Patent Publication Number: US-11663898-B2

Title: Remote health monitoring system

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 13/911,213, filed Jun. 6, 2013, now U.S. Pat. No. 10,297,132, issued on May 21, 2019, which is a continuation of U.S. application Ser. No. 13/446,490, filed Apr. 13, 2012, now U.S. Pat. No. 8,478,418, issued on Jul. 2, 2013, which claims the benefit of U.S. Provisional Patent Application No. 61/476,072, filed Apr. 15, 2011, titled “Remote Health Monitoring System,” the entire contents of each of which are hereby incorporated by reference herein, for all purposes. 
    
    
     TECHNICAL FIELD 
     The present invention relates to remote physiologic monitoring systems and, more particularly, to patient-worn remotely-controlled physiologic monitoring systems. 
     BACKGROUND ART 
     Remote monitoring of ambulatory patients enables doctors to detect or diagnose heart problems, such as arrhythmias, that may produce only transient symptoms and, therefore, may not be evident when the patients visit the doctors&#39; offices. Several forms of cardiac event monitors have been used. 
     A “Holter” monitor is worn by a patient and collects and stores data for a period of time, typically at least 24 hours, and in some cases up to two weeks. After the data has been collected, the Holler monitor is typically brought or sent to a doctor&#39;s office, laboratory or the like, and the data is retrieved from the monitor and analyzed. Holter monitors are relatively inexpensive, but they cannot be used for real-time analysis of patient data, because the data is analyzed hours, days or weeks after it has been collected. 
     More timely analysis of heart data is made possible by pre-symptom (looping memory) event monitors. Such a device collects and stores patient data in a “loop” memory device. The event monitor constantly overwrites previously stored data with newly collected data. The event monitor may include a button, which the patient is instructed to actuate if the patient feels ill or otherwise detects a heart-related anomaly. In response, the event monitor continues to record data for a short period of time and then stops recording, thereby retaining data for a time period that spans the button actuation, i.e., the retained data represents a period of time that extends from (typically) a few minutes before the user actuated the button to (typically) a few minutes after the user actuated the button. The retained data may then be sent via a modem and a telephone connection to a doctor&#39;s office or to a laboratory for analysis. Although such an event monitor can facilitate analysis of patient data more proximate in time to the patient-detected anomaly, relying on the patient to actuate the device and then send the data can be problematic. 
     Some event monitors automatically detect certain arrhythmias and, in response, record electrocardiograph (ECG) data. Automatic event monitors are thought to be more sensitive, but less specific, than manually triggered cardiac event monitors for significant cardiac arrhythmias. However, these devices still rely on patients to send the recorded data for analysis, and there is still a delay between detection of a suspected arrhythmia and transmission of the data. 
     Mobile cardiovascular telemetry (MCT) refers to a technique that involves noninvasive ambulatory cardiac event monitors that are capable of continuous measurements of heart rate and rhythm over several days. For example, CardioNet, Philadelphia, Pa., provides an MCT device under the trade name “Mobile Cardiac Outpatient Telemetry” (MCOT). The MCOT device includes an automatic ECG arrhythmia detector. The MCOT device couples to a cellular telephone device to immediately transmit automatically detected abnormal ECG waveforms to a remote monitoring center, which can then alert a physician. The MCOT device also includes a memory capable of storing up to 96 hours of ECG waveform data, which can be transmitted over standard telephone lines to the remote monitoring center at the end of each day. Although data about automatically detected arrhythmias are sent immediately to the remote monitoring center, without requiring patient action, the computational resources and corresponding electrical power (battery) required to perform the automatic ECG analysis in the MCOT device are significant. 
     Some MCT devices continuously send all collected ECG data to a remote monitoring center for analysis. These MCT devices typically do not perform any ECG analysis of their own. Although no patient-initiated action is required, the large amount of data transmitted by the MCT wireless devices congests the wireless channels used to convey the data. Furthermore, a large amount of computational resources is required at the remote monitoring center to analyze the continuous stream of received data, especially when many patients are monitored by a single data center. 
     U.S. Pat. Publ. No. 2010/0298664 discloses a wireless ECG data collection and analysis system. 
     U.S. Pat. No. 7,996,187 discloses a personal health monitor that collects and processes physiologic data and wirelessly transmits the processed data to a remote entity. 
     U.S. Pat. Publ. No. 2009/0076405 discloses a wireless respiration monitoring system. Upon receipt of a notification, a medical provider, a remote monitoring system or a medical treatment device can trigger a higher data sample rate in the patient-worn monitor device and use the higher sample rate data collected thereafter to verify an alert condition. 
     U.S. Pat. No. 7,801,591 discloses a healthcare information management system that displays patient information at various levels of analysis, based on user need and sophistication level. 
