Patent Publication Number: US-9901740-B2

Title: Clinician programming system and method

Description:
PRIORITY DATA 
     The present application is a divisional patent application of U.S. patent application Ser. No. 13/600,875, filed on Aug. 31, 2012, entitled “Clinician Programming System and Method”, now U.S. Pat. No. 8,903,496, issued Dec. 2, 2014, the disclosure of which is hereby incorporated by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     This disclosure is directed to an external monitor connection for a clinician programmer. 
     BACKGROUND 
     Neurostimulation devices deliver therapy in the form of electrical stimulation pulses to treat symptoms and conditions, such as chronic pain, Parkinson&#39;s disease, or epilepsy, for example. Implantable neurostimulation devices, for example, deliver neurostimulation therapy via leads that include electrodes located proximate to the muscles and nerves of a patient. 
     Clinician programmers are used to control and program the neurostimulation devices with stimulation sequences to treat symptoms and conditions. These clinician programmers and devices of their type are relatively small to allow for easy transportation and storage. The portability has its price, however. It is difficult for more than one person to view the relatively small screen of a handheld programmer. People would have to crowd around the device to be able to attempt to see what is happening on the screen. 
     Further, even though the clinician programmer is portable, there are some areas where its use may be restricted. For instance, a clinician programmer may be covered under the drapes while a sales representative is talking to the patient. The clinician programmer thus may not be visible to the physician. As another example, the clinician programmer may not be a sterile device and cannot be taken into the sterile field in an operating room. Since the clinician programmer must remain outside of the sterile field, the physician is unable to read the screen while performing the procedure. Accordingly, the physician must verbally interact with and rely on someone (an external operator), who acts as his eyes and hands controlling the programmer outside of the sterile field. The situation could also be reversed, where the physician is doing the programming, and the staff is observing his/her actions, for example, talking to the patient at the head end of the surgery table. In any case, requiring an extra person results in additional time for the procedure to be completed as a result of the verbal communication of the programming device state and adjustments to be made between the physician and the external operator. The verbal interchange may also result in miscommunication which will add additional time to complete the procedure and possibly result in more severe consequences. 
     The present disclosure is directed to devices, systems, and methods that address one or more deficiencies in the prior art. 
     SUMMARY 
     This disclosure is directed to a patient programmer in communication with an external monitor that helps to alleviate the problems set out above. When demonstrating the device, for example, the screen can be displayed on a large monitor for group viewing. In addition, when used for a procedure within an operating room, the programmer can be kept outside the sterile field, but its user interface can be made available for viewing by the physician and others through a projector or large screen monitor. In many cases, the external screen may be the only screen that the physician can see, because the clinician programmer is under the cover or tucked away. 
     In one exemplary aspect, the present disclosure is directed to a clinician programming system operable to control an implantable medical device. The clinician programming system includes a clinician programmer with a housing. The clinician programmer includes: a processor and memory having executable instructions enabling programming of an implantable pulse generator; a user interface configured to receive inputs by a clinician instructing operation of an implantable pulse generator; a first display configured to display information indicative of the inputs by the clinician or display information indicative of status of an implantable pulse generator, the first display having a first display size; an implant communication interface configured to transmit information from the clinician programmer to an implantable pulse generator and configured to receive information from an implantable pulse generator; and a display communication interface configured to transmit content shown on the display. The clinician programming system also includes a secondary unit separate from the housing of the clinician programmer, the secondary unit having a secondary display of a second display size, the secondary display being configured to communicate with the clinician programmer via the secondary display communication interface and configured to display information received via the secondary display communication interface. The secondary display may display information either mirrored or extended from the clinician programmer. 
     In one exemplary aspect, the present disclosure is directed to a clinician programmer. The clinician programmer includes a first display configured to display information to a user relating to an implantable device; a user input mechanism configured to receive inputs from the user controlling content shown on the first display; a secondary unit communication interface selectively attachable to a secondary unit, the secondary unit communication interface configured to transmit information to a secondary unit having a secondary display and configured to receive information for processing from the secondary unit; and a controller configured to receive a user input from the user input mechanism, the user input selecting a first mode that sends a display signal to the secondary display causing content shown on the secondary display to mirror or extend content shown on the first display and a second mode that sends a display signal to the secondary display causing content shown on the secondary display to differ from content shown on the primary display. 
     In one exemplary aspect, the present disclosure is directed to a clinician programmer. The clinician programmer includes a programming software module configured to generate a treatment program executable on an implantable medical device as a result of a user input; an implant communication interface configured to send the treatment program to an implantable medical device to operate the implantable device and configured to receive information from the implantable device; a primary display configured to display information relating to the treatment program; a secondary display unit communication interface configured to transmit information to a secondary display unit and configured to receive information from a secondary display unit; a microphone in communication with the secondary display unit communication interface and configured to capture audio from the user for transmission from the secondary display unit communication interface; and a speaker in communication with the a secondary display unit communication interface and configured to receive signals representing audio captured at the secondary display unit. 
     In one exemplary aspect, the present disclosure is directed to a surgical arrangement used when programming an implantable medical device. The surgical arrangement includes: a non-sterile (or wrapped sterile) clinician programmer having a memory storing instructional information for programming an implantable pulse generator and having a first display screen configured to display the instructional information to a user, the clinician programmer having a secondary display unit interface comprising a transmitter and a receiver configured to send display signals and configured to receive instructional signals; a secondary unit comprising a second display screen sized larger than the clinician programmer first display screen, the second display screen being disposed for viewing from a sterile room and connectable with the clinician programmer, the secondary unit being configured to receive the instructional information from the clinician programmer and display the instructional information on the second display screen under the instruction of the clinician programmer; and an implantable pulse generator in communication with one of the secondary unit and the clinician programmer, the implantable pulse generator having a memory and processor configured to activate electrodes based on information received from said one of the secondary unit and the clinician programmer, the implantable pulse generator being configured to electrically receive said information displayed relating to an electrode of the implantable pulse generator. 
