Abstract:
A personal and/or institutional health and wellness communications system, which may be used for a variety of emergency and non-emergency situations using two-way communication devices and a bi-directional communication network. In one application two-way pagers are adapted for use in the system. In one application cellular devices are adapted for use in the system. In one application an assisted living response center is established using various embodiments of the present personal and/or institutional communications system. The system provides multiple levels of prioritization, authentication of person (task, step, process or order), and confirmation via interrogation of person, device, or related monitor. One embodiment provides a method for receiving, evaluating and responding to calls received from a subscriber, patient, related party, or health care provider or health care system.

Description:
BACKGROUND OF THE INVENTION 
     The present application is a continuation-in-part of co-pending U.S. patent application Ser. No. 09/956,474 filed Sep. 19, 2001, which is a continuation of U.S. patent application Ser. No. 09/384,165, filed Aug. 27, 1999 and now issued as U.S. Pat. No. 6,356,192, which claims priority to U.S. provisional patent application Ser. No. 60/135,862, filed May 25, 1999 and to U.S. provisional patent application Ser. No. 60/105,493 filed Oct. 23, 1998. The present application is also a continuation-in-part of a co-pending U.S. patent application filed Mar. 28, 2002, entitled “Method and System for Wireless Tracking”, which claims priority to a provisional patent application Ser. No. 60/279,401, filed Mar. 28, 2001. 
    
    
     The present invention relates generally to bi-directional personal and health-wellness provider communication system and in particular to a personal communication system suitable for use with children, vulnerable adults (such as those in assisted living situations), and more specifically, medically distressed persons and those in whom an personal medical device has been deployed, for medical testing, and for other life enhancements. 
     There are several trends which taken together are causing a change in the way medical services are delivered. Among other things, these include longer lifespan, medical technology improvements, automation of diagnostic processes, specialization of caregivers, the rapid pace of technology that causes a shortening of the amortization of development and investment costs, increasing expense of medical care centers, and the shortage of health care workers. 
     The results of these trends are manifold. They include moving more of the delivery of services out of a medical center and away from the direct supervision of highly trained medical personnel. They include providing personal medical devices to allow long-term patients to resume a more mobile lifestyle. They include allowing patients to be treated from home for issues of cost and comfort. They include reducing the level of training associated with caregivers so that in some cases, even a casual passerby is able to provide meaningful assistance with devices once associated only with properly trained medical personnel, for example using Portable Automated Defibrillators. However, the remoteness of patients from professional caregivers increases the need for communications systems to monitor the patient, deliver care, and communicate. 
     What is needed in the art is an improved detection system that is friendly to a mobile user, that is easy to adapt to existing devices, that is easy to install, that is inexpensive, and that provides substantial interoperability between wireless technologies, communication network providers, and other widely used medical and public systems. 
     SUMMARY OF THE INVENTION 
     One skilled in the art will readily recognize that the embodiments described solve all of these problems and many more not mentioned expressly herein. 
     Personal Medical Devices (PMD) take many forms. PMDs may be surgically implanted, strapped externally to the body, carried in a pocket, transported in a carrying case, or installed as a home appliance. They may be used only for rare emergencies, on an occasional basis, on a regular schedule, or in a continuous or nearly continuous fashion. PMDs may monitor individual or combinations of body functions such as heart function, respiration, body chemistry, brain function, or muscular/skeleton actions. PMDs may provide body functions such as mechanical hearts, kidney dialysis, digestive or respiratory activities. PMDs may be used to deliver drugs, heart defibrillation, or other treatment. PMDs may be used to enhance wellness, test drug therapies, monitor patient health, deliver long-term care, or treat acute conditions. 
     We describe a device and method to couple with PMDs to provide wireless communication and locating functions. The purpose for communications include but are not limited to the following: to provide health care professionals with access to information for remote diagnostic capabilities; to provide notification of acute conditions possibly requiring immediate assistance, transportation to a medical center, or remote treatment action; to provide a location information of mobile persons for caregivers; to notify responsible parties of the occurrence of a medical condition; and to provide remote intervention assistance by caregivers through verbal or visual interaction. 
     In one embodiment, in order to provide mobility for users of PMDs in a public environment, we employ standard network communication systems to deliver a comprehensive medical communications service. In one embodiment, the communications network links together the PMD, casual caregivers, a medical center, an emergency dispatch center, medical databases, and related responsible parties. This group of associated parties is able to combine resources to improve the survivability during an acute medical event. 
     In one embodiment, the medical communications system delivers an end-to-end comprehensive solution to provide care to a remote or mobile user of a PMD. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a block diagram showing the overall structure of the system of the present invention. 
         FIG. 2  is a block diagram showing the internal structure of a portable device. 
         FIG. 3  is a block diagram showing the structure of a user interface module. 
         FIGS. 4A–4F  are block diagrams showing various configurations of the system of the present invention. 
