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 other two models similar in structure are Life Scope G5 and Life Scope G7 bedside monitors.

 

The common setup for Life Scope G9 bedside monitor comprises of the Core unit, a 19-inch display monitor (three display monitors can be supported), and a configured BSM-1700 (Life Scope PT) transport monitor placed on a JA-694PA Data Acquisition Unit (DAU).

 

Take note the shown JA-694 DAU does not have an IP address for scalable and flexible networking purpose, and the DAU does not communicate with any other devices except to the Core Unit via 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.

 

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 a completely independent PC unit is enclosed in the main unit. The independent PC unit is a wonderful 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 the sheer weakness in product development capability against competition

 

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 had never been confident enough to use a PC in a monitor because of stability concern. The opportunity came after learning from a subsidiary office the trick Philips uses to restart a hanged PC Central Monitor. So, for the first time in Life Scope G9 bedside monitor, a standalone PC unit was included but not integrated into the monitoring block. Instead, the monitoring block keeps an eye on the PC Unit and resets it when it hangs or freezes. The independent PC unit is the reason for the Core Unit's large physical size. The same mechanism can be used on a panel PC instead of such as a big PC block, as is the case for Life Scope G5 bedside monitor (replacing the Life Scope TR bedside monitor).  

 

NIHON KOHDEN took a long time 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.

Life Scope Genesis G9 bedside monitor is only good for the kind of protected sales the manufacturer enjoyed 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 wide exchange of measurement-data but can you find it?

Not only there is a missing measurement-data network, there are also plenty of missing connector sockets on the AY-663P input unit or, in its place, a Life Scope PT transport monitor.

Similarly configured input units with different SpO2 algorithms

The prominent feature of the AY-663P Input Unit (or Life Scope PT transport monitors) is the utilization of flexible MULTI (short for multi-parameter) sockets that are for sharing use by a group of internal hardware, and can also be diverted to be serial ports. These sockets are colored yellow.

 

The yellow MULTI sockets can be utilized for IBP, Temperature, Cardiac Output, FiO2 and Thermistor-method Respiration, plus a variety of digital serial kit sets. These MULTI sockets demand the use of expensive measurement cables with valid NIHON KOHDEN digital hexadecimal parameter code embedded in their connection plugs; this is a mandatory requirement because the sockets are shared for many parameters. The parameter code informs the monitor what internal hardware and software are needed for a newly plugged-in measurement cable, since there will be more than one type of cable.

 

The end result of using flexible MULTI sockets means a certain amount of physical connector sockets are dispensed with, which really upsets users and they want their physical sockets back! There is no benefit from having socket flexibility, since shortage of physical connector sockets leads to serious usage inflexibility for users!

 

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

 

Veiled in secrecy, NIHON KOHDEN does not explain to the market how they could make sockets that are flexible enough for a total five types of internal hardware, as well as being diverted for use as serial ports for self-contained kit sets. Almost all sales and marketing people employed in Japan Head Office have no engineering background, so there are plenty of "company secrets" that should not be discussed with the distributors or customers.

Here are the relevant facts, and it was a quest to find the solution for a small module with a front panel that did not have enough panel space to mount all the needed connector sockets.

 

 

Back in the 1990s,  NIHON KHODEN identified five types of analog hardware (Temperature, IBP, Cardiac Output, Thermistor-method Respiration, FiO2) to form a hardware community that link to only two sockets meant for sharing use. These flexible communal sockets are known as MULTI (short for multi-parameter) sockets and colored yellow.

 

The hardware community, known as a MULTI-PARAMETER UNIT (MPU), was a design to minimize the number of physical sockets on a front panel with limited space area, resulting in an MPU with the unusual characteristics of having more hardware than MULTI sockets. We need to view the MPU from the right perspective to understand that this is not a design to adopt when there is sufficient panel space to mount all the necessary sockets.

