NIHON KOHDEN Launched The First and The Last Two Digital Modular Monitors

Category: NIHON KOHDEN (日本光電) Life Scope monitoring history from the 1990s, Life Scope monitors networking. In this article, we look at the development details of Life Scope BSS-9800 bedside station, including the reason why the MULTI sockets and Smart Cables were developed. The monitor was not ready, despite its delayed launch and the product was a failure turning a crisis into despair.  

 

 

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NIHON KOHDEN Life Scope Patient Monitors Struggling The Disruptive Digital Revolution (III)

  Digital Defeat: A Crushing Blow That Echoes Endlessly

 

Our greatest glory is not in never failing, but in rising every time we fall -  Confucius

It was exciting time for NIHON KOHDEN in August 1998, as the company was preparing for the launch of the first digital modular monitor and expecting the worst to be finally over. It was unsuspectingly the onset of a much bigger crisis.

 

With the race against time, the 1997 Asian Financial Crisis was a relief from the red-hot Asian markets where competitors were all having a great time growing their businesses exponentially while Nihon Kohden was only getting a few crumbs! Against such a battered backdrop, the focus for NIHON KOHDEN cannot be on innovation but getting the first digital-based monitors out as soon as possible. Any claim of innovation from this period is doubtful and should be questioned.

 

NIHON KOHDEN's attempt to make digital modular monitors was a failure, one that was unfortunately disastrous.

The inability to complete all necessary aspects of making a digital modular monitor

 

 

The moment came that Life Scope S (BSS-9800) Bedside Station as the first Life Scope model to offer Ethernet LAN connectivity was finally launched in August 1998 (Signals 354) internationally. For a while it did seem that the worst was finally over, but it was soon game over before the product could be launched in the biggest US market.

 

It was a major product development failure not only adding to the financial woes but propelled the ongoing crisis into a dire despair. The failure turned disastrous as it led NIHON KOHDEN to initiate an all-out effort to hide the incompetence to make digital modular monitors, and also took the risk to export new type biphasic defibrillators before the design was found clinically sound for use, and long before it was approved for domestic use in Japan.

 

The first NIHON KOHDEN digital modular monitor launched in August 1998

 

The Life Scope S Bedside Station was to replace top-model Life Scope 14 (BSM-8800) and herald to the export market NIHON KOHDEN was finally into the digital age.

 

Life Scope S Bedside Station unfortunately, was a product failure

 

The Life Scope S bedside station was launched with many missing software, scheduled for gradual upgrading over time. When the Life Scope S product development was suddenly suspended about a year from its export launch, these planned upgrades were left unfinished.

 

The failure meant NIHON KOHDEN did not succeed in making modular monitors, and it was a major defeat in executing digital transformation strategy the company had yet to admit publicly.

The top-model Life Scope S bedside station was complemented by a lower-priced Life Scope M (BSM-9510) bedside monitor, using the same measurement data-exchange network platform as Life Scope S. The Life Scope M bedside monitor had lower processing power, only capable of sharing basic modules with Life Scope S bedside station.

As shown, the Life Scope M bedside monitor had a built-in six-slot module rack.

Lower-priced Life Scope M (BSM-9510) modular bedside monitor complemented the Life Scope S bedside station

 

Life Scope M modular monitor was launched in June 1999, only to be abruptly withdrawn from the market just not long after launch. The abrupt end to BSM-9510 (Life Scope M) modular monitor showed there was serious doubts about the performance of the new modular bedside monitor even as a basic patient monitor.

 

There remained no official confirmation of product withdrawal, so it certainly looked like the problem could be fixed with time. This assumption was finally negated with the release of configured Life Scope A (BSM-5100) series monitors.

Life Scope M (BSM-9510) modular monitor suffered the terrible destiny of a quick death

 

At the time NIHON KOHDEN was responding to an important emerging trend of using a high-density digital multi-parameter module as basic building block for modular monitors

 

 

In analog modular monitors, only single parameter modules were produced by NIHON KOHDEN. However, when designing new digital modules for the Life Scope S bedside station and Life Scope M bedside monitor, the company discovered 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 monitors.