         FIG. 5  is a network diagram showing communications through the system of the present invention. 
         FIG. 6  is a chart showing the uses of various data by a dispatcher or medical caregiver. 
         FIG. 7  is a general block diagram of the power management function. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     This detailed description provides a number of different embodiments of the present system. The embodiments provided herein are not intended in an exclusive or limited sense, and variations may exist in organization, dimension, hardware, software, mechanical design and configuration without departing from the claimed invention, the scope of which is provided by the attached claims and equivalents thereof. 
     The present system provides many benefits, including but not limited to, low cost, easy installation, limited power requirements and wireless operation and signal transmission. Many other benefits will be appreciated by those skilled in the art upon reading and understanding the present description. 
     U.S. Provisional Patent Application No. 60/098,392, filed Aug. 29, 1998; U.S. Provisional Patent Application No. 60/098,270 filed Aug. 28, 1998; U.S. Provisional Patent Application No. 60/105,493 filed Oct. 23, 1998; and U.S. Provisional Patent Application No. 60/135,862 filed May 25, 1999, are all hereby incorporated by reference in their entirety. 
     Personal Medical Device 
       FIG. 1  is a block diagram showing the interoperability of a personal medical device (PMD)  100  with a medical device interface (MDI)  200  and a network  400 . As can be seen, the PMD  100  may interact directly with the network  400  or through the mediation of the MDI  200 . Alternatively, the PMD may interact with a personal wireless device  500  which in turn interacts with the network. 
       FIG. 2  is a block diagram depicting the components of one embodiment of a PMD  100 . In one embodiment, the PMD includes a power module  110 . The power module  110  may be a battery or a line connection. If a battery, it may be rechargeable. In one embodiment the PMD includes a memory  120 . In one embodiment the PMD includes a processor  130 . The processor  130  executes instructions from its programming and also may participate in data transfer between other components of the PMD  100 . 
     Optionally, PMD  100  has connections to related external or embedded devices. In one embodiment, PMD  100  includes connections to detectors  140 . Detectors  140  may be any sensor of bodily or physiological parameters such as, but not limited to: temperature, motion, respiration, blood oxygen content, electrocardiogram (ECG), electroencephalogram (EEG), and other measurements. 
     Optionally, PMD  100  has connections to outputs  150 . The outputs may be signaled by changes in voltages, impedance, current, magnetic field, electromagnetic energy such as radio frequency signals, infrared signals or optical signals, and audible or other forms of mechanical energy. The outputs may be direct changes of state, analog, or digital in form. Several embodiments are possible, and the examples given herein are not intended in a limiting or restrictive sense. The outputs may be activated and controlled by the medical device interface  200  or the processor  130 , or by the actuation of the detector  140  or a combination of these. The outputs  150  may be used, for example, to actuate solenoids, operate motors, or apply electrical current to the heart. 
     Optionally, PMD  100  has connections to data input/output ports  160 . Data I/O ports  160  may include, but are not limited to: serial, parallel, USB, etc. 
     Optionally, PMD  100  includes a User Interface Module (UIM)  200 . The UIM  200  may allow users to view or enter data, conduct voice communications, use a camera to transmit images, or view a screen for graphical images. 
     Optionally, PMD  100  includes a wireless communications module  300 . In one embodiment the wireless communications module includes systems and standards for Local Area Wireless  330 . In one embodiment the wireless communications are designed to be Network Based Communications (NBC)  360 . 
     User Interface 
       FIG. 3  depicts User Interface Module (UIM)  200 . In one embodiment of UIM  200 , display  220  is included. Display  220  may be any standard device for displaying information, such as a CRT, plasma display, LED, LCD, etc. or equivalent. 
     Preferably the UIM  200  includes data input means  240 . Data input means may be any standard means for inputting information, such as a keypad, touch screen, bar code scanner, telephone keypad, buttons, switches, etc., or equivalent. 
     In one embodiment of UIM  200 , a speaker/microphone module  260  is included. Speaker/microphone module may be any device for producing sound, such as a speaker or microphone or the equivalent. 
     In one embodiment of UIM  200 , a camera  280  is included. Camera  280  may be a still camera, video camera, etc. 
     Communications 
       FIGS. 4A–4E  depict various possible wireless communication paths that may be used by the PMD  100  to connect to the long-range bi-directional network  400 . 
       FIG. 4A  depicts one embodiment of the present system. PMD  100  communicates to Personal Wireless Device (PWD)  500  with local area wireless (LAW)  330 . PWD  500  includes a LAW  330  compatible with LAW  330  in PMD  100 . In one embodiment, PWD  500  includes a UIM  200 . PWD  500  includes network based communications (NBC)  360 . NBC  360  communicates information received from LAW  330  to long-range bi-directional network  400 . 
       FIG. 4B  depicts another embodiment of the present system. PMD  100  communicates to the network  400  through NBC  360 . LAW  330  is not employed. 
