Life Scope G9 (CSM-1901) Patient Monitor and Measurement Data Network from NIHON KOHDEN

Category: Product Review, NIHON KOHDEN (日本光電) Life Scope J (Jupiter) to Genesis series Life Scope monitors (CSM-1000 series); the missing digital modular platform in Life Scope G9 (CSM-1901), Life Scope G7 (CSM-1700 series) and Life Scope G5 (CSM-1500 series) bedside monitors.

Life Scope G9 (CSM-1901) bedside monitor inherits the closing Life Scope J bedside monitor configuration

The first of NIHON KOHDEN Genesis series bedside monitors started with a high-end model, Life Scope G9 (CSM-1901) Bedside Monitor. The basic configuration offered comprises of the Core unit, a 19-inch display monitor (three display monitors can be supported), and a BSM-1700 (Life Scope PT) transport monitor placed on a JA-694PA Data Acquisition Unit (DAU) connected to the main unit using point-to-point serial communication.

 

 

There are two types of Data Acquisition Units that the BSM-1700 transport monitor can make use of; the JA-694 DAU has four yellow common-use multi-parameter sockets while the JA-690 DAU has none. It should surprise you the JA-690 DAU or JA-694 DAU both do not have an IP address for scalable and flexible networking purpose, and the way to connect to the main unit is achieved via direct  digital serial communication.

 

The Life Scope PT transport monitor acts as an input unit when placed on the Data Acquisition Unit (DAU) linked to the Core Unit of Life Scope G9, and upon mechanically released from the DAU will turn into an independent transport monitor. Beware the wireless flaw when this happens, as the transport monitor is not linked by WiFi or Telemetry to the central monitor; the details are available in another article.

Data continuity at the central monitor is assured only after the transport monitor is re-attached back to any host monitor as input unit, and stored data is then updated via host monitor to the central monitor. 

When a transport monitor is not required, the cheaper AY-663P Input Unit is being used instead and expanded with a AA-674P four-socket expansion box or making use of the four expansion sockets on the JA-694 DAU.

There are four models of Life Scope PT (BSM-1700) transport monitor to select from. The alternative AY-663P Input Unit can be substituted with AY-653P Input Unit using Nellcor OxiMax algorithm or AY-633P Input Unit using Masimo SET algorithm as a choice for users.  

 

The Core Unit is the new name for the usual main unit, the name update is because this time an independent PC unit is part of the Core Unit. The PC unit is the piece of addition that makes it possible for Life Scope G9 bedside monitor to have web browsing capability, the first time ever for a Nihon Kohden Life Scope bedside monitor!

 

Other than the Core Unit being new, the rest of the items mentioned above are all existing hardware initially designed for Life Scope TR (BSM-6000 series) bedside monitors. A sense of history is necessary to understand the shallowness of Life Scope G9 bedside monitor design.

Life Scope G9 Bedside Monitor being the first NIHON KOHDEN patient monitor ever to be equipped with a web browser revealed underlying weakness in product development capability

 

Before Life Scope G9 (CSM-1901), None of the Life Scope patient monitors (including Central Monitors) had ever been able to access external servers for images of Ultrasound, CT, MRI, Laboratory test results, clinical decision support etc. These servers usually utilize portal technology for access and a patient monitor needs a web browser as well as an additional non-realtime network path to access them for services.

NIHON KOHDEN was finally able to introduce the first monitor with built-in web browsing capability after learning from Singapore subsidiary office the trick Philips uses to restart a hanged PC Central Monitor. NIHON KOHDEN is using a PC for the first time in the Life Scope G9 bedside monitor, so system stability is a top concern. To have peace of mind, the PC unit is a stand-alone and not integrated into the monitoring block in G9; the cue from Philips is to use the monitoring block to keep an eye on the PC Unit and reset it when it hangs or freezes. The independent PC unit is the reason for the Core Unit's large physical size.

 

Why does NIHON KOHDEN take so long to release a patient monitor with a web browser?

An old slide of Philips introducing the (long-discontinued) IntelliVue MP20/ MP30 patient monitors should make clear our point.

 

"Portal technology compatible" bedside monitors from a leading competitor

The Philips slide showed the middle to high end products (namely IntelliVue MP40, MP50, MP60, MP70, MP90) all have web browsers already incorporated at that point of time. In the year 2013, the IntelliVue MP20, MP30 patient monitors were already replaced by newer IntelliVue MX400/ MX450 patient monitors. The events just described had taken place long before the launch of Life Scope G9 bedside monitor, making clear this can only be tolerated in the domestic market in Japan, which is protectively insulated from international high-tech competitions.

Portal Technology application illustration

What we are seeing is a demonstration to the world how extreme is NIHON KOHDEN in falling behind the international competitors in digital technology.

The Life Scope Genesis G9 bedside monitor is only good for protected sales in Japan

 

Do you understand what does this mean? Such sentences had nothing to say.

 

First, it is being promoted as a modular monitor; a modular monitor needs a network infrastructure for exchange of measurement-data but this is blatantly missing.

Next, there are plenty of missing connector sockets on the AY-663P input unit or in its place, the Life Scope PT transport monitor. The prospective buyers should question the benefit of the three flexible sockets when many more sockets are needed!

