An In-depth Review of NIHON KOHDEN Life Scope PT (BSM-1700 Series) Transport Monitor and its Data Non-Continuity

Category: NIHON KOHDEN Life Scope TR (BSM-6000 series), Life Scope PT (BSM-1733, BSM-1753, BSM-1763, BSM-1773), Life Scope Telemetry, Life Scope J (BSM-9101) bedside monitor, Nihon Kohden SpO2 algorithm type, semi-quantitative Waveform, Host Monitor, MULTI connectors, discontinuous seamless monitoring, IntelliVue X2, patient monitoring

Life Scope PT transport monitors are derived from

the bulky input units of Life Scope TR (BSM-6000 series) bedside monitors

 

These 5.5-inch transport monitors are adapted from the three types of multi-parameter Input Units designed initially for configured Life Scope TR (Life Scope BSM-6000 series) bedside monitors.

 

Both transport monitors and Input Units are also currently key constituents of Life Scope G9 (CSM-1901) bedside monitor, Life Scope G5 (CSM-1500 series) bedside monitors, and Life Scope G7 (CSM-1700 series) bedside monitors. 

 

The transport monitors design is an attempt to imitate the Philips IntelliVue MMS X2, by the addition of touch-screen, storage memory and rechargeable battery to the existing Input Units, doing away the need to attach it to a portable monitor during patient transfer.

 

Configured Input Units made into Transport Monitors imitating Philips IntelliVue MMS X2

There are three types of standard Input Units that are used on Life Scope TR (BSM-6000) bedside monitors, and only input units using Nellcor and Masimo algorithms are available in the US market.

 

Below image shows the three types of typical Input Units,

1. AY-663P Input Unit uses NIHON KOHDEN SpO2 algorithm

2. AY-653P Input Unit uses Nellcor OxiMax SpO2 algorithm

3. AY-633P Input Unit the Masimo SET SpO2 algorithm

 

Similarly configured input units with different SpO2 algorithms; what are these yellow connection sockets?

Other than placing the input unit directly onto the monitor main unit, it is possible to place the input unit closer to the patient by using a DAU (Data Acquisition Unit) extension. Note a DAU extension can only be connected to the main unit using point-to-point serial communication, no networking interface is possible; this is because the main unit does not have networking capability to route data to individual measurement devices (i.e. modules).

 

Do not confuse the measurement network with the clinical monitoring network (officially known as LS-NET), which is the network connecting bedside monitors to Central Nurse Stations. From this basic observation, we can easily detect NIHON KOHDEN patient monitors using a DAU extension are not modular monitors.

 

 

There are two types of DAU extensions, the JA-694 DAU has four additional yellow MULTI sockets for use by the input unit while the JA-690 DAU comes without any yellow MULTI sockets (see below picture). The expansion sockets are for the many extra hardware in the shown input unit and users should need them by default. How these compromised yellow MULTI sockets work will be explained in details in this same article.

 

When a transport monitor is needed, the input unit is replaced by a Life Scope PT transport monitor; the transport monitor works as an input unit when attached to a main unit known as the Host Monitor, and becomes an independent transport monitor upon its release from the Host Monitor.

 

From Input Unit to Transport Monitor

 

There are four models of Life Scope PT (BSM-1700 series) transport monitors:

1. Life Scope BSM-1773 transport monitor (Nihon Kohden older version SpO2 algorithms)

2. Life Scope BSM-1763 transport monitor (Nihon Kohden current version SpO2 algorithms)

3. Life Scope BSM-1753 transport monitor (OEM SpO2 board supplied by Nellcor)

4. Life Scope BSM-1733 transport monitor (OEM SpO2 board supplied by Masimo)

 

The DAU extensions with Life Scope PT transport monitor and Input Unit

 

The difference among the four transport monitor models is the SpO2 algorithms.

 

The four types of Life Scope PT transport monitors

 

The two models (BSM-1773 and BSM-1763) on left side of above table make use of Nihon Kohden SpO2 algorithms but they have different version of SpO2 algorithm. The version for US market is using the previous-generation algorithm, and why would the US market need an older version of current SpO2 algorithm is really a puzzle.