       FIG. 4C  depicts another embodiment of the present system. PMD  100  communicates through data port  160  to Medical Device Interface (MDI)  600 . In one embodiment, MDI  600  includes a UIM  200 . In this embodiment, MDI  600  includes a LAW  330  and communicates to PWD  500  through LAW  330 . PWD  500  includes a LAW  330  compatible with MDI  600 . Preferably, PWD  500  includes UIM  200 . Preferably, PWD  500  includes NBC  360  and communicates to long-range bi-directional  400  through NBC  360 . 
       FIG. 4D  depicts another embodiment of the present system. PMD  100  communicates through data port  160  to MDI  600 . MDI  600  may include UIM  200 . Preferably, MDI  600  includes NBC  360  and communicates to long-range bi-directional network  400  through NBC  360 . 
       FIG. 4E  depicts another embodiment of the present system. PMD  100  communicates through LAW  330  to another PMD  100 , which in turn communicates through data port  160  to a third PMD  100 . 
       FIG. 4F  shows that a single medical device interface  600  can communicate simultaneously with multiple PMDs  100 . 
     About Local Area Wireless Communications 
     LAW  330  may include, but is not limited to, infrared or radio frequency (RF). Any suitable RF system that conforms to FCC requirements and power requirements may be used. Preferably, the BLUETOOTH standard is used. BLUETOOTH is a 2.4 GHz wireless technology employed to transport data between cellular phones, notebook PCs, and other handheld or portable electronic gear at speeds of up to 1 megabit per second. The BLUETOOTH standard was developed by the Bluetooth Special Interest Group (“BSIG”), a consortioum formed by Ericsson, IBM, Intel, Nokia, and Toshiba. The BLUETOOTH standard is designed to be broadband compatible and capable of simultaneously supporting multiple information sets and architecture, transmitting data at relatively high speeds, and providing data, sound, and video services on demand. Of course, other suitable wireless communication standards and methods now existing or developed in the future are contemplated in the present invention. In addition, embodiments are contemplated that operate in conjunction with a BLUETOOTH or BLUETOOTH-like wireless communication standard, protocol, or system where a frequency other than 2.4 GHz is employed, or where infrared, optical, or other communication means are employed in conjunction with BLUETOOTH or BLUETOOTH-like wireless RF communication techniques. 
     In one embodiment, the present system includes a transceiver in compliance with BLUETOOTH® technical specification version 1.0, herein incorporated by reference. In one embodiment, the present system includes a transceiver in compliance with standards established, or anticipated to be established, by the Bluetooth Special Interest Group. 
     In one embodiment, the present system includes a transceiver in compliance with standards established, or anticipated to be established, by the Institute of Electrical and Electronics Engineers, Inc., (IEEE). The IEEE 802.15 WPAN standard is anticipated to include the technology developed by the BLUETOOTH® Special Interest Group. WPAN refers to Wireless Personal Area Networks. The IEEE 802.15 WPAN standard is expected to define a standard for wireless communications within a personal operating space (POS) which encircles a person. 
     In one embodiment, the transceiver is a wireless, bi-directional, transceiver suitable for short-range, omni-directional communication that allows ad hoc networking of multiple transceivers for purposes of extending the effective range of communication. Ad hoc networking refers to the ability of one transceiver to automatically detect and establish a digital communication link with another transceiver. The resulting network, known as a piconet, enables each transceiver to exchange digital data with the other transceiver. According to one embodiment, BLUETOOTH® involves a wireless transceiver transmitting a digital signal and periodically monitoring a radio frequency for an incoming digital message encoded in a network protocol. The transceiver communicates digital data in the network protocol upon receiving an incoming digital message. 
     According to one definition, and subject to the vagaries of radio design and environmental factors, short-range may refer to systems designed primarily for use in and around a premises and thus, the range generally is below a mile. Short-range communications may also be construed as point-to-point communications, examples of which include those compatible with protocols such as BLUETOOTH®, HomeRF™, and the IEEE 802.11 WAN standard (described subsequently). Long-range, thus, may be construed as networked communications with a range in excess of short-range communications. Examples of long-range communication may include, Aeris MicroBurst cellular communication system, and various networked pager, cellular telephone or, in some cases, radio frequency communication systems. 
     In the event that transceiver includes a transceiver compatible with BLUETOOTH® protocol, for example, then the personal device may have sufficient range to conduct bi-directional communications over relatively short-range distances, such as approximately 10 to 1,000 meters or more. In some applications, this distance allows communications throughout a premise. 
