Patent Publication Number: US-2022230742-A1

Title: Medical device management

Description:
This application claims the benefit of U.S. Provisional Patent Application No. 63/140,115, filed Jan. 21, 2021 and U.S. Provisional Patent Application No. 63/213,004, filed Jun. 21, 2021, each of which is incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     This disclosure generally relates to medical devices. 
     BACKGROUND 
     Medical devices (e.g., an implantable medical device or an external medical device) may include electrical stimulation devices, drug pumps, insulin pumps, or cardiac stimulation devices. Electrical stimulation devices, for example, neurostimulators or neurostimulation devices, may be external to or implanted within a patient, and configured to deliver electrical stimulation therapy to various tissue sites to treat a variety of symptoms or conditions such as chronic pain, tremor, Parkinson&#39;s disease, epilepsy, or other neurological disorders, urinary or fecal incontinence, sexual dysfunction, obesity, or gastroparesis. An electrical stimulation device may deliver electrical stimulation therapy via electrodes, e.g., carried by one or more leads, positioned proximate to target locations associated with the brain, the spinal cord, pelvic nerves, tibial nerves, peripheral nerves, the gastrointestinal tract, or elsewhere within a patient. Stimulation proximate the spinal cord, proximate the sacral nerve, within the brain, and proximate peripheral nerves is often referred to as spinal cord stimulation (SCS), sacral neuromodulation (SNM), deep brain stimulation (DBS), and peripheral nerve stimulation (PNS), respectively. 
     SUMMARY 
     In general, this disclosure describes techniques for prioritizing patient information associated with one or more patients of a plurality of patients receiving treatment by a clinician. Medical devices managed by a clinician may generate patient information to help the clinician review an operating status of the medical devices. The medical devices may be implantable and/or wearable and may be configured to provide one or more of deep brain stimulation (DBS), spinal cord stimulation (SCS), sacral neuromodulation (SNM), and peripheral nerve stimulation (PNS), targeted drug delivery (TDD), or another therapy. For example, patient information for an implantable fluid delivery device may indicate one or more of a current reservoir status, a projected refill status, a device replacement status, a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. A clinician device may display a complete listing (e.g., a spreadsheet or dashboard, such as a “snapshot”) of patient information for all of the clinician&#39;s patients. The clinician may determine an efficacy of treatment and/or improve a therapy for the clinician&#39;s patients using the complete listing of all of the patient information. 
     In accordance with the techniques of this disclosure, one or more processors may be configured to select patient information from a subset of the plurality of medical devices based on one or more importance attributes associated with the patient information. For example, the one or more processors may sort, filter, highlight, and/or unhide the selected patient information. In this way, the one or more processors may help the clinician prioritize a treatment of patients that are more likely to benefit from a clinician review. 
     For example, the clinician may select one or more importance attributes to include a threshold number of patient adjustments. Medical devices associated with a higher number of patient adjustments (such as drug dosage or stimulation intensity adjustments) may be more likely to benefit from a review by a clinician than medical devices with a lower number of patient adjustments. As such, the clinician may select the threshold number of patient adjustments to target patient information for a subset of medical devices for review. In this example, the one or more processors may prioritize patient information indicating a number of patient adjustments that exceeds the threshold number of patient adjustments. Accordingly, the one or more processors may prioritize the patient information such that the clinician may quickly review patient information for patients that have a relatively high number of patient adjustments. 
     In this way, a system may help to identify problem patients (e.g., patients that may benefit from review by a clinician), which may improve a therapy provided to the patient. Moreover, identifying problem patients may allow a clinician to more quickly review a pertinent subset of a complete listing of patient information, which may help to reduce an amount of time a clinician spends reviewing patient information. 
     In one example, a method for prioritizing patient information associated with one or more patients of a plurality of patients receiving treatment via respective devices of a plurality of medical devices includes receiving, by one or more processors, patient information from each medical device of the plurality of medical devices and selecting, by the one or more processors, the patient information from a subset of the plurality of medical devices based on one or more importance attributes associated with the patient information. The method further includes prioritizing, by the one or more processors, the selected patient information to generate a list of one or more prioritized patients of the plurality of patients and causing, by the one or more processors, an output of an indication of the patient information for the one or more prioritized patients. 
     In another example, a method for medical device testing based on patient information associated with one or more patients of a plurality of patients receiving treatment via respective devices of a plurality of medical devices includes receiving, by one or more processors, first patient information for a first medical device of the plurality of medical devices and selecting, by the one or more processors, the first patient information for the first medical device based on one or more importance attributes associated with the first patient information. The method further includes initiating, by the one or more processors, a diagnostic test of the first medical device in response to selecting the first patient information to generate diagnostic information for the first medical device. 
     The summary is intended to provide an overview of the subject matter described in this disclosure. It is not intended to provide an exclusive or exhaustive explanation of the systems, device, and methods described in detail within the accompanying drawings and description below. Further details of one or more examples of this disclosure are set forth in the accompanying drawings and in the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a conceptual diagram illustrating an example system that includes an implantable medical device (IMD) in the form of a neurostimulation device configured to deliver spinal cord stimulation (SCS) and an external programmer, in accordance with one or more techniques of this disclosure. 
         FIG. 2  is a block diagram illustrating an example of an IMD in the form of a stimulation device, in accordance with one or more techniques of this disclosure. 
         FIG. 3  is a block diagram illustrating an example of an external programmer suitable for use with the IMD of  FIG. 2 , in accordance with one or more techniques of this disclosure. 
         FIG. 4  is a block diagram illustrating an example of one or more remote servers and one or more remote clients suitable for use with the IMD of  FIG. 1 , in accordance with one or more techniques of this disclosure. 
         FIG. 5  is a flow diagram illustrating a process for prioritizing patient information, in accordance with one or more techniques of this disclosure. 
         FIG. 6  is a flow diagram illustrating a process for initiating a diagnostic test, in accordance with one or more techniques of this disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Efficacy of treatment (e.g., stimulation, drug delivery, etc.) in eliminating or alleviating symptoms, preventing or delaying onset or progression of aspects of, or restoring functions impaired or diminished by a disease, disorder, syndrome or injury, may vary according to the parameters used to deliver the treatment to a patient. Selection of electrode positions relative to a neural target, as one example, can elicit a desired response to the stimulation. Delivering stimulation with different stimulation parameters, such as different electrodes, electrode combinations and/or polarities, or different stimulation amplitudes, pulse widths, pulse rates, or cycling can result in differences in efficacy for a variety of therapies such as, for example, spinal cord stimulation (SCS) to relieve pain or restore physical function or control in the case of spinal cord injury or degeneration. 
     To allow a clinician to review patient information for patients using medical devices, the remote device may include a user interface configured to present patient information associated with patients receiving treatment by the clinician. For example, the remote device may present a listing of patient information that includes, for each medical device associated with patients of the clinician, an identifier for a respective patient associated with a medical device, information relating to the medical device and/or information relating to the patient. Examples of information relating to the medical device may include, for example, a battery status, current reservoir status, patient adjustment, operating status, or other information. Examples of information relating to the patient may include, for example, a patient pain level, a patient activity level, or other information. However, as the number of patients increases, the amount of information presented in the listing of patient information may increase, which may obscure patient information for patients that may benefit from a prioritized review (e.g., problem patients). 
     The techniques of this disclosure may include one or more processors configured to prioritize patient information associated with one or more patients of a plurality of patients receiving treatment by a clinician. For example, one or more processors arranged in an external clinician programmer device and/or a cloud may be configured to select patient information from a subset of the plurality of medical devices based on one or more importance attributes associated with the patient information. For instance, the one or more processors may sort, filter, highlight, and/or unhide the selected patient information. For example, one or more importance attributes stored in memory may include a threshold number of patient changes. In this example, the one or more processors may highlight patient information that comprises a number of patient changes that exceeds the threshold number of patient changes. Configuring the one or more processors to use one or more importance attributes to sort, filter, highlight, and/or unhide the selected patient information may help the clinician prioritize a treatment of patients that are more likely to benefit from a clinician review. 
     In examples where a medical device includes an implantable fluid delivery device, the one or more importance attributes associated with the patient information may relate to one or more drug pump attributes including at least one of: a current reservoir status, a projected refill status, a device replacement status, a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. In examples where a medical device includes an implantable stimulation device, the one or more importance attributes associated with the patient information may relate to one or more neurostimulator attributes, including at least one of: a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. 
     For example, the clinician may select one or more importance attributes to include a threshold number of patient adjustments. Medical devices associated with a higher number of patient adjustments (such as drug dosage or stimulation intensity adjustments) may be more likely to benefit from a review by a clinician than medical devices with a lower number of patient adjustments. As such, the clinician may select the threshold number of patient adjustments to target patient information for a subset of medical devices for review. In this example, the one or more processors may prioritize patient information indicating a number of patient adjustments that exceeds the threshold number of patient adjustments. In this way, the one or more processors may prioritize the patient information such that the clinician may quickly review patient information for patients that have a relatively high number of patient adjustments. 
     In some examples, one or more processors may be configured to initiate a diagnostic test of a medical device in response to selecting the patient information to generate diagnostic information for the medical device. The one or more processors may receive the diagnostic information and present the diagnostic information to a clinician. For example, the diagnostic test may comprise performing a lead location diagnostic test. In some examples, the diagnostic test may comprise performing an impedance measurement of a lead. As used herein, impedance may be measured by stimulating one electrode and recording on the same electrode (e.g., classical impedance) or may be measured by stimulating on one electrode and recording on another electrode (e.g., cross impedance). The diagnostic test may comprise sensing an evoked compound action potential (ECAP) signal. In this way, the one or more processors may help the clinician collect diagnostic information. The one or more processors may use diagnostic information to help prioritize a treatment of patients that are more likely to benefit from a clinician review. 