 

While NIHON KOHDEN is recognized for developing the non-invasive SpO2 measurement principle in the 1970s, the company is no longer in the forefront of non-invasive SpO2 technology. The two models on the right side of above table (BSM-1733, BSM-1753) are using SpO2 OEM boards supplied by Masimo and Nellcor respectively.

 

 

Life Scope TR bedside monitors had been upgraded to

Life Scope G5 series bedside monitors using panel PCs as displays

  

The updated model of Life Scope TR series are the Life Scope G5 series bedside monitors; the main units of Life Scope G5 bedside monitors are Life Scope TR main units updated with integrated panel PCs replacing previous LCD displays. The new web browsing capability of Life Scope G5 bedside monitor comes from the panel PC.

 

As shown, the Life Scope G5 uses the same type of input units as the Life Scope TR except it chooses to use an expansion box with the four MULTI sockets lined up horizontally instead of vertically like the Life Scope TR. The function of either expansion box is the same regardless of whether the sockets are lined up horizontally or vertically. 

 

  

 

The Life Scope G5 series bedside monitors are released as part of new Genesis family series and there are two models:

1. Life Scope CSM-1501 bedside monitor has a 12.1-inch panel PC

2. Life Scope CSM-1502 bedside monitor has a 15.6-inch panel PC

 

There is an alternative model to Life Scope G5 bedside monitors, known as Life Scope G7 bedside monitors. This latter series do not have a place to mount the input unit on the main unit and it is mandatory for Life Scope G7 bedside monitors to make use of a DAU extension for interfacing with input units or Life Scope PT transport monitors.

 

Two screen sizes are available for the Life Scope G7:

1. Life Scope CSM-1701 bedside monitor has a 15.6-inch panel PC

2. Life Scope CSM-1702 bedside monitor has a 19-inch panel PC

  

 

Life Scope G7 monitor configuration is more cost-effective than using Life Scope G5 bedside monitor when a DAU extension is needed, because of hardware saving. A Life Scope G7 bedside monitor uses the same socket expansion (AA-174P) as Life Scope G5, with MULTI sockets arranged horizontally, and using a newer JA-170PA Data Acquisition Unit which does not come with any MULTI sockets.

 

  

There is a big problem with using Life Scope PT (BSM-1700)

as a transport monitor

 

There are only two ways a Life Scope PT transport monitor (BSM-1700) can have direct communication with a central monitor.

 

The two methods are: 

1. Using the Ethernet port of the SC-170R AC Cradle, when the monitor is placed on it.

2. Using an optional ZS-900PK telemetry transmitter attached to its side.

 

 

When a Life Scope BSM-1700 PT monitor is acting as an input unit to a Host Monitor, it should look like what is shown below. The Host Monitor can be Life Scope G5 [CSM-1501, CSM-1502] bedside monitors, Life Scope G7 [CSM-1701, CSM-1702] bedside monitors or the Life Scope G9 [CSM-1901] bedside monitor.

 

When the input unit leaves the Host Monitor to become a transport monitor, we are told it switches to using a telemetry transmitter to keep in contact with the Central Monitor.

 

When placed on a DAU extension, Life Scope PT monitor has no option to communicate directly with the Central Station, only as an integrated part of the Host Monitor.

This picture below, however, tells us a different story. The optional ZS-900PK transmitter actually cannot be attached to the transport monitor when the latter is placed on a DAU extension acting as Input Unit to a Host Monitor. This means when the same Life Scope PT bedside monitor leaves the Host Monitor to become a transport monitor, it does not have a telemetry transmitter at its side to communicate with the Central Monitor. There is no way the transport monitor can update the Central Monitor what is going on with the patient during transportation.

 

In reality, the Central Monitor does not even know the existence of a transport monitor, because the Life Scope PT bedside monitor on a DAU extension does not communicate directly with the Central Monitor, but as an integrated part of the Host Monitor.

 

Life Scope PT transport monitor when placed on a DAU extension cannot have a telemetry transmitter

This is not a design problem, as you will soon learn. It is the outdated protocols of the clinical monitoring network (officially known as LS-NET) linking the bedside monitors to the Central Nurse Stations; the protocols are not ready to support moving "a patient that is attached with a monitor" from one bed location to another, as doing so causes confusion to the Central Monitors.

