Controlling a personal medical device

• US 8,965,508 B2
• Filed: 02/17/2014
• Issued: 02/24/2015
• Est. Priority Date: 06/11/2003
• Status: Active Grant

• Current Assignee: Jeffrey A. Matos
• Original Assignee: Jeffrey A. Matos
• Inventors: Matos, Jeffrey A.
• Primary Examiner(s): Stice, Paula J
• Application Number:
  US14/181,876
• Publication Number:
  US 20140371816A1
• Time in Patent Office: 372 Days
• Field of Search: 607/60, 607/30, 607/32
• US Class Current: 607/30
• 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 5/1171 based on the shapes or appearances of their bodies or parts thereof
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/18 for vehicle drivers or machine operators
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/33 specially adapted for cooperation with other devices
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 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 1/3621 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 1/3727 : characterised by the modulation technique
• 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 1/3906 : characterised by the form of the shockwave
• CPC Class Codes: A61N 1/3956 : Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/3962 : in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 : Pacing therapy
• CPC Class Codes: B60W 2040/0818 : Inactivity or incapacity of driver
• CPC Class Codes: B60W 2040/0872 : Driver physiology
• CPC Class Codes: B60W 40/09 : Driving style or behaviour
• CPC Class Codes: G16H 20/30 : relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 20/40 : relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/63 : for local operation
• CPC Class Codes: G16H 40/67 : for remote operation
• CPC Class Codes: G16H 50/20 : for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 : for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 50/70 : for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: H04B 1/40 : Circuits

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. 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, said PMD being 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 Pth transmitting/receiving (T/R) device for electronic communication with said first T/R device of said PMD; and

(ii) a Pth processor, coupled to said Pth 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.

2. The apparatus defined in claim 1, 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.

3. The apparatus defined in claim 2, 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.

4. The apparatus defined in claim 2, 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.

5. The apparatus defined in claim 1, wherein said PMD is an implanted medical device (IMD), implanted in a body of said patient.

6. The apparatus defined in claim 5, wherein said medical data is internal medical data, acquired within a body of said patient.

7. The apparatus defined in claim 6, 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.

8. The apparatus defined in claim 6, 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.

9. The apparatus defined in claim 6, 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.

10. The apparatus defined in claim 9, 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.

11. The apparatus defined in claim 10, 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.

12. The apparatus defined in claim 10, 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.

13. The apparatus defined in claim 9, 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.

14. The apparatus defined in claim 13, 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.

15. The apparatus defined in claim 13, 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.

16. The apparatus defined in claim 9, wherein said internal control signal is assigned the highest priority;

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

17. The apparatus defined in claim 9, 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.

18. The apparatus defined in claim 17, wherein said patient external control signal is assigned the highest priority;

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

19. The apparatus defined in claim 9, 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.

20. The apparatus defined in claim 19, 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.

21. The apparatus defined in claim 20, 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.

22. The apparatus defined in claim 19, 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 MD.

23. The apparatus defined in claim 19, 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.

24. The apparatus defined in claim 23, 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.

25. The apparatus defined in claim 19 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.

26. The apparatus defined in claim 9, 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.

27. The apparatus defined in claim 26, 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.

28. The apparatus defined in claim 9, 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.

29. The apparatus defined in claim 28, 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.

30. The apparatus defined in claim 29, 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.

31. The apparatus defined in claim 28, 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.

32. The apparatus defined in claim 28, 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.

33. The apparatus defined in claim 5, 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.

34. The apparatus defined in claim 1, wherein said PMD is an external medical device (EMD), located external to the body of said patient.

35. The apparatus defined in claim 34, 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 END is operative to sense a representation of said internal medical data transmitted by said internal third sensing device.

36. The apparatus defined in claim 34, wherein said medical data is external medical data, acquired outside of a body of said patient.

37. The apparatus defined in claim 36, 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.

38. The apparatus defined in claim 36, 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.

39. The apparatus defined in claim 1, wherein said first processor is operative to permanently assign at least one of said priority levels indicating said control hierarchy.

40. 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;

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

said at least one local external control signal, and

said at least one remote external control signal.

41. The apparatus defined in claim 40, 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.

42. The apparatus defined in claim 40, 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.

43. The apparatus defined in claim 40, 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.

44. The apparatus defined in claim 40, 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.

45. The system defined in claim 40, 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.

46. The system defined in claim 45, 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.

47. The system defined in claim 45, 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.

48. The system defined in claim 45, 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.

49. The system defined in claim 48, 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.

50. The system defined in claim 45, 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.

51. The system defined in claim 45, 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.

52. The system defined in claim 51, 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.

53. The system defined in claim 45, 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.

54. The system defined in claim 53, 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.

55. The system defined in claim 45, 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.

56. The system defined in claim 40, 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.

57. The system defined in claim 56, 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.

58. The system defined in claim 40, 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.

59. The system defined in claim 58, 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.

60. The system defined in claim 58, 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.

61. The system defined in claim 58, 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.

62. The system defined in claim 61, 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.

63. The system defined in claim 58, 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.

64. The system defined in claim 63, 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.

65. The system defined in claim 58, 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.

66. The system defined in claim 65, 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.

67. The system defined in claim 58, 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.

68. The system defined in claim 40, 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.

69. The system defined in claim 40, 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;

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

said at least one local external control signal,

said at least one remote external control signal, and

said at least one additional external control signal.

70. The system defined in claim 40, 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.

71. The system defined in claim 40, 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.