     SUMMARY OF EMBODIMENTS 
     An embodiment of the present invention provides a system for remote physiologic monitoring of a body of a patient. The monitoring is performed in association with a remote server. The system includes a plurality of sensors and a transceiver assembly. Each sensor of the plurality of sensors configured to be coupled to the body of the patient to generate respective physiologic data about the body. The transceiver assembly includes a memory, a controller and a wireless transceiver. The transceiver assembly is communicatively coupled to the plurality of sensors. The transceiver assembly is configured to receive the physiologic data from the plurality of sensors. The transceiver assembly is also configured to store the received physiologic data in the memory. The stored data is referred to as “more detailed data.” The transceiver assembly is configured to send a subset of the received physiologic data (referred to as “less detailed data”), via the wireless transceiver, to the remote server. The less detailed data sent to the remote server is characterized by: a lower resolution than the more detailed data stored in the memory for a corresponding time period and/or a lower sampling rate than the more detailed data stored in the memory for a corresponding time period and/or having been received from a different set of the sensors than the more detailed data stored in the memory for a corresponding time period. The transceiver assembly is configured to fetch at least a portion of the more detailed physiologic data from the memory, in response to a signal from the remote server. In addition, in response to the signal from the remote server, the transceiver assembly is configured to send the fetched more detailed physiologic data to the remote server. 
     The less detailed data sent to the remote server may be characterized by a lower resolution than the more detailed data stored in the memory for a corresponding time period and/or a lower sampling rate than the more detailed data stored in the memory for a corresponding time period. 
     The remote server may be configured to receive the less detailed physiologic data sent by the transceiver assembly and automatically analyze the received less detailed physiologic data for an indication of a health-related anomaly. If the health-related anomaly is indicated, the remote server may be configured to automatically send the signal to the transceiver assembly. 
     The health-related anomaly may be or include an arrhythmia. 
     The remote server may also be configured to receive the more detailed physiologic data and automatically analyze the received more detailed physiologic data to verify the indicated health-related anomaly. 
     The remote server may be configured to analyze the less detailed physiologic data according to a first analytic technique and analyze the more detailed physiologic data according to a second analytic technique. The second analytic technique may have a higher specificity for the health-related anomaly than the first analytic technique. 
     The remote server may be configured to automatically analyze the received less detailed physiologic data for the indication of the health-related anomaly using ECG data and automatically analyze the received more detailed physiologic data to verify the indicated health-related anomaly using data other than ECG data. 
     The remote server may be configured to display a first user interface configured to accept at least one user-specified criterion. The remote server may be configured to automatically analyze the received less detailed physiologic data for the indication of the health-related anomaly, based on at least a portion of the less detailed physiologic data meeting the user-specified criterion. 
     The remote server may be configured to display a first user interface configured to accept at least one user-specified criterion and automatically analyze the received more detailed physiologic data to verify the indicated health-related anomaly, based on at least a portion of the more detailed physiologic data meeting the user-specified criterion. 
     The wireless transceiver may include a cellular telephone. 
     The wireless transceiver assembly may include a cellular telephone coupled via a short-range wireless link to the wireless transceiver. The cellular telephone may be configured to: store the more detailed data in the memory; send the less detailed data to the remote server; responsive to the signal, fetch the at least the portion of the more detailed physiologic data from the memory and send the fetched more detailed physiologic data to the remote server via a wireless carrier network. 
     The system may also include a cellular telephone configured to be communicatively coupled to a wireless carrier network. The cellular telephone may be configured to receive the physiologic data sent by the transceiver assembly via the wireless transceiver and send the received physiologic data via the wireless carrier network to the remote server. 
     The system may also include an application program configured to be executed by a cellular telephone that is configured to be communicatively coupled to a wireless carrier network. The application program may be configured to receive the physiologic data sent by the transceiver assembly via the wireless transceiver and send the received physiologic data via the wireless carrier network to the remote server. 
     The plurality of sensors may include an ECG sensor and at least one accelerometer. The remote server may be configured to calculate a respiration rate, based at least in part on data from the ECG sensor and data from the at least one accelerometer. 
     The remote server may be configured to calculate a first candidate respiration rate, based on the data from the ECG sensor and calculate a second candidate respiration rate based on the data from the at least one accelerometer. If a difference between the first and second candidate respiration rates is less than a predetermined value, the remote server may calculate the respiration rate as an average of the first and second candidate respiration rates. If both the first and second candidate respiration rates are within a predetermined range, the remote server may calculate the respiration rate as being equal to the first candidate respiration rate. If only the first candidate respiration rate is within the predetermined range, the remote server may calculate the respiration rate as being equal to the first candidate respiration rate. If only the second candidate respiration rate is within the predetermined range, the remote server may calculate the respiration rate as being equal to the second candidate respiration rate. 
     The remote server may be configured to accept, through a first user interface, a user-specified data collection parameter. In response to accepting the user-specified data collection parameter, the remote server may be configured to send the data collection parameter to the transceiver assembly. The transceiver assembly may be configured to receive the data collection parameter and, in response to receipt of the data collection parameter, to change the resolution and/or the sampling rate of the less detailed physiologic data thereafter sent to the remote server. 
     The remote server may be configured to generate a first display, in a first user interface, from the less detailed physiologic data received from the transceiver assembly. In response to a user input, the remote server may be configured to generate a second display, in the first user interface, from at least a portion of the more detailed physiologic data received from the transceiver assembly and corresponding to a time associated with the data displayed in the first display. 