Similarly configured input units with different SpO2 algorithms

The prominent feature of the AY-663P Input Unit (or Life Scope PT transport monitor) is the utilization of yellow common-use multi-parameter sockets. These yellow sockets do not accept ordinary measurement cables but only measurement cables that have NIHON KOHDEN parameter codes embedded in their yellow plugs. The end result of using these flexible connector sockets means a good amount of needed connector sockets are removed from the monitor, which is undesirable. In reality, there is no benefit from using these flexible multi-parameter sockets since the shortage of connector sockets will lead to serious usage inflexibility for users!

 

The archaic 1990s concept of a MULTI-PARAMETER UNIT (MPU)

 

Veiled in secrecy, NIHON KOHDEN does not explain to the market how they could make sockets that are flexible for five types of internal hardware, as well as being able to accept a number of independent self-contained serial kit sets whose output are processed data in serial digital format. Almost all sales/ marketing people employed in Japan Head Office have no engineering background, so there is no shortage of "company secrets" that must not be discussed with the distributors or customers.

 

Here are the relevant facts. Back in the 1990s,  NIHON KHODEN identified five types of analog hardware (Temperature, IBP, Cardiac Output, Thermistor Respiration, FiO2) that can be linked from the inside onto the yellow flexible common-use multi-parameter sockets and to make use of these internal hardware, an external measurement cable with a valid digital code on its plug needs to be inserted into one of the yellow common-use sockets. These measurement cables that comes with coded plugs are collectively cited as Smart Cables by the manufacturer and the embedded digital codes are also known as parameter-selection codes.

 

Each yellow flexible multi-parameter socket selects only one channel of the internal hardware, except for Temperature allowing two channels of hardware to be selected.

Note well the hardware mentioned here (Temperature, IBP, Cardiac Output, Thermistor Respiration and FiO2) are linked to the yellow flexible socket from the inside, and not from the outside

An external measurement cable with a valid digital code embedded in its plug can make use of the corresponding internal hardware if available

The configured hardware using the Smart Cables are grouped into an electronic block known as MULTI-PARAMETER UNIT (MPU), complete with a small number of yellow common-use multi-parameter sockets. The number of yellow multi-parameter sockets in the MPU cannot be arbitrary, and must correspond to the number of internal IBP hardware channels specified.

It is the design rule that all MULTI-parameter sockets must be able to do IBP monitoring, and to adhere to this rule each socket comes with its own exclusive IBP hardware. The term "exclusive" denotes the attached IBP hardware to each yellow multi-parameter socket is not intended for sharing by other multi-parameter sockets in the MPU block.

Principle of operation

During use, a multi-parameter socket utilizes its own exclusive IBP hardware when a measurement cable with an IBP code embedded is plugged into it. For non-IBP monitoring, the socket can access a common pool comprising Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware in the MPU, which all common-use multi-parameter sockets can access.

 

Given the large amount of hardware in the MPU block, more MULTI-parameter sockets should be added whenever possible, to make good use of the hardware that would otherwise be idling in the MPU. As shown in above image, this is done by using an external expansion box filled with more yellow multi-parameter sockets (each with its own associated IBP amplifier hardware).

 
The yellow common-use sockets are added using analog interface, and limited to four, this is to avoid signal deterioration caused by voltage drop and noise.

 

Many are actually puzzled by the contents of the MPU but refrained from asking or simply faced with a wall of silence, why is this a design with many internal hardware queuing up just to share a limited number of common-use sockets for availability to users? The truth is because the design was originally devised to solve the problem of limited panel space to mount many needed connector sockets! In situations when panel space is enough to accommodate all the necessary connector sockets, it is just a waste of money to adopt such a design; clearly, its continued use regardless of need indicates there is more than meets the eye.

The manufacturer does not discuss this, but users can always find out by yourself how many channels of internal IBP hardware are supplied

 

Knowing a functional yellow common-use multi-parameter socket always come with its own exclusive one-channel IBP hardware, a user can accurately and conclusively tell how many IBP monitoring hardware channels are supplied with any monitor just by tallying the total number of available yellow multi-parameter sockets. For example, if your monitor is delivered with five functional yellow common-use sockets, you had paid for five built-in IBP hardware channels when you indeed only need one or two.

This being the design rule, and the key word is "functional" because a non-functional MULTI-parameter socket may not need to care about the capability to do IBP monitoring, such a socket can be found on the CardioLife TEC-5600 series defibrillators and this socket cannot do IBP monitoring, it is a fake MULTI-parameter socket and can only be used as a serial port for mainstream CO2 kit sets.

Variations to the basic theme

There are variations to the basic theme, such as

a. doing without use of external expansion box,

b. increasing the number of multi-parameter sockets in the MPU,

c. reducing the hardware configured in the MPU.

In the AY-663P, AY-653P, AY-633P Input Units (or Life Scope PT transport monitors), 3 channels of IBP amplifiers, 2 channels of Temperature, one channel each of Thermistor Respiration, FiO2 and Cardiac Output are configured in the MPU for use by Smart Cables.