     In one exemplary aspect, the present disclosure is directed to a method for performing trial stimulation during neurostimulator implant surgery. The method includes: providing a clinician programmer having a first display screen having a first display screen size; providing an external secondary unit having a second display screen having a second display screen size that is visible to medical personnel, for example operating room staff working within the sterile field; providing at least one stimulation lead operable to provide electrical stimulation to target tissue within a patient; connecting the clinician programmer to the external monitor; operating the clinician programmer to control the stimulation provided through the stimulation lead and to display information related to the stimulation on the external monitor; and displaying information relating to the stimulation lead on either one of the first and the second display screens, or both. 
     In one exemplary aspect, the present disclosure is directed to a method for programming an implantable device. The method includes: receiving an input at a user interface on a tablet-style clinician programmer; generating a first display signal on the clinician programmer that updates content on a first display based on the received user input, the first display having a first size; generating a second display signal for transmission to a secondary unit having a second display separate from the clinician programmer, the second display having a second size, wherein generating the second display signal includes enhancing the content of the second display signal to provide a clear image on the second size display; and transmitting the second display signal from the clinician programmer to the second display. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Aspects of the present disclosure are best understood from the following detailed description when read with the accompanying figures. 
         FIGS. 1A and 1B  are illustrations of a patient&#39;s spine with an exemplary electrical stimulator treatment system disposed to treat a particular region of the spine in accordance with one aspect of the present disclosure. 
         FIG. 2  is a block diagram showing an exemplary external monitor interface system in accordance with one aspect of the present disclosure. 
         FIG. 3  is a block diagram of a clinician programmer for use in the exemplary external monitor interface system of  FIG. 2 . 
         FIG. 4  is an exemplary user interface illustrating the generation of a pain map or a stimulation map. 
         FIG. 5  is an illustration of an exemplary use of the exemplary external monitor interface system of  FIG. 2  in accordance with one exemplary aspect of the present disclosure. 
         FIG. 6  is an illustration of an exemplary use of the exemplary external monitor interface system of  FIG. 2  in accordance with one exemplary aspect of the present disclosure. 
         FIG. 7  is a flow chart showing an exemplary method of using the external monitor interface system of  FIG. 2  in accordance with one exemplary aspect of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The following disclosure provides many different embodiments, or examples, for implementing different features of various embodiments. Specific examples of components and arrangements are described below to simplify the present disclosure. These are, of course, merely examples and are not intended to be limiting. In addition, the present disclosure may repeat reference numerals and/or letters in the various examples. This repetition is for the purpose of simplicity and clarity and does not in itself dictate a relationship between the various embodiments and/or configurations discussed. 
     The devices, systems, and methods described herein introduce an improved way for controlling and programming an implanted medical device. They use a clinician programmer (“CP”) with a first display electrically coupled (for example, coupled in a wired or wireless manner) to a second display disposed for viewing by others than the clinician performing the programming. In one example, the CP may be outside a sterile field, but may be in communication with a display viewable to others who are within the sterile field. This may be particularly helpful to surgeons who perform surgeries and must issue instructions to a programming clinician to direct or control an implant in a certain manner. The surgeon may look at the second display and see the settings and programming as it occurs on the CP, instead of relying merely on verbal feedback from the programming clinician. This may streamline the surgery and since the surgeon can now see the clinician programming screen, may help assure the surgeon that his instructions are being carried out as requested without relying solely on verbal feedback. This may reduce verbal communication errors between staff during programming. Accordingly, this may provide a level of redundancy and risk management not achieved when programming is performed with only a CP outside the sterile field. In another example, the CP sends information shown on its display to the second larger display for viewing by additional people. This may be particularly helpful during training processes, when the clinician may be instructing trainees or other clinicians in treatment techniques, for example. 
       FIG. 1A  is a side view of a spine  10 , and  FIG. 1B  is a posterior view of the spine  10 .  FIG. 1B  shows an exemplary electrical stimulator treatment system  100  disposed to treat a spinal region for treating a symptom, such as chronic pain. The system includes an implantable pulse generator (IPG)  102  that delivers electrical stimulation therapy to the patient, and a CP  104 . 
     Referring now to  FIGS. 1A and 1B , the spine  10  includes a cervical region  11 , a thoracic region  12 , a lumbar region  14 , and a sacrococcygeal region  16 . The cervical region  11  includes the top seven vertebrae, which may be designated with C1-C7. The thoracic region  12  includes the next twelve vertebrae below the cervical region  11 , which may be designated with T1-T12. The lumbar region  14  includes the final five “true” vertebrae, which may be designated with L1-L5. The sacrococcygeal region  16  includes nine fused vertebrae that make up the sacrum and the coccyx. The fused vertebrae of the sacrum may be designated with S1-S5. 
     Neural tissue (not illustrated for the sake of simplicity) branches off from the spinal cord through spaces between the adjacent vertebrae. The neural tissue, along with the cord itself, can be individually and selectively stimulated in accordance with various aspects of the present disclosure. For example, referring to  FIG. 1B , the IPG  102  is implanted inside the body. A conductive lead  108  is electrically coupled to the circuitry inside the IPG  102 . The conductive lead  108  may be removably coupled to the IPG  102  through a connector, for example. A distal end of the conductive lead  108  is attached to one or more electrodes  110 . In the example shown, the electrodes  110  are implanted adjacent to a desired nerve tissue in the thoracic region  12 . The distal end of the lead  108  with its accompanying electrodes may be positioned beneath the dura mater using well-established and known techniques in the art. 
     The electrodes  110  deliver current drawn from the IPG  102 , thereby generating an electric field near the neural tissue. The electric field stimulates the neural tissue to accomplish its intended functions. For example, the neural stimulation may alleviate pain in an embodiment. In other embodiments, a stimulator as described above may be placed in different locations throughout the body and may be programmed to address a variety of problems, including for example but without limitation; prevention or reduction of epileptic seizures, bladder control, weight control or regulation of heart beats. 
