Apparatus for controlling an implantable medical device

• US 20170189701A1
• Filed: 01/17/2017
• Published: 07/06/2017
• 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 10,751,540 B2
• Time in Patent Office: Days
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• 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 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• 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

A system and methods of maintaining communication with a medical device for exchange of information, instructions, and programs, in a highly reliable manner. Apparatus and methods for accomplishing this task include:

• • 1) The inclusion of a locating device in the system, in close proximity to an implanted device, but which does not drain the implanted device battery. The locating device may be implanted or external to the body.
  • 2) The use of motion detection and global positioning system devices to locate elements within a communicating system for the medical device;
  • 3) The assessment of received signal quality by elements of the system;
  • 4) The use of a notification system for a device user who is moving out of range of communications; and
  • 5) Documenting the absolute and functional integrity of instructions received by the medical device.

Claims

1-43. -43. (canceled)

44. A medical treatment system having a medical device which allows a person using the device access to a medical expert that can communicate with the medical device from a remote site, said system comprising, in combination:

(A) an electronic medical device (EMD) unit comprising, in combination;

(1) a first wireless transmitting/receiving (T/R) device for transmitting information to, and for receiving at least one control signal from, a plurality of remote locations;

(2) a medical treatment device, coupled to said first T/R device, for treating said person in response to control signals applied thereto;

(B) a remote station (RS) unit at said remote location including;

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

(2) a second transmitting/receiving (T/R) device, coupled to said input device, for electronic communication with the first T/R device of said remotely located EMD; and

(C) at least one communication relay unit, x said communication relay unit(s) numbered from “

1”

to “

x”

, each yth communication relay unit including a (y+2)th communication relay transmitting/receiving (T/R) device for communicating with at least two of (i) the EMD, (ii) the RS, (iii) one of said communication relay units, and (iv) at least one other communication relay unit, wherein

(1) x is an integer which is at least the integer 1

(2) y is an integer ranging from the integer 1 to the integer x; and

wherein at least one of said units is a first unit further comprising;

(a) a first global positioning system, for determining a location of said first unit;

(b) a first communication quality assessment device, coupled to said first global positioning system, for assessing the expected quality of communication signals to be received by the T/R device associated with at least one of (i) said first unit and (ii) at least one other of said units, and for producing a first communication quality signal in dependence upon the respective expected quality of said communication signals; and

(b) a first mode selection device coupled to said respective, associated T/R device and said first communication quality assessment device for selecting the mode of communication with at least one other one of said units, in response to receipt of said communication quality signal from said communication quality assessment device;

thereby to select a mode of communication in dependence upon the current location of said unit and to improve the communication of said EMD unit and said RS unit;

48. The medical treatment system defined in claim 44, wherein, upon the detection of a location, a respective mode selection device of said at least one first unit is operative to control at least one of:

(i) the selection of at least one other unit with which said at least one first unit communicates;

(ii) a power output for said T/R device of said first unit;

(iii) a signal sensitivity for said T/R device of said first unit;

(iv) at least one transmission frequency for said T/R device of said first unit;

(v) an output signal modulation type for said T/R device of said first unit;

(vi) a selection of at least one of a connection via (a) a radiofrequency link, (b) Internet, (c) a hard wire connection, for said T/R device of said first unit;

(vii) a rate of information transfer;

(viii) a method of signal encoding; and

(ix) a message repetition frequency.

49. The medical treatment system defined in claim 44, wherein:

(a) the respective communication quality assessment device includes a memory for storing a location of at least one stationary communication unit selected from the group consisting of (i) a stationary remote station, and (ii) at least one stationary communication relay unit; and

(b) said global positioning system is operative to repeatedly determine the spatial relationship between said at least one first unit and at least one of (i) said stationary remote station and (ii) said at least one stationary communication relay unit.

50. The medical treatment system defined in claim 44, wherein:

(1) the global positioning system of said at least one first unit is coupled to the respective T/R device of said at least one first unit, for transmission of respective labeled coordinate information including;

(a) information which identifies said respective first unit; and

(b) location information relating to said respective first unit;

(2) an at least one other second unit includes;

(a) a respective second communication quality assessment device, coupled to the respective T/R device of said second unit, for receipt of said labeled coordinate information from said at least one first unit, and for producing a respective second communication quality signal in dependence upon said labeled coordinate information; and

(b) a second mode selection device coupled to said respective T/R device of said second unit and to said second communication quality assessment device, for selecting the mode of communication between at least one pair of units, each said pair comprising (i) said second unit and (ii) a first unit, in response to receipt of said respective second communication quality signal from said second communication quality assessment device;

whereby said second communication quality assessment device is responsive to said location information from said at least one first unit, to determine if said at least one pair of units is in an acceptable location for communication.