 

 

To access each type of hardware, an external measurement cable with a digital parameter code stored in its plug needs to be inserted into one of the two MULTI sockets. These measurement cables that come with yellow coded plus are collectively cited as Smart Cables by the manufacturer and each embedded digital parameter code pinpoints the exact type of internal hardware and software needed by a particular measurement cable.

 

Each yellow MULTI socket selects one channel of the internal hardware, except for Temperature allowing two channels of hardware to be selected.

 

 

As an exception, a MULTI socket can link up to two channels of Temperature hardware

 

Note the hardware mentioned here (Temperature, IBP, Cardiac Output, Thermistor-method Respiration and FiO2) are linked to the shared-use MULTI 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

Below image shows the MULTI-PARAMETER UNIT (MPU), complete with two yellow MULTI sockets for communal sharing. An external Smart Cable with a valid parameter code selects the needed hardware in the MPU using one of the two MULTI sockets.

Based on the fact both MULTI sockets must be capable of doing IBP monitoring, and the logic that IBP hardware should be more than the number of MULTI sockets, the IBP hardware are therefore not placed in the common pool for sharing; instead each MULTI socket comes with its own dedicated IBP hardware.

 

 

A MULTI socket can only access its own dedicated IBP hardware, and makes use of it when an IBP measurement cable is plugged into it. For non-IBP monitoring, the socket can access the common hardware pool comprising Temperature, Cardiac Output, Thermistor-method Respiration and FiO2 hardware in the MPU.

 

It is observed that the quantity of MULTI sockets in the MPU is not a number that can be decided at will, but corresponds exactly to the number of internal IBP hardware channels that are intended to be placed inside each MPU.

 

Given the large amount of hardware in the MPU, more MULTI sockets are needed to make good use of the hardware that would otherwise be idling. As illustrated, this is achieved by using an external expansion box filled with more MULTI sockets (each with its own dedicated IBP amplifier hardware).

 

This is a process of adding sockets, not monitoring parameters

The additional yellow MULTI sockets are integrated using analog interface, and limited to four sockets to avoid signal deterioration caused by voltage drop and noise.

 

The MULTI sockets are additionally diverted to be serial ports to save on one more physical socket

 

A MULTI socket can be diverted to be a serial port by bypassing internal analog hardware

 

The design concept of the MPU was to solve the problem of limited panel space area, and by using MULTI sockets as serial ports does help in furthering the reduction of one more physical socket on the front panel. The serial port in the original design was only for mainstream CO2 kit sets.

 

 

Shown above is the original label for the two MULTI sockets. It shows each socket can be used for monitoring of IBP, Temperature, Cardiac Output, FiO2, Thermistor-method Respiration, as well as diverted to be a serial port for mainstream CO2 kit sets.

 

The term "MULTI PARAMETER UNIT" can be found in older service manuals

 

The small module mentioned earlier was named Saturn multi-parameter unit and the outcome of the MPU solution is as shown below. The Saturn module is housed in a 8-slot module rack, with two expansion boxes next to it; altogether there were six MULTI sockets (with six channels of IBP hardware) available for use in this arrangement. It is possible to use the Saturn module alone, but the two MULTI sockets would not be enough.

 

 

Unfortunately, the measurement-data communication platform between the module rack housing and monitor main unit was unstable with plenty of performance issues, and had to be finally given up for good. This means the first two modular monitors developed by the manufacturer were failures, and they were withdrawn before registration in the biggest US market.

 

 

After the decision to stop development work on the measurement-data networking platform, NIHON KOHDEN moved to promote socket flexibility as a mean to achieve scalability. The initial concern was just to assure the protected Japanese domestic market, which was buying more than 90% of the factory production for monitors.

 

In reality, the MPU without the module rack is meaningless and most importantly, there was no demand for socket flexibility in the market outside of Japan. 

   

Professionally, 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 to share a limited number of low-cost sockets? The truth is because the design was actually a compromise to accommodate a limited panel space area not enough for all necessary connector sockets. In situations when we have ample panel space area, there is no need for such a compromise and the use of an MPU (with its Smart Cables and MULTI sockets) actually becomes a burden and waste of money. Its continued use regardless of need is the very reason for its eventual failure.