     Techniques described herein may be directed to implantable medical devices and external medical devices. Examples described herein may describe techniques with reference to medical devices, however, aspects of such techniques may apply to any medical device. Again, examples of medical devices, which may be external or implantable), may include drug pumps, insulin pumps, or cardiac stimulation devices. 
       FIG. 1  is a conceptual diagram illustrating an example system  100  that includes an implantable medical device (IMD)  110  configured to deliver SCS therapy, processing circuitry  140 , and an external programmer  150 , in accordance with one or more examples of this disclosure. Although the examples described in this disclosure are generally applicable to a variety of medical devices including external devices and IMDs, application of such techniques to IMDs and, more particularly, implantable electrical stimulators (e.g., neurostimulators) will be described for purposes of illustration. More particularly, the disclosure will refer to an implantable SCS system for purposes of illustration, but without limitation as to other types of medical devices or other therapeutic applications of stimulation. 
     External programmer  150  may be configured to provide patient information to support techniques for identifying problem patients, whose patient information should potentially be prioritized for determination of patient treatment or patient communication. In some examples, external programmer  150  may help to cause IMD  110  to perform a diagnostic test, for example, to capture patient data in response to identifying patient  105  as a problem patient. 
     As shown in  FIG. 1 , system  100  includes an IMD  110 , leads  130 A and  130 B, and external programmer  150  shown in conjunction with a patient  105 , who is ordinarily a human patient. In the example of  FIG. 1 , IMD  110  is an implantable electrical stimulator that is configured to generate and deliver electrical stimulation therapy to patient  105 , e.g., for relief of chronic pain or other symptoms, or restoration or support of physical function or control in the case of spinal cord injury or degeneration, via one or more electrodes  132 A,  132 B of leads  130 A and/or  130 B, respectively. In the example of  FIG. 1 , each lead  130 A,  130 B includes eight electrodes  132 A,  132 B respectively, although the leads may each have a different number of electrodes. Leads  130 A,  130 B may be referred to collectively as “leads  130 ” and electrodes  132 A,  132 B may be referred to collectively as electrodes  132 . In other examples, IMD  110  may be coupled to a single lead carrying multiple electrodes or more than two leads each carrying multiple electrodes. 
     IMD  110  may be a chronic electrical stimulator that remains implanted within patient  105  for weeks, months, or years. In other examples, IMD  110  may be a temporary, or trial, stimulator used to screen or evaluate the efficacy of electrical stimulation for chronic therapy. In one example, IMD  110  is implanted within patient  105 , while in another example, IMD  110  is an external device coupled to one or more leads percutaneously implanted within the patient. In some examples, IMD  110  uses electrodes on one or more leads, while in other examples, IMD  110  use one or more electrodes on a lead or leads and one of more electrodes on a housing of the IMD. In further examples, IMD  110  may be leadless and instead use only electrodes carried on a housing of IMD. 
     IMD  110  may be constructed of any polymer, metal, or composite material sufficient to house the components of IMD  110  (e.g., components illustrated in  FIG. 2 ) within patient  105 . In this example, IMD  110  may be constructed with a biocompatible housing, such as titanium or stainless steel, or a polymeric material such as silicone, polyurethane, or a liquid crystal polymer, and surgically implanted at a site in patient  105  near the pelvis, abdomen, or buttocks. In other examples, IMD  110  may be implanted at other suitable sites within patient  105 , which may depend, for example, on the target site within patient  105  for the delivery of electrical stimulation therapy. The outer housing of IMD  110  may be configured to provide a hermetic seal for components, such as a rechargeable or non-rechargeable power source. In addition, in some examples, the outer housing of IMD  110  is selected from a material that facilitates receiving energy to charge the rechargeable power source. 
     In the example of  FIG. 1 , electrical stimulation energy, which may be delivered as regulated current or regulated voltage-based pulses, is delivered from IMD  110  to one or more target tissue sites of patient  105  via leads  130  and electrodes  132 . Leads  130  position electrodes  132  adjacent to target tissue of spinal cord  120 . One or more of the electrodes  32  may be disposed at a distal tip of a lead  130  and/or at other positions at intermediate points along the lead. Leads  130  may be implanted and coupled to IMD  110 . The electrodes  132  may transfer electrical stimulation generated by an electrical stimulation generator in IMD  110  to tissue of patient  105 . Although leads  130  may each be a single lead, a lead  130  may include a lead extension or other segments that may aid in implantation or positioning of lead  130 . 
     The electrodes of leads  130  may be electrode pads on a paddle lead, circular (e.g., ring) electrodes surrounding the body of the lead, conformable electrodes, cuff electrodes, segmented electrodes (e.g., electrodes disposed at different circumferential positions around the lead instead of a continuous ring electrode), any combination thereof (e.g., ring electrodes and segmented electrodes) or any other type of electrodes capable of forming unipolar, bipolar or multipolar electrode combinations for therapy. Ring electrodes arranged at different axial positions at the distal ends of lead  130  will be described for purposes of illustration. Deployment of electrodes via leads  130  is described for purposes of illustration, but electrodes may be arranged on a housing of IMD  110 , e.g., in rows and/or columns (or other arrays or patterns), as surface electrodes, ring electrodes, or protrusions. 
     Stimulation parameters defining the electrical stimulation pulses delivered by IMD  110  through electrodes  132  of leads  130  may include information identifying which electrodes have been selected for delivery of the stimulation pulses according to a stimulation program and the polarities of the selected electrodes (the electrode combination), and voltage or current amplitude, pulse rate (e.g., frequency), and pulse width of the stimulation pulses. The stimulation parameters may further include a cycle parameter that specifies when, or how long, stimulation is turned on and off. Stimulation parameters may be programmed prior to delivery of the stimulation pulses, manually adjusted based on user input, or automatically controlled during delivery of the stimulation pulses, e.g., based on sensed conditions. 
     Although the example of  FIG. 1  is directed to SCS therapy, e.g., to treat pain or restore or support physical function or control in the case of spinal cord injury or degeneration, in other examples, system  100  may be configured to treat other conditions that may benefit from stimulation therapy. For example, system  100  may be used to treat tremor, Parkinson&#39;s disease, epilepsy, or other neurological disorders, urinary or fecal incontinence, sexual dysfunction, obesity, or gastroparesis, or psychiatric disorders such as depression, mania, obsessive compulsive disorder, or anxiety disorders. Hence, in some examples, system  100  may be configured to deliver SNM, DBS, PNS, or other stimulation, such as peripheral nerve field stimulation (PNFS), cortical stimulation (CS), gastrointestinal stimulation, or any other stimulation therapy capable of treating a condition of patient  105 . 
     Leads  130  may include, in some examples, one or more sensors configured to sense one or more physiological parameters of patient  105 , such as patient activity, pressure, temperature, or other characteristics. At least some of electrodes  132  may be used to sense electrical signals within patient  105 , additionally or alternatively to delivering stimulation. IMD  110  is configured to deliver electrical stimulation therapy to patient  105  via selected combinations of electrodes carried by one or both of leads  130 , alone or in combination with an electrode carried by or defined by an outer housing of IMD  110 . The target tissue for the electrical stimulation therapy may be any tissue affected by electrical stimulation. In some examples, the target tissue includes nerves, smooth muscle or skeletal muscle. In the example illustrated by  FIG. 1 , the target tissue is tissue proximate spinal cord  120 , such as within an intrathecal space or epidural space of spinal cord  120 , or, in some examples, adjacent nerves that branch off spinal cord  120 . Leads  130  may be introduced into spinal cord  120  in via any suitable region, such as the thoracic, cervical or lumbar regions. 
     Stimulation of spinal cord  120  may, for example, prevent pain signals from traveling through spinal cord  120  and to the brain of patient  105 . Patient  105  may perceive the interruption of pain signals as a reduction in pain and, therefore, efficacious therapy results. In other examples, stimulation of spinal cord  120  may produce paresthesia which may reduce the perception of pain by patient  105 , and thus, provide efficacious therapy results. In some examples, some electrical stimulation pulses may be directed to glial cells while other electrical stimulation (e.g., delivered by a different electrode combination) is directed to neurons. In other examples, electrical stimulation pulses may be directed to restore a function lost due to a spinal cord injury. 
     IMD  110  may generate and may deliver electrical stimulation therapy to a target stimulation site within patient  105  via the electrodes of leads  130  to patient  105  according to one or more therapy stimulation programs. A therapy stimulation program specifies values for one or more parameters that define an aspect of the therapy delivered by IMD  110  according to that program. For example, a therapy stimulation program that controls delivery of stimulation by IMD  110  in the form of stimulation pulses may define values for voltage or current pulse amplitude, pulse width, and pulse rate (e.g., pulse frequency) for stimulation pulses delivered by IMD  110  according to that program, as well as the particular electrodes and polarities forming an electrode combination used to deliver the stimulation pulses. 
     A user, such as a clinician, caretaker, or patient  105 , may interact with a user interface of an external programmer  150  to program IMD  110 . External programmer  150  may represent a physician programmer or patient programmer. Programming of IMD  110  may refer generally to the generation and transfer of commands, programs, or other information to control the operation of IMD  110 . In this manner, IMD  110  may receive the transferred commands and programs from external programmer  150  to control electrical stimulation therapy. External programmer  150  may transmit therapy stimulation programs, program groups, stimulation parameter adjustments, therapy stimulation program selections, user input, or other information to control the operation of IMD  110 , e.g., by wireless telemetry or wired connection. 
     External programmer  150  may perform a stimulation parameter adjustment that changes a set of stimulation parameters of an existing program. For example, external programmer  150  may automatically, semi-automatically, or based on a user selection, may determine or more stimulation parameter adjustments for an existing program. In this example, external programmer  150  may pass through the one or more parameter adjustments for the existing program. For instance, external programmer  150  may determine a parameter adjustment (e.g., receive the adjustment from a user input from a health professional) that sets an intensity value of a particular stimulation parameter of a program and may relay the parameter adjustment to IMD  110 . 