51. The medical treatment system defined in claim 50, wherein

(a) said at least one second unit further comprises a second global positioning system, coupled to said second communication quality assessment device, for determining a location of said second unit;

(b) said at least one second communication assessment device is operative to utilize location information from each pair of units wherein one member of the pair is selected from said at least one first unit and the other member of the pair is selected from said at least one second unit, to determine at least one of;

(i) a change in the position of each of the two members of each pair of two units;

(ii) the presence of a motionless state of a pair, in which neither member of such pair of said units is moving, and

(iii) the presence of a state in which at least one member of a pair of said units is moving.

52. The medical treatment system defined in claim 51, wherein

(a) at least one of said second units is a local control unit;

(b) at least two of said first units transmit respective labeled coordinate information to said at least one local control unit;

(c) the communication quality assessment device of said local control unit is operative to analyze all received location information and to determine optimization information comprising at least one of (i) an optimal route for communications among said second unit and said at least two first units, and (ii) optimal communication parameters for said second unit and said at least two first units;

(d) the communication quality assessment device of said local control unit is further coupled to the T/R device of said local control unit, to cause said T/R device to transmit said optimization information, for each first which transmitted said respective labeled coordinate information; and

(e) the T/R device of each of said first units is coupled to the respective communication quality assessment device of said first units;

wherein

(i) each of said first units transmits respective labeled coordinate information to said local control unit;

(ii) the communication quality assessment device of said local control unit determines respective optimization information for said first units;

(iii) said optimization information is transmitted to said first units, and supplied to said respective mode selection device of said first units;

thereby to improve communication among said local control unit and said at least two first units.

53. The medical treatment system defined in claim 51, comprising one second unit and a plurality of first units, wherein,

(a) each of a plurality of first units transmits respective labeled coordinate information to said one second unit;

(b) the communication quality assessment device of said second unit is operative to analyze all received location information and determine optimization information comprising at least one of (i) a route for improved communication among said second unit and said plurality of first units, and (ii) parameters for improved communication among said second unit and said plurality of first units;

(c) the communication quality assessment device of said second unit is further coupled to the T/R device of said second unit, to cause said device to transmit said optimization information; and

(d) the T/R device of each of said plurality of first units is coupled to the respective communication quality assessment device of each of said first unit;

wherein

(i) each of said plurality of first units transmits respective labeled coordinate information to said second unit;

(ii) the communication quality assessment device of said second unit determines said optimization information for said second unit and said plurality of first units;

(iii) said optimization information is transmitted to said first units, and passed to each said respective mode selection device;

whereby said second unit is a master control unit;

thereby to optimize communications between said EMD unit and said RS unit.

54. The medical treatment system defined in claim 53, wherein:

(a) the communication quality assessment device of said master control unit includes a memory for storing a location of all stationary units; and

(b) said communication quality assessment device of said master control unit is operative to determine the spatial relationship between each said stationary unit, and each other unit.

55. The medical treatment device system defined in claim 52, wherein said communication parameters include at least one of:

(i) a choice of power output for at least one T/R device;

(ii) a choice of signal sensitivity for at least one T/R unit;

(iii) a choice of at transmission frequency for at least one T/P unit;

(iv) a choice of output signal modulation type for at least one T/R unit;

(v) a choice of the rate of information transfer;

(vi) a choice of the method of signal encoding; and

(vii) a choice of message repetition frequency.

56. The medical treatment device system defined in claim 53, wherein said communication parameters include at least one of:

(i) a choice of power output for at least one T/R device;

(ii) a choice of signal sensitivity for at least one T/R unit;

(iii) a choice of at transmission frequency for at least one T/R unit;

(iv) a choice of output signal modulation type for at least one T/R unit;

(v) a choice of the rate of information transfer;

(vi) a choice of the method of signal encoding; and

(vii) a choice of message repetition frequency.