Apart from the higher electronic density, the difference between a single parameter module and a multi-parameter module is the presence of a CPU processor in the latter; the output of a multi-parameter module is thus processed digital data. This new development of distributed processing made it possible for patient data to be stored and moved with the module. Digital modules can also be connected directly to a (proprietary) digital data-exchange network as a node.

 

Marquette modular monitors distributed by NIHON KOHDEN in Japan

In Life Scope S BSS-9800 Bedside Station and Life Scope M BSM-9510 Bedside Monitor, Nihon Kohden wanted to follow the trend, which was to release multi-parameter modules for the first time, similar to what Marquette was already offering for Solar 7000/8000 modular monitors.

 

There were many types of Marquette multi-parameter TRAM modules to choose as basic building block

 

For Nihon Kohden to offer a variety of multi-parameter modules would only exacerbate a long-standing delivery problem, it was eventually decided to offer only one type of multi-parameter module for all prospects. This meant only one comprehensive type of multi-parameter module was offered and it was named the Saturn module. The manufacturer could do it because it has strong bargaining power in the protected Japanese domestic market.

NIHON KOHDEN offered only one type multi-parameter module as mandatory building block for modular monitor

Not all the hardware were needed by each prospect but there was only one type multi-parameter module, it was either take it or none; if you have a small need, this module is not what you want. Obviously this is not acceptable in ex-Japan market when facing strong competitors with various multi-parameter modules for customization. Many prospects could not even pronounce the brand correctly outside of Japan.

 

Below BSS-9800 brochure shows Life Scope S Bedside Station offering only one type of multi-parameter module at its launch in August 1998.

 

There is only one type of multi-parameter module in this brochure

 

 

Even occupying a 3-slot width of the module rack, the Saturn multi-parameter module (August 1998) was not big enough to hold all necessary connector sockets required by the large amount of hardware

 

Nihon Kohden intended a module rack integrated physically with the main unit to form a limited footprint just big enough to stack the display monitor on top of it (see below illustration). The physical size of the Saturn multi-parameter was therefore constrained; in addition, the multi-parameter module must still work in combination with other parameter modules like recorder, sidestream CO2, BIS, EEG, Flow/ PAW, SvO2 in the module rack. In conclusion, we ended up seeing a small Saturn module with insufficient space to hold all the necessary connector sockets.

The Saturn module was intended to be physically small in size

The elegant but expensive solution from NIHON KOHDEN for the physical size limitation of the Saturn module was to modify two connector sockets for sharing use

 

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

The method selected by NIHON KOHDEN was to make use of coded measurement cables known as Smart Cables to share two modified connector sockets. The patient monitoring hardware can be separated into two blocks in the Saturn module:

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

- ECG

- SpO2

- NIBP

(MULTI-PARAMETER UNIT) The hardware sharing the two adapting MULTI-parameter sockets in this block only use Smart Cables for connections:

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

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

- Cardiac Output

- FiO2

- Thermistor Respiration

Huge amount of hardware had to share only two modified connector sockets as a compromise

The adapting MULTI-parameter sockets were additionally allowed to be diverted as costly digital serial ports so that mainstream CO2 digital serial kit sets can also use it; this being an easy task since no internal analog hardware is being involved. Remember this is for purpose of minimizing connector sockets on the Saturn multi-parameter module, and it does not make sense outside this context.

The mainstream CO2 comes in the form of a self-contained serial kit set, utilizing the MULTI-parameter socket only as a link to the monitor.

The label for the yellow MULTI-parameter socket indicated the five specific hardware plus mainstream CO2 using it as a serial port.

 

The label for the yellow MULTI-parameter sockets on the Saturn module

 

Only up to four MULTI-parameter sockets can be added to relieve the shortage of sockets

 

It is obvious the two MULTI-parameter sockets on the Saturn module are not enough for use, more sockets are badly needed. The shortage of sockets could be improved by adding one or two extension satellite boxes containing two MULTI-parameter sockets each. As this is an analog solution, only a maximum of four MULTI-parameter sockets can be added this way.