Users should first find out how many channels of IBP hardware are supplied, it may be much more than you need

 

Knowing an authentic yellow MULTI socket always come with its own dedicated one-channel IBP hardware, a user can accurately tell what is going on just by tallying the number of available MULTI sockets. For example, if your monitor is delivered with five functional yellow MULTI sockets, you had unknowingly paid for five channels of built-in IBP hardware when you may only need one or two.

The key word here is "authentic" because a non-functional (fake) MULTI socket does need to care about the capability to do IBP monitoring, such a socket can indeed be found on the CardioLife TEC-5600 series defibrillators. The fake yellow MULTI socket on said TEC-5600 series defibrillators is just a serial port that cannot be used for any other parameter except 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 MULTI sockets to access the extensive hardware already placed in the MPU of the 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 they are therefore not part of the MPU

 

The digital hexadecimal parameter code is programmed into a non-volatile EEPROM chip (Electrically Erasable Programmable Read-only Memory) mounted on a small flexible PC board soldered electrically 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 stored in the plug of the measurement cable

 

Regret there is no patient-monitoring hardware embedded in the NIHON KOHDEN Smart Cables and this makes a big difference as to how you appraise a monitor that comes with MULTI sockets

 

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 being soldered 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.

 

Below shows the MPU knows what cable is being inserted by reading the parameter codes in the plugs. MP1 and MP2 and are two different plugs with different codes embedded.

 

The MPU identified Plug 1 as IBP and Plug 2 as Temperature

 

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 in 2001, 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, which was launched in June 2007. The Life Scope TR bedside monitors also do not provide details as it was launched in April 2008 (after Life Scope J monitor).

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 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 socket doubles as a serial port by bypassing the internal analog hardware, going straight to the digital APU (Analog-block Processing Unit) and onward to the DPU.  For a parameter using the internal analog hardware, the analog signal needs to be converted to digital before it can go 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

 

With the use of an MTU block, a MULTI socket by itself does not automatically mean all the five types of mentioned parameters are available for measurements; it still depends on which hardware are decided for placement inside for selection by Smart Cables.

 

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.

 

Putting things into perspective, most patient monitoring parameters cannot be added using self-contained serial kit sets. As shown, the AE-918P Neuro Unit or strip chart recorder are examples, and they are not linked using a MULTI socket, but as any external third-party device.

 

 

When an MPU is not equipped with FiO2 hardware internally, no amount of MULTI sockets is going to provide this measurement capability. The amount of hardware placed in each MPU varies, so is the system support for serial kits and external devices (and powered separately).

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 MPU

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. The customers are paying for the unnecessary higher costs, only to be led into having an unrealistic expectation of what the Smart Cables and MULTI sockets can actually deliver.

 

The serious shortage of physical sockets when using a MULTI socket (case study of Life Scope BSM-2300K series bedside monitors)

Preceding Life Scope VS bedside monitors was the Life Scope BSM-2300K series monitors, let's see how the sole yellow MULTI socket was actually being used in this series.

 

The portable 8.4-inch Life Scope i (BSM-2301K)

 

To insist on use of Smart Cables, the Life Scope BSM-2301K monitor has one yellow MULTI socket flexible enough for three types of measurements, namely:

 

a. Invasive Blood Pressure

b. Thermistor-method Respiration

c. Mainstream CO2 (using self-contained serial kit sets)

 

Without any use of Smart Cables, all IBP, Thermistor-method Respiration and mainstream CO2 are freely available for carefree use via their respective dedicated sockets. The use of Smart Cables makes things unnecessarily complicated and requires deliberate operator attention and choice to choose one among three (IBP, Thermistor-method Respiration and mainstream CO2), but why introduced a need to choose? 

 

This is obviously unwarranted stress and inconvenience, what is wrong with the conventional way of using three dedicated sockets for the job? If MULTI socket is such a superior proposal, why is the Temperature socket a dedicated one?