     LAW  330  may include a separate, integrated or software based short-range bi-directional wireless module. The short-range network may be based upon HomeRF, 802.11, Bluetooth or other conventional or unconventional protocols. However, these are short-range networks and the meaning imposed herein is to include premises and facility based wireless networks and not to describe long-range networks such as cellular telephone networks used to communicate over long-distances. Such a system may include programmable or automatically selecting electronics to decide whether to conduct communications between the network module and an optional base station using the short-range module or the network module. In one embodiment the system may employ different portions of the network to provide short-range or long-range network connections, depending on the distance between the devices and the base stations. In one such embodiment, the network automatically adjusts for different required transmission distances. 
     In one embodiment, the transceiver is compatible with both a long-range communication protocol and a short-range communication protocol. For example, a person located a long distance away, such as several miles, may communicate with the transceiver using a cellular telephone compatible with the long-range protocol of transceiver. 
     Other short-range communication protocols are also contemplated and the foregoing examples are not to be construed as limitations but merely as examples. 
     About Long-Range Bi-Directional Network Based Communications 
     Long-range network based communications  360  refers to a type of communications system that has a greater range than LAW  330 , primarily because more power is available and/or because of an FCC license. 
     NBC  360  may include a long-range wireless communications network  362 , such as a cellular network, satellite network, paging network, narrowband PCS, narrowband trunk radio, or other wireless communication network. Combinations of such networks and other embodiments may be substituted without departing from the present system. 
     In one embodiment, the long-range wireless network  362  is a cellular communications network. In another embodiment, the long-range wireless network is a paging network. In another embodiment the long-range wireless network is a satellite network. In another embodiment the long-range wireless network is a wideband or narrowband PCS network. In another embodiment the long-range wireless network is a wideband or narrowband trunk radio module. Other networks are possible without departing from the present system. In one embodiment, the NBC  360  supports multiple network systems, such as a cellular module and a two-way paging module, for example. In such embodiments, the system may prefer one form of network communications over another and may switch depending on a variety of factors such as available service, signal strength, or types of communications being supported. For example, the cellular network may be used as a default and the paging network may take over once cellular service is either weak or otherwise unavailable. Other permutations are possible without departing from the present system. 
     The long-range wireless network  362  employed may be any consumer or proprietary network designed to serve users in range of the detection system, including, but not limited to, a cellular network such as analog or digital cellular systems employing such protocols and designs as CDPD, CDMA, GSM, PDC, PHS, TDMA, FLEX™, ReFLEX™, iDEN™, TETRA™, DECT, DataTAC™, and Mobitex™, RAMNET™ or Ardis™ or other protocols such as trunk radio, Microburst™, Cellemetry™, satellite, or other analogue or digital wireless networks or the control channels or portions of various networks. The networks may be proprietary or public, special purpose or broadly capable. However, these are long-range networks and the meaning imposed herein is not to describe a premises or facility based type of wireless network. 
     The long-range wireless network  362  may employ various messaging protocols. In one embodiment Wireless Application Protocol (WAP) is employed as a messaging protocol over the network. WAP is a protocol created by an international body representing numerous wireless and computing industry companies. WAP is designed to work with most wireless networks such as CDPD, CDMA, GSM, PDC, PHS, TDMA, FLEX, ReFLEX, iDEN, TETRA, DECT, DataTAC, and Mobitex and also to work with some Internet protocols such as HTTP and IP. Other messaging protocols such as iMode™, WML, SMS and other conventional and unconventional protocols may be employed without departing from the design of the present embodiment. 
     As an example, these long-range communication protocols described above may include, but are not limited to, cellular telephone protocols, one-way or two-way pager protocols, and PCS protocols. Typically, PCS systems operate in the 1900 MHZ frequency range. One example, known as Code-Division Multiple Access (CDMA, Qualcomm Inc., one variant is IS-95) uses spread spectrum techniques. CDMA uses the full available spectrum and individual messages are encoded with a pseudo-random digital sequence. Another example, Global Systems for Mobile communications (GSM), is one of the leading digital cellular systems and allows eight simultaneous calls on the same radio frequency. Another example, Time Division Multiple Access (TDMA, one variant known as IS-136) uses time-division multiplexing (TDM) in which a radio frequency is time divided and slots are allocated to multiple calls. TDMA is used by the GSM digital cellular system. Another example, 3G, promulgated by the ITU (International Telecommunication Union, Geneva, Switzerland) represents a third generation of mobile communications technology with analog and digital PCS representing first and second generations. 3G is operative over wireless air interfaces such as GSM, TDMA, and CDMA. The EDGE (Enhanced Data rates for Global Evolution) air interface has been developed to meet the bandwidth needs of 3G. Another example, Aloha, enables satellite and terrestrial radio transmissions. Another example, Short Message Service (SMS), allows communications of short messages with a cellular telephone, fax machine and an IP address. Messages are limited to a length of 160 alpha-numeric characters. Another example, General Packet Radio Service (GPRS) is another standard used for wireless communications and operates at transmission speeds far greater than GSM. GPRS can be used for communicating either small bursts of data, such as e-mail and Web browsing, or large volumes of data. 