 

The missing telemetry transmitter

The communication link is re-established only after the Transport Monitor is again attached to a Host Monitor as Input Unit; once this condition is met, the patient data stored in the Life Scope PT during the transportation period will be updated to the Host Monitor and Central Monitor.

 

This is not what the users want, since the patient should be monitored on the Central Monitor during transportation.

 

The telemetry transmitter option can only be used on BSM-1700 monitor operating as a over-priced stand-alone monitor, because such a purpose-built monitor is about twice the price of other equivalent monitors. In addition, most manufacturers can offer cheaper WiFi for mobility instead of telemetry. It should be noted telemetry use is subsidized in Japan, while we cannot find another country having the same policy; the image below showing a Life Scope BSM-1700 transport monitor equipped with a ZS-900PK telemetry transmitter should therefore be a rare sight outside of Japan.

 

 

The brochure talked about continuous monitoring using telemetry but such communication does not exist when Life Scope PT acts as a transport monitor. Why is there a need to include the misleading description?

 

Why is this description so out of context?

The reason Philips IntelliVue MMS X2 can have continuous link

with the Central Monitor after leaving the Host Monitor

The Philips IntelliVue MMS X2 is similarly a transformation of MMS (multi-measurement server module) into a compact monitor with display and battery, primary purpose to link an MMS module to a patient and follow the patient's movement.

 

IntelliVue MMS X2 was launched long before BSM-1700

 

The reason Philips can do it is simply there is no problem with the protocols, and supported by updated telemetry. When the IntelliVue MMS X2 is connected to a host monitor, it has two ways to connect to the Central Monitor (IntelliVue Information Center).

 

Option 1: The first way is via the Host Monitor (wired Ethernet or WiFi), which is the only default for Nihon Kohden.

 

Option 2: The second way is via its own wireless telemetry transceiver, and a direct communication with the Central Nurse Station.

 

The OPTION 2 should be selected if it is going to be used as a transport monitor; it means patient identity is linked to the telemetry transceiver, and the Host Monitor (containing more hardware and also tells the location) is automatically paired to it for monitoring at the Central Station.

During patient transfer, the IntelliVue MMS X2 disconnects from Host Monitor, with the hardware and old location no longer associated with the patient. The MMS X2 now operates as a mobile monitor, and communication link with Central Station continues since the telemetry transceiver is always inside the IntelliVue MMS X2.

When the patient arrives at a new location, a new Host Monitor (which tells the new location) is now paired to the transport monitor's telemetry transceiver for monitoring at the Central Station. Such patient transfer is truly seamless at the system level.

 

The telemetry transceiver in the IntelliVue MMS X2 is the token for tracking the patient

In fact, the Philips IntelliVue MMS X2 was released much earlier than the Life Scope BSM-1700 transport monitor, so there was no reason the project leader of BSM-1700 could be unaware of this important requirement. The reason was due to the outdated protocols of the LS-NET clinical monitoring network, which do not allow moving "patients that are attached with monitors" from one bed location to another.

 

It should also be mentioned that Nihon Kohden Telemetry Technology is outdated by Philips' standards.

The Outdated

Clinical Network Protocols

Using the SC-170R AC Cradle, a stand-alone BSM-1700 monitor (not acting as input unit to a host monitor) can connect to a Central Nurse Station using wired Ethernet.

Shown below is how a BSM-1700 monitor rests on an SC-170R AC Cradle. The SC-170R AC Cradle provides the Ethernet socket for connection to the clinical monitoring network (LS-NET), as well as powering a BSM-1700 monitor placed on it and charging its internal battery for next transport use.

 

The SC-170R AC Cradle does not make practical sense

When a purpose-built BSM-1700 monitor is placed on a SC-170R AC Cradle, its function is only a stand-alone ordinary monitor. To justify its use, Life Scope BSM-1700 monitor must qualify as a "PICK and GO" monitor but it is not.

 

The problem is the outdated network protocols of LS-Net, which define behaviors for communications on the network connecting bedside monitors and central monitors; this protocols is still at the first-generation version and needs a major revision.

