Controlling a personal medical device

• US 9,533,161 B2
• Filed: 02/23/2015
• Issued: 01/03/2017
• 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:
  US14/628,502
• Publication Number:
  US 20150190646A1
• Time in Patent Office: 680 Days
• Field of Search: 607/5, 607/32, 607/60
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61M 2205/3553 remote, e.g. between patient's home and doctor's office
• CPC Class Codes: A61M 2205/3592 using telemetric means, e.g. radio or optical transmission
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/201 Glucose concentration
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/37217 characterised by the communication link, e.g. acoustic or tactile
• CPC Class Codes: A61N 1/37235 Aspects of the external programmer
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37252 Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: A61N 1/39622 : Pacing therapy
• CPC Class Codes: G16H 10/60 : for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/63 : for local operation
• CPC Class Codes: G16H 40/67 : for remote operation
• CPC Class Codes: H04B 17/309 : Measuring or estimating channel quality parameters
• CPC Class Codes: H04L 1/0003 : by switching between different modulation schemes
• CPC Class Codes: H04L 1/0013 : Rate matching, e.g. puncturing or repetition of code symbols
• CPC Class Codes: H04L 1/0015 : characterised by the adaptation strategy
• CPC Class Codes: H04L 1/0026 : Transmission of channel quality indication
• CPC Class Codes: H04W 24/02 : Arrangements for optimising operational condition
• CPC Class Codes: H04W 4/023 : using mutual or relative location information between multiple location based services [LBS] targets or of distance thresholds

Abstract

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

Claims

1. Apparatus comprising an implantable medical device (IMD), which is controlled by one of three control sources, one internal control source and two sources situated at external locations, said device comprising, in combination:

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

a medical treatment device configured to treat said patient in response to treatment device signals applied thereto;

a first sensor circuit, having a first sensor circuit output, configured to produce 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

a first processor, coupled to each of

said first sensor circuit output,

said first T/R device, and

said treatment device,

configured to

analyze said at least one first sensor circuit output signal, and, based on the analysis, generate (A) at least one first medical information signal representing said internal medical data, and (B) an internal control signal configured to control said treatment device;

generate at least one treatment device signal; and

select an operating state, in response to a state control signal, said operating state indicating a hierarchy among said internal control signal, said first external control signal and said second external control signal, said operating state selected from the group consisting of;

a first operating state, in which

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

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

a second operating state, in which

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

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

a third operating state, in which

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

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

a fourth operating state, in which

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

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

a fifth operating state, in which

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

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

a sixth operating state, in which

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

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

wherein said first processor is operative to select the control signal with the highest priority among said three control signals to generate said at least one treatment device signal, in accordance with the operating state;

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

said internal control signal;

said first external control signal; and

said second external control signal.

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

a first input device, configured to input a state setting command, and configured to produce a command signal;

a second processor coupled to said first input device, configured to generate a state control signal in response to said command signal;

a command transmitting device, coupled to said second processor, configured to transmit state control signal to said first processor via said first T/R device;

wherein said first processor is operative to set said operating state in dependence upon said received state control signal; and

wherein said first T/R device is further operative to receive said state control signal;

thereby to set the operating state of said IMD.

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

a third processor configured to generate a second state control signal;

a second T/R device, coupled to said third processor, configured to transmit said second state control signal to said first processor via said first T/R device, and configured to receive said signal representing the internal medical data of said patient;

wherein;

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

said first processor is operative to set said operating state in dependence upon said received second state control signal; and

wherein said first T/R device is further operative to receive said state control signal;

thereby to set the operating state of said IMD.