     In one embodiment, a long-range communication protocol is based on two way pager technology. Examples of two way pager protocols include ReFLEX™ (Motorola) format, InFLEXion© (Motorola) format, NexNet© (Nexus Telecommunications Ltd. of Israel) format and others. 
     Other long-range communication protocols are also contemplated and the foregoing examples are not to be construed as limitations but merely as examples. 
     About the Personal Wireless Device and Medical Device Interface 
     A medical device interface  600  is similar to a personal wireless device  500  except that network based communications  360  is optional with a medical device interface  600 . 
     The personal wireless device  500  or medical device interface  600  may be of several different designs. For example, in one embodiment it may be a “response messaging” capable two-way pager. This is service where a two-way pager receives a message and optional multiple-choice responses. The user can select the appropriate responses. Such a design may be adapted to provide basic control options related to the system. 
     In another embodiment, the personal wireless device  500  or medical device interface  600  may be a programmable two-way paging device such as the Motorola PageWriter™ 2000. This is a class of device that acts as both a two-way pager and a handheld computer also known as a PDA (Personal Digital Assistant). 
     In another embodiment, the personal wireless device  500  or medical device interface  600  may be a cellular telephone. The cell phone may be analog or digital in any of the various technologies employed by the cell phone industry such as PCS, or CDMA, or TDMA, or others. The cell phone may have programmable capability such as is found in a Nokia™ 9000 series of devices. 
     In embodiments where the user employs standard or adapted paging or cell phones as their personal wireless device  500  or medical device interface  600 , security passwords may be entered by using numeric or other keys on a phone. In another embodiment, the security password may be entered by speaking words. In this embodiment, the system may use word recognition, voice recognition or a combination of these technologies. In the embodiment of a pager, a distinct order of pressing certain keys could provide the equivalent of a security code. For example, 3 short and 1 long on a certain key; or once on key ‘a’, once on key ‘b’, and once more on key ‘a’. 
     In another embodiment, the personal wireless device  500  or medical device interface  600  is a handheld computer. Many personal digital assistants (PDAs) offer programmable capability and connectivity to various types of long-range wireless networks. An example of this type of device is the PalmPilot™ or Palm series of devices manufactured by Palm, Inc. In these embodiments where a programmable personal wireless device  500  or medical device interface  600  is used such as a PalmPilot, PageWriter or programmable cell phone, the programmable nature of the devices facilitates the implementation of industry-standard designs and would allow for the development of a program written for the devices. 
     In another embodiment, a special manufactured device may be manufactured to serve the needs of the system user. 
     In another embodiment, the personal medical device  100  is directly connected to a personal wireless device  500  that is manufactured as an integrated unit. 
     About the Central Communications Base Station 
     In one embodiment, the personal medical device  100  communicates with a device referred to herein as central communication base station  700 . Central communication base station  700  may include a first transceiver compatible with BLUETOOTH® or other short-range wireless network as described herein. Base station may provide a repeater service to receive a message using BLUETOOTH® and to retransmit the message using a different communication protocol or also using BLUETOOTH® communication protocol. 
     Base station  700  may also include a second transceiver or a wired interface having access to another communication network  750 . The second transceiver or wired interface may retransmit the signal received from the personal device  100  or received from some other device. In this way, central communication base station  700  may serve to extend the communication range of the personal device. For example, a message between the personal device and an emergency-dispatch center may be coupled to communication with the base station  700  connected network  750  and a short-range wireless network. Communications between the personal device  100  and a device coupled to communicate with the base station  700  connected network  750  may be considered long-range communications. 
     Base station may  700  also communicate bi-directionally within the premise with one or more additional compatible devices. These may be a second personal device  100  or any other device. 
     The base station connected network  750  may be a public switched telephone network (PSTN), a pager communication network, a cellular communication network, a radio communication network, the Internet, or some other communication network. It will be further appreciated that with a suitable repeater, gateway, switch, router, bridge or network interface, the effective range of communication of a short-range transceiver may be extended to any distance. For example, base station  700  may receive transmissions on a BLUETOOTH® communication protocol and provide an interface to connect with the base station connected network  750 , such as the public switched telephone network (PSTN) using the base station link. In this case, a wired telephone at a remote location can be used to communicate with the personal device  100 . As another example, the range may be extended by coupling a BLUETOOTH® transceiver with a cellular telephone network, a narrow band personal communication systems (“PCS”) network, a CELLEMETRY® network, a narrow band trunk radio network or other type of wired or wireless communication network. 
     Examples of devices compatible with such long-range protocols include, but are not limited to, a telephone coupled to the public switched telephone network (PSTN), a cellular telephone, a pager (either one way or two way), a personal communication device (such as a personal digital assistant, PDA), a computer, or other wired or wireless communication device. 