     The remote server may be further configured, in response to the user input, to send the signal to the transceiver assembly. 
     Another embodiment of the present invention provides a method for remote physiologic monitoring of a body of a patient. According to the method, physiologic data is received from a plurality of sensors coupled to the body of the patient. The received physiologic data is stored in a memory. The stored data is referred to as “more detailed data.” A subset of the received physiologic data (referred to as “less detailed data”) is wirelessly sent to a remote server. The less detailed data sent to the remote server is characterized by: a lower resolution than the more detailed data stored in the memory for a corresponding time period and/or a lower sampling rate than the more detailed data stored in the memory for a corresponding time period and/or having been received from a different set of the sensors than the more detailed data stored in the memory for a corresponding time period. Responsive to a signal from: the remote server, at least a portion of the more detailed physiologic data is fetched from the memory. The fetched more detailed physiologic data is sent to the remote server. 
     The less detailed data sent to the remote server may be characterized by: a lower resolution than the more detailed data stored in the memory for a corresponding time period and/or a lower sampling rate than the more detailed data stored in the memory for a corresponding time period. 
     In addition, the less detailed physiologic data may be received at the remote server. The received less detailed physiologic data may be automatically analyzed for an indication of a health-related anomaly. If the health-related anomaly is indicated, the signal may be automatically sent. 
     The more detailed physiologic data may be received and the received more detailed physiologic data may be automatically analyzed to verify the indicated health-related anomaly. 
     Analyzing the less detailed physiologic data may include analyzing the less detailed data according to a first analytic technique. Analyzing the more detailed physiologic data may include analyzing the more detailed data according to a second analytic technique. The second analytic technique may have a higher specificity for the health-related anomaly than the first analytic technique. 
     Yet another embodiment of the present invention provides a system for remote physiologic monitoring of a body of a patient. The monitoring is performed in association with a remote server. The system includes a plurality of sensors and a transmitter assembly. Each sensor of the plurality of sensors is configured to be coupled to the body of the patient to generate respective physiologic data about the body. The transmitter assembly includes a memory, a controller and a wireless transmitter. The transmitter assembly is communicatively coupled to the plurality of sensors. The transmitter assembly is configured to receive the physiologic data from the plurality of sensors and store the received physiologic data in the memory. The stored physiologic data is referred to as “more detailed data.” The transmitter assembly is also configured to automatically analyze a subset of the received physiologic data (referred to as “less detailed data”) for an indication of a health-related anomaly. The less detailed data is characterized by: a lower resolution than the more detailed data stored in the memory for a corresponding time period and/or a lower sampling rate than the more detailed data stored in the memory for a corresponding time period and/or having been received from a different set of the sensors than the more detailed data stored in the memory for a corresponding time period. If the health-related anomaly is indicated, the transmitter assembly is configured to automatically fetch at least a portion of the more detailed physiologic data from the memory and send the fetched more detailed physiologic data to the remote server. 
     The less detailed data may be characterized by at least one of: a tower resolution than the more detailed data stored in the memory for a corresponding time period and/or a lower sampling rate than the more detailed data stored in the memory for a corresponding time period. 
     The remote server may be configured to receive the more detailed physiologic data and automatically analyze the received more detailed physiologic data to verify the indicated health-related anomaly. 
     The transmitter assembly may be configured to analyze the less detailed physiologic data according to a first analytic technique, and the remote server may be configured to analyze the more detailed physiologic data according to a second analytic technique. The second analytic technique may have a higher specificity for the health-related anomaly than the first analytic technique. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention will be more fully understood by referring to the following Detailed Description of Specific Embodiments in conjunction with the Drawings, of which: 
         FIG.  1    is a schematic block diagram of an embodiment of the present invention. 
         FIG.  2    is a more detailed schematic block diagram of an embodiment of the present invention. 
         FIG.  3    is a schematic diagram illustrating one possible combination of physiological sensors and a possible placement of the sensors on a torso of a patient, according to an embodiment of the present invention. 
         FIG.  4    contains a hypothetical ECG waveform representing detailed data collected from the sensors of  FIG.  3    and stored in a memory, according to an embodiment of the present invention. 
         FIG.  5    contains a waveform representing a less detailed version of the data collected from the sensors of  FIG.  3    and sent to a remote server, according to an embodiment of the present invention. 
         FIG.  6    contains a waveform representing the more detailed data a transceiver assembly sends to the remote server in response to a request from the server, according to an embodiment of the present invention. 
         FIG.  7    contains a table of exemplary resolutions, sample rates and transmission duty cycles, according to an embodiment of the present invention. 
         FIG.  8    contains a table that lists exemplary threshold values for several patient activity levels, according to an embodiment of the present invention. 
         FIG.  9    is a flowchart illustrating a process for calculating a respiration rate, according to an embodiment of the present invention. 