     External programmer  150  may be characterized as a physician or clinician programmer if external programmer  150  is primarily intended for use by a physician or clinician. In other cases, external programmer  150  may be characterized as a patient programmer if external programmer  150  is primarily intended for use by a patient. A patient programmer may be generally accessible to patient  105  and, in many cases, may be a portable device that may accompany patient  105  throughout the patient&#39;s daily routine. For example, a patient programmer may receive input from patient  105  when the patient wishes to terminate or change stimulation therapy. In general, a physician or clinician programmer may support selection and generation of programs by a clinician for use by IMD  110 , whereas a patient programmer may support adjustment and selection of such programs by a patient during ordinary use. In other examples, external programmer  150  may include, or be part of, an external charging device that recharges a power source of IMD  110 . In this manner, a user may program and charge IMD  110  using one device, or multiple devices. 
     IMD  110  and external programmer  150  may exchange information and may communicate via wireless communication. Examples of communication techniques may include, for example, radiofrequency (RF) telemetry and inductive coupling, but other techniques are also contemplated. In some examples, external programmer  150  includes a communication head that may be placed proximate to the patient&#39;s body near the IMD  110  implant site to improve the quality or security of communication between IMD  110  and external programmer  150 . Communication between external programmer  150  and IMD  110  may occur during power transmission or separate from power transmission. 
     IMD  110 , in response to commands from external programmer  150 , may deliver electrical stimulation therapy according to one or more therapy stimulation programs, or a group of programs to a target tissue site of the spinal cord  120  of patient  105  via electrodes  132  on leads  130 . In some examples, IMD  110  automatically modifies therapy stimulation programs as therapy needs of patient  105  evolve over time. For example, the modification of the therapy stimulation groups or programs may cause the adjustment of at least one parameter of the plurality of stimulation pulses. 
     In accordance with the techniques of the disclosure, external programmer  150  may be configured to determine patient information for a clinician to review. While  FIG. 1  shows one programmer (e.g., external programmer  150 ), some examples may include additional and/or alternative programmers. For example, a system may include a patient programmer and a clinician programmer. The patient may interact with the patient programmer to select pain rating, a patient activity rating, a side effect rating, and/or initiate a patient adjustment. The clinician programmer may receive the information from the patient programmer (e.g., directly or through a networked communication link). External programmer  150  may generate the patient information based on input by patient  105 . For instance, patient  105  may interact with a user interface of external programmer  150  to select a pain rating, a patient activity rating, a side effect rating, and/or initiate a patient adjustment. In some examples, external programmer  150  may automatically or semi-automatically generate the patient information. For example, external programmer  150  may generate the patient information using an output from one or more sensors (e.g., one or more accelerometers and/or one or more gyroscopes) arranged on external programmer  150 . 
     In some examples, external programmer  150  may generate the patient information based on information from IMD  110 . For example, external programmer  150  may receive an output from IMD  110  indicating a device operational status. The device operation status may indicate, for example, a battery level of IMD  110 . Examples of device operation status may include, for example, a time recharging, a time utilized by group of programs or a program, events that may have occurred during a given time, or a battery status. In some examples, external programmer  150  may receive an output from IMD  110  indicating one or more sensed signals. Sensed signals from IMD  110  may include, for example, one or more of a heart rate, a respiration rate, an electrocardiogram, a breathing rate, evoked potential, Electromyography (EMG), or local field potential (LFP). 
     In some examples, the neurological signals sensed within a brain of patient  105  may reflect changes in electrical current produced by the sum of electrical potential differences across brain tissue. Examples of neurological brain signals include, but are not limited to, bioelectric signals generated from LFP sensed within one or more regions of spinal cord  120 . Electroencephalogram (EEG) signal or an electrocorticogram (ECoG) signal are also examples of bioelectric signals. For example, neurons generate the bioelectric signals, and if measured at depth, it is LFP, if measured on the coretex, it is ECoG, and if on scalp, it is EEG. In this disclosure, the term “oscillatory signal source” is used to describe a signal source that generates bioelectric signals. 
     One example of the feature of interest (e.g., biomarker) within the LFPs is synchronized beta frequency band (13-33 Hz) LFP activity recorded within the sensorimotor region of the subthalamic nucleus (STN) in Parkinson&#39;s disease patients. The source of the LFP activity can be considered as an oscillatory signal source, within the brain of the patient, that outputs an oscillatory electrical voltage signal that is sensed by one or more of electrodes  116  and/or  118 . The suppression of pathological beta activity (e.g., suppression or squelching of the signal component of the bioelectric signals generated from the oscillatory LFP signal source that is within the beta frequency band) by both medication and DBS may correlate with improvements in the motor symptoms of patients who have Parkinson&#39;s disease. 
     In accordance with examples described in this disclosure, system  100  (e.g., via external programmer  150  and/or a remote device) may select the patient information from a subset of the plurality of medical devices based on one or more importance attributes associated with the patient information. In some examples, external programmer  150  or another remote device (e.g., computer station of a clinician, one or more processors in a cloud, etc.), commonly referred to as one or more remote devices, may receive patient information from plurality of patients having respective medical devices. For instance, IMD  110  may be one of the medical devices. 
     The one or more remote devices output information that allows the clinician to review patient information to determine if change in therapy is needed, to confirm that therapy is being delivered, etc. The clinician may support many patients, and viewing the patient information for all patients may be cumbersome and not allow the clinician to focus on patients whose care should be evaluated further. This disclosure describes example ways for the one or more remote devices to output information that is more readily usable by the clinician so as to more quickly focus on patients that should be prioritized (e.g., whose care should be evaluated). 
     In this way, the example techniques improve the technology of therapy delivery while setting forth examples integrated into practical applications. For instance, the example techniques prioritize patient information based on various criteria that allows a clinician to more readily view patient information for patients whose care should be evaluated. Moreover, system  100  may allow the clinician to respond faster compared to systems that do not prioritize patient information, which may reduce a delay in modifying therapy provided (e.g., select a program) to patient  105 . 
     For instance, system  100 , which includes the one or more remote devices, may sort, filter, highlight, and/or unhide the selected patient information. For example, one or more importance attributes stored in memory may include a threshold number of patient changes. In this example, system  100  may highlight patient information that comprises a number of patient changes that exceeds the threshold number of patient changes. For instance, a patient with a relatively high number of therapy changes may be more likely to be dissatisfied with a therapy being provided than a patient with a relatively low number of therapy changes. Configuring the one or more processors to use one or more importance attributes to sort, filter, highlight, and/or unhide the selected patient information may help the clinician prioritize a treatment of patients that are more likely to benefit from a clinician review. In this way, system  100  may help to identify problem patients (e.g., patients that may benefit from review by a clinician), which may improve a therapy provided to the patient. Moreover, identifying problem patients may allow a clinician to more quickly review a pertinent subset of a complete listing of patient information, which may help to reduce an amount of time a clinician spends reviewing patient information. 
     In accordance with the techniques of the disclosure, external programmer  150  may cause IMD  110  to initiate a diagnostic test. Examples of a diagnostic test may include, for example, a lead location diagnostic, an impedance measurement, and/or sensing an evoked compound action potential (ECAP) signal. For example, a remote device (e.g., a remote server or remote client) may cause external programmer  150  to initiate the diagnostic test. In some examples, however, external programmer  150  may initiate the diagnostic test without the remote device. 
     In some examples, IMD  110  may sense an ECAP signal in response to the request to initiate the diagnostic test. ECAPs are a measure of neural recruitment because each ECAP signal represents the superposition of electrical potentials generated from a population of axons firing in response to an electrical stimulus (e.g., a stimulation pulse). Changes in a characteristic (e.g., an amplitude of a portion of the signal or area under the curve of the signal) of an ECAP signals occur as a function of how many axons have been activated by the delivered stimulation pulse. For a given set of parameter values that define the stimulation pulse and a given distance between the electrodes and target nerve, the detected ECAP signal may have a certain characteristic value (e.g., amplitude). Therefore, a system can determine that the distance between electrodes and nerves has increased or decreased in response to determining that the measured ECAP characteristic value has increased or decreased. For example, if the set of parameter values stays the same and the ECAP characteristic value of amplitude increases, the system can determine that the distance between electrodes and the nerve has decreased. 
     External programmer  150  may request a patient input. For example, in response to an instruction from a remote device (e.g., a remote server or remote client), external programmer  150  may output a request for patient  105  to input one or more of a pain rating, a side effect rating, or a confirmation of a patient activity level. The patient activity level may include, for example, standing, walking, laying down, or voiding. 
     External programmer  150  may output patient information automatically, semi-automatically, or manually generated using input by patient  105  to a remote device (e.g., a remote server or remote client). As described further herein, the remote device may use the patient information to help to identify problem patients (e.g., patients that may benefit from review by a clinician), which may improve a therapy provided to patient  105 . Moreover, identifying problem patients may allow a clinician to more quickly review a pertinent subset of a complete listing patient information, which may help to reduce an amount of time a clinician spends reviewing patient information. 
       FIG. 2  is a block diagram illustrating an example configuration of components of an IMD  200 , in accordance with one or more techniques of this disclosure. IMD  200  may be an example of IMD  110  of  FIG. 1 . In the example shown in  FIG. 2 , IMD  200  includes stimulation generation circuitry  202 , switch circuitry  204 , sensing circuitry  206 , telemetry circuitry  208 , processing circuitry  210 , storage device  212 , sensor(s)  222 , power source  224 , lead  230 A carrying electrodes  232 A, which may correspond to lead  130 B and electrodes  132 B of  FIG. 1 , and lead  230 B carrying electrodes  232 B, which may correspond to lead  130 B and electrodes  132 B of  FIG. 1 . 