     It is understood that the IPG  102 , the lead  108 , and the electrodes  110  may be implanted completely inside the body, or may have only one or more components implanted within the body while other components remain outside the body. When they are implanted inside the body, the implant location may be adjusted (e.g., anywhere along the spine  10 ) to deliver the intended therapeutic effects of spinal cord electrical stimulation in a desired region of the spine. The IPG  102  in this system is a fully implantable, battery-powered neurostimulation device for providing electrical stimulation to a body region of a patient. In some embodiments, an external pulse generator (EPG) is used. The EPG is identical to the IPG but the connection is done through percutaneous wires (communication may still be wireless though). In the example shown in  FIG. 1B , the IPG  102  is configured to provide neural stimulation to the spine. However, in other embodiments, IPG  102  may be a different type of pulse generator, including, for example, a pacemaker, a defibrillator, a trial stimulator or any other type of medical device. Here, the IPG  102  is structurally configured and arranged for wireless programming and control through the skin of the patient. Accordingly, it includes a transmitter and receiver capable of communicating with external programming and control devices, such as the CP  104 . It also includes a rechargeable power source, such as a battery configured to be wirelessly recharged through the patient&#39;s skin when a charger is externally placed in the proximity of the IPG  102 . 
     The CP  104  is typically maintained in a health care provider&#39;s possession and can be used to program the IPG  102  as a part of the implantation treatment and later during office visits. For example only, the CP  104  can define the available stimulation programs for the IPG  102  by enabling and disabling particular stimulation programs, can define the actual stimulation programs by creating defined relationships between pulses, and perform other functions. 
       FIG. 2  is a block diagram showing an exemplary clinician programming system  150 . The programming system  150  includes the CP  104 , the IPG  102 , a secondary display unit  152 , a patient feedback tool (“PFT”)  210 , and a surgeon input device  212 . 
     The CP  104  is, in one embodiment, a tablet-style device with a touch screen and radios for communicating with active implantable medical devices, such as neurostimulators like the IPG  102 . As can be seen in  FIG. 2 , the CP  104  includes a processor  160 , memory  162 , a user interface  164 , and a communication interface  166 . 
     As shown in  FIG. 2 , the user interface  164  includes a primary display screen  168 , an input mechanism  170 , a speaker  172 , and a microphone  174 . The speaker  172  and the microphone  174  enable audio communication between the CP  104  and the secondary display unit  152 . For example, the speaker  172  may be linked with a microphone  186  on the secondary display unit  152 , and the microphone  174  may enable communication with a speaker  184  on the secondary display unit  152 . As described below, this may be useful when the CP  104  and the secondary display unit  152  are in different locations. 
     The communication interface  166  enables the CP  104  to communicate with other components of the clinician programming system  150 . In the embodiment shown, the communication interface  166  includes a secondary display communication interface  176  and a peripheral interface  178 . These, along with other elements of the CP  104 , are described in detail with reference to  FIG. 3 . 
       FIG. 3  shows a block diagram of a more detailed construction of the CP  104 . Referring to  FIG. 3 , the CP  104  includes a printed circuit board (“PCB”) that is populated with a plurality of electrical and electronic components that provide power, operational control, and protection to the CP  104 . The processor  160  is a controller for controlling the CP  104 , and indirectly programming, controlling, and responding to the IPG  102 , the secondary display unit  152 , the PFT  210 , and the surgeon input device  212 . In one construction, the processor  160  is an applications processor model i.MX515 available from Freescale Semiconductor. More specifically, the i.MX515 applications processor has internal instruction and data caches, multimedia capabilities, external memory interfacing, and interfacing flexibility. Further information regarding the i.MX515 applications processor can be found in, for example, the “IMX510EC, Rev. 4” data sheet; dated August 2010; published by Freescale Semiconductor at www.freescale.com, the content of the data sheet being incorporated herein by reference. Of course, other processing units, such as other microprocessors, microcontrollers, digital signal processors, etc., can be used in place of the processor  160 . 
     The CP  104  includes memory  162 , which can be internal to the processor  160  (e.g., memory  305 ), external to the processor  160  (e.g., memory  310 ), or a combination of both. The memory  162  stores sets of instructional information with stimulation control parameters that are available to be selected for delivery through the communication interface  166  to the IPG  102  for electrical stimulation therapy or to the secondary display unit  152  for display to a plurality of individuals in the surgical area or elsewhere. Exemplary memory include a read-only memory (“ROM”), a random access memory (“RAM”), an electrically erasable programmable read-only memory (“EEPROM”), a flash memory, a hard disk, or another suitable magnetic, optical, physical, or electronic memory device. The processor  160  executes software that is capable of being stored in the RAM (e.g., during execution), the ROM (e.g., on a generally permanent basis), or another non-transitory computer readable medium such as another memory or a disc. The CP  104  also includes input/output (“I/O”) systems that include routines for transferring information between components within the processor  160  and other components of the CP  104  or external to the CP  104 . 
     Software included in the implementation of the CP  104  is stored in the memory  305  of the processor  160 , RAM  310 , ROM  315 , or external to the CP  104 . The software includes, for example, firmware, one or more applications, program data, one or more program modules, and other executable instructions. The processor  160  is configured to retrieve from memory and execute, among other things, instructions related to the control processes and methods described below for the CP  104 . For example, the processor  160  is configured to execute instructions retrieved from the memory  162  for establishing a protocol to control the IPG  102 . Some embodiments include software modules configured to provide instructions for accomplishing particular tasks handled by the CP  104 . For example, the CP  104  includes a programming software module configured to generate a treatment or stimulation program based on input received from a user of the CP  104 . A secondary display software module controls the signals and communication sent from the CP  104  to the secondary display unit  152 . Additional exemplary software will be described in further detail below. 
     Since the secondary display screen  182  is larger than the primary display screen  164  as described below, the secondary display software module may be configured to enhance the resolution or otherwise format or modify the display signal in a way that creates a clearer image of the content on the secondary display. This may ensure that a relatively clear image is shown on a secondary screen having a larger screen size than that of the CP primary display screen  164 , while not requiring as high resolution for the smaller primary display screen  164 . 
     One memory shown in  FIG. 3  is memory  310 , which can be a double data rate (DDR2) synchronous dynamic random access memory (SDRAM) for storing data relating to and captured during the operation of the CP  104 . In addition, a secure digital (SD) multimedia card (MMC) can be coupled to the CP for transferring data from the CP to the memory card via slot  315 . Of course, other types of data storage devices can be used in place of the data storage devices shown in  FIG. 3 . 