         FIG.  10    is a schematic block diagram of an embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS 
     In accordance with embodiments of the present invention, methods and apparatus are disclosed for locally collecting and locally storing physiologic data from an ambulatory patient, wirelessly sending only a proper subset of the collected data to a remote central server and there automatically analyzing the sent data in real time. The sent subset of the collected data is less detailed than the data collected and stored by a local patient-attached data collector. 
     The central server employs a two-tiered analysis methodology. If the first tier, which performs a high-sensitivity but low-specificity analysis, detects a possible arrhythmia in the received subset of the collected data, the server requests the data collector to retrospectively send more detailed data the collector previously stored, i.e., more detailed data from around the time of the suspected arrhythmia. 
     The second tier performs a high-specificity analysis of the more detailed data to confirm or refute (“verify”) the suspected arrhythmia. Thus, overall utilization of the wireless channel used to send the data is kept low by sending detailed data only when necessary to verify a suspected arrhythmia. Furthermore, electrical power (battery) and computational resource requirements of the patient-attached data collector are kept low, because the data collector performs no data analysis. 
     Thus, significantly, embodiments of the present invention enable the remote server to operate primarily on a less detailed subset of collected data and retrospectively obtain more detailed data when necessary to verify a suspected arrhythmia. In contrast, no known prior art ambulatory patient monitor stores detailed collected data locally and sends only a subset of the collected data to a remote server. No known prior art remote server requests more detailed data from an earlier time period (“retrospectively requests data”) in response to detecting a suspected arrhythmia and then uses the more detailed data to verify the suspected arrhythmia. 
     A “subset” of the collected data means less than all of the collected data. The subset may, for example, be a downsampled (lower sampling rate) or quantized (less accurate samples) version of the collected data. The subset may include data from one or more sensors or one or more types of data, such as heart rate, ECG waveform, respiration rate, SpO2, blood pressure, body movement (such as provided by accelerometers). The more detailed data may include data from all the same, some of the same or different sensors or different types of data. SpO2 is a measure of the amount of oxygen attached to hemoglobin cells in circulating blood system. SpO2 is typically given as a percentage, normal is around 96%. The “S” in SpO2 stands for “Saturation.” 
       FIG.  1    is a schematic block diagram of an embodiment of the present invention. A data collector and set of physiologic sensors (collectively identified at  100 ) is assigned to each monitored patient. The physiologic sensors are attached to the patient, and data collected from the sensors are stored in a memory  103  within the data collector  100 . Time stamps, corresponding to times at which the data were collected, or other suitable data timing information is also stored in the memory  103 . If the memory  103  becomes full or reaches a predetermined fullness, the data collector  100  begins overwriting previously stored data, beginning with the oldest data. Thus, the memory  103  stores the most recently collected data on a rolling basis. 
     The data collector  100  includes, or is coupled to, a suitable wireless transceiver  104 , such as a cellular telephone. A subset of the collected data (identified as “less detailed data”  106 ), including information about when the data were collected, is sent wirelessly to a central remote server  107 , such as via a cellular telephone network  108 . The less detailed data  106  may be a downsampled version of the collected data. That is, the less detailed data  106  may have a lower sampling rate than the collected and stored data. For example, only every Nth sample of the collected data may be included in the less detailed data  106 , where N is an integer or rational fraction that provides a sampling rate sufficient for the first tier analysis. Optionally or alternatively, the less detailed data  106  May be a quantized version of the collected data. That is, the less detailed data  106  may be rounded or otherwise include fewer digits of accuracy than the collected data, although sufficient for the first tier analysis. 
     The central server  107  may serve many per-patient data collectors  100 . The central server  107  performs a high-sensitivity analysis  109  of the less detailed data  106 . The high-sensitivity analysis  109  is configured such that it has a low probability of generating a false negative result. That is, the high-sensitivity analysis  109  is not likely to fail to detect an actual arrhythmia. However, to achieve this high level of sensitivity, the high-sensitivity analysis  109  is likely to generate a relatively large number of false positive results, i.e., the first analytical tier may have low specificity. 
     A relatively large number of false positive results is, however, acceptable for several reasons, including only a relatively small subset of the collected physiological data is sent via the wireless channel  108 , thereby conserving the wireless channel&#39;s carrying capacity. Conserving wireless channel carrying capacity may be important to support a large number of per-patient data collectors  100  over the wireless channel  108  and/or to enable the wireless channel  108  to carry other types of traffic, such as text messages, streaming video and voice telephone calls, most or all of which may be unrelated to the physiological monitoring described here. Thus, at least conceptually, false positives are traded, at least in part, for increased wireless channel capacity. Furthermore, the bulk or all of the false positives are filtered out by the second tier of analysis, as described next. 
     If the high-sensitivity analysis  109  detects a suspected arrhythmia, the high-sensitivity analysis  109  sends a request  112  to the data collector  100 . The request  112  identifies a time period of interest, such as a time period surrounding the time at which the data that lead to the suspicion were collected. In response to the request  112 , the data collector  100  fetches more detailed data for the requested time period from the memory  103  and sends the more detailed data  115  to the central server  107 , and then a high-specificity analysis  118  is performed on the more detailed data  115 . Preferably, the second analytical tier  118  is also high in sensitivity, so it has a low probability of generating a false negative result. 