As the hardware in the AY-663P, AY-653P and AY-633P Input Units are extensive, they were designed to work with external expansion boxes (such as AA-674P expansion box or the expansion panel on the JA-674P Data Acquisition Unit) which can add two or four yellow common-use multi-parameter sockets to access the hardware already in the MPU of input units.

 

The NIBP, SpO2, ECG and two channels of Temperature in said input units or Life Scope PT monitor do not make use of Smart Cables and are therefore not part of the MPU

 

The digital hexadecimal parameter code is stored in a non-volatile EEPROM chip (Electrically Erasable Programmable Read-only Memory) mounted on a small flexible PC board electrically wired to the pins of the cable plug. It is not costly to make the Smart Cables but they are being priced highly by the manufacturer; only the common IBP cable can be sourced from China suppliers at a reasonable price.

A non-volatile digital parameter code is embedded in the plug of the measurement cable

 

One MULTI-parameter socket can select two Temperature hardware channels.

Each MULTI-parameter socket can take two channels of Temperature measurements

 

The common-use yellow multi-parameter sockets are additionally diverted to serve as digital serial ports

This is the part that involves using external monitoring hardware, but these are all self-contained kit set units supplying an already-processed digital output in serial digital format, using the yellow connector socket only as a link to the digital processing stage of the monitor.

As explained earlier, the design concept of MPU was to solve the problem of limited panel space, by using the multi-parameter sockets as serial ports does help in the further reduction of mounted sockets and is the reason for this arrangement. This being an easy task since there is no need for additional internal analog hardware; the processed digital signals from the serial kit sets just bypass the analog stage and go straight to the digital processing stage of the monitor.

Shown below is the original label for the yellow multi-parameter socket, indicating the five specific hardware and also serving as serial port for mainstream CO2 serial kits; the purpose of this arrangement was to minimize the number of sockets being used on a limited panel space. Outside of this context, the arrangement does not make sense because of cost.

 

The original label for the yellow MULTI-parameter sockets when they were first used

 

Straying from the original intention, which was only for mainstream etCO2 serial kit set, there is now proliferation of self-contained digital serial kits using the MULTI-parameter sockets as serial ports to link to the monitor when there is no problem of limited panel space.

 

Currently, 2nd SpO2, BIS and NMT kit sets etc. are using the multi-parameter sockets as serial ports, which is a costly arrangement that cannot be justified.

 

There is no patient-monitoring hardware embedded in the NIHON KOHDEN Smart Cables

 

Under US FDA rule, a cable is only a cable if it does not change the signal that passes through it. A Smart Cable embedded with a non-volatile digital hexadecimal code is just a cable and does not change a signal passing through it, but if it has an amplifier it becomes a medical device and definitely requires FDA registration. Can you find any stand-alone NIHON KOHDEN Smart Cable registered with US FDA as a medical device? We do not.

Make no mistake, when the Smart Cables are used with serial kit sets, such as mainstream CO2 kit sets or the NMT AF-101P kit set, the registration is for the active serial kit set (just like any other manufacturers) and not the passive Smart Cable.

 

It is unsubstantiated marketing messages and we are going to show you beyond any doubt, there is absolutely no active electronics in the Smart Cables. Messages such as "New Modular Technology" and "The Module is in the cable!" are just the wild imaginations of people without the necessary electronics knowledge.

What do the manufacturer mean by this statement? 

It started with the Life Scope TR (BSM-6000) series monitors in the USA market and gradually adopted officially for International markets. These are precise statements.

The continued repetitions of an assertion without offering any proof does not make it the truth!

This is just assertion without offering any proof

 

Chip makers need huge demand to justify each of their products, so which chip manufacturer is supplying NIHON KOHDEN the variety of analog chips given the extremely low volume in demand? If we were to open up the plug of a Smart Cable, what do we see? A small PC board is seen attached to some pins of the yellow plug.

 

A small PC Board is soldered to some pins of the yellow connection plug

 

The PC board confirms a cheap non-volatile digital EEPROM chip is being used to code the Smart Cable.

 

A cheap digital EEPROM chip was what we found inside the yellow Smart Cable plug

If we were to open up the plug of a compatible IBP cable from China suppliers, what do we see? It is the same thing, a plug with an embedded non-volatile digital code defined by NIHON KOHDEN.

 

Irrefutable proof the IBP amplifier hardware is configured internally, an important fact no longer shown on later monitor manuals

The Life Scope BSM-2301 bedside monitor was launched before the Life Scope TR bedside monitors, and the Service Manual is clear on the design; manuals for later models stop providing such information. The major move to curb details in manuals started from Life Scope J (BSM-9101) Bedside Monitor, launched before the Life Scope TR bedside monitors.

In BSM-2301 service manual, you can see the IBP and thermistor respiration are internal hardware inside the Life Scope BSM-2301 monitor. These hardware are clearly shown being linked internally to the MULTI-parameter socket, and to make use of either hardware, a Smart Cable with the correct code must be plugged into the MULTI socket.

 

Can you see the IBP amplifier and thermistor respiration hardware are internal components of the Life Scope BSM-2301 monitor?

The MULTI-parameter socket doubles as a serial port without any need for internal monitoring hardware, only as a link to the monitor. In the block diagram below, the processed digital serial data from a CO2 kit set goes straight to the digital microcontroller APU (Analog-block Processing Unit) and is forwarded to the DPU.  For a parameter using the internal analog hardware, the analog signal needs to pass through an Analog-Digital converter before going to the APU for digital processing.