The said LS-NET protocols only work when the monitors do not move with the patients; it was developed at a time when a monitor is always stationary at a fixed location, and only the patients were being transferred from one location to another. Patient identity was by a combination of both monitor and location, with assumption of a non-moving monitor; the protocols now needs a fundamental revamp to allow patients moving together with their monitors.

This means although a BSM-1700 monitor placed on a SC-170R AC Cradle is easily released mechanically by a lever, the BSM-1700 monitor cannot be used as a valuable "PICK and GO" monitor due to the outdated network protocols of LS-NET.

The manufacturer had confirmed there would be patient location confusion at the Central Nurse Station for such a setup shown in below image.

 

Life Scope PT placed on a SC-170R AC Cradle causes confusion when used with a Central Monitor!

 

In the above monitoring setup with a Central Monitor, the Central Monitor would still remember the last bed locations even if the patients (together with the Life Scope PT monitor) had been swapped between BED ONE and BED TWO. This is serious matter.

 

Instruction not to link the AC Cradle to a central monitor

Above image shows the relevant explanation to sales teams. There is no clear indication the company is capable of fixing it yet, because of existing limited development resources.

 

 

Thus, the SC-170R AC Cradle is only meaningful for telemetry use in Japan where there is government subsidy for monitors making use of telemetry, one of entry barrier for foreign competitors. There is no similar subsidy system for telemetry monitor outside of Japan.

 

The yellow flexible MULTI sockets

on the Life Scope PT transport monitor

 

The distinctive feature of Life Scope PT transport monitor is the utilization of three flexible MULTI (short for multi-parameter) sockets. The flexible MULTI sockets are specially colored yellow for easy identification.

 

The ECG, NIBP, SpO2 parameters and two channels of Temperature hardware on the Life Scope PT monitor are connected using dedicated sockets (conventional way). The 2nd SpO2 for neonatal use is provided using a serial kit sets connected via the flexible MULTI sockets acting as a serial port.

 

 

Each flexible yellow MULTI socket is capable of measuring

1. IBP

 

    < Configured first-come, first-served hardware cache > 

2. One channel of Cardiac Output

    < Acting as a serial port, with system software supporting following kit sets>

3. BIS

4. Mainstream CO2

5. 2nd SpO2

6. NMT

 

Other than IBP (which has one channel dedicated to each individual MULTI socket), the other hardware parameters are on a first-come, first-served basis because the hardware are configured internally, and therefore limited. If one of the MULTI socket had claimed the one channel of Cardiac Output, the other MULTI sockets can no longer utilize the same hardware.

 

The serial kit sets supported is dependent on the system software, such as NMT was newly added; this is same as any configured monitor in the market.

 

Whether each MULTI socket should be performing the role of (1), (2), or as a serial port depends on the exact code found in the plug of the measurement cable that operates each individual MULTI socket. A flexible MULTI socket must by definition accept more than one type of measurement cable, and the parameter code embedded in the plug is the method adopted to differentiate the cables, this code informs the monitor what internal hardware or software are needed for support when a measurement cable is being plugged in. The special measurement cables with codes embedded to operate the yellow flexible MULTI sockets are known as Smart Cables.

 

More MULTI sockets can be added using the JA-694P DAU extension, which can add four MULTI sockets when the Life Scope PT monitor is placed on it. 

 

 

In the above picture, the four yellow MULTI sockets on the JA-694P DAU extension work the same way as the MULTI sockets on the Life Scope PT monitor. The JA-694P DAU extension does not come with new sharing hardware, except the IBP amplifier attached to each MULTI sockets, which is a total of four IBP amplifiers. The existing configured Cardiac Output hardware in the Life Scope PT monitor is available to all MULTI sockets on a first-come, first-served basis. The serial kit sets supported by Life Scope PT system software can also use any of these additional MULTI sockets.

 

There is no free lunch, the trade-off is flexibility vs. sufficiency. The consequence of using flexible sockets for general use actually translates to insufficient physical sockets for users, and the deprived users are screaming to have their missing sockets back. How can there be any customer value from socket flexibility when its use creates a shortage of physical sockets for users?

 

What does this mean?

The manufacturer made the grave mistake of rationalizing the flexible MULTI sockets are exhibiting characteristics similar to what modular monitors offer, only to learn painfully from market rejections flexible sockets are actually poor man's sockets. It was unnecessary lessons, and to be expected if you truly understand the working principles.

