice resulting from said second processor analysis of said patient assessment signal, and (2) the therapy choice indicated by said fourth input device, is transmitted to said first T/R device;

thereby to transmit the therapy choice of both the patient and the second processor.

137. The system defined in claim 121, wherein said remote external control station further comprises a remote patient assessment device, coupled to said third processor, for remotely assessing the physiologic state of said patient, and for generating a remote assessment signal in response thereto, and wherein:

(i) said third processor is operative to analyze said remote assessment signal and, based on the analysis, to generate a first remote processor signal indicating a therapy choice for said medical treatment device, and

(ii) in response to said first remote processor signal, said third T/R device is operative to transmit a remote external control signal indicating the therapy choice of said third processor, to said first T/R device;

whereby said remote external control station controls the therapy choice of said IMD.

138. The system defined in claim 137, wherein said remote patient assessment device is operative to analyze said signal representing an internal medical state of a patient and, based on the analysis, to cause said third processor to generate said first remote processor signal indicating a therapy choice for said medical treatment device.

139. The system defined in claim 137, wherein:

(i) said third T/R device is operative to receive a signal transmitted by said second T/R device concerning the physiologic state of said patient as measured external to the body of said patient; and

(ii) said remote patient assessment device is operative to analyze such external medical signal and, based on the analysis, to cause said third processor to generate said first remote processor signal indicating a therapy choice for said medical treatment device.

140. The system defined in claim 137, further comprising a database, coupled to said remote patient assessment device, for storing and providing database information concerning at least one of:

(i) the patient using the IMD,

(ii) the IMD,

(iii) a prior use of the IMD by the patient,

(iv) a prior use of other implanted medical devices (IMDs) by the patient,

(v) a prior use of a substantially similar IMD by other patients, and

(vi) a prior use of different IMDs by other patients; and

wherein said third processor is further operative to utilize both (i) a received signal representing an internal medical state of the patient (ii) information obtained from said database for the determination of the first remote processor signal indicating a therapy choice for said medical treatment device.

141. The system defined in claim 140, wherein said third processor is further operative to cause said third T/R device to transmit a representation of said database information to at least one of:

(a) said first T/R device, and

(b) said second T/R device,

thereby to allow for the use of said database information by at least one said first processor and said second processor.

142. The system defined in claim 121, wherein said remote external control station further comprises:

(a) a second display device, coupled to said third processor, for display of information representing the medical state of said patient, based on said signal representing an internal medical state of a patient, and

(b) a fifth input device, coupled to said third processor, for inputting a medical treatment device therapy selection by a medical professional;

wherein;

(i) in response to said a therapy selection by said medical professional, said third processor is operative to generate a second remote processor signal indicating a therapy choice of said medical professional, and

(ii) in response to said second remote processor signal, said third T/R device is operative to transmit a remote external control signal representing the medical professional choice to said first T/R device;

whereby said medical professional controls the therapy choice of said medical treatment device.

143. The system defined in claim 137, further comprising a sixth input device, coupled to said third processor, for inputting a medical treatment device therapy selection, if any, by a medical professional;

wherein;

(i) if the medical professional does not input a medical therapy selection to said sixth input device, said first remote processor signal, if any, causes said third T/R device to transmit a remote external control signal representing the therapy choice indicated by said first remote processor signal to said first T/R device, and

(iii) if the medical professional does input a medical therapy selection to said sixth input device, said third processor causes said third T/R device to transmit a remote external control signal representing the therapy choice indicated by said sixth input device to said first T/R device;

thereby to establish a control hierarchy for treatment selection source in which the treatment selection by said medical professional takes priority over a treatment selection based on the analysis of said remote patient assessment signal.

144. The system defined in claim 137, further comprising a seventh input device, coupled to said third processor, for inputting a medical treatment device therapy selection, if any, by the medical professional;

wherein;

(i) if said third processor generates said first remote processor signal, a remote external control signal representing the therapy choice resulting from said third processor analysis is transmitted to said first T/R device, and

(iii) if said third processor does not generate said first remote processor signal, and if said medical professional does input a medical therapy selection to said seventh input device, a remote external control signal representing the therapy choice indicated by said seventh input device is transmitted to said first T/R device;

thereby to establish a control hierarchy for treatment selection source in which the treatment selection based on the analysis of said remote patient assessment signal takes priority over a treatment selection of said medical professional.