     The high-specificity analysis  118  is configured such that it has a low probability of generating false positive results. That is, the high-specificity analysis  118  is not likely to indicate an arrhythmia when none actually occurred. If the high-specificity analysis  118  verifies that an arrhythmia occurred, an alarm may be raised or information may be displayed  121 , such as to alert a physician or technician. 
     In order to provide results with high specificity and high sensitivity, the high-specificity analysis  118  needs the more detailed data  115 , as well as typically consuming more computational resources than the high-sensitivity analysis  109 . Requesting  112  and sending  115  the more detailed data utilizes a portion of the wireless channel capacity. However, this utilization occurs only relatively infrequently, i.e., when the high-sensitivity analysis  109  detects a suspected arrhythmia. In addition, the high-specificity analysis  118  consumes a relatively large amount of computational resources. Again, however, this consumption occurs only relatively infrequently. 
     Thus, the two-tiered analysis  109  and  118  can be seen, at least conceptually, as a tradeoff between, on one hand, complexity involving two separate analysis tiers and occasional high wireless channel and computation resource utilization and, on the other hand, an overall reduction of wireless channel and computational resource utilization. The overall scheme disclosed herein requires fewer computational resources, and correspondingly less power (battery), on the per-patient data collector  100  than prior art schemes that attempt to analyze the collected data at the per-patient device and notify a central system only when an arrhythmia is detected. In addition, the overall scheme uses less wireless channel capacity and fewer central analysis server resources than prior art systems that send constant streams of all collected data to a central server for analysis. 
     Furthermore, the overall scheme is well suited for implementation in a “cloud computing” environment, where computing resources are available on demand. Thus, in some embodiments, the additional computational resources required for the high-specificity analysis  118  need not be pre-allocated and, therefore, idle most of the time. Instead, computational resources for the high-specificity analysis  118  can be dynamically and automatically utilized, requested or scheduled whenever they are required. Such a cloud computing environment is available from Amazon Web Services LLC under the trade name Amazon Elastic Compute Cloud (Amazon EC2) and RightScale cloud management from RightScale, Inc. 
       FIG.  2    is a schematic block diagram of an embodiment of the present invention, showing more detail than  FIG.  1   . One or more physiological sensors  200  are coupled to a transceiver assembly  203 . The coupling may be provided by via a short-range wireless system, such as Bluetooth transceivers. Alternatively, the coupling may be provided by wires or optical cable. The transceiver assembly  203  includes a memory  103  and a long-range wireless transceiver  104 , such as a cellular telephone transceiver, as discussed above. The long-range wireless transceiver  104  may be replaced by any suitable wireless transceiver, such as a WiFi transceiver (not shown). 
     A controller  206  directs operation of the transceiver assembly  203 . The controller  206  may be implemented by a microprocessor executing instructions stored in a memory, such as the memory  103  or another memory. The controller  206  receives data from the sensors  200  and stores the received data in the memory  103 . The controller  206  also provides a less detailed version  106  of the sensor data to the long-range wireless transceiver  104  for transmission, via the wireless network  108 , to the remote server  107 . The controller  206  may be coupled to the long-range wireless transceiver  104  via wires, optical cables or a short-range wireless system, such as Bluetooth. 
     Optionally or alternatively, part or all of the functions of the controller  206  and the memory  103  may be implemented by a processor and a memory within the long-range wireless transceiver  104 . For example, a “smart phone” may store and execute an application program (software)  207  configured to receive the data from the sensors  200 , store the received sensor data in a memory of the smart phone and transmit a subset of the collected data to the remote server  107 . In response to the request  112  from the remote server  107 , the application program  207  may fetch the more detailed data  115  and send it to the remote server  107 . Furthermore, the application program  207  may alter, such as in response to commands from the remote server  107 , data collection parameters, such as sampling rate and sampling precision, and data transmission parameters, such as sampling rate and sampling precision of the less detailed data  106  and of the more detailed data  115 , as well as transmission packet size, packet transmission rate, number of samples per packet, etc. 
     The controller  206  and the long-range wireless transceiver  104  should check authenticity of each other and authority to receive data and to be controlled by each other, prior to engaging in substantive communications, transmission of sensor data, control, etc. Furthermore, data and control communications, particularly wireless communications, between and among components of embodiments should be encrypted. For example, wireless data communications between the sensors  200  and the controller  206 , between the controller  206  and the long-range wireless transceiver  104  and between the long-range wireless transceiver  104  and the remote server  107  should be suitably encrypted, such as to protect patient privacy. 
     The transceiver assembly  203  may be implemented as one physical assembly. Alternatively, the transceiver assembly  203  may be implemented as two physically separable components, one component including the controller  206  and the memory  103 , and the other component including the long-range wireless transceiver  104 . Such a two-part division is indicated by dashed line  208 . The two components may communicate with each other via a short-range wireless system, such as Bluetooth (not shown). The tasks of receiving the data from the sensors  200 , storing the received data in the memory  103  or in a memory in a smart phone and generating the less detailed data  106  from the collected data may be divided or allocated between the controller  206  and the smart phone. 