Relevant page in the combined Service Manual for BSM-2301A, BSM-2301K, BSM-2303K, BSM-2304A

 

 

It is simple-minded to think the use of Smart cables can actually upgrade a configured monitor to be modular

 

Additional monitoring parameter capability can be added to a configured monitor using serial kit sets or via interfaces to external equipment, but these are realized through the system software of the monitor and has nothing to do with the type of sockets or cables being used.

 
With the use of a MTU block, a yellow multi-parameter socket by itself does not automatically mean all the five types of mentioned parameters are available for measurements; it still depends on whether what hardware are actually being placed inside for selection by Smart Cables.

 

When the MTU block of a monitor is not equipped with FiO2 hardware internally, no amount of yellow multi-parameter sockets is going to provide this measurement capability. The amount of configured hardware linked to each multi-parameter socket varies, so is the system support for serial kits and external interfaces.

Examples of configured hardware and serial kits using Smart Cables

It is the built-in hardware that determine the parameter capability; and in the case of serial kit sets and external equipment interfaces, the system software. This of course, is the same description as a configured patient monitor

 

 

Actual internal hardware and system support for serial kits varies for each multi-parameter unit

It is clear monitors with input units using Smart Cables are still configured monitors. The only advantage of using Smart Cables is to allow sharing of connector sockets (which are of negligible hardware cost), but the cost needed to make use of Smart Cables is far way higher. It is just a magic show and illogical for practical use; we are therefore justified to look for the real motive behind its continued use.

The manufacturer is choosing to overlook the captured value from using Smart Cables is negative for users!

Take a closer look at the AY-663P Input Unit shown below, it needs at least ten sockets for carefree use but the manufacturer can only provide three yellow multi-parameter sockets for 3/10 ratio time-sharing use. This means only three of the ten connectable cables can plug into the input unit at any one time. The input unit is so short of connector sockets, why would anyone need such a skewed input unit?

 

The number of yellow multi-parameter sockets on AY-663P Input Unit is not arbitrary, but dependent on the number of IBP hardware intended for said Input Unit, which is three IBP amplifier hardware specified. Since each yellow multi-parameter socket comes with its own associated one-channel IBP hardware, the manufacturer cannot provide more than three multi-parameter sockets.

 

Notice the two channels of Temperature hardware in the shown input unit are not making use of the yellow MULTI-parameter sockets for connections, this is to provide relief to the three yellow multi-parameter sockets which are not enough for use. 

A skewed input unit delivering pain of not having enough connector sockets

The BIS, Second SpO2, ETCO2 and NMT parameters are self-contained kit sets with processed digital serial data using the input unit only as a link to the monitor, they have no reason to queue for the scarce yellow MULTI-parameter sockets.

 

What value can the users capture from using input units that come with deficiency of connector sockets?

 

The next item to appear is an external box (AA-674P) which comes with four multi-parameter sockets, which is meant to add more yellow multi-parameter sockets to supplement the inadequate three on the AY-663P Input Unit. This is not a choice, the three flexible multi-parameter sockets on the AY-663P Input Unit are definitely not enough for use!

The number of yellow multi-parameter sockets that can be added to AY-663P Input Unit is limited to four (see earlier explanation), which means the maximum number of yellow multi-parameter sockets available for use is seven. It is obvious the AY-663P Input Unit is incomplete without the AA-674P expansion box, and the manufacturer should have just designed an input unit with enough connector sockets in the first place. So, why are they not doing it? 

AA-674P box not only compensates for four missing sockets on the AY-663P Input Unit but also adds four channels of IBP hardware

The purpose of this odd arrangement is to imitate the scalability process of adding patient-monitoring parameters when yellow multi-parameter sockets are being shown visually added to the input unit; but what we should know is the manufacturer is only adding sockets, and not patient-monitoring parameters. This is just a magic show.

What the market really want is scalability of patient-monitoring parameters!

The scalability of patient-monitoring parameters is the one being sought after by the market, not scalability of usable connector sockets. The act of adding four yellow multi-parameter sockets using the AA-674P expansion box also means adding another four more IBP hardware channels to what are already configured in the AY-663P Input Unit. Do you really need seven channels of IBP hardware? You have no choice.

The AY-663P Input Unit is incomplete without the AA-674P expansion box, this just means users are paying for the maximum seven channels of configured IBP amplifier hardware in one go, which is quite rare a requirement.

The limitation of four additional multi-parameter sockets means it is not possible for the AY-663P Input Unit to make use of two AA-674P expansion boxes; be sure to ask for a field demonstration to verify the truth if any salesman insists on this possibility!

In the case of Life Scope PT transport monitor, the four additional multi-parameter sockets are made available on the JA-694PA DAU.

Yellow multi-parameter sockets on JA-694A DAU

Elaborate time-sharing are applied to things that are expensive (high in demand, an asset), and not worth the efforts for things that are cheap (high in supply, a commodity) like a connector socket or a switch!