     Stimulation generation circuitry  202  may generate electrical stimulation pulses selected to alleviate symptoms or dysfunction of one or more diseases, disorders, injuries, or syndromes. Intensity level unit  245  may be configured to set an intensity of the electrical stimulation pulses. Intensity may be a function of amplitude, pulse width, and/or frequency of the electrical stimulation pulses. While square wave stimulation pulses are described, stimulation signals may take other forms, such as continuous-time signals (e.g., sine waves) or the like. Each of leads  230 A,  230 B may include any number of electrodes  232 A,  232 B. In the example of  FIG. 2 , each set of electrodes  232 A,  232 B includes eight electrodes A-H. In some examples, the electrodes are arranged in bipolar combinations. A bipolar electrode combination may use electrodes carried by the same lead  230 A,  230 B or different leads. For example, an electrode A of electrodes  232 A may be a cathode and an electrode B of electrodes  232 A may be an anode, forming a bipolar combination. 
     Switch circuitry  204  may include one or more switch arrays, one or more multiplexers, one or more switches (e.g., a switch matrix or other collection of switches), or other electrical circuitry configured to direct stimulation signals from stimulation generation circuitry  202  to one or more of electrodes  232 A,  232 B, or directed sensed signals from one or more of electrodes  232 A,  232 B to sensing circuitry  206 . In some examples, each of the electrodes  232 A,  232 B may be associated with respective regulated current source and sink circuitry to selectively and independently configure the electrode to be a regulated cathode or anode, in which case switch circuitry  204  may not be necessary to direct stimulation signals to electrodes. Instead, current sourced or sunk by selected electrodes may be individually controlled. Stimulation generation circuitry  202  and/or sensing circuitry  206  also may include sensing circuitry to direct electrical signals sensed at one or more of electrodes  232 A,  232 B. 
     Sensing circuitry  206  may be configured to monitor signals from any combination of electrodes  232 A,  232 B. Although sensing circuitry  206  is shown as part of IMD  200 , sensing circuitry  206  may be included in a separate device (e.g., a separate body worn device). In some examples, sensing circuitry  206  includes one or more amplifiers, filters, and analog-to-digital converters. Sensing circuitry  206  may be used to sense electrophysiological signals. In some examples, sensing circuitry  206  detects electrophysiological signals from a particular combination of electrodes  232 A,  232 B. In some cases, the particular combination of electrodes for sensing electrophysiological signals includes different electrodes than a set of electrodes  232 A,  232 B used to deliver stimulation pulses. Alternatively, in other cases, the particular combination of electrodes used for electrophysiological sensing includes at least one of the same electrodes as a set of electrodes used to deliver stimulation pulses to patient  105 . Sensing circuitry  206  may provide signals to an analog-to-digital converter, for conversion into a digital signal for processing, analysis, storage, or output by processing circuitry  210 . In some examples, sensing circuitry  206  may be configured to sense an output from an accelerometer and/or to sense a temperature from a temperature sensor. 
     Telemetry circuitry  208  may support wireless communication between IMD  200  and an external programmer (not shown in  FIG. 2 ) or another computing device under the control of processing circuitry  210 . Processing circuitry  210  of IMD  200  may receive, as updates to programs, values for various stimulation parameters such as amplitude and electrode combination, from the external programmer via telemetry circuitry  208 . Telemetry circuitry  208  in IMD  200 , as well as telemetry circuits in other devices and systems described herein, such as the external programmer, may accomplish communication by radiofrequency (RF) communication techniques. In addition, telemetry circuitry  208  may communicate with an external medical device programmer (not shown in  FIG. 2 ) via proximal inductive interaction of IMD  200  with the external programmer. The external programmer may be one example of external programmer  150  of  FIG. 1 . Accordingly, telemetry circuitry  208  may send information to the external programmer on a continuous basis, at periodic intervals, or upon request from IMD  110  or the external programmer. 
     Processing circuitry  210  may include any one or more of a microprocessor, a controller, a digital signal processor (DSP), an application specific integrated circuit (ASIC), a field-programmable gate array (FPGA), discrete logic circuitry, or any other processing circuitry configured to provide the functions attributed to processing circuitry  210  herein may be embodied as firmware, hardware, software or any combination thereof. As shown, processing circuitry  210  may comprise a lead diagnostic unit  241 , an impedance measurement unit  243 , and an intensity level unit  245  that may each comprise circuitry and/or software instructions. The software instructions associated with lead diagnostic unit  241 , impedance measurement unit  243 , and intensity level unit  245  may be stored, for example, at storage device  212 . 
     Storage device  212  may be configured to store information within IMD  200  during operation. Storage device  212  may include a computer-readable storage medium or computer-readable storage device. In some examples, storage device  212  includes one or more of a short-term memory or a long-term memory. Storage device  212  may include, for example, random access memories (RAM), dynamic random access memories (DRAM), static random access memories (SRAM), magnetic discs, optical discs, flash memories, or forms of electrically programmable memories (EPROM) or electrically erasable and programmable memories (EEPROM). In some examples, storage device  212  is used to store data indicative of instructions for execution by processing circuitry  210 , such as, for example, instructions associated with lead diagnostic unit  241 , impedance measurement unit  243 , and intensity level unit  245 . 
     Power source  224  may be configured to deliver operating power to the components of IMD  200 . Power source  224  may include a battery and a power generation circuit to produce the operating power. In some examples, the battery is rechargeable to allow extended operation. In some examples, power source  224  may be configured to recharge a battery through proximal inductive interaction between an external charger and an inductive charging coil within IMD  200 . Power source  224  may include any one or more of a plurality of different battery types, such as nickel cadmium batteries and lithium ion batteries. 
     In accordance with the techniques of the disclosure, telemetry circuitry  208  may process a request from external programmer  150  to initiate a diagnostic test. For example, lead diagnostic unit  241  of processing circuitry  210  may perform a lead location diagnostic of a lead of leads  230  in response to the request to initiate the diagnostic test. For example, lead diagnostic unit  241  may track a lead tip movement in relation to stimulation changes (e.g., a lead or an impedance issue) or lead location check. Lead diagnostic unit  230  may monitor lead tip movement by, for example, monitoring impedance changes between electrodes on separate leads. In response to impedance changes above a threshold between relatively placed electrodes, lead diagnostic unit  230  may determine that the electrodes may have moved. Lead diagnostic unit  230  may measure impedance changes between any of several electrodes on one lead to any of several electrodes on the other lead. Lead diagnostic unit  230  may measure impedance changes between multiple combinations of electrodes between separate leads. Movement of a lead  230  may result in therapy being provided in a different part of patient  105 , which may reduce an effectiveness of therapy provided by IMD  110  to patient  105 . Testing for the movement of a lead of leads  230  may help to identify when a patient would benefit from a review by the clinician. For example, a clinician may set an importance attribute for a lead position difference to prioritize patient information indicating that at least one lead of leads  230  moves more than a threshold value. 
     In some examples, impedance measurement unit  243  of processing circuitry  210  may perform an impedance measurement of a particular lead of leads  230  in response to the request to initiate the diagnostic test. A change in impedance of a particular lead of leads  230  may indicate a reduction in an effectiveness of therapy provided by IMD  110  to patient  105 . Testing for the impedance of leads  230  may help to identify when a patient would benefit from a review by the clinician. For example, a clinician may set an importance attribute for a lead impedance difference to prioritize patient information indicating that at least one lead of leads  230  changes in impedance more than a threshold value. 
       FIG. 3  is a block diagram illustrating an example configuration of components of an example external programmer  300 . External programmer  300  may be an example of external programmer  150  (e.g., an external patient programmer or an external clinician programmer) of  FIG. 1 . Although external programmer  300  may generally be described as a hand-held device, external programmer  300  may be a larger portable device or a more stationary device. In addition, in other examples, external programmer  300  may be included as part of an external charging device or include the functionality of an external charging device. As illustrated in  FIG. 3 , external programmer  300  may include processing circuitry  352 , storage device  354 , user interface  356 , telemetry circuitry  358 , and power source  360 . Storage device  354  may store instructions that, when executed by processing circuitry  352 , cause processing circuitry  352  and external programmer  300  to provide the functionality ascribed to external programmer  300  throughout this disclosure. Each of these components, circuitry, or modules, may include electrical circuitry that is configured to perform some, or all of the functionality described herein. For example, processing circuitry  352  may include one or more processors, such as, one or more microprocessors, DSPs, ASICs, FPGAs, or any other equivalent integrated or discrete logic circuitry, as well as any combinations of such components, configured to perform the processes discussed with respect to processing circuitry  352 . External programmer  300  may represent a patient programmer, clinician programmer, or another device. 
     In general, external programmer  300  includes any suitable arrangement of hardware, alone or in combination with software and/or firmware, to perform the techniques attributed to external programmer  300 , and processing circuitry  352 , user interface  356 , and telemetry circuitry  358  of external programmer  300 . While external programmer  300  is connectable to the Internet and/or a cloud, in some examples external programmer  300  is not connected and/or is not connectable to the Internet and/or a cloud. In various examples, external programmer  300  may include one or more processors, such as one or more microprocessors, DSPs, ASICs, FPGAs, or any other equivalent integrated or discrete logic circuitry, as well as any combinations of such components. External programmer  300  also, in various examples, may include a storage device  354 , such as RAM, ROM, PROM, EPROM, EEPROM, flash memory, a hard disk, a CD-ROM, including executable instructions for causing the one or more processors to perform the actions attributed to them. Moreover, although processing circuitry  352  and telemetry circuitry  358  are described as separate modules, in some examples, processing circuitry  352  and telemetry circuitry  358  are functionally integrated. In some examples, processing circuitry  352  and telemetry circuitry  358  correspond to individual hardware units, such as ASICs, DSPs, FPGAs, or other hardware units. 