     The peripheral interface  178  is configured, depending on the embodiment, to receive data or signals from the IPG  102 , the PFT  210 , and the surgeon input device  212 . Accordingly, it may include an implant communication interface, a PFT communication interface, and a surgeon input device communication interface. The implant communication interface includes structure and components enabling the CP  104  to send or receive information to and from the IPG  102 . For example, it may comprise a radio transceiver that enables one-way or two-way communication with the IPG  102 . The interface  178  may include components for wireless or wired communication and may be configured with any of the components discussed above with reference to the secondary display communication interface  176 . In one example, the implant communication interface  178  comprises a medical implant communication service (MICS) RF transceiver used to communicate with the IPG  102  to communicate desired changes and to receive status updates from and relating to the IPG  102 , such as battery status and any error information. In this example, the MICS RF transceiver utilizes a loop antenna for the communications with the IPG  102 . Other antennas, such as, for example, dipole, chip antennas, or other antennas known in the art also may be used. The CP  104  may also include a programming interface used during manufacturing to load an operating system and program the CP  104 . 
     The PFT communication interface and the surgeon input device communication interface may include structure and components enabling the CP to send and receive information to and from the PFT and the surgeon input device. These interfaces may be similar to that of the implant communication interface, or alternatively, may be otherwise enabled. Depending on the embodiment, the PFT communication interface and the surgeon input device communication interface may be one or more ports for wired communication, such as universal serial bus (USB) connectivity  355 , including a Type A port and a Micro-B port; a related port for supporting Joint Test Action Group (JTAG) or other plug-in style port, or may be wireless using, for example, Wi-Fi portion  325  and Bluetooth portion  330  that respectively include a Wi-Fi communication interface, a Bluetooth communication interface, an antenna switch, and a related antenna all of which allows wireless communication following the Wi-Fi Alliance standard and Bluetooth Special Interest Group standard. Of course, other wireless local area network (WLAN) standards and wireless personal area networks (WPAN) standards can be used with the CP  104 . Any other interface enabling communication between the CP  104  and the PFT  120  or surgeon input device  212  may be used. In some embodiments, the interface  178  is the same as the interface  176 . 
     The secondary display communication interface  176  includes multiple bi-directional radio communication capabilities. Specific wireless portions included with the CP  104  are a Wi-Fi bi-direction radio communication portion  325 , and a Bluetooth bi-direction radio communication portion  330 . The Wi-Fi portion  325  and Bluetooth portion  330  include a Wi-Fi communication interface, a Bluetooth communication interface, an antenna switch, and a related antenna all of which allows wireless communication following the Wi-Fi Alliance standard and Bluetooth Special Interest Group standard. Of course, other wireless local area network (WLAN) standards and wireless personal area networks (WPAN) standards can be used with the CP  104 . 
     The CP  104  includes multiple communication portions for wired communication. Exemplary circuitry and ports for receiving a wired connector include a port for supporting universal serial bus (USB) connectivity  355 , including a Type A port and a Micro-B port, a portion and related port for supporting Joint Test Action Group (JTAG) connectivity  360 , and a portion and related port for supporting universal asynchronous receiver/transmitter (UART) connectivity  365 . Of course, other wired communication standards and connectivity can be used with or in place of the types shown in  FIG. 3 . 
     The secondary display communication interface  176  includes the structure and components enabling the CP  104  to send or receive information to and from the secondary display unit  152 . In one embodiment, the secondary display communication interface  176  is integral with the CP  104  and is available along an edge, such as a lower edge, under a protective cover of the CP  104 . In one embodiment, the secondary display communication interface  176  includes a HDMI port formed in a housing of the CP  104 . The interface  176  may allow connection to the external secondary display unit  152  via a micro High-Definition Multimedia Interface (HDMI)  370 , which provides a compact audio/video interface for transmitting uncompressed digital data to the external display unit  152 . The use of the HDMI connection  370  allows the CP  104  to transmit video (and audio) communication to the external display unit  152 . This may be beneficial in situations where others (e.g., the surgeon) may want to view the information being viewed by a CP user. The surgeon typically has no visual access to the CP  104  in the operating room. The HDMI connection  370  allows the surgeon to view information from the CP  104 , thereby allowing greater communication between the clinician and the surgeon. For a specific example, the HDMI connection  370  can broadcast a high definition television signal that allows the surgeon to view the same information that is shown on the LCD (discussed below) of the CP  104 . In addition, as HDMI signals are compatible with DVI, the CP  104  can also be connected, with the proper cabling, to other external display devices that only support DVI input. In some embodiments, audio and video can be played independently. In other embodiments, audio and video can be played in a synchronized manner. 
     In another embodiment, the secondary display communication interface  176  includes a wireless transmitter and receiver configured to wirelessly communicate with the secondary display communication interface  176 . In one example, it includes structure and encoding for Wi-Fi communication. In another example, it includes structure and encoding for Bluetooth communication. Additional wireless protocols are contemplated. In some examples, the secondary display communication interface  176  is a networking port on the CP that enables the CP  104  to communicate with the secondary display unit  152  over a WAN, LAN, or other network, including the Internet. 
     The CP  104  includes three hard buttons: a “home” button  335  for returning the CP to a home screen for the device, a “quick off” button  340  for quickly deactivating stimulation, and a “reset” button  345  for rebooting the CP  104 . The CP  104  also includes an “ON/OFF” switch  350 , which is part of the power generation and management block (discussed below). In some embodiments, the “reset” button  345  may be eliminated, and the “ON/OFF” switch  350  can be used to remove all power when held long enough. 