The next picture shows Philips time-sharing one channel bio-amplifier hardware between IBP and Temperature measurements, and there was no sharing of connector socket; this is exactly the opposite of what Nihon Kohden is doing. The said manufacturer merely ensures physically it is not possible to make use of both the  PRESS and the TEMP socket at the same time, and the objective is to make it possible for the same hardware to be used for different purpose at different time.

 

This design shares the expensive hardware, not the cheap sockets

 

Case study using Philips modular monitor

The AY-663P Input Unit together with AA-674P expansion box corresponds to a Philips MMS module with an extension. These are operating at the configured level, not modular.

The Philips MMS modules (initiated by Hewlett Packard) are however additionally capable of being linked to a real-time measurement data network using Ethernet

 

Remember the HP Agilent M3/M4 portable monitor?

While the Philips MMS modules can be upgraded using extensions, each also has an IP address for linking onto the Measurement Ethernet network. Scalable monitoring is achieved by slotting individual modules into a module rack linked to the Measurement Network; in the same way, expensive modules can be shared.

On the contrary, NIHON KOHDEN failed to realize a workable Measurement Network and the Life Scope TR Input Units do not have IP addresses for networking. There is no way to scale monitoring parameters or sharing expensive modules using networking, only via serial kit sets or linking to independent devices using custom interfaces.

The Philips MMS module (and extension) serves as the basic module and can be expanded using a measurement LAN

The huge amount of hardware inside the AY-663P Input Unit

 

First we filter out the parameters that are using self-contained serial kit sets, these are mainstream CO2, 2nd SpO2, BIS and NMT hardware for the AY-663P Input Unit.

 

We can then conclude the hardware contents of the AY-663P Input Unit to be: 

 

CONVENTIONAL BLOCK

(The hardware using dedicated sockets and ordinary measurement cables)

- 2 channels of Temperature

- ECG

- SpO2

- NIBP 

MPU BLOCK with three MULTI-parameter sockets

(The hardware only use Smart Cables for connections)

- 3 channels of IBP (3 MULTI sockets = 3-ch IBP)

- 2 channels of Temperature (1 MULTI socket = 2-ch TEMP)

- Cardiac Output

- FiO2

- Thermistor Respiration

Also using the three Multi-parameter sockets are self-contained BIS, 2nd SpO2, mainstream CO2 and NMT serial kit sets utilizing the sockets as serial ports

These configured hardware in the Multi-parameter Unit of AY-663P is the reason for its size

In the AA-674P expansion box, each of the four MULTI sockets makes use of its own IBP hardware when a IBP Smart Cable is plugged in; for the other four parameters, the sockets can access and make use of the Temperature, Cardiac Output, FiO2 and Thermistor Respiration hardware already configured in the Multi-parameter Unit of AY-663P Input Unit.

The hardware in the AA-674P expansion box

There was no proper viability assessment for the liberal use of Smart Cables and is only leading customers into having an unrealistic expectation of what these cables can actually deliver. The apparent flexibility of the MULTI sockets is in reality an adaptation with negative captured value for the users.

Origin and purpose of the MULTI-parameter Unit (MPU) design from the previous century

 

In the 1990s, when developing the first digital modular monitor, the development team encountered a problem of insufficient front panel space for all needed connector sockets on the first digital multi-parameter module being made. The Smart Cables were originally devised only to resolve this product issue.

 

 

The critical care market had already moved to using a digital multi-parameter module with higher density of electronic components as a basic building block for modular monitor, and NIHON KOHDEN wanted to be seen as responsive to this market development.

 

Such a multi-parameter module means there is need for more connector sockets on the front panel. The first digital multi-parameter module made by the company was named the Saturn module and you can see from below illustration the panel space is very limited for this Saturn module.

The Saturn module was intended to be physically small in size

The solution from NIHON KOHDEN for panel space limitation of the Saturn module was to introduce a MULTI-parameter sub-unit with five types of hardware (IBP, Temperature, Cardiac Output, FiO2 and Thermistor Respiration) which were found to be suitable for sharing two common-use sockets and colored it yellow.

 

The Saturn module turned to sharing two modified connector sockets as solution to the constraint of space for more sockets

In the Saturn module, the hardware are divided into two blocks, a normal block and a MULTI-parameter Unit.

ORDINARY BLOCK

(These hardware make use of dedicated sockets and ordinary measurement cables)

- ECG

- SpO2

- NIBP

MULTI-PARAMETER UNIT with two yellow sockets

(These hardware only use Smart Cables for connections)

- 2 channels of IBP (2 MULTI sockets = 2-ch IBP)

- 4 channels of Temperature (2 MULTI sockets = 4-ch TEMP)

- Cardiac Output

- FiO2

- Thermistor Respiration

Also using the two Multi-parameter sockets are self-contained mainstream CO2 serial kit sets utilizing the sockets as serial ports

Huge amount of configured hardware in the Saturn module

The MULTI-parameter Unit design has many hardware sharing only two MULTI-parameter sockets, this is to solve the problem of limited panel space. This, however, is only part of the solution.

More MULTI-parameter sockets are of course needed to make good use of the hardware that would otherwise be idling. This is done by using an external expansion box filled with MULTI-parameter sockets, each with its own IBP amplifier hardware.