     Storage device  354  (e.g., a storage device) may store instructions that, when executed by processing circuitry  352 , cause processing circuitry  352  and external programmer  300  to provide the functionality ascribed to external programmer  300  throughout this disclosure. For example, storage device  354  may include instructions that cause processing circuitry  352  to obtain a parameter set from memory or receive user input and send a corresponding command to IMD  110 , or instructions for any other functionality. In addition, storage device  354  may include a plurality of programs, where each program includes a parameter set that defines therapy stimulation or control stimulation. Storage device  354  may also store data received from a medical device (e.g., IMD  110 ). For example, storage device  354  may store data recorded at a sensing module of the medical device, and storage device  354  may also store data from one or more sensors of the medical device. 
     Processing circuitry  352  may be configured to control IMD  110  with a program to provide stimulation. For example, processing circuitry  352  may automatically or semi-automatically set or adjust programs at IMD  110  by transmitting, with telemetry circuitry  358 , instructions to IMD  110 . For instance, in response to a change (e.g., a change indicated by user input, a change sensed by IMD  110 , etc.) in activity of a patient (e.g., standing, walking, voiding, etc.), processing circuitry  352  may automatically or semi-automatically set or adjust programs at IMD  110 . For instance, processing circuitry  352  may, in response to determining that the patient would not like to void, output instructions to IMD  110  to use a first group stored at IMD  110  for controlled voiding. In this instance, processing circuitry  352  may, in response to determining that the patient would like to void, output instructions to IMD  110  to use a new group or program stored at IMD  110  for controlled voiding. 
     User interface  356  may include a button or keypad, lights, a speaker for voice commands, a display, such as a liquid crystal (LCD), light-emitting diode (LED), or organic light-emitting diode (OLED). In some examples the display includes a touch screen. User interface  356  may be configured to display any information related to the delivery of electrical stimulation. User interface  356  may also receive user input (e.g., indication of when the patient perceives a stimulation pulse) via user interface  356 . The input may be, for example, in the form of pressing a button on a keypad or selecting an icon from a touch screen. The input may request starting or stopping electrical stimulation, the input may request a new spatial electrode pattern or a change to an existing spatial electrode pattern, of the input may request some other change to the delivery of electrical stimulation. 
     Telemetry circuitry  358  may support wireless communication between the medical device and external programmer  300  under the control of processing circuitry  352 . Telemetry circuitry  358  may also be configured to communicate with another computing device via wireless communication techniques, or direct communication through a wired connection. In some examples, telemetry circuitry  358  provides wireless communication via an RF or proximal inductive medium. In some examples, telemetry circuitry  358  includes an antenna, which may take on a variety of forms, such as an internal or external antenna. 
     Examples of local wireless communication techniques that may be employed to facilitate communication between external programmer  300  and IMD  110  include RF communication according to the 802.11 or Bluetooth® specification sets or other standard or proprietary telemetry protocols. In this manner, other external devices may be capable of communicating with external programmer  300  without needing to establish a secure wireless connection. As described herein, telemetry circuitry  358  may be configured to transmit a spatial electrode movement pattern or other stimulation parameter values to IMD  110  for delivery of electrical stimulation therapy. 
     Power source  360  is configured to deliver operating power to the components of external programmer  300 . Power source  360  may include a battery and a power generation circuit to produce the operating power. In some examples, the battery is rechargeable to allow extended operation. Recharging may be accomplished by electrically coupling power source  360  to a cradle or plug that is connected to an alternating current (AC) outlet. In addition, recharging may be accomplished through proximal inductive interaction between an external charger and an inductive charging coil within external programmer  300 . In other examples, traditional batteries (e.g., nickel cadmium or lithium ion batteries) may be used. In addition, external programmer  300  may be directly coupled to an alternating current outlet to operate. 
     Processing circuitry  352  may implement API  351  to facilitate the control of IMD  110 . API  351  may include patient information unit  359  and diagnostic unit  361 . Patient information unit  359  may automatically, semi-automatically, or manually generate patient information using, for example, sensed data, patient input, or other information. For example, patient information unit  359  may output, with telemetry circuitry  358 , patient information to a remote device and/or a remote client. 
     Diagnostic unit  361  may be configured to cause IMD  110  to perform one or more diagnostic tests. For example, diagnostic unit  361  may receive first patient information from a first medical device (e.g., IMD  110 ). In some examples, diagnostic unit  361  may output the first patient information to a remote device and receive an indication that the first patient information is selected. Diagnostic unit  361  may select the first patient information from a plurality of medical devices based on one or more importance attributes associated with the first patient information. Diagnostic unit  361  may initiate a diagnostic test of the first medical device to generate diagnostic information for the first medical device in response to the selection of the first patient information. Diagnostic unit  361  may output, with telemetry circuitry  358 , an indication of diagnostic information associated with the diagnostic test to a remote device and/or a remote client. For example, diagnostic unit  361  may output an indication of an impedance or change in impedance of a lead of leads  230 . In some examples, diagnostic unit  361  may output an indication of a position or a change of position of a lead of leads  230 . 
     The architecture of external programmer  300  illustrated in  FIG. 3  is shown as an example. The techniques as set forth in this disclosure may be implemented in the example external programmer  300  of  FIG. 3 , as well as other types of systems not described specifically herein. Nothing in this disclosure should be construed so as to limit the techniques of this disclosure to the example architecture illustrated by  FIG. 3 . 
       FIG. 4  is a block diagram illustrating an example of one or more remote servers  470  (referred to herein as “remote server  470 ”) and one or more remote clients  472  (referred to herein as “remote clients  472 ”) suitable for use with the IMD of  FIG. 1 , in accordance with one or more techniques of this disclosure. Remote server  470  may represent a cloud computing infrastructure, such as, for example a cloud or web interface. Remote client  472  may represent a clinician device geographically remote from external programmer  150  and/or IMD  110 . In some examples, remote server  470  may work with remote client  472 . For instance, remote server  470  may store data or at least partially process data for remote client  472 . Remote client  472  may be used by a health professional at a doctor&#39;s office and the patient and IMD  110  may be at a home of the patient. Remote server  470  and/or remote client  472  may be referred to herein as a remote device. Network  454  may comprise one or more wired (e.g., Ethernet) and/or wireless networks (e.g., Wi-Fi™, Bluetooth™, Zigbee™, IEEE 802.11, etc.). In some examples, network  454  may comprise the Internet. While the previous examples refer to remote client  472  as performing various processes, any combination of medical devices, external programmers  450 , remote server  470 , or remote client  472  may perform such processes. Moreover, remote client  472  (or any combination of medical devices, external programmers  450 , remote server  470 , or remote client  472 ) may perform the processes described as being performed by external programmer  150  of  FIG. 1  and/or external programmer  300  of  FIG. 3 . 
     A remote device (e.g., remote server  470  and/or remote client  472 ) may be configured to control IMD  110  with a program or a group of programs to provide stimulation. For example, the remote device may automatically or semi-automatically set or adjust programs at IMD  110 . For instance, in response to a change in activity of a patient (e.g., standing, walking, voiding, etc.), the remote device may automatically or semi-automatically set or adjust programs at IMD  110 . For instance, the remote device may receive sensor information or user input information from IMD  110  or external programmer  150  via the network  454  that indicates a change in activity of the patient. While the following examples refer to remote client  472  as performing processes directed to identifying problem patients, initiating a diagnostic test, prioritizing a delivery of data, scheduling a virtual appointments, any combination of medical devices  410 A- 410 N (collectively, “medical devices  410 ”), external programmers  450 A- 450 N (collectively, “external programmers  450 ”), remote server  470 , or remote client  472  may perform processes described herein directed to identifying problem patients, initiating a diagnostic test, prioritizing a delivery of data, scheduling a virtual appointments. 
     Remote client  472  may provide a snapshot where a clinician can access centralized patient data. For example, the snapshot may allow the clinician to sort and/or filter a patient list on different parameters to see “interesting” patients. For instance, remote client  472  may provide the snapshot that, instead of flipping through views, allows a clinician to develop rules for highlighting interesting patients. In some examples, the snapshot may comprise one or more “cards”, where a card may be added to view with information on why a patient is interesting, a next action to take, and/or other information. In some examples, a card may include one or more of: when does patient need refill; whether or not the patient missed upload; when will a fill alarm expire; and/or information from an external patient programmer. Information from the external patient programmer patient may include, for example, a bolus use in a patient-controlled mode (PTM) device and/or whether or not the patient has used patient boluses (e.g., the patient may delay appointment). 
     Remote client  472  may be configured to compare the information from the external programmer to user-configurable thresholds (e.g., a date of when to notify clinician) such as user-configurable dates for notification. In this way, remote client  472  may help the snapshot be flexible for different patients and/or different clinicians and/or help to make some actions limited to a practice account manager (e.g., when refill moved out so, different people are not producing different results based on different skill levels). Remote client  472  may present the snapshot such that any individual patient page shows why a particular patient is interesting (e.g., in an upper left corner) and/or allows the clinician to follow and unfollow the particular patient. For instance, remote client  472  may determine that a particular patient is interesting if the particular patient would warrant further review/attention, or would warrant some kind of patient monitoring. Remote client  472  may present the snapshot to include a section on implants that shows an implant status (e.g., the patient may have two pumps where one pump is a replacement pump). 
     In some examples, remote client  472  may track changes via serial numbers such that remote client  472  may track information for filtering. For example, remote client  472  may map a serial number to a device (e.g., leads, catheters). In some examples, remote client  472  may track number of changes (e.g., parameters) via each serial number. In some examples, remote client  472  may, in identifying particular patients, add recommendation of other features that may be utilized or optimized (e.g., could be new, extra features or features for remediation). For example, remote client  472  may add to a patient review system (PRS), ECAPs, etc. as recommendations (e.g., if a patient is making many changes when moving to different postures). In this way, remote client  472  may identify new features to add and/or one or more refinement of features. 