     In one embodiment, the long distance network  750  may include a telephone network, which may include an intranet or the Internet. Coupling to such a network may be accomplished, for example, using a variety of connections, including a leased line connection, such as a T-1, an ISDN, a DSL line, or other high-speed broadband connection, or it may entail a dial-up connection using a modem. In one embodiment, the long distance network  750  may include a radio frequency or satellite communication network. In addition, one or more of the aforementioned networks may be combined to achieve desired results. 
     Short-range communication protocols, compatible with the base station may include, but are not limited to, wireless protocols such as HomeRF™, BLUETOOTH®, wireless LAN (WLAN), or other personal wireless networking technology. HomeRF™, currently defined by specification 2.1, provides support for broadband wireless digital communications at a frequency of approximately 2.45 GHz. 
     Other long-range and short-range communication protocols are also contemplated and the foregoing examples are not to be construed as limitations but merely as examples. 
     The base station  700  may be compatible with more than one communication protocol. For example, the base station may be compatible with three protocols, such as a cellular telephone communication protocol, a two-way pager communication protocol, and BLUETOOTH® protocol. In such a case, a particular personal device  100  may be operable using a cellular telephone, a two-way pager, or a device compatible with BLUETOOTH®. 
     In one embodiment, the personal device  100  can communicate with a remote device using more than one communication protocols. For example, the personal device may include programming to determine which protocol to use for communicating. 
     The determination of which communication protocol to use to communicate with a remote device may be based on power requirements of each transceiver, based on the range to the remote device, based on a schedule, based on the most recent communication from the remote device, or based on any other measurable parameter. In one embodiment, the personal device  100  communicates simultaneously using multiple protocols. 
     In one embodiment, there are various types of networks connected to the base station  700 . These may be telephone networks, modem connections, frame relay systems, spread-spectrum, DSL, cable modems, dedicated line or other similar wire based communication and data networks. In addition, these may be long-range, bi-directional, wireless networks as describe above. 
     In one embodiment, there is a connection to the Internet using various Internet protocols such as TCP/IP/HTTP/HTCP and others. 
     Other Connections from the Personal Medical Device 
     In one embodiment, signals generated by the medical device are received by a central monitoring station  800 . The central monitoring station  800  may include operators that provide emergency dispatch services. An operator at the central monitoring station  800  may also attempt to verify the authenticity of a received alarm signal. In one embodiment, the alarm signal generated by the personal device  100  is first transmitted to a user, using either a short-range or long-range communication protocol, who then may forward the alarm signal to a monitoring station if authentic or cancel the alarm signal if the alarm is not valid. 
     In one embodiment, the personal device  100  may communicate with a building control or security system  900  by communicating using its transceiver. For example, the personal device may operate as an auxiliary input to a building control or security system. In which case, if the personal device  100  detects a security event, by way of a sensor coupled to the personal device, then an alarm signal is transmitted from the personal device, via its transceiver, to the building security system. The building security system, if monitored by a central monitoring station, then forwards the alarm signal to the monitoring station. In one embodiment, the personal device  100  can receive a transmission from a separate building control or security system. If the building security system detects an alarm condition, then the security system can, for example, instruct the personal device to repeatedly toggle power to load a flashing light visible from the exterior of the building that may aid emergency personnel in locating an emergency site. Alternatively, the personal device can establish communications with a predetermined remote device or a central monitoring service. 
     Routing Paths from the Personal Medical Device 
     The present invention includes, but is not limited to, the following routing paths from the personal device  100 : 
     1) short-range wireless to long-range wireless in a pre-designed system. That is, both the personal device  100  and the device with which it communicates have been set up in communication in advance. For example, the personal device  100  is connected to a short-range wireless module that communicates to a cell phone or other wireless network device carried by the user. 
     2) short-range wireless to long-range wireless “ad hoc”: the personal device sets up a short-range “ad hoc” network to any available long-range network connection. 
     3) short-range wireless to any network connection. For example, the personal device  100  is connected to a short-range wireless module that communicates to a telephone or Internet base station in a person&#39;s home. 
     4) long-range wireless directly. For example, the personal device  100  is directly connected to a long-range wireless network module. 
     Transmission to the Personal Medical Device 
     In addition, feedback may be transmitted to a remote device based on the operation of the personal device. For example, if a user issues a command to the personal device using a cellular telephone, then the display of the phone will indicate the changes arising from the command. In one embodiment, the cellular telephone, the base station, emergency monitoring center, or other device displays real time information from the personal device  100 . 
     Various methods may be used to communicate with, or send a message or instruction to, the personal device  100  from a remote location. For example, using a cellular telephone, a user may speak a particular phrase, word or phoneme that is recognized by the cellular telephone which then generates and transmits a coded message to the personal device  100 . As another example, the user may manipulate a keypad on the telephone to encode and transmit a message to the personal device. 
     Data Types Communicated to and from the Personal Medical Device 
     Table I below shows the types of data that may be communicated to and/or from the personal device  100 , and the direction of data flow. 