     In  FIG. 2 , the CP  104  includes the primary display screen  168  arranged for viewing by the clinician operating the CP  104  and configured to display information relating to the programmer  104 , the IPG  102 , the secondary display unit  152 , the PFT  210 , and/or the surgeon input device  212 . The input mechanism  170  permits a user to control images on the display and to make selections within a limited scope, so as to control the relationships between different control aspects. In  FIG. 3 , the primary display screen  168  and the input mechanism  170  are merged into a touch screen I/O device  375  for providing a user interface with the clinician. The touch screen display  375  can be a liquid crystal display (LCD) having a resistive, capacitive, or similar touch-screen technology. It is envisioned that multitouch capabilities can be used with the touch screen display  375  depending on the type of technology used. However, in place of a touch screen display, a computer keyboard, a standard pointing device, such as a mouse or trackball, or other input devices are also contemplated. 
     The CP  104  includes a camera  380  allowing the device to take pictures or video. The resulting image files can be used to document a procedure or an aspect of the procedure. For example, the camera  380  can be used to take pictures of barcodes associated with the IPG  102  or the leads  120 , or documenting an aspect of the procedure, such as the positioning of the leads. Similarly, it is envisioned that the CP  104  can communicate with a fluoroscope or similar device to provide further documentation of the procedure. Other devices can be coupled to the CP  104  to provide further information, such as scanners or RFID detection. Similarly, the CP  104  includes an audio portion  385  having an audio codec circuit, audio power amplifier, and related speaker for providing audio communication to the user, such as the clinician or the surgeon. 
     The CP  104  further includes a power generation and management block  390 . The power block  390  has a power source (e.g., a lithium-ion battery) and a power supply for providing multiple power voltages to the processor, LCD touch screen, and peripherals. 
     In one embodiment, the CP  104  is a handheld computing tablet with touch screen capabilities. The tablet is a portable personal computer with a touch screen, which is typically the primary input device. However, an external keyboard or mouse can be attached to the CP  104 . The tablet allows for mobile functionality not associated with even typical laptop personal computers. 
     In operation, the IPG  102  (which may also be an EPG) through the use of the implanted medical electrical leads  108 , and specifically the electrodes  110  ( FIG. 1B ), stimulates neurons of the spinal cord  10 . The IPG  102  selects an electrode stimulating configuration, selects a stimulation waveform, regulates the amplitude of the electrical stimulation, controls the width and frequency of electrical pulses, and selects cathodic or anodic stimulation. This is accomplished by a healthcare professional (e.g., a clinician), using the CP  104 , setting the parameters of the IPG  102 . The setting of parameters of the IPG results in a “program,” which is also referred to herein as a “protocol,” for the electrode stimulation. Programming may result in multiple protocols that the patient can choose from. Multiple protocols allow, for example, the patient to find a best setting for paresthesia at a particular time of treatment. 
     Returning now to the block diagram in  FIG. 2 , the secondary display unit  152  includes a relatively large display screen suitable for displaying system information to a surgeon or patient when used in the operating room, to a group of students, or to other groups. In one example, the secondary display unit  152  is disposed within an operating surgical room where it can be seen by a surgeon performing a surgery. The secondary display unit  152  includes a display screen  182 , a speaker  184 , a microphone  186 , and a communication interface  188 . It is understood that the speaker  184  and the microphone  186  are optional and may be omitted in some embodiments. 
     Because the CP  104  is a portable device and includes a relatively small primary display screen  168 , it is not easily viewed by multiple people at a single time. However, the display screen  182  of the secondary display unit  152  is sized larger than the display screen  168  of the primary CP  104  and enables multiple people to simultaneously view the screen and allows surgeons to see the IPG status or action taken by the CP. In one example, the display screen  182  is more than twice the size of the primary display screen  168  of the CP  104 . One exemplary display screen  182  is sized with a diagonal measurement greater than about 22 inches. Another exemplary display screen  182  is sized with a diagonal measurement greater than about 30 inches. Other sizes, both larger and smaller are contemplated. The display screen, in some examples, is a large monitor whose image is controlled entirely from the clinician programmer  104 . In one example it is a smart monitor configured to convert information received from the clinician into a three-dimensional image and to display information in a three-dimensional manner. 
     The speaker  184  and microphone  186  are linked respectively with the microphone  174  and the speaker  172  on the CP  104 . As such, communication is enabled between individuals proximate the secondary display unit  152  and the individual proximate to and operating the CP  104 . As indicated above, this may be useful when the CP  104  and the secondary display unit  152  are in different locations. In one embodiment, the communication via the microphones and the speakers on the CP  104  and the secondary display unit  152  communicate over the same secondary display communication interface  176  and the CP interface  190 . In other embodiments, they have separate communication channels, wired or wireless, for transmitting and receiving information. 
     The communication interface  188  in the secondary display unit  152  includes a CP interface  190  and a peripheral interface  192 . The CP interface  190  is configured, depending on the embodiment, to receive data or signals from the secondary display communication interface  176  on the CP  104 . For example, the CP interface  190  may connect to the secondary display communication interface  176  on the CP  104  via HDMI using a Type D Micro to Type A HDMI connector. Alternatively, or in addition to, the HDMI signals may be compatible with DVI. Thus, the CP  104  can also be connected, with the proper cabling, to other external display devices that only support DVI input. 
     In one example, the secondary display unit is configured to display the same information as the primary display screen  168  on the CP  104 . This mirroring of the screens  168 ,  182  enables a surgeon in an operating room and the clinician who is operating the CP to see the same information, albeit in different locations. 
     The peripheral interface  192  is configured, depending on the embodiment, to receive data or signals from the IPG  102 , the PFT  210 , and the surgeon input device  212 . In one example, the peripheral interface  192  comprises a MICS RF transceiver used to communicate with the IPG  102 , the PFT  210 , and the surgeon input device  212 . As described above, the MICS RF transceiver may utilize a loop antenna for its communications, with other antennas, such as, for example, dipole, chip antennas, or others known in the art also considered. For example, a communications link can be established between the IPG  102  and the secondary display unit  152 , and communications can then occur over a MICS transceiver using a standard frequency for a medical device transmission. 