     Remote client  472  may track a lead tip movement in relation to stimulation changes (e.g., a lead or an impedance issue) and/or run an impedance check or lead location check. For example, remote client  472  may track a lead tip movement in relation to stimulation changes (e.g., a lead or an impedance issue) or lead location check. Movement of a lead  230  may result in therapy being provided in a different part of patient  105 , which may reduce an effectiveness of therapy provided by IMD  110  to patient  105 . Remote client  472  may perform an impedance measurement of a particular lead of leads  230  in response to the request to initiate the diagnostic test. A change in impedance of a particular lead of leads  230  may indicate a reduction in an effectiveness of therapy provided by IMD  110  to patient  105 . 
     Remote client  472  may use one or more accelerometers to track changes relative to efficacy. For instance, remote client  472  may determine that changes relative to efficacy may correspond to too many changes and, in response to the determination, filter up the patient information. Remote client  472  may allow the clinician to configure a preset in preferences when the patient information is prioritized. Remote client  472  may use a rolling trend over time as threshold for a change (e.g., upgrade) in prioritization of the patient. 
     Remote client  472  may use one or more accelerometers in a pump, ambulatory or not ambulatory, as indication of activity of patient. For instance, laying down too much may indicate pain. Remote client  472  may use patient activity as an input to filter. For example, remote client  472  may determine that a relatively low patient activity (e.g., inactive) indicates a lack of efficacy of therapy. In contrast, remote client  472  may determine that a relatively high patient activity (e.g., very active) indicates opportunity to adjust to save power. 
     Remote client  472  may apply data-informed access to IMD data. For example, remote client  472  may reduce a frequency or adjust timing of data recovery based on patient status. Remote client  472  may step up frequency of monitoring if there is a problem or prioritization or just use normal monitoring when there is no problem or prioritization (e.g., but could prioritize or recommend for prioritization based on the information that is retrieved). Remote client  472  may refrain from triggering off of diary events, e.g., for pelvic health, based on the data-informed access to IMD data. 
     Remote client  472  may increase cycling (e.g., an amount of time therapy is not provided) and/or reduce amplitude. For example, remote client  472  may cause one of medical devices  410  to operate in a low energy mode if everything seems to be going well. Remote client  472  may, when using ECAPS, bin ECAPs measurements in response to stimulation pulses into over and under stimulation status. In this way, remote client  472  may determine how often a patient adjusts out of range. 
     Remote client  472  may automate a request to silence alarm. In some examples, remote client  472  may generate additional diagnostic tests on one or more of medical devices  410  as described further herein. Remote client  472  may present a snapshot that shows not just interesting patients, but interesting settings for patients (e.g., overuse or underuse of drug). 
     Remote client  472  may group multiple patients. For example, remote client  472  may present a snapshot that provides a population level analysis and/or visualization. For instance, remote client  472  may generate a patient population group with better or worse outcomes. Remote client  472  may group patients based on one or more of a physiologic response or patient attributes. Examples of patient attributes may include, for example, a program, a placement of a medical device, a disease state, a clinic, or other attributes. In some examples, remote client  472  may cause external programmers  450  to present one or more questions for a patient. For instance, remote client  472  may cause external programmer  450  to present “Are you on non-pump (systemic) meds in addition to pump meds?”. 
     In some examples, patient attributes may include multi-modal data inputs. Examples of multi-modal data inputs may include, for example, a scan bar code, a radio-frequency (RF) read, or camera identify process to identify a drug. In this example, remote client  472  may cause external programmers  450  to direct the patient to answer questions and/or collect other information, such as, for example, input from wearable devices. 
     In some examples, remote client  472  may be configured to apply a failover process where patient information is collected from medical devices  450  and in the case of one or more patient attributes being unavailable from medical devices  450 , remote client  472  may attempt to collect the unavailable patient attributes from one or more wearable devices. In this example, in the case of one or more patient attributes being unavailable from both medical devices  450  and wearable device(s), remote client  472  may attempt to collect the unavailable patient attributes from patient-reported outcomes (PROs). In some examples, remote client  472  may combine data from this hierarchy (e.g., medical devices, then wearable devices, then PROs). In some examples, however, remote client  472  may use information from a single device (e.g., only a medical device, only a wearable device, only PROs). 
     In some examples, remote client  472  may perform a longitudinal data acquisition process. For example, remote client  472  may collect patient information (e.g., patient attributes) from different devices and across different device types (e.g., in hierarchy of devices). For instance, remote client  472  may collect a first set of attributes for a patient from medical device  410 A, a second set of attributes for the patient from a wearable device associated with the patient, and a third set of attributes for the patient collected from PROs input into external programmer  450 A. 
     Remote client  472  may recommend or even automate changes to device settings of medical devices  410  and/or communication to the patient, such as, for example, silencing an alarm, request additional diagnostic (e.g., physiologic measures or impedance measures). 
     Remote client  472  may detect medical concerns. Examples of medical concerns may include, for example, one or more of a dose escalation, or a potential use of more stimulation than needed or the potential for a patient being drug naive after catheter issue. 
     Remote client  472  may provide support for identifying interesting patient populations (e.g., rather than just individuals). For example, remote client  472  may identify a group of patients associated with a relatively high efficacy of therapy and/or a relatively low efficacy of therapy. In some examples, remote client  472  may identify a group of patients associated with an increase in outcome (e.g., where efficacy of a current therapy is improving relative to previous therapy). Remote client  472  may identify a group of patients associated with a respective range of measures. For instance, client  472  may group or bin patients associated with a range of PROs or a range of activity levels. In some examples, remote client  472  may report across populations to recommend target patient attributes and/or practices (e.g., drugs used or lead placement). 
     In some examples, remote client  472  may track a number of times a patient changes parameters of the medical device associated with the patient. Examples of a patient change may include, for example, a stim-up operation, a stim-down operation, a change of a pulse-width (PW), or a rate. A change in pulse-width may be in microseconds (μs). Remote client  472  may recommend other features that are not being optimized or utilized. Remote client  472  may track what features are being used and how often the features are being used. Remote client  472  may track a lead tip movement. Remote client  472  may track a patient activity via a 3-axis accelerometer plot. The 3-axis accelerometer plot may be easily for a clinician to understand a patient activity and to apply changes to help yield efficacy. Remote client  472  may notify a physician if too many changes are occurring (e.g., a number of changes exceed a threshold value). In some instances, too many changes of a medical device may indicate a possible yield issue. 
     Remote client  472  may use accelerator information from an accelerometer arranged into a (e.g., a medical device configured for TDD) to track patient activity. Remote client  472  may track a body position via 3-axis accelerometer to understand more of the patient activity and/or patient sleep. In some examples, remote client  472  may track a body position via 3-axis accelerometer to determine whether the patient is bed ridden. Remote client  472  may use a weighting on patient attributes that is at least partly pre-configured with patient data, which may help a clinician decide which patient attributes to use for flagging. 
     Remote client  472  may comprise an on-board, local, or remote diagnostic system configured to run periodically, or in response to triggering, to identify problems with patients receiving therapy. Problems may be indicated by patient input, therapy usage patterns, and/or sensed signals or conditions (e.g., impedance, ECAPs, and/or pressure). Based on indicated problems, remote client  472  may run diagnostic tests (smart troubleshooting), e.g., on devices, leads, catheters, or other components, schedule appointments, and/or generate a series of questions to elicit patient input regarding the problem. As one example, lead integrity could be indicated by field spread measurements and/or presence or absence of ECAP signals. 
     Remote client  472  may perform one or more selection of diagnostic steps aided by machine learning of troubleshooting approaches taken for a large population of similarly situated patients. Remote client  472  may be configured based on clinician preference to identify to the clinician (e.g., by notification or presentation) particular patients having specified types or severity levels of problems, thereby prioritizing or filtering data. In this way, the clinician receives a “hot list” of patients experiencing particular problems or problems of a specified severity, while filtering out information the clinician does not need. 
     The clinician may specify a remediation plan (e.g., automated changes in therapy parameters, automated scheduling of appointments, additional monitoring) or escalation plan (e.g., browser presentation, email, text, call or personnel) that is automatically performed by the diagnostic system to eliminate the problem and/or escalate levels of attention to the problem by the clinician. 
     Remote client  472  may trigger one or more remediation plans and/or escalation plans by different problem types, severity levels, or other conditions tailored to the clinician or patient. In some examples, remote client  472  may only provide data to the clinician if a problem is identified, instead of always sending data. 
     By tailoring remediation, escalation, and prioritization of problems, a clinician has flexibility in managing the amount of information raised to their attention. This may be advantageous for limiting information consumed by high volume clinicians, with many patients, but also for highlighting significant problems presented to lower volume clinicians. In some examples, the clinician also may select the type and quantity of information available for viewing by patients. 
     For example, remote client  472  may receive one or more importance attributes associated with the patient information. For example, a clinician may select the one or more importance attributes with a user interface of remote client  472 . In some examples, remote client  472  and/or remote server  470  may automatically or semi-automatically generate the one or more importance attributes. Examples of one or more importance attributes may include, for example, one or more of a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. For medical devices that include an implantable fluid delivery device, the one or more importance attributes may include, for example, one or more of a current reservoir status, a projected refill status, a device replacement status, a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. The one or more importance attributes may comprise a recharge history, a position (e.g., a fall or seizure using an accelerometer), a number of stimulation parameter adjustments of IMD  110 , how long IMD  110  is out of sensing parameter (e.g., an efficacy of treatment), a number of high seizure burden events with a cardiac signal, dyskinesia, a number of voids (e.g., using a PRO of bathroom use). 
     In accordance with the techniques of the disclosure, remote client  472  may receive patient information from each medical device of medical devices  410 . Remote client  472  may select the patient information from a subset of the plurality of medical devices based on one or more importance attributes associated with the patient information. Remote client  472  may prioritize the selected patient information to generate a list of one or more prioritized patients of the plurality of patients. In some examples, an order of the prioritizing is specified by the user (e.g., the clinician). In some examples, remote client  472  may rank of patients based on relative a change between a baseline measurement and a current measurement. Patients comprising a higher change between the baseline measurement and the current measurement may need greater attention from the clinician for further follow-up because their electrode-to-neural interface underwent a bigger change compared to patients comprising a lower change between the baseline measurement and the current measurement. 