 

The wild assertion of a module in the cable needs a closer critical look.

 

 

 

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 public statements and the manufacturer has a duty to ensure its accuracy. 

 

Where are the evidence of physical amplifiers in the Smart Cables?

Under US 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. We have yet to find the stand-alone IBP measurement cable shown in the brochure registered with US FDA as a medical device.

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.

 

 

This MULTI-PARAMETER UNIT (MPU) design from the 1990s

was a trade-off of flexibility vs. sufficiency

 

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 the entire sales and marketing people employed in Japan Head Office have no engineering background, how could any one discuss anything of substance with the distributors or customers (except for prices and deliveries). Mind you, the group comprises people who provide advice and product trainings to distributor frontline sales teams.

 

Why did the manufacturer forget that these flexible yellow MULTI sockets were originally designed for frugal use should be the biggest challenge for sales.

Here are the historical facts, and the company was looking for a solution to solve the problem of a new type of digital multi-parameter module with only a small front panel that did not have enough space to mount all the needed connection sockets.

 

The small panel needing a solution

The problem was not unique to NIHON KOHDEN, and the solution from Marquette and SpaceLabs, for example, is to integrate more than one signal onto a socket and using an external splitter to get back the original individual signals.

 

Example of getting back original P1 and P2 from an integrated signal

The thought-provoking solution from NIHON KOHDEN was, however, to frugally share a small number of common sockets. So far, time-sharing of connector sockets is only done by Nihon Kohden, and avoided by all other manufacturers of patient monitors.

 

That was in the 1990s, and NIHON KHODEN development team managed to identify five types of analog hardware (Temperature, IBP, Cardiac Output, Thermistor-method Respiration, FiO2) that could form a hardware group frugally sharing just two sockets that are flexible for group use. The two flexible sockets are known as MULTI (short for multi-parameter) sockets and are specially colored yellow for easy identification.

 

The hardware group and flexible sockets together made up the MULTI-PARAMETER UNIT (MPU), and was a peculiar design to minimize the number of physical sockets needed on a front panel that had a limited space area.

 

The first MPU made by Nihon Kohden

To operate the yellow flexible MULTI socket, 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 plugs 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. Thus, the Smart Cables are mandatory to operate the yellow flexible MULTI sockets.

 

The MPU detects each type of measurement cable by reading the cable code

 

The original multi-parameter module (with networking capability) that made use of the MPU is known as the Saturn multi-parameter module, as shown below. The left side is the conventional section (ECG, SpO2 and NIBP) while the right section is the MPU with two yellow flexible MULTI sockets. The MPU was a design to have flexibility over sufficiency, taking advantage of the space constraint to have sufficient sockets.

 

The yellow sockets are flexible because there are insufficient sockets

Each MULTI socket will only access its own dedicated IBP hardware, and makes use of its when an IBP measurement cable is plugged into it. For the first-come, first-served hardware, both MULTI sockets can access the common pool comprising Temperature, Cardiac Output, Thermistor-method Respiration and FiO2 hardware. The hardware are configured, and placed in the MPU before leaving the factory, and as such limited, so it is not possible to exceed the maximum available hardware.

 

The parameter code is a digital hexadecimal ID programmed into a non-volatile EEPROM (Electrically Erasable Programmable Read-only Memory) mounted on a small flexible PC board and wired to the plug of a Smart Cable at the factory.

 

The flexible PCB with an EEPROM chip

Users cannot change the code after production using settings on the monitor; the EEPROM is not expensive, but the Smart Cables are, and only the common IBP measurement cable can be sourced from China suppliers at a reasonable price. The hex code can be easily read by direct access to an exposed original cable.

 

A non-volatile code is embedded in the plug of a Smart Cable

Each yellow MULTI socket can only link to one channel of the internal hardware, except for Temperature which can accommodate up to two.