Analog solution of adding up to four MULTI-parameter sockets using external boxes

The image gives an impression of scalability when we skip the details, but all necessary hardware are already embedded in the Saturn module except for additional IBP amplifiers which must be tied to the number of available MULTI-parameter sockets. As the Saturn module only has two yellow MULTI-parameter sockets, it is impossible to perform more than two channels of IBP monitoring; this means IBP hardware must always correspond to the number of MULTI-parameter sockets available. For this reason, each MULTI-parameter socket always come with their own one-channel IBP hardware. This means each MULTI-parameter socket makes use of their own IBP hardware when a Smart Cable with an IBP code is plugged in.

What you are seeing is making use of space external to the Saturn module to compensate up to four missing sockets on the Saturn module.

Each functional MULTI socket always come with their own one-channel IBP amplifier hardware

The extension Smart module is therefore a 2-channel IBP box with two MULTI-parameter sockets. The sockets make use of their own IBP hardware when IBP monitoring is selected by the operator; for the other four parameters, the sockets can access and make use of the Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware already embedded in the MULTI-parameter Unit of Saturn module.

Remember,

"Each functional yellow MULTI socket always come with their own one-channel IBP amplifier hardware"

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

How do the Smart Cables work?

 

There are cheaper and more practical alternatives to solving the problem of insufficient space on the input panel, such as commonly integrating more than one signal onto a socket and using an external splitter to resolve the signals.

 

Example of resolving integrated signals to individual P1 and P2

 

So far, time-sharing of connector sockets is only done by NIHON KOHDEN and not repeated by any other leading manufacturers of patient monitors for obvious reasons.

It is foremost important to know the overall cost is very high to share connector sockets.

 

The connector sockets that were being time-shared are known as MULTI-parameter Sockets (or MULTI sockets) and colored yellow. The yellow MULTI-parameter sockets must be used in conjunction with coded measurement cables known as Smart Cables, and the plug of a Smart Cable has the same color as the MULTI sockets. The Smart Cables are each marked with a digital hexadecimal code to identify the type of hardware needed by the measurement cable; the code is also known as parameter code.

 

Overview

 

 

The digital code is stored in an EEPROM chip mounted on a small flexible PC board electrically wired to the pins of the cable plug. The hexadecimal code in the EEPROM is inserted at the factory and not allowed to change after production. It is actually not difficult 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 code is stored in the plug of the measurement cable gives switching instruction to an engaged MULTI socket

 

NIHON KOHDEN had identified five types of internal hardware that can be linked to the MULTI-parameter sockets and to make use of these hardware, a cable with the correct code must be plugged into one of the MULTI-parameter sockets. Each socket selects only one channel of the hardware, except for Temperature allowing two channels of hardware to be selected.

 

Principle of Operation

One socket can select two Temperature hardware channels.

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

In addition, we should not forget that the MULTI-parameter sockets are also being used as serial ports without selecting any hardware. This is meaningful when facing the constraint of space but illogical when such constraint is not present.

A yellow shared-use MULTI socket is a high-cost serial port when it does not select any hardware

 

MULTI 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, however, gives the false illusion of a mighty MULTI socket when the capabilities are in reality coming from the system software.

 

Make no mistake, the serial kit sets are self-contained and whether a particular kit set is supported depends on the system software, not on the type of connector sockets being used.

 

To reiterate, 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 sockets.

 

Forceful diversion of signal path to pass through the MULTI sockets

There is no technical need for the serial kit sets to use the yellow time-shared MULTI sockets.

 

The digital serial data does not need to pass through a MULTI socket

 

 

The serial kit sets are independent self-contained packages with electronic boxes, drawing only power from the MULTI sockets. A small connector socket is all it needs for handling such digital serial data.

 

Only a small connector socket is needed for handling a one-bit digital data

 

Putting things into perspective, most patient monitoring parameters cannot be made into serial kits; it is the exception rather than the rule. Thus, although serial kit sets could be used by configured monitors for capability expansion but it is limited in scope and does not upgrade a configured monitor to be modular.

 

For example, the AE-918P Neuro Unit or a strip recorder cannot be linked to a yellow MULTI socket as serial kits.