     A suitable gateway  209 , as well as other well-known computer networking equipment, such as network switches, routers, firewalls and the like, may be used to couple the remote server  107  to the wireless network  108 . The remote server  107  includes a physiological data analyzer  212 , which is configured to perform the high-sensitivity analysis  109  and the high-specificity analysis  118  discussed above, with respect to  FIG.  1   . The remote server  107  may include a database  215 , and the data analyzer  212  may be configured to store the received less detailed data  106  and/or the received more detailed data  115 , or a portion thereof, in the database  215 . The data may be stored in the database  215  in an encrypted form to increase security of the data against unauthorized access. 
     A physician application program  218  allows a physician to control parameters of the system, such as threshold values used by the data analyzer  212  in performing the high-sensitivity  109  and/or the high-specificity  118  analyses. Optionally, the physician application program  218  also allows the physician to set operating parameters of the transceiver assembly  203 , such as the amount by which the less detailed data is downsampled, quantized, etc. 
     The physician application program  218  also displays data to the physician and allows the physician to select types of data to display, time periods of the data to display, levels of data detail to display and other operating parameters of the system. For example, the physician may select a beginning and ending time surrounding a suspected or verified arrhythmia for display. In response to a query by the physician, the physician application program  218  may fetch and display data from the database  215 . If the requested data is not available in the database  215 , or if the requested data is not available in the database  215  at the level of detail requested by the physician, the physician application program  218  may automatically communicate with the transceiver assembly  203  to fetch the appropriate data in the appropriate amount of detail. 
     The physician application program  218  may implement appropriate security protocols, such as requiring the physician to enter logon credentials, so as to appropriately limit access to patient data and comply with regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). 
     A user interface/web server  221  accepts user (physician, patient or administrator) inputs and generates appropriate displays to facilitate user interaction with the physician application program  218  and a patient application program  214 , described below. The user interface/web server  221  may generate a window-metaphor based computer user interface on a screen (not shown) coupled to the remote server  107 , or the user interface/web server  218  may generate web pages that are rendered by a browser  227  executed by a separate user computer (not shown). The web server  221  and the web browser  227  may communicate with each other using an appropriate encrypted protocol, such as Hypertext Transfer Protocol Secure (HTTPS). 
     The patient application program  224  provides access by a patient to her own data, using appropriate patient logon credentials and an appropriately secured browser connection. 
       FIG.  3    is a schematic diagram illustrating one possible combination of physiological sensors  300 ,  303  and  309  and a possible placement of the sensors on a torso  312  of a patient. One of the sensors  309  may be attached at about the elevation of the diaphragm of the patient. Each sensor  300 - 309  may be attached to the torso  312  using well-known gel pads or other conventional attachment techniques. Any combination of well-known physiological electrodes may be used for the sensors  300 - 309 . For example, the sensors  300 - 309  may include any combination of SpO2 sensors, blood pressure sensors, heart electrodes, respiration sensors, movement and activity sensors, and the like. Movement or activity may be sensed with appropriate accelerometers or gyroscopes, such as micro electro-mechanical system (MEMS) devices. The sensors  300 - 309  may be connected via wires or optical cables  315  and  318  or via wireless links, such as Bluetooth links. Respiration data may be derived from ECG baseline data, as is known to those of skill in the art. 
     The transceiver assembly  203  ( FIG.  2   ), or a portion thereof, may be attached to, and supported by, one of the sensors  309 , as indicated at  321 . Optionally, other sensors, such as a patient weight measuring device, blood pressure cuff, etc., may be disconnectably coupled via wires, optical cables or wirelessly to the transceiver assembly  203 . 
     As noted, the transceiver assembly  203  collects physiologic data, stores the collected data in a memory  103  and sends a less detailed version of the data  106  to the remote server  107 . Upon detecting a suspected arrhythmia, the remote server  107  requests  112  more detailed data.  FIG.  4    contains a hypothetical ECG waveform  400 , representing detailed data collected from the sensors  200  and stored in the memory  103 . That is, the collected data has a relatively high sampling rate and a relatively high resolution. Assume the waveform  400  includes a portion  403 , during which the waveform is anomalous. 
       FIG.  5    contains a waveform  500 , representing a less detailed version  106  of the collected data. The less detailed data  106  is transmitted to the remote server  107 . The high-sensitivity analysis  109  ( FIG.  1   ) performed by the data analyzer  212  ( FIG.  2   ) detects the anomaly  403  as a suspected arrhythmia. Responsive to this detection, the data analyzer  212  ( FIG.  2   ) sends a request  112  to the transceiver assembly  203  for more detailed data for a time period  503  around the anomaly  403 . The length of the period  503  may depend on the type of anomaly detected by the data analyzer  212 . Various types of anomalies, and corresponding time periods  503 , may be specified by the physician via the physician application program  218 . 