57. The medical treatment system defined in claim 51, wherein:

(a) the T/R device of at least one additional unit is operative to (i) receive said labeled coordinate information from said at least one first unit, and (ii) re-transmit said information;

(b) the T/R device of said at least one second unit is operative to receive said re-transmitted labeled coordinate information; and

(c) the mode selection device of said at least one second unit is operative to select the mode of communication between;

(1) said at least one second unit and

(2) at least one of;

(i) said at least one first unit, which initially transmitted said coordinate information,

(ii) said at least one additional, which re-transmitted said coordinate information, and

(iii) yet one other unit;

thereby

to allow position information of a unit to be propagated among the medical treatment system units, to optimize communications within the medical treatment system.

58. The medical treatment system defined in claim 52, wherein:

(a) the T/R device of at least one more unit is operative to (i) receive said optimization information from said at least one second unit, and (ii) re-transmit said optimization information;

(b) the T/R device of said at least one first unit is operative to receive said re-transmitted optimization information; and

(c) the selection device of said at least one first unit is operative to select the mode of communication between

(1) said at least one first unit and

(2) at least one of;

(i) said at least one second unit, which initially transmitted said optimization information,

(ii) said at least one more unit, which re-transmitted said optimization information, and

(iii) yet one other unit;

thereby

to allow communication optimization information to be propagated among the medical treatment system units, to optimize communications within the medical treatment system.

45-47. -47. (canceled)

59-63. -63. (canceled)

64. A medical treatment system having a medical device which allows a person using the device access to a medical expert that can communicate with the medical device from a remote site, said system comprising, in combination:

(1) an electronic medical device (EMD) unit comprising, in combination;

(a) a first wireless transmitting/receiving (T/R) device for transmitting information to, and for receiving at least one control signal from, a plurality of remote locations;

(b) a medical treatment device, coupled to said first T/R device, for treating said person in response to control signals applied thereto;

(2) a remote station (RS) unit at said remote location including;

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

(b) a second transmitting/receiving (T/R) device, coupled to said input device, for electronic communication with the first T/R device of said remotely located EMD unit; and

(3) at least one communication relay unit, x said unit(s) numbered from “

1”

to “

x”

, each yth unit including;

(a) a (y+2)th communication relay transmitting/receiving (T/R) device for communicating with at least two of (i) the EMD unit, (ii) the RS unit, (iii) one of said communication relay units, and (iv) at least one other communication relay unit;

(b) a yth communication quality assessment device for assessing at least one of the expected and the actual quality of communications signals to be received by said (y+2)th communication relay T/R device from at least one of (i) said EMD unit, (ii) said RS unit, and (iii) said at least one other communication relay unit, and for producing a yth communication quality signal in dependence upon the respective assessed quality of the communication signals; and

(c) a yth mode selection device coupled to each of said respective (y+2)th T/R device and said respective communication quality assessment device for selecting the mode of communication with at least one of (i) said EMD unit, (ii) said RS unit, and (iii) said at least one other communication relay unit, in response to receipt of said respective communications quality signal from said respective communication quality assessment device;

wherein

(1) x is an integer which is at least the integer 1, and

(2) y is an integer ranging from the integer 1 to the integer x;

whereby

communication between said EMD and said RS may be improved.

65-104. -104. (canceled)

105. A medical treatment and testing apparatus, for medical treatment of a person, which allows a remote station to perform testing on the apparatus from a remote location, said apparatus comprising, in combination:

(A) an electronic medical device comprising, in combination;

(1) first transmitting and receiving device (T/R) device;

for transmitting information to, and for receiving at least one control signal from and a remote station;

(2) at least one sensor for producing a sensor signal representing a physiologic state of a person;

(3) a first processor, having an input and an output, for receiving said sensor signals, for making a decision related to medical therapy for said person, responsive to said sensor signals, and for producing a first therapy signal output representing said decision;

(4) a medical treatment device, for applying medical treatment to said person;

(5) an input switching device, having;

(a) a plurality of inputs, including;

(i) one input coupled to said first T/R device, for receipt of test signals, and

(ii) at least one other input coupled to said at least one sensor, for receipt of sensor signals;

(b) an output, coupled to said first processor input;

said input switching device being responsive to a first control signal received from said first T/R device for selecting the input to be outputted;

(6) an output switching device, having;

(a) an input, coupled to said first processor output for receipt of said first processor therapy signal;

(b) a plurality of outputs, including;