 

Life Scope-i does not have enough physical connector sockets

 

The patient monitoring hardware in the Life Scope BSM-2301 bedside monitor are divided into a conventional block and an MPU block. The conventional block uses dedicated sockets and ordinary measurement cables while the MPU block makes use of Smart Cables with different parameter code for different hardware.

CONVENTIONAL BLOCK

- 1-ch TEMP

- ECG

- SpO2

- NIBP

MPU BLOCK with one MULTI socket

- 1-ch IBP

- Thermistor-method Respiration

- <MULTI socket as serial port> Mainstream CO2 Kit Sets

The reality is the shortage of two physical connector sockets, and an avalanche of complaints from users. The manufacturer was pressured to respond with an updated model, BSM-2303K. The solution from new model BSM-2303K is to add a new isolated yellow MULTI socket.

 

The MPU of the Life Scope BSM-2301K was not designed to take on expansion, and any additional MULTI socket will load the operation of existing MPU, causing it to malfunction. The additional (fake) MULTI socket is not linked to the MPU, just an independent socket with its own dedicated IBP amplifier hardware.

The new socket's job was to relieve existing functional MULTI socket. It was ironical, a solution relying on a dedicated socket for IBP; it was clear the complaints was the result of sharing a flexible socket.

 

Under pressure, the manufacturer returned to users a dedicated physical socket for IBP

Case study of Life Scope VS (BSM-3000 series) bedside monitors

The use of Smart Cables has unintentional negative captured value for the users, as can be seen from below illustration. Users of the left monitor (BSM-3500 series with 2 channels of IBP) requires five physical connections sockets for carefree use, but only two shared-use MULTI sockets are provided for a 2/5 sharing ratio.

 

Without any use of Smart Cables, all five parameters are freely available for carefree use via their respective dedicated sockets. The use of Smart Cables just makes things unnecessarily complicated and requires deliberate operator attention and a conscious efforts to choose two among the five. This is unwarranted attention, stress and inconvenience. What is wrong with using five dedicated sockets, which is a far superior norm since all parameters are available for connections at any time without hesitation. What user benefit is the manufacturer trying to provide?

  

Similarly, users of the right monitor (BSM-3700 series with 3 channels of IBP) requires six physical connection sockets for carefree use but the manufacturer insists three shared-use sockets are enough. This means the manufacturer only wants to place 3 channels of IBP hardware in the MPU of the BSM-3700 series monitors and ignore the user's pain; this kind of forceful approach can only happen in a protected Japanese market when users bargaining power is low. It is another matter for the export markets.

 

How does such dire shortage of connector sockets benefit a user?

 

These monitors are in dire shortage of necessary connector sockets, the value captured by users is negative

It was not what the manufacturer expected, but users want their physical sockets back. This is market forces encountered outside of Japan, and the manufacturer has to return the missing physical connector sockets (as shown in below picture). This is essentially a reset of the monitor back to using dedicated sockets, but at a high cost. Flexible connector sockets do not make sense to the market and there is no demand for them.

This picture tells us users want all their missing physical sockets back

 

Life Scope G9 makes use of the AY-663P Input Unit, so let's take a closer look at the AY-663P Input Unit shown below, it needs at least ten physical sockets for carefree use but the manufacturer can only provide three yellow MULTI sockets on a ratio of 3/10 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 MULTI sockets, why would anyone need such a skewed input unit? This is worse than the Life Scope VS bedside monitors, so the reaction from users is obvious.

 

The number of yellow MULTI sockets on AY-663P Input Unit is not arbitrary and cannot be decided at will to be seven or eight, but corresponds exactly to the number of IBP hardware intended for placement in the MPU of AY-663P Input Unit. Adding more MULTI sockets has the unintended consequence of adding more IBP hardware channels.

 

Notice the two channels of Temperature hardware in the shown input unit are not making use of the MULTI sockets for connections, this is to provide relief to the three MULTI sockets which the designers know too well, are far from enough.  

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 sockets.