 

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

Given the large amount of hardware that are idling in the MPU block, more physical sockets are needed to make good use of these valuable hardware; yet, only physical sockets in the form of MULTI sockets can access the MPU. The arrangement to add more physical sockets is thus achieved using external expansion boxes filled with two or more MULTI sockets (each with its own dedicated IBP amplifier hardware). It is important at this point to be clear the purpose is to add more physical sockets linking to the existing MPU, and not to add more monitoring parameters. The expansion boxes do not have new hardware except for the IBP hardware that comes with each MULTI socket.

 

This is a process limited to adding more physical sockets and its dedicated IBP hardware

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

 

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.

 

The MPU Block without the module rack is meaningless

  

 

A serial kit parameter code send digital serial data packet straight

to the digital processing stage

 

Again, like a configured monitor, the MPU can accept use of serial kit sets for capability extension (supported by necessary software). This is done via a specific parameter code, whose execution means to bypass the internal analog hardware and go directly for digital processing, and the MULTI socket is acting as a serial port. As is common knowledge, the identity of a serial kit set is contained in the header of the data packet. By screening the header packet, the monitor can tell what type of serial kit set is being connected, and will not process the data if the system software does not support it.

 

A MULTI socket goes straight to the digital processing stage when the serial kit code is detected

It was a logical move then, because the purpose of the MPU was to solve the problem of limited panel space area, and by using MULTI sockets as serial ports do help in furthering the reduction of physical sockets on the front panel.

 

The digital network connecting the main unit to the module racks is known as the measurement network and is illustrated as follows. To add more module rack to the network, it was done using a cascading cable.

 

 

Unfortunately, the digital measurement LAN network for data communication between module rack housing and monitor main unit was unstable requiring huge processing power, and had to be finally given up for good. This means the first two digital modular monitors (shown below) developed by the manufacturer were failures, and were not ready for releases. They were withdrawn before FDA registration in the biggest US market.

 

Do not confuse the failed measurement LAN network with the clinical monitoring network (LS-NET), which is for data exchanges between bedside monitors and central nurse stations.

 

The first two genuine modular monitors were failures

After the decision to stop development work on the digital measurement LAN network, a younger team of engineers with lesser experience took over key positions. The younger team proved risk-averse and decided to keep the MPU, using the expansion sockets to simulate scalability. This was unexpected, because they did it only to avoid the risk of working on a new measurement LAN; at the same time, they also knew they could get away with it in Japan given the low bargaining power of users in the domestic market. This means all current Life Scope monitors do not have a measurement network to address individual measurement device, which is what that makes a modular monitor different from a configured monitor.

 

The MPU was only a compromise to accommodate limited panel space area and should never be misrepresented as an innovation; without the module rack, the MPU is meaningless and there is no demand in the market for socket flexibility. In marketing, we first establish there must be a sizeable demand from market research before a product is actually created to meet the detected demand; this process was deliberately bypassed.

 

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.

 

We had also found a standalone yellow MULTI socket that does not have any IPB amplifier attached, such a socket can be found on the CardioLife TEC-5600 series defibrillators. 

 

 

The weak arguments for using the yellow flexible MULTI sockets

have begun to fall apart

In 2001, a popular Life Scope BSM-2301K (also known as Life Scope i) was launched and many customers bought it for standalone applications not restricted by system compatibility. It was popular because the Life Scope BSM-2300K series range of monitors were the first in the industry to adopt the new-generation type 8.4-inch high-resolution touchscreen introduced by the electronics industry. The new touchscreen display was a huge jump in touchscreen technology and made for highly-intuitive operation, hence its popularity. The company tried to attribute its popularity to the use of Smart Cables and a flexible MULTI socket. Let's see if this is true.

 

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

 

The obvious flaw is one multi-purpose socket cannot replace

three fixed-purpose sockets

  

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

 

1. Invasive Blood Pressure

2. Thermistor-method Respiration

3. Mainstream CO2 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 bordering on frivolity.

 

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

 

This is compromised usage, like a poor man affording only one physical socket for three types of use

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 has ECG, NIBP, SpO2 and one channel of Temperature hardware.

 

The MPU has one channel of thermistor-mehod respiration hardware in the first-come, first-served hardware cache while one channel of IBP hardware is attached to the MULTI socket. System software support for use of the MULTI socket as serial port is limited to mainstream CO2.