4. The apparatus defined in claim 1, further comprising

a first external control station configured to control said IMD, said first external control station including:

a fourth processor;

a first display device, coupled to said fourth processor, configured to display internal medical data of said patient;

a second input device, coupled to said fourth processor, configured to produce a first external control signal in response to an inputted treatment choice, and configured to input commands selected from a group consisting of;

a patient using said IMD,

a medical professional, and

an administrator,

a third T/R device, coupled to said fourth processor, configured to receive internal medical data of said patient, and configured to transmit said first external control signal; and

a second external control station configured control said IMD, said second external control station including;

a fifth processor;

a second display device, coupled to said fifth processor, configured to display internal medical data of said patient;

a third input device, coupled to said fifth processor, configured to produce a second external control signal in response to an inputted treatment choice, and configured to input commands selected from another group consisting of;

a patient using said IMD,

a medical professional, and

an administrator,

a third T/R device, coupled to said fifth processor, configured to receive for internal medical data of said patient, and configured to transmit said second external control signal.

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

a third external control station configured to control said IMD, including;

a sixth processor configured to produce a first external control signal in response to analysis by said sixth processor of said internal medical data; and

a fifth T/R device, coupled to said sixth processor, configured to receive internal medical data of said patient, and configured to transmit said first external control signal

a fourth external control station configured to control said IMD, including;

a seventh processor configured to produce a second external control signal in response to analysis by said seventh processor of said internal medical data; and

a sixth T/R device, coupled to said seventh processor, configured to receive internal medical data of said patient, and configured to transmit said second external control signal.

6. The apparatus defined in claim 5, wherein

said third external control station further comprises a database, coupled to said sixth processor, configured to store information concerning at least one of:

a patient using the IMD,

the IMD,

a prior use of the IMD by the patient,

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

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

a prior use of different IMDs by other patients;

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

information obtained from said database, and

said received internal medical data; and

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

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

said second sensor circuit output signal, and

said received internal medical data.

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

a fifth external control station configured control said IMD, including;

a eighth processor;

a third display device, coupled to said eighth processor, configured to display internal medical data of said patient;

a fourth input device, coupled to said eighth processor, configured to produce a first external control signal in response to an inputted treatment choice, and configured to input commands from a member of the group consisting of

a patient using said IMD,

a medical professional, and

an administrator,

a seventh T/R device, coupled to said eighth processor, configured to receive internal medical data of said patient, and Configured to transmit said first external control signal; and

a sixth external control station configured to control said IMD, including;

a ninth processor configured to produce a first external control signal in response to analysis by said ninth processor of said internal medical data; and

an eighth T/R device, coupled to said ninth processor, configured to receive internal medical data of said patient, and configured to transmit said second external control signal.

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

a database, coupled to said ninth processor, configured to store information concerning at least one of:

a patient using the IMD,

the IMD,

a prior use of the IMD by the patient,

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

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

a prior use of different IMDs by other patients; and

a third sensor circuit, having a third sensor circuit output coupled to said ninth processor, configured produce at least one third sensor circuit output signal at said third sensor circuit output in response to external medical data sensed from the patient by said third sensor circuit;

wherein;

said ninth processor is operative to select a therapy choice based on analysis by said ninth processor of at least on

information obtained from said database,

said third sensor circuit output signal, and

said received internal medical data and

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

9. The apparatus defined in claim 1, further comprising a seventh external control station configured to control said IMD, including:

a tenth processor;

a fourth display device, coupled to said tenth processor, configured to display internal medical data of said patient;

a fifth input device, coupled to said tenth processor, configured to produce said first external control signal in response to an inputted treatment choice, and configured to input commands from a member of the group consisting of;

a patient using said IMD,

medical professional, and

an administrator,

an ninth T/R device, coupled to said tenth processor, configured to receive internal medical data of said patient, and configured to transmit external control signals;

wherein;

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

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

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

a database, coupled to said tenth processor, configured to store information concerning at least one of

patient using the IMD,

the IMD,

a prior use of the IMD by the patient,

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

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

a prior use of different IMDs by other patients;

a fourth sensor circuit, having a fourth sensor circuit output coupled to said tenth processor, configured to produce at least one fourth sensor circuit output signal at said fourth sensor circuit output in response to external medical data sensed from the patient by said fourth sensor circuit;

wherein;

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

information obtained from said database, and

said fourth sensor circuit output signal, and

said received internal medical data; and

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

11. The apparatus defined in claim 1, wherein:

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

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

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

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

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

said internal control signal; and

each of said external control signals.