     To prioritize, remote client  472  may sort the patient information such that relatively high priority patient information is shown before relatively low priority patient information (e.g., at a top of a list of patient information). In some examples, remote client  472  may filter the patient information such that relatively low priority patient information is not presented to a clinician and remaining patient information is presented to the clinician. In some examples, remote client  472  may highlight the patient information such that relatively high priority patient information is shown with a marking (e.g., bold font, large font, highlighting, etc.) that is not used for relatively low priority patient information. Remote client  472  may unhide the patient information based on the priority such that relatively high priority patient information is presented to a clinician and remaining patient information is not presented to the clinician. Remote client  472  may cause an output of an indication of the patient information for the one or more prioritized patients. 
     In some examples, remote client  472  may prioritize the selected patient information based on severity levels assigned to scenarios to generate a list of one or more prioritized patients of the plurality of patients. For example, a low reservoir status for drug delivery may be assigned a scenario with a relatively high severity level and a patient activity level may be assigned a scenario with a relatively low severity level. 
     In some examples, remote client  472  may prioritize the selected patient information based on a therapy usage pattern to generate a list of one or more prioritized patients of the plurality of patients. For example, remote client  472  may prioritize patient information indicating a number of changes to patient therapy of a first patient of the plurality of patients over a period of time that exceeds a threshold number of changes. The threshold number of changes may be pre-defined, automatically configured by remote client  472 , or input by the clinician. For example, remote client  472  may determine the threshold number of changes based on a baseline usage value for the patient and a clinician specified change threshold of the one or more importance attributes selected by the clinician. The period of time may be pre-defined, user specified, automatically determined by remote client  472 . One or more of a medical device (e.g., one of medical devices  410 ), an external programmer (e.g., one of external programmers  450 ), remote server  470 , or remote client  452  may determine the baseline usage value for the patient. 
     Remote client  472  may prioritize the selected patient information based on a patient activity level to generate a list of one or more prioritized patients of the plurality of patients. For example, remote client  472  may prioritize patient information indicating the patient activity level of the patient over a period of time is less than a threshold patient activity level. The threshold patient activity level may be pre-defined, automatically configured by remote client  472 , or input by the clinician. For example, remote client  472  may determine the threshold patient activity level based on a baseline activity for the patient and a clinician specified activity change threshold of the one or more importance attributes selected by the clinician. One or more of a medical device (e.g., one of medical devices  410 ), an external programmer (e.g., one of external programmers  450 ), remote server  470 , or remote client  452  may determine the baseline patient activity level for the patient. The patient activity level may include one or more of standing, walking, laying down, or voiding. 
     For example, remote client  472  may determine an activity level based on an amount of sleep indicated by patient information. For example, in response to a determination that an amount of sleep indicated by the patient information is less than a sleep threshold, remote client  472  may prioritize the patient information. Remote client  472  may determine an activity level based on an indication of patient information that specifies an amount of time a patient is active. In some examples, remote client  472  may determine an activity level based on an amount of time (e.g., a number of minutes per day) a patient is active as indicated by patient information. For example, in response to a determination that an amount of time a patient is active is less than an active time threshold, remote client  472  may prioritize the patient information. 
     Remote client  472  may prioritize patient information based on an amount of medication used as indicated by patient information. For example, in response to a determination that an amount of medication used by a patient is greater than a medication usage threshold, remote client  472  may prioritize the patient information. 
     Remote client  472  may use different risk control measures for different patients and different risk scenarios. Remote client  472  may assign different trust levels to different patients to permit them to make therapy adjustments or grant requests for remote therapy adjustments, e.g., based on different trust levels and/or different scenarios. Approval of therapy changes for some patients may be voluntary or based on website, email or text communication with a caregiver, whereas other patients may require live voice or video communication. Live communication may be more important for TDD therapies. In some examples, remote client  472  may mediate an audio or video communication (immediate or scheduled) between patient and caregiver to address an urgent scenario. Remote client  472  may use time-stamped audio or video snippets to observe patient condition and grant approval for patient adjustment or remote adjustment. Likewise, approval of therapy changes for different scenarios may be subject to different communication modes, such that one scenario may be handled with less urgent, less intrusive communication while another may be handled with different, more intrusive modalities. 
     Although shown as separate entities, in some examples, functionality may be distributed differently than that shown in  FIG. 4 . For example, remote server  470  and remote client  472  may be the same system. While the previous examples refer to remote client  472  as performing various processes, any combination of medical devices, external programmers  450 , remote server  470 , or remote client  472  may perform such processes. 
       FIG. 5  is a flow diagram illustrating a process for prioritizing patient information, in accordance with one or more techniques of this disclosure.  FIG. 5  is discussed with reference to  FIGS. 1-4  for example purposes only. In the following example, remote client  472  performs  502 - 508  of  FIG. 5 . However, in other examples, other devices may perform the process of  FIG. 5  as explained in further detail below. In the following examples, IMD  110  is used as a medical device. However, in some examples, an external medical device may be used instead of IMD  110 . 
     Remote client  472  may receive patient information from each medical device of the plurality of medical devices ( 502 ). In some examples, remote client  472  may select an energy mode based on the received patient information. For instance, remote client  472  may output an indication to enable a low energy mode at the first medical device (e.g., IMD  110 ) based on the first patient information. 
     Remote client  472  may select the patient information from a subset of the plurality of medical devices based on one or more importance attributes associated with the patient information ( 504 ). In some examples, the plurality of medical devices may include at least one implantable stimulation device. For example, the plurality of medical devices may include implantable medical devices configured to deliver at least one of electrical stimulation therapy or fluid delivery therapy. In this example, the one or more importance attributes may relate to one or more neurostimulator attributes of the at least one implantable stimulation device, including at least one of: a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. The one or more importance attributes may be selected by a user input. For example, a clinician may provide the user input based on the clinician&#39;s preferences. 
     In some examples, the plurality of medical devices may include at least one implantable fluid delivery device. In this example, the one or more importance attributes may relate to one or more drug pump attributes of the at least one implantable fluid delivery device including at least one of: a current reservoir status, a projected refill status, a device replacement status, a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. 
     In some examples, the patient information comprises first patient information and the first patient information includes a therapy usage pattern indicating a number of changes to patient therapy of a first patient of the plurality of patients over a period of time. In this example, remote client  472  may determine whether the number of changes to patient therapy of the first patient over the period of time exceeds a threshold number of changes and select the first patient information for the first patient in response to a determination that the number of changes to patient therapy of the first patient over the period of time exceeds the threshold number of changes. Remote client  472  may determine the threshold number of changes based on a baseline usage value for the first patient and a change threshold of the one or more importance attributes. For instance, remote client  472  may determine the threshold number of changes by calculating a difference between a baseline usage value for the first patient (e.g., determined at an initial configuration or a rolling average) and a change threshold of the one or more importance attributes that is specified by a clinician. 
     In some examples, the patient information comprises first patient information and the first patient information comprises a patient activity level of a first patient of the plurality of patients over a period of time. In this example, remote client  472  may select the first patient information for the first medical device in response to a determination that the patient activity level of the first patient over a period of time is less than a threshold patient activity level. In some examples, remote client  472  may determine the threshold patient activity level based on a baseline activity value for the first patient and an activity value of the one or more importance attributes. For instance, remote client  472  may determine the threshold patient activity level by calculating a difference between a baseline activity value for the first patient (e.g., determined at an initial configuration or a rolling average) and an activity value of the one or more importance attributes that is specified by a clinician. The patient activity level may comprise standing, walking, laying down, or voiding. 
     In response to the selecting of patient information, remote client  472  may initiate a diagnostic test. For example, remote client  472  may select first patient information for a first medical device of the plurality of medical devices. In this example, remote client  472  may initiate a diagnostic test of the first medical device to generate diagnostic information for the first medical device in response to selecting the first patient information. For instance, remote client  472  may cause IMD  110  to perform a lead location diagnostic for the plurality of leads inserted into the first patient. Remote client  472  may cause IMD  110  to perform an impedance measurement of a lead of the plurality of leads inserted into the first patient. In some examples, remote client  472  may cause IMD  110  to sense an evoked compound action potential (ECAP) signal for the first patient. Remote client  472  may receive an indication of the diagnostic information associated with the diagnostic test and present the indication of the diagnostic information associated with the diagnostic test. 
     In some examples, remote client  472  may cause an adjustment of an operation for providing therapy in response to a selection of patient information. For example, remote client  472  may cause a first medical device (e.g., IMD  110 ) to adjust an operation for providing therapy to the first patient (e.g., patient  105 ) in response to selecting first patient information. The adjustment in the operation may include one or more of automated changes in therapy parameters provided by the first medical device to the first patient, or additional monitoring by the first medical device of the first patient. 
     In some examples, remote client  472  may request a patient reported outcome (PRO) in response to a selection of patient information. For example, remote client  472  may output a request for patient activity level to the first medical device in response to selecting the first patient information. The patient activity level may include standing, walking, laying down, or voiding. 
     In some examples, remote client  472  may request one or more sensed signals in response to a selection of patient information. For example, remote client  472  may output a request for one or more sensed signals to the first medical device in response to selecting the first patient information. The one or more sensed signals may include one or more of an electrocardiogram, a breathing rate, evoked potential (e.g., ECAP), Electromyography (EMG), or local field potential (LFP). 
     In some examples, remote client  472  may request device information in response to a selection of patient information. For example, remote client  472  may output a request for an operation status to the first medical device in response to selecting the first patient information. In some examples, remote client  472  may receive an indication of a serial number for the first medical device. For instance, IMD  110  and/or external programmer  150  may output the indication of the serial number. 