       FIG.  6    contains a waveform  600 , representing the more detailed data  115  ( FIG.  2   ) the transceiver assembly  203  sends to the remote server  107 . The more detailed data  115  has a higher sampling rate, higher resolution and/or contains data from more sensors than the less detailed data  106 . Using the more detailed data  115 , the high-specificity analysis performed by the data analyzer  212  verifies the suspected arrhythmia  603 . 
       FIG.  7    contains a table  700  of exemplary resolutions, sample rates and transmission duty cycles (times between data transmissions from the transceiver assembly  203  to the remote server  107 ). Each row of the table  700  represents a different combination of these parameters. Each row is labeled with a “Setting,” indicating relative timeliness of the data feed from the transceiver assembly  203 , such as based on relative seriousness of the patient&#39;s condition. Thus, the transceiver assembly  203  may store more highly resolved data (in terms of the number of bits per sample), more data samples (in terms of the number of samples per second) and/or data from more sensors or more types of sensors than are sent to the remote server  107 . Furthermore, the transceiver assembly  203  may store data for a period of time after data representing that time period has been sent to the remote server  107 . The specific settings in the table  700  are only examples of what a physician may determine from a range of possible values. 
     The remote server  107  may be configured to determine data collection parameters, either manually, such as in response to inputs received via the physician application program  218 , or automatically, such as in response to collected data meeting one or more predetermined criteria, such as detecting an anomaly in the collected data. A physician may select, via the physician application program  218 , one of the sets of data collection parameters shown in table  700 , or the physician may specify custom values, such as values for each patient, by entering the values via the physician application program  218 . The physician may specify, via the physician application program  218 , different data collection parameters for different time periods of a day, different days or any other specified time periods. Similarly, through the physician application program  218 , the physician may alter threshold values, against which the data analyzer  212  compares collected data. Optionally or alternatively, which set of data collection parameters, i.e., which row of the table  700 , is used may depend in part or in whole on the amount of charge remaining in the battery that powers the transceiver assembly  203 , the sensors  200  (if there is a separate battery for the sensors) and/or the long-range wireless transceiver  104 . Less remaining charge may cause selection of a lower setting in the table  700 . 
     In some embodiments, data collection and/or transmission parameters may be automatically changed in response to automatically detecting a measured physiologic data value exceeding or falling below a predetermined threshold. For example, if respiration rate, SpO2 or blood pressure exceeds a high-limit threshold or falls below a low-limit threshold, the remote server  107  can instruct the transceiver assembly  203  to increase the rate at which data is sampled from the sensors  200  and/or transmitted as less detailed data  106  or more detailed data  115  to the remote server  107 . Similarly, the data sampling resolution and data transmission rate (from the transceiver assembly  203 ) or other parameter (collectively referred to herein as “data collection parameters”) may be increased. 
     Some or all of the thresholds may be predetermined or they may be specified on a per-patient basis by the physician via the physician application program  218 . Optionally or alternatively, some or all of the thresholds may be automatically determined based on collected data. For example, if data: collected from a patient indicates to the remote server  107  that the patient is exercising, i.e., if for example data from the accelerometers indicates body movements consistent with the patient performing jumping jacks or sit-ups, thresholds for respiration and heart rate may be automatically increased until after these movements cease to be detected, plus an optional rest period.  FIG.  8    contains a table  800  that lists exemplary threshold values for several patient activity levels. 
     Optionally, after the metric that caused a data collection parameter to be increased returns to normal for at least a predetermined period of time, the data collection parameter may be returned to its original value or a value intermediate the increased value and its original value. The data collection parameter may be returned to its original value in timed stages or stages based on measured data values. 
     The anomaly that triggers request  112  for retrospective data or a change in the data collection parameters may be more complex than a measured value exceeding or falling below a threshold value. In some embodiments, an automatically detected anomaly in the measured ECG automatically triggers the request  112  for retrospective data or altering one or more data collection parameters. For example, the ECG data may be processed by the data analyzer  212  to automatically classify heartbeats using morphology and heartbeat interval features, as described by Philip de Chazal, et al., in “Automatic Classification of Heartbeats Using ECG Morphology and Heartbeat Interval Features,” IEEE Transactions on Biomedical Engineering, Vol. 51, No. 7, July, 2004, the contents of which are hereby incorporated by reference. In other words, collected data may be processed, before a determination is made whether an anomaly has been detected. 
     As noted, arrhythmia may be suspected or verified (or both) using ECG data, non-ECG data or a combination thereof. For example, an arrhythmia may be suspected or verified, based in whole or in part on respiration rate. The respiration rate may be determined based on data from one or more accelerometers in the sensors attached to the torso of the patient, as shown for example in  FIG.  3   . Chest movements detected by the accelerometers may be filtered, such as within expected frequencies and amplitudes, to derive the respiration rate. For example, one accelerometer may be included in in the sensor  309  ( FIG.  3   ), which is located adjacent the patient&#39;s diaphragm, and another accelerometer may be include in the sensor  300  or  303 . Relative motion between the two locations on the torso  312  represented by the two accelerometers closely represents diaphragm movement and, therefore, breathing. 