(i) one output coupled to said medical treatment device; and

(ii) one output coupled to said first T/R device, for transmission of test results; and

said output switching device being responsive to a second control signal received from said first T/R device for selecting the output of said output switching device;

(B) a remote station unit at said remote location, including;

(1) a first input device, responsive to a technical expert, for producing at least one remote control signal for controlling and testing said medical device;

(2) a second transmitting/receiving (T/R) device, coupled to said input device, for electronic communication with the first T/R device of said remotely located EMD unit; and

(3) a first output device, coupled to said second T/R device, for receipt of said first therapy signal;

wherein

(I) In a first operating state,

said input switching device;

couples said sensor signal to said first processor input, and

uncouples said first T/R device from said first processor input; and

said output switching device;

couples said first processor output to said medical treatment device; and

uncouples said first processor output from said first T/R device; and

(II) In a second operating state,

said input switching device;

uncouples said sensor signal from said first processor input, and

couples said first T/R device to said first processor input; and

said output switching device;

uncouples said first processor output from said medical treatment device; and

couples said first processor output to said first T/R device; and

(III) said technical expert determines the choice of operating state by inputting control signals to said second T/R device which are transmitted to said first T/R device, and then passed to the input of each of said input switching device and said output switching device, for respective control thereof;

(IV) said technical expert (a) applies test signals to said first input device, which are passed sequentially by said second T/R, said first T/R and said input switching device to said first processor input; and

(b) receives the first processor output, which is passed sequentially by said output switching device, said first T/R device, and said second T/R device, for evaluation;

whereby, in said first operating state, said medical treatment device is operative to provide treatment based on said sensor signals; and

in said second operating state, said technical expert evaluates the response of said first processor to a test signal,

thereby to determine whether said first processor is functioning properly.

106-123. -123. (canceled)

124. A medical treatment system having an implantable medical device, which provides location information pertaining to a person in whom the device is implanted, to facilitate communication between the device and a remote location, said system comprising:

(1) electronic medical apparatus adapted to be implanted in a human, a so-called implantable medical device (“

IMD”

) comprising, in combination;

(a) an IMD communications device for at least one of

(i) transmitting IMD information signals to, and

(ii) receiving at least one IMD control signal from

at least one remote location; and

(b) a medical treatment device, coupled to said IMD communications device, for treating said patient;

(2) a first locator device, adapted to be located in the close vicinity of said human in whom the IMD is implanted, comprising a wireless first locator transmitting device, operative to transmit first locator signals;

(3) a plurality of second locator devices, each comprising;

(a) a second locator receiving device, operative to receive (i) said first locator signals, and (ii) at least one IMD signal, selected from the group consisting of (A) an IMD information signal, and (B) an IMD control signal;

(b) at least one microprocessor, coupled to said second locator receiving device, for assessing the quality of the received first locator signals and for producing a communication quality signal in dependence upon said assessed quality; and

(c) a second locator transmitting device, coupled to said at least one microprocessor, for transmitting (i) said communication quality signal and (ii) said at least one IMD signal when received;

(4) a communication management device, comprising;

(a) a communications device, for

(i) receiving said communication quality signals; and

(ii) transmitting a communication optimization signal; and

(b) a controlling device, coupled to said communications device, for

(i) analyzing said received communication quality signals; and

(ii) causing said communications device to transmit said communication optimization signal providing information for optimizing communications between said IMD and a selected one of said second locator devices, based on said received communication quality signals;

whereby said first and second locator devices provide information about the location of said IMD without direct interaction with the IMD, thereby to improve communication with the IMD.

125. The medical treatment system defined in claim 124, wherein said communication optimization signal indicates a selection of one second locator device from among said plurality of second locator devices that provides a best communications quality with said IMD, thereby to indicate an optimum choice among said second locator devices for communication with said IMD.

126. The medical treatment system defined in claim 125, wherein said IMD communications device is further operative to receive said communication optimization signal and, based on the information contained therein, to optimize communications with at least one of said second locator devices.

127. The medical treatment system defined in claim 125, wherein at least one of said second locator devices is further operative to receive said communication optimization signal and, based on the information contained therein, to optimize communications with said IMD.

128. The medical treatment system defined in claim 124, wherein

(i) said communication optimization signal is an alarm signal;

and

(ii) said alarm signal is produced by said communication management device if each of said received communication quality signal indicates a signal quality which is less than a given value, said given value reflecting inadequate signal quality for communication.