     The IPG  102  includes all the treatment information required for treating the patient condition with the electrodes  110 , but also includes a communication interface  192 . In one embodiment, the communication interface  192  is configured to communicate with one or both of the CP  104  and the secondary display unit  152  and convey information including IPG status, treatment status, program operation, and other information to the CP  104  and/or the secondary display unit  152 . The secondary display unit  152 , under the control of the CP  104 , may communicate with the IPG communication interface  192  and may convey new treatment programs, including electrode management routines, such as activating particular electrodes in a particular order with a particular intensity, by varying amplitude, pulse width, and frequency. Once these treatment programs are received, the IPG  102  may execute or respond to the received information as directed by the clinician programmer  104  through the secondary display unit  152 . In one example, the IPG  102  also communicates directly with the peripheral communication interface  178  of the CP  104 . This embodiment may work well when the IPG  102  is in the proximity of the CP  104  and able to receive information via wireless or wired transmission. 
     The PFT  210  is sized to be held by a patient and can be used to provide feedback during programming of the IPG  102 . In one example, the PFT  210  may be used to provide feedback to the CP  104  while a clinician operating the CP  104 , under instruction from the surgeon, develops the protocol for the IPG  102 . In one example, the PFT  210  is an ergonomic handheld device having a sensor (also referred to as input), a controller, and a communications output. The sensor can include a discrete switch and/or a continuously variable input, such as through the use of a thermocouple, strain gauge, pressure sensor, piezoelectric device, accelerometer, displacement mechanism, or other variable sensing mechanism. It is envisioned that the use of a continuously variable input can provide magnitude information, thereby providing improved feedback information from the patient. 
     The PFT  210  includes a communication interface  214  that communicates information to the communication interface  188  on the secondary display unit  152 , which relays the information to the CP  104 . For example, the communication interface  214  and the peripheral interface  192  may establish a communication link. Communications can then occur over Bluetooth or other wireless formats. The CP  104  may then, if appropriate, adjust the display imagery on one or both of the primary display screen  168  and the display screen  182  of the secondary display unit  152  to reflect the patient feedback. 
     The PFT  210  is used to help the surgeon program the IPG  102  based on patient feedback. For example in use, the CP  104  activates one or more of the electrodes (on leads that are connected to the IPG  102 ) in various patterns. When the patient feels a sensation as a result of a stimulus, such as a stimulus for paresthesia, he or she activates a sensor on the PFT  210 . The activation of the sensor indicates to the clinician programming system  150  that the patient felt the stimulus and can also convey the degree of sensation that is felt, depending on the type of sensor that is employed. Given that there may be a delay from the time the patient feels a sensation and activates the sensor, the system  150  then re-stimulates the most recently-activated combinations of electrodes, and the patient again uses the PFT  210  to indicate when (and to what degree) a sensation is felt in order to determine the combination of electrodes to which the patient was reacting. Further description of methods for use of the PFT  210  are disclosed in U.S. patent application Ser. No. 13/118,781, filed on May 31, 2011, titled “Device to Provide Feedback For Neurostimulation Programming”, the contents of which are incorporated herein by reference in its entirety. 
     In some embodiments, the patient may use the clinician programmer or another portable device (for example an electronic tablet or an electronic programmer) to draw a pain map and/or a stimulation map. For example, referring to  FIG. 4 , an exemplary user interface  215  illustrating the generation of a pain map or a stimulation map  220  is illustrated. The user interface  215  may be displayed through a touch-sensitive screen. The user interface  215  shows a three-dimensional model of a human body, which can be rotated and moved around. Using his fingers, the patient may be able to paint the pain/stimulation map  220  on a region of the human body to indicate the sensation he is experiencing in that region. During the painting process, the patient may choose the hue and the intensity of the color of the painted pain and stimulation regions to represent the various types of pain/stimulation or degrees of pain/stimulation. It is understood that the pain/stimulation map  220  may also be generated by a healthcare professional. The PFT  210  may be used to indicate the intensity of pain/stimulation, but the maps are displayed either on the clinician programmer (or tablet) or the external monitor. 
     Referring back to  FIG. 2 , the surgeon input device  212  is sized and configured to be held by the surgeon or other medical care provider within the sterile field in an operating room. Using it, the surgeon can control one or both of the CP  104  and the secondary display unit  152 . The surgeon input device  212  may permit a surgeon to select particular images on the display screen  182  of the secondary display unit  152 , which may be conveyed to the CP  104 . In one embodiment, the CP allows a surgeon to select a particular electrode from an array of electrodes and to select activation including increasing and decreasing amplitude and frequency. This communication to the CP  104  through the secondary display unit  152  may help reduce the reliance on verbal cues and instructions passed to the clinician outside the sterile field, allowing the clinician to rely on more visual instructions simultaneously viewable by both the surgeon and the programming clinician. The surgeon input device  212  includes a communication interface  216  that communicates information to the communication interface  188  on the secondary display unit  152 , which relays the information to the CP  104 . For example, the communication interface  216  and the peripheral interface  192  may establish a communication link, and communications can then occur over a MICS transceiver using a standard frequency for a medical device transmission. The CP  104  may then, if appropriate, adjust the display imagery on one or both of the primary display screen  168  and the display screen  182  of the secondary display unit  152  to reflect the surgeon input. 
     In one aspect, this disclosure is directed to a method for displaying information on a CP to operating room staff working within a sterile field. One example of this will be described with reference to  FIG. 5 . The CP  104  is not a sterile device, so the external connection of the secondary display communication interface  176  may be used to display content shown on the primary display screen  168  of the CP  104  to those in the operating room while the CP  104  remains outside of the sterile field and outside the operating room. Making the content of the primary display screen  168  of the CP  104  viewable by the physician performing a procedure reduces the interaction required between a physician and the individual outside of the sterile field assisting the physician by performing the programming on the CP  104 . The physician can easily see the operating state of the IPG  102  as shown on the CP  104  and does not require the individual assisting outside of the sterile field to describe it. Allowing the physician himself to see the actual information on the primary display screen  168  of the CP  104  reduces the time spent to perform the procedure, as well as reduce the occurrence of any miscommunications and any resulting undesirable consequences, for example reducing the probability of an infection. 