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

said internal medical data; and

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

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

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

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

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

a first transmitting/receiving (T/R) device configured to transmit at least one signal representing internal medical data of a patient to, and configured to receive a first external control signal from a first external control source;

a medical treatment device configured to treat said patient in response to treatment device signals applied thereto;

a first sensor circuit, having a first sensor circuit output, configured to produce 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

a first processor, coupled to each of

said first sensor circuit output,

said first T/R device, and

said treatment device,

configured to

analyze said at least one first sensor circuit output signal, and, based on the analysis, generate (A) at least one first medical information signal representing said internal medical data, and (B) an internal control signal configured to control said treatment device,

generate at least one treatment device signal; and

select one of at least three operating states in response to a received state control signal;

wherein;

in a first operating state,

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

in a second operating state,

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

in a third operating state,

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

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

said internal control signal; and

said first external control signal.

15. The apparatus defined in claim 14, wherein said first processor is operative in said third operating state to select a therapy choice from the group consisting of:

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

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

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

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

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

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

16. The apparatus defined in claim 15, wherein said first intermediate amount of therapy is selected from the group consisting of:

the arithmetic average of said first amount of therapy and said second amount of therapy; and

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

17. The apparatus defined in claim 14, further comprising a command station configured to set the operating state of said MD, said command station including

a command input device, configured to input a state setting command and to produce a command signal;

second processor, coupled to said command input device, configured to generate a state control signal in response to said command signal;

a command transmitting device, coupled to said second processor, configured to transmit said state control signal to said first processor via said first T/R device;

thereby to set the operating state of said IMD.

18. The apparatus defined in claim 14, further comprising a first external control station configured to control said IMD, said first external control station including:

a third processor;

a display device, coupled to said third processor, configured to display internal medical data of said patient;

an input device, coupled to said third processor, configured to produce a first external control signal in response to an inputted treatment choice, and configured to input commands from at least one of

a patient using said IMD,

a medical professional, and

an administrator,

a second T/R device, coupled to said third processor, configured to receive internal medical data of said patient, and configured to transmit said first external control signal to said IMD.

19. The apparatus defined in claim 18, further comprising a first identifier signal source, coupled to said second T/R device, configured to provide a first identifier signal;

wherein said second T/R device is further operative to transmit said first identifier said first T/R device; and

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

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

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

20. The apparatus defined in claim 14, further comprising a second external control station configured to control said IMD, said second external control station including:

a fourth processor configured to produce a second external control signal in response to analysis by said fourth processor of said internal medical data; and

a third T/R device, coupled to said fourth processor, configured to receive internal medical data of said patient, and configured to transmit said second external control signal.

21. The apparatus defined in claim 20, wherein said second external control station further comprises a database, configured to store information concerning at least one of:

the patient,

the IMD,

a prior use of the IMD by the patient,

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

a prior use of a substantially similar by other patients, and

a prior use of different IMDs by other patients;

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

information obtained from said database, and

said received internal medical data.

22. The apparatus defined in claim 20, wherein:

said second external control station further comprises a second sensor circuit, having a second sensor circuit output coupled to said fourth processor, configured to produce 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;

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

analysis of said second sensor circuit output signal, and

said received internal medical data.

23. The apparatus defined in claim 20, further comprising a second identifier signal source, coupled to said third T/R device, configured to provide a second identifier signal;

wherein aid third T/R device is her operative to transmit said second identifier signal to said first T/R device; and

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

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

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

24. The apparatus defined in claim 14, wherein:

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

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

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

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

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

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

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

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

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

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

25. The apparatus defined in claim 24, wherein said second intermediate amount of therapy is selected from the group consisting of:

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

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

a polynomial function, of at least the first degree, of at least one of said amount of therapy, said second amount of therapy, and said third amount of therapy;

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

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

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

26. The apparatus defined in claim 14, wherein:

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

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

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

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

a third additional operating state in which id treatment device delivers a third intermediate amount of therapy, if

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

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

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

27. The apparatus defined in claim 26, wherein said third intermediate amount of therapy is selected from the group consisting of:

the arithmetic average of each of said amounts of therapy;

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

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

a polynomial function, of at least the first degree, of at least one of any one of the amounts of therapy, and a plurality of the amounts of therapy.