129. The medical treatment system defined in claim 125, further comprising a remote station (“

RS”

), comprising

(a) a RS communications device for at least one of

(i) receiving IMD information signals from at least one of said second locator devices, and

(ii) transmitting at least one IMD control signal to at least one of said second locator devices; and

(b) a RS controlling device, coupled to said RS communications device, for processing said IMD information;

whereby said remote station is operative to provide supervisory services for the management of said IMD.

130. The medical treatment system defined in claim 129, wherein said RS communications device is further operative to receive said communication optimization signal and, based on the information contained therein, to optimize communications between said RS and at least one of said second locator devices.

131. A medical treatment system having an implantable medical device, which provides location information pertaining to a person in whom the device is implanted, to facilitate communication between the device and a remote location, said system comprising:

(1) electronic medical apparatus adapted to be implanted in a human person, a so-called implantable medical device (“

IMD”

) comprising, in combination;

(a) an IMD communications device for at least one of

(i) transmitting IMD information signals to, and

(ii) receiving at least one IMD control signal from

at least one remote location;

(b) a medical treatment device, for treating said person; and

(c) a first processor, coupled to each of said IMD communications device and said medical treatment device,

wherein said processor is operative to

(i) control said medical treatment device, and

(ii) process said IMD signals; and

(2) a first locator device, adapted to be located in the close vicinity of said human in whom the IMD is implanted, comprising a wireless first locator transmitting device, operative to repeatedly transmit first locator signals;

thereby to allow for tracking of the location of said IMD without utilizing an IMD energy source.

132. The system defined in claim 131, wherein said first locator device and said IMD are mechanically linked, such that both are adapted to be implanted in said human, in whom both said devices continue to be mechanically linked.

133. The system defined in claim 131, wherein said first locator device and said IMD are not mechanically linked.

134. The system defined in claim 131, further comprising a plurality of second locator devices, each comprising:

(a) a second locator receiving device, operative to receive said first locator signals; and

(b) a second processor, coupled to said second locator receiving device, for

(i) assessing the quality of the received first locator signals, if any, and

(ii) producing a communication quality signal in dependence upon said assessed quality; and

(c) a second locator transmitting device, coupled to said second processor, for transmitting said communication quality signal

wherein the communication quality signals produced by a particular second locator device represent a distance between said first locator device and the respective second locator device; and

whereby each of said second locator devices provides an assessment of the proximity between said IMD and said second locator device.

135. The system defined in claim 134, wherein each second processor is operative to cause the respective second locator transmitting device to transmit a zero communication quality signal, in the absence of a received first locator signal.

136. The system defined in claim 134, wherein

(1) at least one of said second locator receiving devices is further operative to receive said IMD signals, selected from the group consisting of (A) IMD information signals, and (B) IMD control signals;

(2) the respective second locator transmitting device is further operative to transmit said received IMD signals;

(3) the respective second processor is further operative to cause said respective second locator transmitting device to transmit said received IMD signals;

whereby said at least one second locator devices is operative to relay received IMD signals.

137. The system defined in claim 134, further comprising a communication management device, comprising:

(a) a communications device, operative to

(i) receive said communication quality signals;

(ii) transmit a communication optimization signal; and

(iii) receive said IMD signals, selected from the group consisting of (A) IMD information signals, and (B) IMD control signals; and

to transmit said received IMD signals;

(b) a communications processor, coupled to said communications device, operative to

(i) analyze said received communication quality signals;

(ii) generate a communications optimization signal providing information for optimizing communications with said IMD, based on said received communication quality signals;

(iii) cause said communications device to transmit said communication optimization signal; and

(iv) cause said communications device to transmit said received IMD signals;

whereby said first and second locator devices provide information about the location of said IMD without direct interaction with the IMD, and

whereby said communications device is operative to relay received IMD signals.

138. The system defined in claim 137, wherein, upon generation of a communications optimization signal indicating a quality of communication less than a threshold value of quality, said communications device processor is operative to cause a remedial action selected from the group consisting of:

(a) alteration of an operating characteristic of said communications management device;

(b) pausing said communications device to transmit a signal which causes an alteration of an operating characteristic of at least one second locator device, wherein said second locator receiving device is further operative to receive said signal and said second processor is further operative to cause said alteration;

(c) causing said communications device to transmit a signal which causes an alteration of an operating characteristic of said electronic medical apparatus, wherein said IMD communication device is further operative to receive said signal and said first processor is further operative to cause said alteration; and

(d) production of an alarm signal.