 

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 manual

 

 

Life Scope S Bedside Station Was Not Yet Ready Even After Long Delays

When BSS-9800 Life Scope S Bedside Station was finally released in 1998, the first problem spotted was the outdated Ethernet Port. Reflecting a much-delayed launch under tremendous stress, the Ethernet port was an outdated AUI port (10Base5 Thick Ethernet) instead of a up-to-date RJ45 Port (10Base-T) which had become the standard installation. A costly AUI-RJ45 transceiver was needed in order to allow it to connect to a 10BaseT Ethernet hub; Life Scope S was far from being ready.

 

The first unexpected sight on the Life Scope S (BSS-9800) Bedside Station was the outdated Ethernet AUI network socket

 

The Ethernet output was also not isolated and an additional Network Isolation unit was needed to protect the patient.

 

Linking BSS-9800 Bedside Station to a Ethernet Hub

The Life Scope S was described as a Bedside Station instead of just bedside monitor because the BSS-9800 Bedside Station was fashioned after the SpaceLabs UCW

 

The Life Scope S can be configured as a 16-bed Central Nurse Station

 

Like the SpaceLabs UCW model, the Life Scope S main unit can be utilized as a Central Monitor. This capability allowed a all-Life-Scope-S system installation. The workstation ambition was to be achieved using a slot-in PC card, but it had to be abandoned with the suspension of product development for Life Scope S.

 

The overall ambition was to eventually offer a system configuration close to what SpaceLabs was already offering in 1998 as shown below. This proved lofty with the failure of Life Scope S bedside station and only remained relevant as an active topic for new product development discussions.

 

SpaceLabs UCW has network access to the PCMS multi-disclosure Workstation and Chartmaster Server (Clinical Information System) 

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

 

The two 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 network for data exchange between main unit and modules was disappointing

 

The product failure was huge financial losses incurred at a time when the company was already suffering badly from poor sales due to the lag in digital technology know-how.

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

 

Failure to make a functional measurement data-exchange network meant NIHON KOHDEN was downgraded to be a manufacturer only capable of making configured patient monitors

 

 

 

Keeping alive the Smart Cables as a mean to hide the missing exchange network for measurement-data

 

In line with the release of CNS-9300 series Central Monitors, a new 12.1-inch Life Scope P (BSM-4100 series) configured color bedside monitors were released in late 2000.

An additional 12.1 inch configured model, the BSM-5100 series (Life Scope A) bedside monitors were added in September 2002.

 

In markets outside Japan, it was ludicrous BSM-4100 and BSM-5100 series (left) had to compete against modular IntelliVue MP40/ MP50

Before the launch of Life Scope A (BSM-5100 series) configured monitors, no one could be sure if the problematic modular data-exchange platform could be fixed. The launch of a configured Life Scope A series bedside monitors using only the legacy Multi-parameter Unit in September 2002 confirmed what we needed to know, and the start of a new reality.

 

Date of first introduction and use

Those who had wondered why Life Scope A (BSM-5100) configured series was not designed as a modular monitor eventually realized NIHON KOHDEN had already lost the ability to make new modular monitors.

Life Scope A monitor had no reason to keep the MULTI-parameter Unit

Configured Life Scope A (BSM-5100) series monitors was a shocking and painful sight to behold; it was a monster monitor with plenty of panel space, yet filled with so many yellow shared-use MULTI-parameter sockets. It also caught our attention the manufacturer had knowingly added two extra dedicated Temperature sockets to mitigate the socket shortages, fully acknowledging their awareness of the basic facts. 

 

Use of the Multi-parameter sockets here must be seen as intentionally extending its life cycle for a purpose which becomes crystal clear after the Life Scope J bedside monitor was released.

 

A configured Life Scope A bedside monitor replacing the withdrawn Life Scope M modular monitor implied the company has stopped working on any replacement. NIHON KOHDEN has totally given up making modular monitors!

 

NIHON KOHDEN has given up making modular monitors

 

 

Without doubt, sales for the configured BSM-5100 series monitors could not be good for the export market. It was there to fill the vacuum vacated by Life Scope M modular bedside monitor in the Japanese domestic market.

The problem is, it did not just stop here.

 

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👉 Chapter Four:  NIHON KOHDEN Started Exporting New-type Biphasic Defibrillators Without Any Clinical Research Paper To Validate Its Use

 

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