                         TABLE I               Data Type   Direction of transmission                   diagnosis (suggested by PMD/MDI or from   bi-directional       medical center       manual request   from PMD       identification (e.g., bluetooth serial   from PMD       number, PMD ID, account number)       use alert (e.g., opening a container, etc.)   from PMD       activation (shock, release medication, brain   bi-directional       stimulation)       body reading (electrical, chemical, analog,   from PMD       digital, mechanical, temperature, etc.)       two-way voice (to responding agency,   bi-directional       bystander, or patient)       digital instructions   bi-directional       standard I/O ports   bi-directional       camera: visual, video exhange   bi-directional       authorizations and authentications   bi-directional       Security codes, data confirmations,   bi-directional       acknowledgements       transceiver activation   to PMD       encryption   bi-directional       interaction with related PMDs   bi-directional       verification (alarms, emergencies)   bi-directional                    
Data Flow Examples
 
     One possible example of data flow to and from the personal device  100  is shown in  FIG. 5 . 
     The personal device  100  may be implanted in the victim V, or carried on the person of the victim V. For example the personal device  100  may be a pacemaker that is imbedded in the chest cavity of the victim V and connected by leads to the victim&#39;s heart, as is well known in the art. 
     In this example, the victim V undergoes some sort of cardiac problem, such as tachycardia, that causes the personal device  100  to attempt to establish communication with a caregiver. While this is going on, a bystander B attempts to give aid to the victim V. The bystander B is carrying on his person a medical device interface  500  or a personal wireless device  600 . When the personal device  100  attempts to establish communication, it sets up communication with the personal wireless device  600  by local area wireless  330 . For example, if the personal device  100  and personal wireless device  600  both use BLUETOOTH for local area wireless communications, the personal device  100  and personal wireless device  600  will follow the communications protocols of the BLUETOOTH standard and establish communications. 
     Next, the personal device  100  may request the personal wireless device  600  to establish a connection to the dispatcher or medical caregiver D, using network based communications  360 . For example, the personal wireless device  600  may be a cell phone or PDA. Using network based communications  360 , the personal wireless device establishes a connection to the computer of the dispatcher or medical caregiver D. 
     Alternatively, the personal wireless device  600  may establish a connection to an automatic processor P, which has database DB that contains information on the victim&#39;s medications, medical history, pre-existing conditions, possible diagnoses, personal records, personal device information, treatment strategies, response plans, identities or responsing agencies, and other data. 
     Either the dispatcher D or the processor P may then send an inquiry through the personal wireless device  600  to the personal device  100 , instructing the personal device  100  to send various data, for example, electrocardiogram data. Using this transmitted data, the dispatcher or processor may then make a diagnosis and identify a treatment strategy. 
     The dispatcher D may then alert responding personnel R, such as a paramedic unit, to travel to the victim V. In the event that the victim&#39;s personal device  100  has location identification capability (discussed below), the dispatcher D will be able to give the exact location of the victim to the responding personnel R. The dispatcher D may also alert responsible parties RP such as the victim&#39;s parents of the location. 
     Until the responding personnel R reach the scene, the dispatcher D may establish voice communications with the bystander B through the bystander B&#39;s personal wireless device  600 . The dispatcher may ask the bystander B to use the camera  280  of the personal wireless device to transmit an image of the victim V. The dispatcher D may give the bystander B instructions on how to render first aid to the victim V until the responding personnel R arrive. 
     When the responding personnel R reach the victim, they may establish communications through local area wireless  330  from their medical device interface  500  to the victim&#39;s personal device  100 , request data from the personal device  100 , and request the personal device  100  to take some action, such as dispensing medication to the victim V. Their medical device interface  500  may also establish communication with the dispatcher D or medical caregiver using network based communications  360 . 
     The above is just one example of possible data flow to and from the personal device  100 . Many other scenarios are possible. 
       FIG. 6  summarizes data flow from the point of view of a remote caregiver, showing that comprehensive data creates the best options for the remote caregiver. 
     Location Management 
     Optionally, the personal device  100  includes the ability to detect its own location and to communicate this location to authorized requesters. The location-determining function may be device-based, network-based, or a combination of device-based and network-based, as described in co-pending U.S. patent application entitled “Method and System for Wireless Tracking”, filed Mar. 28, 2002, herein incorporated by reference, in the Detailed Description, and in  FIGS. 4A ,  4 B and  4 C therein. 
     As discussed in the referenced patent application ( FIG. 4A ), the personal device  100 B may include a GPS receiver positioned internal to device  100   b .  FIG. 4B  of the referenced patent illustrates a communication network  200 A having integral LDS  165 A. Location information, in one embodiment, is based on a geographical location of first device  100 C and is determined based on timing information for wireless signals between network  200 A and device  100 C. Second device  300  is also connected to communication network  200 A. In one embodiment, a server coupled to network  200 A includes programming to determine location information and selected clients accessing the server are able to receive the location information. Selected clients are those authorized to receive the location information.  FIG. 4C  of the referenced patent application illustrates LDS  145 B and LDS  165 B within first device  100 D and network  200 B, respectively. In such an embodiment, the combination of information generated by LDS  145 B and LDS  165 B provides the location information. 