139. The system defined in claim 138, wherein,

(a) said communication management device operating characteristic alteration comprises a remedial action selected from the group consisting of an alteration of:

(i) a power output for said communications device;

(ii) a signal sensitivity for said communications device;

(iii) at least one transmission frequency for said communications device;

(iv) an output signal modulation type for said communications device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link,

(b) the Internet, (c) a hard wire connection, for said communications device;

(vi) a rate of information transfer by said communications device;

(vii) a method of signal encoding by said communications processor;

(viii) a message repetition frequency, for said communications device; and

(ix) a selection of the device with which said communications management device communicates

(b) said second locator device operation characteristic alteration comprises a remedial action selected from the group consisting of an alteration of

(i) a signal sensitivity of at least one of said second locator receiving device;

(ii) a method of analysis of said received first locator signals by at least one second processor; and

(iii) a selection of the device with which said second locator device communicates; and

(c) said electronic medical apparatus operating characteristic alteration comprises a remedial action selected from the group consisting of an alteration of;

(i) a power output for said IMD communications device;

(ii) a signal sensitivity for said IMD communications device;

(iii) at least one transmission frequency for said IMD communications device;

(iv) an output signal modulation type for said IMD communications device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link,

(b) the Internet, (c) a hard wire connection, for said IMD communications device;

(vi) a rate of information transfer by said IMD communications device;

(vii) a method of signal encoding by said first processor;

(viii) a message repetition frequency, for said IMD communications device;

(ix) and a selection of the device with which said electronic medical apparatus communicates.

140. The system defined in claim 136, further comprising a communication management device, comprising:

(a) a communications device, operative to

(i) receive said communication quality signals; and

(ii) transmit a communication optimization signal; and

(b) a communications processor, coupled to said communications device, operative to

(i) analyze said received communication quality signals;

(ii) generate a communications optimization signal providing information for optimizing communications with said IMD, based on said received communication quality signals; and

(iii) cause said communications device to transmit said communication optimization signal;

whereby said first and second locator devices provide information about the location of said IMD without direct interaction with the IMD, thereby to improve communication with the IMD.

141. The system defined in claim 140, wherein, upon generation of a communications optimization signal indicating a quality of communication less than a threshold value of quality, said communications device processor is operative to cause a remedial action selected from the group consisting of:

(a) causing said communications device to transmit a signal which causes an alteration of an operating characteristic of at least one second locator device, wherein said second locator receiving device is further operative to receive said signal and said second processor is further operative to cause said alteration;

(b) causing said communications device to transmit a signal which causes an alteration of an operating characteristic of said electronic medical apparatus, wherein said IMD communication device is further operative to receive said signal and said first processor is further operative to cause said alteration; and

(c) production of an alarm signal.

142. The system defined in claim 141, wherein,

(a) said second locator device operation characteristic alteration comprises a remedial action selected from the group consisting of an alteration of:

(i) a signal sensitivity of at least one of said second locator receiving device;

(ii) a method of analysis of said received first locator signals by at least one second processor; and

(iii) a selection of the device with which said second locator device communicates; and

(b) said electronic medical apparatus operating characteristic alteration comprises a remedial action selected from the group consisting of an alteration of;

(i) a power output for said IMD communications device;

(ii) a signal sensitivity for said IMD communications device;

(iii) at least one transmission frequency for said IMD communications device;

(iv) an output signal modulation type for said IMD communications device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link,

(b) the Internet, (c) a hard wire connection, for said IMD communications device;

(vi) a rate of information transfer by said IMD communications device;

(vii) a method of signal encoding by said first processor;

(viii) a message repetition frequency, for said IMD communications device; and

(ix) a selection of the device with which said electronic medical apparatus communicates.

143. The system defined in claim 140, wherein

(1) said communications device is further operative to receive said IMD signals, selected from the group consisting of (A) IMD information signals, and (B) IMD control signals;

and is further operative to transmit said received IMD signals;

(2) said communications processor is further operative to cause said communications device to transmit said received IMD signals;

whereby said communications device is operative to relay received IMD signals.