     In some examples, remote client  472  may cause an external device (e.g., external programmer  150 ) associated with the first medical device to request patient input in response to selecting the first patient information. For example, the patient input may include one or more of a pain rating, a side effect rating, or a confirmation of a patient activity level. 
     Remote client  472  may prioritize the selected patient information to generate a list of one or more prioritized patients of the plurality of patients ( 506 ). In some examples, an order of the prioritizing is specified by a user input. For instance, a clinician may provide a user input that specifies a priority level for each of the one or more importance attributes. For example, remote client  472  may first order patient information into groups based on importance attributes assigned to a first severity level. Remote client  472  may order the patient information within each group based on importance attributes assigned to a second severity level. To prioritize, remote client  472  may perform at least one of sorting, filtering, highlighting, or unhiding of patient information. For instance, remote client  472  may filter out (e.g., hide) patient information that does not satisfy any of the one or more importance attributes. In some instances, remote client  472  may bold or highlight patient information that does satisfy at least one of the one or more importance attributes. 
     Remote client  472  may prioritize based on severity levels assigned to scenarios. For example, remote client  472  may assign a low reservoir status for drug delivery a scenario with a relatively high severity level and may assign a patient activity level a scenario with a relatively low severity level. In some examples, the scenarios may include one or more of deep brain stimulation (DBS), spinal cord stimulation (SCS), sacral neuromodulation (SNS), or targeted drug delivery (TDD). 
     Remote client  472  may cause an output of an indication of the patient information for the one or more prioritized patients ( 508 ). For example, remote client  472  may output a request for patient adjustments to the first medical device in response to selecting the first patient information. 
       FIG. 6  is a flow diagram illustrating a process for initiating a diagnostic test, in accordance with one or more techniques of this disclosure.  FIG. 6  is discussed with reference to  FIGS. 1-5  for example purposes only. In the following example, remote client  472  performs  602 - 610  of  FIG. 6 . However, in other examples, other devices may perform the process of  FIG. 6  as explained in further detail below. In the following examples, IMD  110  is used as a medical device. However, in some examples, an external medical device may be used instead of IMD  110 . 
     Remote client  472  may receive first patient information from a first medical device ( 602 ). In some examples, remote client  472  may select an energy mode based on the received first patient information. For example, remote client  472  may output an indication to enable a low energy mode at the first medical device (e.g., IMD  110 ) based on the first patient information. 
     Remote client  472  may select the first patient information from a plurality of medical devices based on one or more importance attributes associated with the first patient information ( 604 ). For example, the plurality of medical devices may include implantable medical devices configured to deliver at least one of electrical stimulation therapy or fluid delivery therapy. For instance, the plurality of medical devices may include at least one implantable stimulation device. In this example, the one or more importance attributes may relate to one or more neurostimulator attributes of the at least one implantable stimulation device, including at least one of: a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. The one or more importance attributes may be selected by a user input. For example, a clinician may provide the user input based on the clinician&#39;s preferences. 
     In some examples, the plurality of medical devices may include at least one implantable fluid delivery device. In this example, the one or more importance attributes may relate to one or more drug pump attributes of the at least one implantable fluid delivery device including at least one of: a current reservoir status, a projected refill status, a device replacement status, a patient adjustment, a patient activity, a patient input, a sensed signal, or a device operational status. 
     In some examples, the first patient information includes a therapy usage pattern indicating a number of changes to patient therapy of a first patient of the plurality of patients over a period of time. In this example, remote client  472  may determine whether the number of changes to patient therapy of the first patient over the period of time exceeds a threshold number of changes and select the first patient information for the first patient in response to a determination that the number of changes to patient therapy of the first patient over the period of time exceeds the threshold number of changes. Remote client  472  may determine the threshold number of changes based on a baseline usage value for the first patient and a change threshold of the one or more importance attributes. 
     In some examples, the first patient information may comprise a patient activity level of a first patient of the plurality of patients over a period of time. In this example, remote client  472  may select the first patient information for the first medical device in response to a determination that the patient activity level of the first patient over a period of time is less than a threshold patient activity level. In some examples, remote client  472  may determine the threshold patient activity level based on a baseline activity value for the first patient and an activity value of the one or more importance attributes. The patient activity level may comprise standing, walking, laying down, or voiding. 
     In some examples, remote client  472  may cause an adjustment of an operation for providing therapy in response to a selection of the first patient information. For example, remote client  472  may cause the first medical device (e.g., IMD  110 ) to adjust an operation for providing therapy to the first patient (e.g., patient  105 ) in response to selecting first patient information. The adjustment in the operation may include one or more of automated changes in therapy parameters provided by the first medical device to the first patient, or additional monitoring by the first medical device of the first patient. 
     In some examples, remote client  472  may cause an external device (e.g., external programmer  150 ) associated with the first medical device to request patient input in response to selecting the first patient information. For example, the patient input may include one or more of a pain rating, a side effect rating, or a confirmation of a patient activity level. For instance, remote client  472  may output a request for patient activity level to the first medical device in response to a selection of the first patient information. The patient activity level may include standing, walking, laying down, or voiding. 
     In some examples, remote client  472  may request device information in response to a selection of patient information. For example, remote client  472  may output a request for an operation status to the first medical device in response to selecting the first patient information. In some examples, remote client  472  may receive an indication of a serial number for the first medical device. For instance, IMD  110  and/or external programmer  150  may output the indication of the serial number. 
     Remote client  472  may initiate a diagnostic test of the first medical device to generate diagnostic information for the first medical device in response to the selection of the first patient information ( 606 ). For example, remote client  472  may cause IMD  110  to perform a lead location diagnostic for the plurality of leads inserted into the first patient. Remote client  472  may cause IMD  110  to perform an impedance measurement of a lead of the plurality of leads inserted into the first patient. In some examples, remote client  472  may cause IMD  110  to sense an ECAP signal for the first patient. In some examples, remote client  472  may output a request for one or more sensed signals to the first medical device in response to a selection of the first patient information. The one or more sensed signals may include one or more of an electrocardiogram, a breathing rate, evoked potential (e.g., ECAP), Electromyography (EMG), or local field potential (LFP). Remote client  472  may receive an indication of the diagnostic information associated with the diagnostic test and present the indication of the diagnostic information associated with the diagnostic test. The diagnostic may include an indication of one or more of lead location information, impedance measurement information, or sensed signal information (e.g., electrocardiogram, a breathing rate, ECAP signal information, and/or LFP information). 
     Remote client  472  may receive an indication of diagnostic information associated with the diagnostic test ( 608 ). For example, remote client  472  may receive an indication of one or more of impedance measurement information, lead placement information, or sensed signal information. Remote client  472  may present an indication of the diagnostic information associated with the diagnostic test ( 610 ). For example, remote client  472  may cause the indication of the diagnostic information to output on a display for viewing by a clinician. 
     It is to be recognized that depending on the example, certain acts or events of any of the techniques described herein can be performed in a different sequence, may be added, merged, or left out altogether (e.g., not all described acts or events are necessary for the practice of the techniques). Moreover, in certain examples, acts or events may be performed concurrently, e.g., through multi-threaded processing, interrupt processing, or multiple processors, rather than sequentially. 
     In one or more examples, the functions described may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored on or transmitted over as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit. Computer-readable media may include computer-readable storage media, which corresponds to a tangible medium such as data storage media, or communication media including any medium that facilitates transfer of a computer program from one place to another, e.g., according to a communication protocol. In this manner, computer-readable media generally may correspond to (1) tangible computer-readable storage media which is non-transitory or (2) a communication medium such as a signal or carrier wave. Data storage media may be any available media that can be accessed by one or more computers or one or more processors to retrieve instructions, code and/or data structures for implementation of the techniques described in this disclosure. A computer program product may include a computer-readable medium. 
     By way of example, and not limitation, such computer-readable storage media can comprise RAM, ROM, EEPROM, CD-ROM or other optical disk storage, magnetic disk storage, or other magnetic storage devices, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. Also, any connection is properly termed a computer-readable medium. For example, if instructions are transmitted from a website, server, or other remote source using a coaxial cable, fiber optic cable, twisted pair, digital subscriber line (DSL), or wireless technologies such as infrared, radio, and microwave, then the coaxial cable, fiber optic cable, twisted pair, DSL, or wireless technologies such as infrared, radio, and microwave are included in the definition of medium. It should be understood, however, that computer-readable storage media and data storage media do not include connections, carrier waves, signals, or other transitory media, but are instead directed to non-transitory, tangible storage media. Disk and disc, as used herein, includes compact disc (CD), laser disc, optical disc, digital versatile disc (DVD), floppy disk and Blu-ray disc, where disks usually reproduce data magnetically, while discs reproduce data optically with lasers. Combinations of the above should also be included within the scope of computer-readable media. 
     Instructions may be executed by one or more processors, such as one or more digital signal processors (DSPs), general purpose microprocessors, application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), or other equivalent integrated or discrete logic circuitry. Accordingly, the terms “processor” and “processing circuitry,” as used herein may refer to any of the foregoing structures or any other structure suitable for implementation of the techniques described herein. In addition, in some aspects, the functionality described herein may be provided within dedicated hardware and/or software modules configured for encoding and decoding, or incorporated in a combined codec. Also, the techniques could be fully implemented in one or more circuits or logic elements. 
     The techniques of this disclosure may be implemented in a wide variety of devices or apparatuses, including a wireless handset, an integrated circuit (IC) or a set of ICs (e.g., a chip set). Various components, modules, or units are described in this disclosure to emphasize functional aspects of devices configured to perform the disclosed techniques, but do not necessarily require realization by different hardware units. Rather, as described above, various units may be combined in a codec hardware unit or provided by a collection of interoperative hardware units, including one or more processors as described above, in conjunction with suitable software and/or firmware.