 

The reality is the absence of two physical sockets for users. However, one of the parameter for the yellow MULTI socket is thermistor-method respiration, which is for use in the operating room to overcome electrical noise interference; this parameter is therefore not for use in the ward. The real shortage felt by users is one missing physical socket, and they are not hesitating to demand it back. Imagine the initial wonder of a flexible socket turned into an outrage for being shortchanged!

 

The MULTI socket on the Life Scope BSM-2301 monitor is a shortcoming, not strength. The manufacturer had got it wrong. 

 

Users do not want to be shortchanged with a poor man's socket

The manufacturer was pressured to respond with an updated model, Life Scope BSM-2303K. The solution from new model BSM-2303K was to add a new yellow socket only for IBP, and made good the missing socket needed by users.

 

The MPU of the Life Scope BSM-2301K was not designed to take on expansion, and any additional MULTI socket could load (disturb) the operation of existing MPU, causing it to malfunction. An additional MULTI socket not linked to the MPU is just an independent socket with its own dedicated IBP amplifier hardware. Such was the socket offered for Life Scope BSM-2303K, noting there was a need to recognize and use the same IBP Smart Cable.

 

With a new socket for IBP, the existing yellow MULTI socket can move away from doing IBP monitoring, and just focus on being a serial port for mainstream CO2 or being an amplifier for respiration monitoring using a thermistor transducer.

 

It was ironical, a solution relying on an extra dedicated socket for IBP; there are now two IBP amplifier hardware in the monitor, which was not the original intention. It was clear the complaints were market rejections of sharing a flexible socket and the solution offered by Life Scope BSM-2303K was to return back the missing physical socket demanded by users.

 

Market rejection forced the manufacturer to return back the missing socket demanded by users

Life Scope BSM-3000 series bedside monitors

have to make good even more physical sockets

Undeterred, NIHON KOHDEN again launched the Life Scope VS bedside monitors in early 2011, with the Life Scope BSM-3500 series monitors (12.1-inch display) equipped with two yellow flexible MULTI sockets while the Life Scope BSM-3700 series monitors (15-inch display) have three yellow flexible MULTI sockets. The value captured by users for both models are again negative.

 

In below picture, users of the left 12-inch model requires five physical connection sockets but only two MULTI sockets are provided (2/5 availability ratio). Similarly, the 15-inch model on the right requires six physical sockets but only three MULTI sockets are provided. The number of MULTI sockets available is limited by the number of IBP channels specified. The use of Smart Cables and MULTI sockets also makes things unnecessarily complicated and requires deliberate attention from operator to choose and act, causing unwarranted stress and inconvenience.

 

All parameters should be freely available for carefree use, and this can be easily achieved by reverting back to using dedicated sockets and software-driven flexible serial ports. How does such a dire shortage of connector sockets make a difference and is of benefit to users?

These monitors are in dire shortage of physical connection sockets for use, the values captured by users are negative

As expected, users soon found out the small number of MULTI sockets on Life Scope VS bedside monitors are not enough for use. The situation for Life Scope VS series bedside monitors is the same as Life Scope BSM-2301K bedside monitor, customers want their physical sockets back because they simply need it!

 

NIHON KOHDEN reluctantly had to offer two options for solution, the AA-372P Smart Expansion Unit returns two missing physical sockets while the AA-374P Smart Expansion Unit returns four missing physical sockets. The AA-374P expansion unit with four sockets is shown in below picture.

 

Life Scope VS series bedside monitors were not designed for expansion, although we were not surprised to find expansion units from Life Scope TR belatedly being offered as solution to the intense demand from users for more physical sockets. There are modifications done to the original items since the model names (AA-372P, AA-374P) are different; the makeshift solution makes the bedside monitor look awkward, resembling a product prototypes still undergoing tests.

 

The manufacturer found a way to return back the missing physical sockets

If you look at the below picture, it is as good as going back to convention, but at a high cost. The rejection messages from the market is for the manufacturer to drop the yellow MULTI sockets for future products.

 

This picture tells us the manufacturer is returning back to users four missing physical sockets

The Life Scope VS monitors were originally not designed for socket expansion, there should be limitations and users may have to pay additional attention to correct socket selections as a result.

 

Turning To Magic Show

 

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.

 

 

Continue to PART TWO