 

To put back some physical sockets, the next item to appear is an external box (AA-674P) which comes with four MULTI sockets, which is meant to add more MULTI sockets to supplement the inadequate three on the AY-663P Input Unit. 
 
Knowing the number of MULTI sockets that can be integrated to AY-663P Input Unit is limited to four sockets due to the analog interface, we know the maximum number of MULTI sockets available for use by AY-663P Input Unit is seven.

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

Since AY-663P Input Unit is incomplete without the AA-674P expansion box, why did the manufacturer not just design an input unit with the intended seven MULTI sockets?

  

This is the tricky part, the purpose of this odd arrangement is to imitate the scalability process of adding patient-monitoring parameters when identical yellow MULTI sockets are being shown visually added to the input unit. However, we should know the manufacturer is only adding sockets, and not patient-monitoring parameters. This is just an intended 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 three MULTI sockets on the AY-663P Input Unit is too little, so customers have to buy the AY-663P Input Unit and AA-674P expansion box in one go. The act of adding four MULTI sockets using the AA-674P expansion box also adds another four IBP hardware to the three already configured in AY-663P Input Unit. Do you really need seven channels of IBP hardware? This is indeed quite rare a requirement.

 

The limitation of four additional MULTI sockets also 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.

Four yellow MULTI sockets can be found 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, allowing direct communication between the main unit and each module. 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

 

The patient monitoring hardware inside the AY-663P Input Unit are divided into a conventional block and an MPU block. The conventional block uses dedicated sockets and ordinary measurement cables while the MPU block makes use of Smart Cables with different parameter code for different hardware. 

CONVENTIONAL BLOCK

- 2 channels of Temperature

- ECG

- SpO2

- NIBP 

MPU BLOCK with three MULTI sockets

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

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

- Cardiac Output

- FiO2

- Thermistor-method Respiration

- <MULTI sockets as serial ports> BIS, 2nd SpO2, mainstream CO2, NMT  

 

The hardware in the MPU block

 

In the AA-674P expansion box, each MULTI socket comes with its own IBP hardware and can access the common hardware pool in the MPU of AY-663P Input Unit.

The hardware in the AA-674P expansion box

Instead of using AA-674P expansion box, the additional four MULTI can also be arranged horizontally using the AA-174P expansion box. This is the version used by Life Scope G5 bedside monitor.

The hardware in the AA-174P expansion box are similar to AA-674P expansion box

Another way to add four MULTI sockets to the AY-663P Input Unit or Life Scope PT transport monitor is of course using JA-694P Data Acquisition Unit. However, the limitation of a maximum of four MULTI sockets always apply.

 

 

Predecessor of Life Scope G9 Bedside Monitor

 

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 replacement for Life Scope J bedside monitor

Taking the MULTI sockets to the "next level"

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 degradation. 

AY-920PA Input Unit with AA-910P expansion box

 

The patient monitoring hardware inside the AY-920PA Input Unit are divided into a conventional block and an MPU block. The conventional block uses dedicated sockets and ordinary measurement cables while the MPU block makes use of Smart Cables with different parameter code for different hardware.

CONVENTIONAL BLOCK

- 2 channels of Temperature

- ECG

- SpO2

- NIBP

MPU BLOCK with four MULTI sockets

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

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

- Cardiac Output

- Thermistor-method Respiration

- FiO2

- <MULTI socklets as serial ports> mainstream CO2, 2nd SpO2, BIS and NMT 

Note:

Other options such as Sidestream CO2, Multi-gas, EEG etc., are connected using external device interface, and not via MULTI sockets.

The configured Life Scope J Bedside Monitor was masquerading as 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 sockets was an impossible configuration; there was obvious intention to hide the fact only four MULTI sockets can be added using an external box.

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 module rack that caused the failure of both Life Scope S bedside station and Life Scope M bedside monitor? The shown module rack and old modules are not 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 rack was just a pretense, and can no longer be feigned after they were discontinued 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 expansion boxes.

Life Scope J bedside monitor has to depend on external device interface for real 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 series bedside monitors is version of Life Scope J bedside monitor using a built-in display

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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