Analog solution of adding more sockets, not more monitoring parameters

The additional sockets are added using analog interface, and limited to a maximum of four MULTI-parameter sockets to avoid signal deterioration caused by voltage drop and noise.

 

The image gives an impression of scalability but this is scalability of connector sockets, and not the scalability of patient-monitoring parameters that is being sought after by the market. All necessary hardware are already configured in the Saturn module except for additional IBP amplifier which must always come with each MULTI-parameter sockets.

 

A MULTI-parameter socket makes use of its own IBP hardware when a Smart Cable with an IBP code is plugged into it; for the other four parameters, the sockets are linked to the common pool of Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware already embedded in the the MULTI-parameter Unit of Saturn module.

It is the hardware rule that all MULTI-parameter socket must be able to do IBP monitoring, each socket has its own IBP hardware that is not shared

The extension Smart module is therefore a 2-channel IBP box adding two MULTI-parameter sockets for use by the Saturn module. Remember, the analog interface limits the number of Smart modules that can be added to the Saturn module to two, making a total of four additional Multi-parameter sockets.

The MULTI-parameter sockets were additionally allowed to be diverted to act as a costly digital serial ports so that mainstream CO2 digital serial kit sets can also use it; we must remember this is for purpose of minimizing connector sockets on the Saturn multi-parameter module, as it does not make sense outside this context.

Keep in mind, a yellow MULTI-parameter socket is a high-cost serial port when it does not select any internal hardware

MULTI-parameter socket poorly utilized as a costly serial port

The initial arrangement was only for mainstream CO2 serial kit sets, but later extended enthusiastically to BIS kit set, 2nd-SpO2 kit set, APCO kit set, NMT kit set etc., whose motivation is highly questionable. given this greatly increases the interface cost compared to a plain serial port

The use of Smart Cables for serial communication does give a false illusion of mighty MULTI-parameter sockets but the capabilities are in reality coming from the system software, not from the type of connector socket being used. 

Simply stated, there is no difference if you connect digital serial data to the monitor using Smart Cables or ordinary serial cables

This is how you connect the BIS processor kit to a yellow MULTI socket

Using Smart Cables for serial interface means an unnecessary jump in demand for more yellow MULTI-parameter sockets and there is no technical need for the serial kit sets to use the yellow MULTI-parameter sockets. Putting things into perspective, most patient monitoring parameters cannot be made into self-contained serial kits; for example, the AE-918P Neuro Unit or a strip chart recorder cannot be linked to a yellow MULTI-parameter socket as serial kit as shown. They are connected as external devices to a monitor.

 

The AE-918P Neuro unit and recorder module are examples that cannot make use of the yellow MULTI sockets

The MULTI-PARAMETER UNIT is an official term found in the service manuals

The Saturn module, together with two satellite boxes adding 4 channels of IBP to the Saturn module is shown below. The four MULTI-parameter sockets on the satellite boxes can also access the MPU of the Saturn module. Together, six IBP channels and six shared-use MULTI-parameter sockets are available to the users.

The sockets on the satellite boxes compensate for the missing connector sockets on the Saturn module

The two bona fide modular monitors that made use of the Saturn multi-parameter modules were failures

 

The two modular monitors that could make use of the first Multi-parameter Module (Saturn module) made by NIHON KOHDEN were Life Scope S (BSS-9800) bedside station and Life Scope M (BSM-9510) bedside monitor; the software supporting the network infrastructure exchanging digital measurement data between the Saturn module and main units was unfortunately, not reliable and both modular monitors ended up as failures.

Life Scope S (BSS-9800) bedside station was a digital modular monitor

 

 

Lower-end Life Scope M bedside monitor was using a (6-slot) built-in module rack. The Life Scope M (BSM-9510) bedside monitor has lower processing power compared to the Life Scope S bedside station.

 

 

From the US FDA records, you could tell Life Scope S and Life Scope M monitors were not launched in the US market

The two genuine modular monitors were found lacking before they could be marketed in the USA market.

The cause of the failure for Life Scope S and Life Scope M modular monitors was the problematic network infrastructure needed by modular monitors for data exchange between modules and main unit. This resulted in Life Scope S bedside station functioning only as a limited monitor while the Life Scope M bedside monitor had to be withdrawn from the market due to insufficient processing power.

There were two digital real-time data network infrastructures used by BSS-9800 Life Scope S bedside station. The software supporting the Ethernet network linking patient monitors to the Central Nurse Station proved stable but the software supporting the network linking the modules to the main units of BSS-9800 bedside station/ BSM-9510 bedside monitor was unreliable and further development work on the network infrastructure was stopped to avoid incurring unbearable losses.

The exchange of measurement-data between main unit and modules was problematic

The product failures were huge financial losses incurred at a time when the company was already suffering badly from poor sales due to the lack of digital technology know-how.

NIHON KOHDEN could not solve the communication problem between main unit and modules

 

Failure to succeed in the measurement data-exchange network infrastructure meant NIHON KOHDEN was downgraded to be a manufacturer only capable of making configured patient monitors

 

To avoid being seen as a failure, the company tried to hide the truth from the market. In order not to reveal NIHON KOHDEN had given up development to make modular monitors, the modular Life Scope S and Life Scope M were still being actively promoted on brochures. Since it could not be for sales improvement, its real purpose was to lie that the company is still capable of making modular monitors.