145. The system defined in claim 137, further comprising an eighth input device, coupled to said third processor, for inputting a medical treatment device therapy selection, if any, by the medical professional;

wherein;

(i) if said third processor generates said first remote processor signal, and if said medical professional does not input a medical treatment device therapy selection, a remote external control signal representing the therapy choice resulting from said third processor analysis of said remote patient assessment signal is transmitted to said first T/R device, and

(ii) if said third processor does not generate said first remote processor signal, and if said medical professional does input a medical treatment device therapy selection, a remote external control signal representing the therapy choice of said medical professional is transmitted to said first T/R device, and

(iii) if said third processor generates said first remote processor signal, and if said medical professional does input a medical treatment device therapy selection, a remote external control signal representing both (1) the therapy choice resulting from said third processor analysis of said remote patient assessment signal, and (2) the therapy choice indicated by said eighth input device, is transmitted to said first T/R device;

thereby to transmit the therapy choice of both the medical professional and the third processor.

146. The system defined in claim 121, further comprising at least one additional external control station comprising:

(i) a respective additional transmitting/receiving (T/R) device for electronic communication with said first T/R device of said IMD; and

(ii) a respective processor, coupled to said respective T/R device, for producing at least one additional external control signal for controlling said IMD whereby said IMD delivers therapy in response to at least one of;

(i) the analysis of said at least one first sensor circuit output signal by said first processor,

(ii) said at least one local external control signal,

(iii) said at least one remote external control signal, and

(iv) said at least one additional external control signal.

147. The system defined in claim 121, further comprising a first command station for setting an operating state of said IMD, said first command station including:

(a) a ninth input device, for inputting a first operating state command, and for producing a first command signal;

(b) a fourth processor coupled to said ninth input device, for generating a first state control signal in response to said first command signal;

(c) a first command transmitting device, coupled to said fourth processor, for transmitting said first state control signal to said first processor via said first T/R device;

wherein, in response to said first state control signal, said first processor is operative to determine which, if any, of a plurality of control signals takes priority;

thereby to define the operation of the IMD upon receipt by said IMD of at least two control signals each indicating a different therapy choice.

148. The system defined in claim 121, further comprising a second command station for setting an operating state of said IMD, said second command station including:

(a) a tenth input device, for inputting a second operating state command, and for producing a second command signal;

(b) a fifth processor coupled to said tenth input device, for generating a second state control signal in response to said second command signal;

(c) a second command transmitting device, coupled to said fifth processor, for transmitting said second state control signal to said first processor via said first T/R device;

wherein, in response to said second state control signal, said first processor is operative to determine which, if any, of a plurality of therapy choices, indicated by a control signal, takes priority;

thereby to define the operation of the IMD upon receipt by said IMD of a control signal indicating a plurality of different therapy choices.

149. The system defined in claim 134, further comprising a third command station for setting an operating state of said local external control station, said third command station including:

(a) an eleventh input device, for inputting a third operating state command, and for producing a third command signal;

(b) a sixth processor coupled to said eleventh input device, for generating a third state control signal in response to said third command signal;

(c) a third command transmitting device, coupled to said sixth processor, for transmitting said third state control signal to said second processor via said second T/R device;

wherein, in response to said third state control signal, said second processor is operative to determine which, if any, of a plurality of control sources takes priority;

thereby to define a control hierarchy for treatment selection source at the local external control station.

150. The system defined in claim 135, further comprising a fourth command station for setting an operating state of said local external control station, said fourth command station including:

(a) a twelfth input device, for inputting a fourth operating state command, and for producing a fourth command signal;

(b) a seventh processor coupled to said twelfth input device, for generating a fourth state control signal in response to said fourth command signal;

(c) a fourth command transmitting device, coupled to said seventh processor, for transmitting said fourth state control signal to said second processor via said second T/R device;

wherein, in response to said fourth state control signal, said second processor is operative to determine which, if any, of a plurality of control sources takes priority;

thereby to define a control hierarchy for treatment selection source at the local external control station.

151. The system defined in claim 143, further comprising a fifth command station for setting an operating state of said remote external control station, said fifth command station including:

(a) a thirteenth input device, for inputting a fifth operating state command, and for producing a fifth command signal;

(b) an eighth processor coupled to said thirteenth input device, for generating a fifth state control signal in response to said fifth command signal;

(c) a fifth command transmitting device, coupled to said eighth processor, for transmitting said fifth state control signal to said third processor via said third T/R device;

wherein, in response to said fifth state control signal, said third processor is operative to determine which, if any, of a plurality of control sources takes priority;

thereby to define a control hierarchy for treatment selection source at the remote external control station.

152. The system defined in claim 144, further comprising a sixth command station for setting an operating state of said remote external control station, said sixth command station including:

(a) a fourteenth input device, for inputting a sixth operating state command, and for producing a sixth command signal;

(b) an ninth processor coupled to said fourteenth input device, for generating a sixth state control signal in response to said sixth command signal;

(c) a sixth command transmitting device, coupled to said ninth processor, for transmitting said sixth state control signal to said third processor via said third T/R device;

wherein, in response to said sixth state control signal, said third processor is operative to determine which, if any, of a plurality of control sources takes priority;

thereby to define a control hierarchy for treatment selection source at the remote external control station.