     As described in the referenced patent application, the device  100  may include an electronic circuit or an electronic circuit and programming to determine location. In one embodiment, LDS  145  uses a terrestrial location system. There are several varieties of terrestrial solutions, including time differential, signal strength, angle of arrival and varieties of triangulation. In one described embodiment, LDS  145  uses a combination of terrestrial and satellite navigation systems. 
     Security 
     The system and method of the present invention may also include various types of security arrangements. 
     It will be appreciated that the ability of various entities spread around a network to receive and/or transmit to and control the personal device  100  requires some measure of security. Only authorized agents should be allowed access to the device  100 . For example, in the example shown in  FIG. 5 , only responding personnel RP (such as trained paramedics) who are on the scene of the event may be allowed to send a command to the personal device  100  causing the personal device  100  to dispense medication to the victim. Certainly, the bystander B should not be allowed this level of access, even though the bystander B&#39;s personal wireless device  600  may be acting as an intermediary in communication from the personal device  100  to the dispatcher D. 
     The following are possible embodiments of security and not meant to be exclusive. 
     First, data transmitted to and from the personal device  100  may be encrypted by standard encryption algorithms, making it essentially impossible for the unsophisticated interceptor to interpret the data. 
     Second, voice and visual channels of transmission may be controlled for activation by the personal device  100  or by an authorized entity, but may not necessarily be encrypted. 
     Third, security keys may be held by a central agency and provided to the responding personnel RP. 
     Fourth, the user of the personal device  100  may have a security key that he can enter to release information or access to authorized parties. 
     A number of strategies may be employed for authorization and authentication. For example, biometrics may be used. Biometrics refers to the measurement of some bodily parameter (such as fingerprint, retinal scan, etc.) that is unique to the individual. 
     Second, a public/private key system can be used in which access to both keys is required for decoding an encrypted message. Each party that wishes to participate in secure communications must create a key set for encrypting and decrypting messages. One key is private and the other is public. The public key is for exchanging with other parties with whom you who wish to participate in secure communication sessions. Each individual owner must keep the private portion of the key secure. The private key also has a secret pass phrase, in the event that it is ever ‘misappropriated’. Public key/private key technology allows the sender to sign a message with their private key. When the recipient receives the message, they can validate the authenticity of the signature because they have the sender&#39;s public key. 
     Third, a user needing access to the device  100  may make a request for such access to a responsible third party. 
     Fourth, the personal device  100  may have pre-authorized authority for certain users. 
     A number of authorization strategies are discussed in co-pending U.S. patent application, entitled “Method and System for Wireless Tracking”, filed Mar. 28, 2002, herein incorporated by reference, in the Detailed Description. 
     About Power Management 
     In a number of scenarios, the power consumed by the personal device  100  is critical. For example, it the personal device  100  is implanted in a human being, long battery life is essential. 
     Although some communications systems, such as BLUETOOTH, have low power consumption states, nevertheless power is being consumed. Further, in an environment such as BLUETOOTH, a BLUETOOTH transceiver that is powered on may constantly be wakened from the low power states whenever a transmission is received from another BLUETOOTH transceiver. 
     It is therefore an important aspect of the present invention to provide a completely powered-off state for the bi-directional communications module, and for a means of signaling the bi-directional communications module to transition from the powered-off state to the powered-on state. The transceiver must consume no power in the powered-off state. 
     A number of mechanisms for doing this signaling are possible. First, a mechanical signal, such as throwing a switch or applying pressure to a pad, may be used. Second, a magnetic signal may be used, as in passing a magnet in the vicinity of the communications module. Third, sound or ultra-sound may be used. Fourth, infrared may be used provided there is a direct line of sight to the communications module. Sixth, radio frequency may be used, which has the advantage of not requiring line of sight to the communications module. 
     Radio frequency is already being used for applications such as automated meter reading and electronic article surveillance. Such applications included un-powered RF receivers such as RFID tags. 
       FIG. 7  shows a general block diagram of this power management function. The personal device  100  is modified to include an un-powered RF receiver  710  that is tuned to a particular frequency. Power-up device  800  has an RF transmitter tuned to the same frequency. When a signal is sent to the RF receiver  710 , the receiver  710  gathers the RF energy and activates logic  720 . Any code transmitted on the frequency is passed to the logic  720 , which decodes it and compares it to a proper wake-up code. If a proper wake-up code is received, logic  720  signals the processor  130  to power-on the communications module  300 . The wake-up code is optional, in that the receiver  710  may just signal the processor  130  directly without decode.