 

The failed modular monitors that still appeared in this brochure was to hide the truth from the market

About 9 years after the launch of modular Life Scope S Bedside Station, a new Life Scope J (BSM-9101) purporting to be a modular bedside monitor was released for export. The monitor was a bizarre attempt to hide the missing technology platform essential for modular monitors.

 

Below picture shows how Life Scope G9 bedside monitor is derived from Life Scope J bedside monitor, with a new Core Unit replacing both MU-910R main unit and QI-930P Interface Unit. To evaluate Life Scope G9 bedside monitor professionally, it is first necessary to study the Life Scope J (BSM-9101) bedside monitor in details.

 

New Life Scope G9 bedside monitor is re-configuration of Life Scope J bedside monitor

Life Scope J Bedside Monitor replaced failed high-end Life Scope S (BSS-9800) modular Bedside Station

Life Scope J (BSM-9101) Bedside Monitor was released in June 2007 using MU-910R as main unit, and an AY-920PA as the input unit.

 

Like the Saturn multi-parameter module, the AY-920PA contains huge amount of hardware and has an internal MPU with four yellow multi-parameter sockets for common use. These four yellow sockets are of course not enough, additional common-use sockets can be linked to AY-920PA Input Unit using an external AA-910P expansion box. The interface between AY-920PA and AA-910P is analog, and the number of yellow sockets can be added is therefore limited to four to avoid signal trouble. 

AY-920PA Input Unit with expansion box

The four yellow multi-parameter sockets means four channels of configured IBP amplifiers inside, and after excluding the serial kit sets (mainstream CO2, 2nd SpO2, BIS and NMT) we can conclude all the hardware in the AY-920PA Input Unit to be:

(CONVENTIONAL BLOCK) The hardware using dedicated sockets and ordinary measurement cables:

- 2 channels of Temperature

- ECG

- SpO2

- NIBP hardware using dedicated sockets.

(MPU BLOCK with four MULTI-parameter sockets) The hardware only use Smart Cables for connections:

- 4 channels of IBP (4 MULTI sockets = 4-ch IBP)

- 6 channels of Temperature (3 MULTI sockets = 6-ch TEMP)

- Cardiac Output

- Thermistor Respiration

- FiO2

Note:

Not using the MULTI-parameter sockets are Sidestream CO2, Multi-gas, EEG etc., which are connected using external device interface.

The configured Life Scope J Bedside Monitor was dressed up to look like a modular monitor

The market communication was meticulously executed to portray Life Scope J (BSM-9101) bedside monitor as a modular monitor when the manufacturer is fully aware it is a true-blue configured monitor.

 

Life Scope J bedside monitor appears to be a modular monitor in this brochure image

In above brochure image, Life Scope J (on the right) is shown using 12 yellow multi-parameter sockets, which is an impossible configuration. There is obvious intention to hide the fact only four multi-parameter sockets can be added using an external box, because this will expose the solution is analog, not digital.

This is a fake configuration, since AY-920PA Input Unit can only make use of one AA-910P expansion unit

In the next picture, you can see the AY-920PA Input Unit was designed in a shape that when combined with the recorder make Life Scope J (BSM-9101) bedside monitor (left) closely resemble the Life Scope S (BSS-9800) bedside station with a 8-slot module rack filled with modules (right).

 

Life Scope J bedside monitor was configured while Life Scope S bedside station was modular

In other words, Life Scope J bedside monitor was specially designed in appearance to look like an updated version of the Life Scope S bedside station.

The components making up a Life Scope J (BSM-9101) bedside monitor system is shown in next picture. The connection from MU-910R Main Unit to AY-920PA Input Unit is using the same connector type utilized by BSS-9800 bedside station; the old modular racks can therefore theoretically be daisy-chained to the AY-920A Input Unit.

Why offer the same old stuff that had caused the failure of both Life Scope S bedside station and Life Scope M bedside monitor? The problematic module racks and old modules could not be merchantable since there was no longer any new module under development!

 

Life Scope J Bedside Monitor is not a bona fide modular monitor

 

The purpose of the questionable module racks and old modules were there for the powerful association of Life Scope J with modular monitors in the minds of the intended audience (including foreign employees). It was a powerful way to get the audience to nod their heads when making claim that the Life Scope J is a modular monitor.

Without offering a new network infrastructure for measurement data, connecting to the old module racks (from BSS-9800 modular monitor) is meaningless. This pretense can no longer be feigned after discontinuity of old module racks and associated modules without replacement.

There was no replacements for the discontinued module rack and modules

The Input Unit and expansion box of Life Scope J bedside monitor is only the equivalence of Life Scope S modular monitor's Saturn module and extension. The rest of the other modules are being solved by using external device interface, a truly configured monitor.

Life Scope J bedside monitor has to depend on external device interface for expansion

The Life Scope J (BSM-9101) Bedside Monitor is relying on using external device interface on the AY-920PA Input Unit or MU-910R Main Unit to third party devices, just like any configured patient monitor in the market.