144. The system defined in claim 143, wherein, upon generation of a communications optimization signal indicating a quality of communication less than a threshold value of quality, said communications device processor is operative to cause a remedial action selected from the group consisting of:

(a) alteration of an operating characteristic of said communications management device;

(b) causing said communications device to transmit a signal which causes an alteration of an operating characteristic of at least one second locator device, wherein said second locator receiving device is further operative to receive said signal and said second processor is further operative to cause said alteration;

(c) causing said communications device to transmit a signal which causes an alteration of an operating characteristic of said electronic medical apparatus, wherein said IMD communication device is further operative to receive said signal and said first processor is further operative to cause said alteration; and

(d) production of an alarm signal.

145. The system defined in claim 144, wherein,

(a) said communication management device operating characteristic alteration comprises a remedial action selected from the group consisting of an alteration of:

(i) a power output for said communications device;

(ii) a signal sensitivity for said communications device;

(iii) at least one transmission frequency for said communications device;

(iv) an output signal modulation type for said communications device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link,

(b) the Internet, (c) a hard wire connection, for said communications device;

(vi) a rate of information transfer by said communications processor;

(vii) a method of signal encoding by said communications device;

(viii) a message repetition frequency, for said communications device; and

(ix) a selection of the device with which said communications management device communicates

(b) said second locator device operation characteristic alteration comprises a remedial action selected from the group consisting of an alteration of

(i) a signal sensitivity of at least one of said second locator receiving device;

(ii) a method of analysis of said received first locator signals by at least one second processor; and

(iii) a selection of the device with which said second locator device communicates; and

(c) said electronic medical apparatus operating characteristic alteration comprises a remedial action selected from the group consisting of an alteration of;

(i) a power output for said IMD communications device;

(ii) a signal sensitivity for said IMD communications device;

(iii) at least one transmission frequency for said IMD communications device;

(iv) an output signal modulation type for said IMD communications device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link,

(b) the Internet, (c) a hard wire connection, for said IMD communications device;

(vi) a rate of information transfer by said IMD communications device;

(vii) a method of signal encoding by said first processor;

(viii) a message repetition frequency, for said IMD communications device; and

(ix) a selection of the device with which said electronic medical apparatus communicates.

146. The system defined in claim 131, further comprising a remote station (“

RS”

) at said remote location including;

(a) a RS transmitting/receiving (“

T/R”

) device, operative to transmit said control signals and to receive said IMD information signals; and

(b) a RS processor, coupled to said RS T/R device, operative to process each of said control signals and said information signals;

wherein said RS processor is further operative to cause said RS T/R to transmit said control signals.

147. They system defined in claim 146, further comprising

(c) an input device, coupled to said RS processor, responsive to a human medical expert, operative to produce at least one IMD control signal for controlling said IMD, and

(d) a display device, coupled to said RS processor, operative to display a representation of said received IMD information signals;

wherein said IMD communications device is operative to receive said IMD control signal, and said medical treatment device is responsive to said IMD control signal for applying a treatment represented by said signal;

whereby said remote human medical expert provides remote control signals to said IMD

148. The system defined in claim 146, wherein said RS processor is further operative to analyze said received IMD information signals, and to select a therapy choice based on said analysis;

and wherein said RS processor is further operative to cause said RS T/R to transmit a control signal representing said therapy choice;

whereby said RS operates as a medical expert system for providing control signals to said IMD.

149. The system defined in claim 146, wherein said RS T/R device is operative to communicate with said IMD over a path selected from the group:

(i) IMD directly to said RS;

(ii) IMD to a second locator device, and thence to said RS;

(iii) IMD to a communication management device, and thence to said RS;

(iv) IMD to a second locator device, thence to a communication management device, and thence to said RS;

(v) RS directly to said IMD;

(vi) RS to a second locator device, and thence to said IMD;

(vii) RS to a communication management device, and thence to said IMD; and

(viii) RS to a communication management device, thence to a second locator device, and thence to said RS.

150. The system defined in claim 131, wherein the IMD further comprises at least one sensor, coupled to said first processor, operative to sense a physiological state of said person and to produce a sensor output signal representing said physiologic state, wherein the receipt of said sensor output signal causes said first processor to cause said IMD communications device to transmit said IMD information signal representing the physiologic state indicated by said sensor output signal.