     The respiration rate may also, or alternatively, be derived from ECG baseline data, as is well known in the art. Either of these respiration rates may be used by the data analyzer  212 . However, some embodiments use both derived rates, as shown in a flowchart in  FIG.  9   . At  900 , ECG and accelerometer data are collected. At  903 , a first candidate respiration rate is calculated, based on the ECG baseline data, and at  906 , a second candidate respiration rate is calculated, based on the accelerometer data. These two candidate rates are compared at  909 . If the difference between the two candidate rates is less than a predetermined value, such as about 10%, an average of the two candidate rates is calculated at  912 , and this average is used  915  by the data analyzer  212 . Optionally, the maximum allowable difference between the two candidate rates, i.e., the limit in  909 , may be specified by the physician via the physician application program  218 . 
     However, if the two candidate rates differ by more than the predetermined value, control passes to  918  if both candidate rates are outside a predetermined range of normal respiration rates, both candidate rates are discarded  921 , and the procedure loops back to  900 . If both candidate rates are not outside the predetermined range of normal respiration rates, i.e., if at least one of the candidate rates is within the range, control passes to  924 . 
     At  924 , if both candidate rates are within the predetermined normal range, the ECG-based candidate respiration rate is used at  927 . However, if only one of the candidate rates is within the predetermined normal range, control passes to  930 . 
     At  930 , if only the ECG-based candidate respiration rate is within the predetermined normal range, the ECG-based candidate respiration rate is used at  933 . However, at  930 , if the ECG-based candidate respiration rate is not within the predetermined normal range, the accelerometer-based candidate respiration rate is used at  936 . 
     Although embodiments in which all the data analysis is performed by the remote server  107  ( FIG.  2   ) have been described, the high-sensitivity analysis  109  ( FIG.  1   ) may optionally or alternatively be performed by the controller  206  or the cellular transceiver  104 , i.e., at the patient, rather than in the remote server  107 , as schematically illustrated in  FIG.  10   . In this case, if an arrhythmia is suspected by the high-sensitivity analysis  1000 , no request signal needs to be sent to the per-patient physiologic sensors and data collector  1003 . Instead, the controller  206  (see  FIG.  2   ) or the cellular transceiver  10  (see  FIG.  2   ) automatically sends the more detailed data to the remote server  1006 , and the remote server  1006  performs the high-specificity analysis  118 , as described above. In such an embodiment, the transceiver assembly  203  (see  FIG.  2   ) may be referred to as a transmitter assembly, because it primarily or exclusively sends data to the remote server  1006  and does not necessarily receive any requests  112  (See  FIGS.  1  and  2   ) from the remote server  1006 . 
     Although embodiments of the present invention have been described as detecting and verifying suspected arrhythmias, other embodiments may be similarly configured and used to detect and verify other health or fitness conditions, such as inappropriate insulin level, respiration, blood pressure, SpO2, body movement, exertion and the like. 
     A remote health monitoring system includes a processor controlled by instructions stored in a memory. For example, the transceiver assembly may include and be controlled by such a processor, and the remote server may be controlled by another such processor. The memory may be random access memory (RAM), read-only memory (ROM), flash memory or any other memory, or combination thereof, suitable for storing control software or other instructions and data. 
     Some of the functions performed by the remote health monitoring system have been described with reference to flowcharts and/or block diagrams. Those skilled in the art should readily appreciate that functions, operations, decisions, etc. of all or a portion of each block, or a combination of blocks, of the flowcharts or block diagrams may be implemented as computer program instructions, software, hardware, firmware or combinations thereof. 
     Those skilled in the art should also readily appreciate that instructions or programs defining the functions of the present invention may be delivered to a processor in many forms, including, but not limited to, information permanently stored on non-writable storage media (e.g., read-only memory devices within a computer, such as ROM, or devices readable by a computer I/O attachment, such as CD-ROM or DVD disks), information alterably stored on writable storage media (e.g. floppy disks, removable flash memory and hard drives) or information conveyed to a computer through communication media, including wired or wireless computer networks. 
     In addition, while the invention may be embodied in software, the functions necessary to implement the invention may optionally or alternatively be embodied in part or in whole using firmware and/or hardware components, such as combinatorial logic, Application Specific Integrated Circuits (ASICs), Field-Programmable Gate Arrays (FPGAs) or other hardware or some combination of hardware, software and/or firmware components. 
     The embodiments of the invention described above are intended to be merely exemplary. While the invention is described through the above-described exemplary embodiments, it will be understood by those of ordinary skill in the art that modifications to, and variations of, the illustrated embodiments may be made without departing from the inventive concepts disclosed herein. For example, although some aspects of remote health monitoring system have been described with reference to a flowchart, those skilled in the art should readily appreciate that functions, operations, decisions, etc. of all or a portion of each block, or a combination of blocks, of the flowchart may be combined, separated into separate operations or performed in other orders. Furthermore, disclosed aspects, or portions of these aspects, may be combined in ways not listed above. Accordingly, the invention should not be viewed as being limited to the disclosed embodiments.