       FIG. 5  shows an operating room  250  and a clinician room  252 . These are separated by a physical barrier, shown here as a wall structure  254 . The operating room  250  is or includes a sterile field. In the example, shown a surgeon performs a procedure on a patient having an implanted IPG  102 , and a clinician stands in the clinician room  252  operating the CP  104 . The patient holds the PFT  210 , and the surgeon holds the surgeon input device  212 . In this example, the CP  104  is disposed in the clinician room  252 , and the secondary display unit  152  and the IPG  102  are disposed in the surgical room  250 . In this embodiment, the CP  104  is a tablet controller fitted with a suitable communications port, for example a micro-HDMI connector. The CP  104  is able to drive a signal over the secondary display communication interface  176  of the CP  104  and copy the display from the primary display screen  168  on the CP  104  to the external secondary display screen  182  on the secondary display unit  152 . 
     The secondary display unit  152  is, in this example, hung on a wall of the surgical room in a fixed location visible to the surgeon and his operating staff. In other examples, it may be visible to the surgeon and his operating staff through a window or other barrier. As can be seen, the secondary display unit  152  is much larger than the CP  104  and is configured to be easily viewable by several people at the same time. In one example, the secondary display screen  182  is at least double the size of the primary display screen  168  of the CP  104 . The secondary display unit  152  includes the speaker  184 , the microphone  186 , and the communication interface  188 . Verbal instructions from the surgeon to the clinician are captured at the microphone  186  and emitted from the speaker  172  on the CP  104 . Likewise, verbal responses from the programmer can be captured by the microphone  174  on the CP  104  and heard though the speaker  184 . In some embodiments, the contents of the screen of the CP  104  may also be broadcast via a suitable communications network. 
     In the example shown, the secondary display unit  152  is hung via a fixation structure  258 . Here, the fixation structure  258  is a fixation bracket that extends from a rigid structure, such as the wall, and supports the secondary display unit  152  in a fixed position. As can be seen, the secondary display unit  152  is tipped at an angle to promote simple and convenient viewing from the sterile field in the surgical room. In this example it is spaced from the surgical area, and may not be a sterile device itself. It is operated without tactile feedback or input directly on the secondary display unit  152 , and may be considered a hands-free device. It is controlled via the CP  104 , but also may relay information collected from the IPG  102 , the PFT  210 , and the surgeon input device  212 . Information is also relayed back from the secondary input to the CP display. 
     The communication interface  188  on the secondary display unit  152 , and particularly the peripheral interface  192  communicates with one or more of the IPG  102 , the PFT  210 , and the surgeon input device  212 . As indicated above, in one embodiment, the peripheral interface  192  provides two-way communication to each of these devices. In other examples, the peripheral interface  192  receives one-way communication from one or more of these devices. The communication interface  188  may be attached onto or otherwise carried on the display screen  182  or on or within its housing. 
     In the illustrated embodiment, a cable  200  extends from the secondary display communication interface  176  of the CP  104  to an outlet  256  shown on the wall structure  254 . In this example, the secondary display communication interface  176  of the CP  104  is a micro-HDMI connector, and the cable  200  may be an HDMI cable extending between the secondary display communication interface  176  of the CP  104  and outlet  256 . 
     The outlet  254  connects to an outlet  256  in the surgical room  250  via a cable within the wall, from which a cable extends to the secondary display unit  152 . Over this wired line, the CP  104  communicates display information for presentation on the secondary display unit  152 . That is, the CP  104  is able to drive a HDMI signal over the secondary display communication interface  176  of the CP  104  to copy the content from the primary display screen  168  on the CP  104  to the external display screen  182  on the secondary display unit  152 . This can also be done via wireless communication. In other words, the wire  200  may not be needed in some embodiments, as the communication between the secondary display unit  152  and external devices are done wirelessly. In that case, the secondary display unit  152  may only need a power source or a battery. 
     In one example, the displayed content mirrors the information displayed on the CP  104 . Accordingly, by viewing the secondary display unit  152 , the surgeon sees the same information as the clinician operating the CP  104 . In another example, the displayed content is different than or includes additional information than that displayed on the CP  104 . Accordingly, with this extended display feature, the surgeon, by viewing the secondary display unit  152 , sees different, but relevant information than the clinician operating the CP  104 . In one example, the information shown on the CP  104  and/or the secondary display unit  152  includes IPG status information, charge information, program information, status and settings for one or more electrodes, including frequency, pulse width, and amplitude information for one or more electrodes. It may also include additional information. In one visualization of the patient&#39;s organs, x-ray information, or status of the patient&#39;s overall condition including items such as vital signs, including blood pressure, temperature, respiratory rates, heart beat, and/or other vitals. 
     In one example, the secondary display unit  152  is connected to a Digital Video Interface (DVI) connector on the CP  104  and the content of the primary display screen  168  was cloned, copied, or replicated onto the display screen  182  of the secondary display unit  152  via the DVI interface. In one example, the system  150  achieves 30 frames per second (FPS) when outputting the primary display screen content to an 800×600 display screen  182 . This is representative of the CP  104  because the data stream format output by the CP  104  over the HDMI interface may be nearly identical to that output from the DVI interface on the EVK. 
     In one example, the CP  104  requires the user to enable the secondary display screen  182  by selecting a display mode for the external display monitor  152 . In one embodiment, the hardware for the secondary display communication interface  176  is arranged to detect when the external secondary display unit  152  is plugged in or otherwise connected. Using this functionality, the CP  104  may detect when the secondary display unit  152  is connected to the secondary display communication interface  176  of the CP  104 , the driver in the CP  104  automatically switches to extending the display on the external monitor. Likewise, when the external secondary display unit  152  is detached, the CP  104  may disable the mirroring or extended display function. 
     Software modules on CP  104  provide instructions for accomplishing particular tasks handled by the CP  104 . In the embodiment described above, the software includes a secondary display unit control module that controls the image generated on the secondary display screen  182 . In one example, the module enables a user to select between two operating modes. For example, a first mode or mirroring mode may control the secondary display screen  182  to show content mimicking that shown on the primary display screen  164 . In this mode, the CP  104  may generate display signals for transmission to the secondary display unit  152  so that the primary and secondary display screens show the same content. A second mode or extended display mode of the secondary display unit may control the secondary display screen  182  to show content different than that shown on the primary display screen  164 . In this mode, the CP  104  may generate display signals for transmission to the secondary display unit  152  so that the primary and secondary display screens show different content, although some content may still overlap. 