151. The system defined in claim 134, wherein

(a) said first locator device further comprises

(i) a first locator receiving device, operative to receive signals from said second locator transmitting device;

(ii) a first locator processor, coupled to each of said first locator receiving device and said first locator transmitting device;

(b) said second locator transmitting device is further operative to transmit second locator signals to said first locator receiving device;

(c) said first locator receiving device provides said second locator signals to said first locator processor;

(d) said first locator processor is operative to analyze the quality of said received signals and to detect a second locator signal quality less than a second threshold value; and

(e) upon detection of said less than threshold value signal, said first locator processor is operative to cause a remedial action selected from the group

(i) modify the operation of said first locator transmitting device;

(ii) modify the operation of said first locator receiving device; and

(iii) cause send first locator transmitting device to transmit an alternate communications optimization signal.

152. The system defined in claim 151, wherein

(a) said second locator receiving device is further operative to receive said alternate communications optimization signal, and in response thereto to

(b) in response thereto, said second processor is operative to cause a remedial action selected from the group

(i) modify the operation of said second locator transmitting device;

(ii) modify the operation of said second locator receiving device; and

(iii) cause send second locator transmitting device to transmit a second communications optimization signal.

153. The system defined in claim 151, wherein

(a) said modification of said first locator transmitting device comprises a remedial action selected from the group consisting of an alteration of:

(i) a power output for said device;

(iii) at least one transmission frequency for said device;

(iv) an output signal modulation type for said device;

(v) a selection of a connection mode from the group consisting of (A) a radiofrequency link,

(B) the Internet, (C) a hard wire connection, for said device;

(vi) a rate of information transfer by said device;

(vii) a method of signal encoding by said first locator processor; and

(viii) a message repetition frequency, for said device;

(b) said modification of said first locator receiving device comprises a remedial action selected from the group consisting of an alteration of;

(i) a signal sensitivity for said device;

(ii) a selection of a connection mode from the group consisting of (A) a radiofrequency link,

(B) the Internet, (C) a hard wire connection, for said device;

(iii) a rate of information transfer by said device;

154. The system defined in claim 152, wherein

(a) said modification of said second locator transmitting device comprises a remedial action selected from the group consisting of an alteration of:

(i) a power output for said device;

(iii) at least one transmission frequency for said device;

(iv) an output signal modulation type for said device;

(v) a selection of a connection mode from the group consisting of (A) a radiofrequency link,

(B) the Internet, (C) a hard wire connection, for said device;

(vi) a rate of information transfer by said device;

(vii) a method of signal encoding by said first locator processor; and

(viii) a message repetition frequency, for said device;

(b) said modification of said second locator receiving device comprises a remedial action selected from the group consisting of an alteration of;

(i) a signal sensitivity for said device;

(ii) a selection of a connection mode from the group consisting of (A) a radiofrequency link,

(B) the Internet, (C) a hard wire connection, for said device;

(iii) a rate of information transfer by said device;

155. The system defined in claim 152, wherein said electronic medical apparatus is further operative to receive said second communication optimization signal, and to cause a remedial action selected from the group consisting of an alteration of:

(i) a power output for said IMD communications device;

(ii) a signal sensitivity for said IMD communications device;

(iii) at least one transmission frequency for said IMD communications device;

(iv) an output signal modulation type for said IMD communications device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link,

(b) the Internet, (c) a hard wire connection, for said IMD communications device;

(vi) a rate of information transfer by said IMD communications device;

(vii) a method of signal encoding by said first processor;

(viii) a message repetition frequency, for said IMD communications device; and

(ix) a selection of the device with which said electronic medical apparatus communicates.

156. The system defined in claim 137, further comprising alarm apparatus, comprising:

(a) a notification device for producing at least one output selected from the group consisting of a sound, a light and a vibration; and

(b) a receiving device, coupled to said notification device, for receiving said communication optimization signal;

wherein

said receiving device causes said notification device to produce said at least one output upon receipt of a communication optimization signal indicating an unacceptable quality of communication between said first and said second locator devices;

thereby to notify at least one person of a potential communication limitation involving said IMD.

157. The system defined in claim 140, further comprising alarm apparatus, comprising:

(a) a notification device for producing at least one output selected from the group consisting of a sound, a light and a vibration; and

(b) a receiving device, coupled to said notification device, for receiving said communication optimization signal;

wherein

said receiving device causes said notification device to produce said at least one output upon receipt of a communication optimization signal indicating an unacceptable quality of communication between said first and said second locator devices;

thereby to notify at least one person of a potential communication limitation involving said IMD.