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

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

a medical treatment device configured said patient in response to treatment device signals applied thereto;

a first sensor circuit, having a first sensor circuit output, configured to produce 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

a first processor, coupled to each

said first sensor circuit output,

said first T/R device, and

said treatment device,

configured to

analyze said at least one first sensor circuit output signal, and, based on the analysis, generate (A) at least one medical information signal representing said internal medical data, and (B) an internal control signal configured to control said treatment device,

generate at least one treatment device signal; and

select one of four operating states, in response to a received state control signal;

wherein;

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

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

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

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

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

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

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

whereby;

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

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

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

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

thereby to cause said first processor to select a source of control of said IMD from among said internal control signal, and said external control signal, in response to said state control signal.

29. The apparatus defined in claim 28, further comprising a command station configured to set the operating state of said IMD, said command station including:

a command input device, configured to input a state setting command and to produce a command signal;

a second processor, coupled to said command input device, configured to generate a state control signal in response to said command signal;

a command transmitting device, coupled to said second processor, configured to transmit said state control signal to said first processor via said first T/R device;

thereby to set the operating state of said IMD.

30. The apparatus defined in claim 28, further comprising a first external control station configured to control said IMD, said first external control station including:

a third processor;

a display device, coupled to said third processor, configured to display internal medical data of said patient;

an input device, coupled to said third processor, configured to produce a first external control signal in response to an inputted treatment choice, and configured to input commands from at least one of;

a patient using said IMD,

a medical professional, and

an administrator,

a second T/R device, coupled to said third processor, configured receive internal medical data of said patient, and to transmit said first external control signal to said IMD.

31. The apparatus defined in claim 30 further comprising a first identifier signal source, coupled to said second T/R device, configured to provide a first identifier signal;

wherein said second T/R device is further operative to transmit said identifier signal to said first T/R device; and

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

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

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

32. The apparatus defined in claim 28, further comprising a second external control station configured control said IMD, said second external control station including:

a fourth processor configured to produce a second external control signal in response to analysis by said fourth processor of said internal medical data; and

a third T/R device, coupled to said fourth processor, configured to receive internal medical data of said patient, and to transmit said second external control signal.

33. The apparatus defined in claim 32, wherein said second external control station further comprises a database, configured to store information concerning at least one of:

the patient,

the IMD,

the prior use of the IMD by the patient,

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

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

the prior use of different IMDs by other patients;

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

information obtained from said database, and

said received internal medical data.

34. The apparatus defined in claim 32, wherein:

said second external control station further comprises a second sensor circuit, having a second sensor circuit output coupled to said fourth processor, configured to produce 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;

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

said second sensor circuit output signal, and

said received internal medical data.

35. The apparatus defined in claim 32 further comprising a second identifier signal source, coupled to said third T/R device, configured to provide a second identifier signal;

wherein said third T/R device is further operative to transmit said second identifier signal to said first T/R device; and

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

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

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

36. The apparatus defined in claim 28, wherein:

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

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

X is an integer ranging from the integer “

1”

to the integer “

N”

;

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

in the (3X+3)th operating state, said internal control signal, if any, controls said treatment device, unless said Xth additional external control signal is received and if said Xth additional external control signal is received, it takes priority over said internal control signal for determining the choice of treatment, if any, administered by said electronic medical treatment device;

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

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

whereby;

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

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

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

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

37. The apparatus defined in claim 28, wherein:

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

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

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

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

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

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

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

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

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

whereby;

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

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

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

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