Week 8 

          This last week I learned that many implantable medical device companies make programmers for doctors and nurses to use that check up on the status of the implantable device. Before I begin discussing the programmers specifically, one interesting thing is that the FDA often relies on the medical companies to make their own regulatory devices. Medical device companies make programmers to collect data on how the devices are operating and then use that data to make improvements for the next up-incoming device. Now, more in detail on the programmer. The programmer is designed to check a variety of parameters such as the battery level, the pacing rate, impedance (detection of loose screws or lead fractures), threshold (minimum amount of energy required to depolarize chamber being paced), and the amount of time the patient is pacing on his/her own. When a patient visits a doctor, the doctor places the programming head of the programmer onto the patient's chest where the medical device was implanted, which then receives the information and sends the visual data onto the programmer screen. With the information collected regarding the device and how a patient's heart functions, in the case of a pacemaker programmer, the doctor can adjust the therapy. All changes are sent by the doctor to the pacemaker making the process of altering a medical device much easier as no surgery is involved.

       

          In 2009, Carol Kasyjanski of New York received the first Internet-based pacemaker by St. Jude Medical. When Kasyjanski visits home, at least once a day, the pacemaker downloads all information collected, such as that by a programmer, and automatically checks the performance of the pacemaker as well as the condition of her heart. All information is then uploaded to a central server where her doctor may browse the data collection at his/her leisure. In addition, any abnormalities or dangers found by the pacemaker notifies the doctor at once. Internet connected medical devices will most likely by entering the market in the next decades as this massive technology movement continues. Few devices currently are connected to the Internet as there are many more systems that need revising and perfecting. For one, collecting data requires memory space, which in turn requires greater energy consumption. With so many updates as well as the desire to make medical devices smaller and smaller, there needs to be changes to the internal system while still ensuring the device functions properly and safely. However, with connection to the Internet, devices need to be better secured. In a 2012 episode of the TV show Homeland, a Vice President is assassinated by a terrorist who hacks his pacemaker and accelerates the pacing until he dies of a heart attack. I am not trying to scare anyone, but there needs to be serious caution as the Internet becomes more prominent in medical devices. If a specific medical device that happens to have Internet access is needed by a patient, the good thing is that the wireless function can be disconnected.

       

          Overall, the integration of the Internet into medical devices both offers a more efficient and convenient addition as well as some realistic concerns as hackers become more and more prevalent. For now though, almost all people with pacemakers will continue to make the trip to the doctor for a routine check-up by the programmer.