 

Life Scope TR Bedside Monitors is a case of throwing good money after bad

After Life Scope J monitor, NIHON KOHDEN went on develop the Life Scope TR (BSM-6000 series) monitors. The latter has a main unit to hold one input unit plus a satellite socket box, there is choice of input units and socket boxes for user selection. Life Scope TR bedside monitors are discussed here because Life Scope G9 inherits the input units from the Life Scope TR series.

 

There are more input units being offered but no genuine scalability of patient-monitoring parameters. 

Compared to Life Scope J, Life Scope TR bedside monitors have more than one type of Input Unit to choose from

Monitoring a patient during transportation

 

The idea of turning the Input Unit on a host monitor into a Transport Monitor was not yet conceived when Life Scope TR (BSM-6000 series) monitors were first designed, the initial design was to follow GE Marquette way, transferring the input unit from Life Scope TR bedside monitor (BSM-6501 or BSM-6701) to a compact 10.4-inch Life Scope TR (BSM-6301) to fulfill the transport role.

 

The original way was to use Life Scope TR 10.4 inch model as transport monitor

The decision to change from following GE Marquette to follow Philips IntelliVue MMS X2

Due to changing market need, a transport monitor was realized by the addition of touch-screen, storage memory and rechargeable battery to the multi-parameter input unit, doing away the need to attach it to a monitor during patient transfer; the design is an adaptation to imitate the Philips IntelliVue MMS X2.

 

Before the introduction of transport monitor Life Scope PT, Nihon Kohden had released the JA-690PA and JA-694PA Data Acquisition Units for the BSM-6000 series bedside monitor in April 2009.

The JA-690PA and JA-694PA data acquisition units were designed so that an Input Unit can be placed next to the patient while allowing the main unit with the screen to be mounted at a suitable height (away from the patient) for purpose of convenient viewing.

 

The purpose of JA-690PA and JA-694PA Data Acquisition Units is to bring the Input Unit nearer to the patient

The Life Scope PT acts as an input unit when placed on the Data Acquisition Unit (DAU), and becomes an independent transport monitor when it is released from the DAU.

Life Scope J main unit using Life Scope PT as transport monitor

 

The Life Scope J bedside monitor MU-910R main unit cannot link directly to JA-690PA or JA-694PA data acquisition unit, a new costly QI-930P Interface Unit was needed. The AY-920PA Input Unit was not needed when using Life Scope PT as transport monitor.

 

Life Scope J with Life Scope PT as input unit and transport monitor

To cut cost, the extra QI-930P Interface Unit must be dispensed with, and an updated new core unit was introduced which has direct interface to the JA-690PA or JA-694PA data acquisition unit. A new Genesis model known as Life Scope G9 bedside monitor was thus born.

 

Life Scope TR bedside monitors updated to be Life Scope Genesis G5 bedside monitors using panel PCs as display

 

The updated model of Life Scope TR is Life Scope G5 bedside monitors; the main unit of Life Scope G5 bedside monitor is Life Scope TR main unit updated with an integrated panel PC replacing previous LCD display. The main unit is now known as Core Unit like Life Scope G9.

There is an alternative model to Life Scope G5 bedside monitors, known as Life Scope G7 bedside monitors. The latter model makes use of a Panel PC as main unit and rely on the data acquisition unit to interface with input units or Life Scope PT transport monitor.

As shown below, the main unit is the panel PC with touchscreen sizes of 15.6-inch and 19-inch. Notice the Input Units (originally designed for Life Scope TR) cannot be placed on the main unit, and a data acquisition unit is mandatory for use. Life Scope G7 monitor configuration makes it redundant to have Life Scope G5 bedside monitor using a data acquisition unit. The external socket box for Life Scope G7 bedside monitor is the same one (AA-174P) as Life Scope G5, with MULTI sockets arranged horizontally and must be linked to a new type Data Acquisition Unit (JA-170PA).

The system weakness discussed in BSM-1700 From Input Unit to Transport Monitor applies to Life Scope G9, G7, G5 bedside monitors as host monitor since it is regardless of the type of Host Monitor being deployed. Essentially, Life Scope PT (BSM-1700 series) has no wireless mechanism to continue linking with the central nurse station the moment it is detached from Life Scope G9 Host Monitor to operate as an independent transport monitor. The Central Nurse Station simply has no idea what is happening to the patient during the period of transport and can only be updated after the transport monitor is attached back to another Host Monitor (i.e. completion of patient transfer). This effectively means using the BSM-1700 as a transport monitor for Life scope G9 and others should be re-examined.

 

Beware the mandatory need for network isolation units when connecting Life Scope G9 Bedside Monitor to a Central Nurse Station

 

When connecting to the real-time patient-monitoring LAN network, it is mandatory for Life Scope G9 Bedside Monitor to observe patient electrical safety by using a network isolation unit. The network isolation unit is needed because the Ethernet LAN interface on the bedside monitor is not isolated for patient safety.

NIHON KOHDEN network isolation transformer

When an isolated monitor with an non-isolated Ethernet port is connected to a hardwired network, it is no longer a medical device unless the above-shown network isolation transformer is introduced between the monitor and network. Dangerous electric shocks can be delivered to the monitored patient through the wired Ethernet network if such a network isolation is not installed. The dangerous electric shocks are potentially lethal and should not be ignored.

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