     The ability to output the primary display screen display to an external, and notably, larger, secondary display unit  152 , such as a large screen monitor or projector, provides a decided advantage when it comes to communicating instructions to and receiving verbal responses from a clinician outside the sterile field, such as in another room. The external secondary display unit  152  makes it much easier for the surgeon and others to view what is happening. 
       FIG. 6  shows another implementation of the system  150  according to one exemplary aspect of the present disclosure. In this example, the CP  104  and the secondary display unit  152  are illustrated being used to display an image to a number of individuals. The system illustrated may be used during instructional sessions, such as during training or education, for example. 
     In this embodiment, the CP  104  is a tablet controller fitted with a micro-HDMI connector, and the cable  200  is a HDMI cable extending between the secondary display communication interface  176  of the CP  104  and the communication interface  188  of the secondary display unit  152 . The CP  104  is able to drive a HDMI signal over the secondary display communication interface  176  of the CP  104  and copies the display from the primary display screen  168  on the CP  104  to the external display screen  182  on the secondary display unit  152 . 
     In this example, the display surfaces of the primary display screen  168  on the CP  104  and the external display screen  182  on the secondary display unit  152  are connected with DirectDraw. Using the DirectDraw API, a screen copy is made of the primary display screen  168  on the CP  104 . A copy of the primarily display screen  168  is then drawn to the secondary display screen&#39;s surface. In one example, the contents displayed on the secondary display screen  182  mirrors that of the primary displace seen  168 . The software routine adds the ability for the screen to be copied automatically at a user defined rate and for the copying to be enabled or disabled as necessary. 
     As discussed above, the CP  104  may require the user to enable the secondary display screen  182  by selecting a display mode for the external display monitor  152 , may be arranged to detect when the external secondary display unit  152  is plugged in or otherwise connected. The ability to output the primary display screen display to an external, and notably, larger, secondary display unit  152 , such as a large screen monitor or projector, provides a decided advantage when it comes to training personnel because it is much easier for multiple people to view what is happening. 
     In one embodiment, the surgeon input device  212  is not a handheld device, but is a motion detector associated with the secondary display unit  152 . In this embodiment, the secondary display unit  152  may include a light source and a camera or sensor to generate a depth map or other imagery of the surgeon or other health care provider in the operating room  250 . By detecting surgeon movement, the surgeon input device  212  may receive inputs for controlling either the CP or features of the secondary input monitor  152 . For example, a surgeon may be able to select a particular electrode or an array of electrodes using the motion detector and increase or decrease the amplitude and frequency of pulses from the electrode or electrode array to create a treatment program that may be loaded onto the IPG  102 . 
       FIG. 7  shows one method of activating the display functionality on the CP  104 . The method includes querying whether the cable is connected for the CP to an external monitor, such as the secondary display unit  152 , as indicated at step  502 . If it is, then the CP  104  operates using control functionality that mirrors or extends the primary display screen  168  of the CP  104  onto the connected display screen  182  of the external display monitor  152 , as indicated at a step  504 . At a step  506 , the CP may be used to program the IPG  102  in the manner known in the art. Meanwhile the secondary display unit  152  continues to mirror or extend the display serene. This continues until the system determines at step  502  that the cable  200  is not connecting the CP  104  and the secondary display unit  152 . If not connected, the CP is operates to end mirroring or extending CP display onto the secondary display unit  152 . So long as the CP  104  is connected, the functionality of the secondary display unit  152  may be utilized. For example, in embodiments using the PFT  210  and/or the surgeon input device  212 , the CP  104  is configured so that all functionality is enabled when the CP  104  and the secondary display unit  152  are connected. 
     In use, a clinician may take the cable  200  and plug it into the secondary display communication interface  176  of the CP  104 . With this connection made the CP  104  can send display information to the secondary display unit  152  for display on the display screen  182 . In one embodiment, over the same cable  200 , feedback information from the secondary display unit  152  can be transmitted to the CP  104 . This feedback information may be from the secondary display unit  152 , or relayed through the secondary display unit  152  to the CP  104  from the PFT  210 , the IPG  102 , or the surgeon input device  212 . In addition, the audio feed between the speakers and microphones on the CP  104  and the secondary display unit  152  may also be carried over the cable  200 . In other embodiments, the system  150  includes a separate feedback line and/or a separate audio feed line. In yet another embodiment, the communication occurs wirelessly over a direct connection, between the CP  104  and the secondary display unit  152 , such as, for example, through infra-red transmission, or over an indirect connection, such as through a wireless network. 
     The IPG  102  may then be implanted using methods and techniques known in the art. The surgeon may give instructions to the programmer of the CP  104  to activate or deactivate particular electrodes to develop a treatment program that provides a suitable level of relief to the patient. Since the surgeon can see the secondary display unit  152 , he knows whether his instructions are being properly carried out without additional questions or explanation from the programmer of the CP  104 . This reduction in reliance on verbal instructions may increase efficiently of the surgical procedure. Further, during the procedure, the surgeon may intervene or request additional views of displayed information using the surgeon input device  212 . This allows the surgeon to have a level of control over the CP  104 , although that level of control may be a lesser level than the level of control of the programmer of the CP  104 . In one example, the surgeon input device may allow the surgeon to select an electrode and modify its frequency or amplitude of applied stimulation. Although the patient programmer is not sterile, the surgeon input deice may be a sterile device, and in one embodiment, is a single-use device that is discarded after use. 
     During the programming process, information from the PFT  210  may be transmitted to the secondary display unit  152 . The secondary display unit  152  may then relay the received information to the CP  104  for consideration or processing. Based on the patient feedback, the CP  104  may be controlled to update the images on the screens  164 ,  182  or provide additional information for programming the implant. Software on the CP  104  may control the images shown on the secondary display screen  182 , as described above. 
     When a stimulation program is set, it may be transmitted to the IPG  102  either directly from the CP  104  or it may be transmitted to the secondary display unit for relay to the IPG  102 . The IPG may then store the treatment program for operation. 
     Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.