NIHON KOHDEN Life Scope PT (BSM-1700 Series) Transport Monitor (PART TWO)

 

 

 

Project Director turned to Magic Show

to create a "modular" monitor

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.

 

Instead of working on a new measurement LAN as replacement, what we saw was a bizarre attempt to hide the missing technology platform essential for modular monitors. The Corporate Director spearheading the Life Scope J bedside monitor project was finally asked to step down from the board in 2006, and had to leave the company because of the seriousness of his incompetence (this happened before June 29, 2006).

 

From subsequent behavior, we know the manufacturer had already crossed the Rubicon, and there was no turning back on Life Scope J bedside monitor. The show just had to go on.

 

 

 

Life Scope J (BSM-9101) Bedside Monitor was finally released in June 2007 (after what was an unusually long delay, apparently as a result of new information curtailment policy and staying vague).

 

The processing main unit for Life Scope J bedside monitor was MU-910R, complete with an AY-920PA Input Unit similar in structure to the Saturn module. The Saturn module was housed in a module rack but AY-920PA Input Unit was not; it meant AY-920PA Input Unit does not need the yellow MULTI sockets.

 

 

The AY-920PA Input Unit follows the Saturn multi-parameter module, containing huge amount of hardware and continued to use an internal MPU with yellow flexible MULTI sockets. Unlike the Saturn module, the MPU of AY-920PA Input Unit has four yellow MULTI sockets instead of two.

 

Given the many hardware in the MPU, these four yellow MULTI sockets are not enough for use, but the manufacturer needed to show scalability, so an external AA-910P expansion box was offered to add four more physical sockets in the form of yellow MULTI sockets.

 

Since four yellow MULTI sockets are not enough, the AA-910P is not really an option but mandatory add-on; it would be cheaper to put all the MULTI sockets in the AY-920PA Input Unit.

 

 

The patient monitoring hardware inside the AY-920PA Input Unit are divided into a conventional block and an MPU block. The ECG, NIBP, SpO2 parameters and two channels of Temperature hardware 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. Six channels of Temperature

3. One channel of Cardiac Output

4. One channel of thermistor-respiration

5. One channel FiO2

 

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

6. BIS

7. Mainstream CO2

8. Second SpO2

9. 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 thermistor-respiration hardware, the other MULTI sockets can no longer utilize the same hardware.

 

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) shown using 12 yellow MULTI sockets was an impossible configuration because the interface between AY-920PA Input Unit and AA-910P expansion box is analog, the number of yellow sockets that can be added must be limited to four to avoid signal degradation. There was obvious intention to hide the fact only four MULTI sockets can be added using an external box. If 12 MULTI sockets are realized, it also means 12 channels of IBP; we should be reminded this is a patient monitor, not a diagnostic polygraph system.

 

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. It was indeed a magic show.

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 is only Saturn module plus two additional MULTI sockets

Without a measurement LAN network, The Life Scope J (BSM-9101) Bedside Monitor main unit cannot reach any individual module, including the recorder. If you inspect the connection, the recorder can only be connected to the main unit by direct wire. External device interface on the AY-920PA Input Unit or on MU-910R Main Unit links to third party devices to add more monitoring parameters, in addition to using serial kit sets.

 

It is just like any configured patient monitor in the market.

Multi-parameter Unit (MPU) documentation

from Life Scope J bedside monitor

The Life Scope BSM-2301 bedside monitor was launched in 2001, and the Service Manual is clear on the MPU 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 These hardware are clearly shown being linked to the MULTI socket, and to make use of either hardware, a Smart Cable with the valid code must be plugged into the MULTI socket.the IBP and thermistor-method respiration are internal hardware inside the Life Scope BSM-2301 monitor. internally

 

The block diagram also tells us the MULTI socket of Life Scope BSM-2301 monitor cannot measure Temperature because there is no Temperature hardware internally linked to it, and the sole Temperature amplifier hardware is dedicated to an external jack. The observation is confirmed by the label for the yellow MULTI socket indicating PRESS/ CO2/ RESP, i.e. no TEMP.

 

This manual confirms IBP and thermistor-respiration hardware are configured internally

The MULTI socket when used as a serial port bypasses 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 to the APU for digital processing. 

Also shown is when MULTI socket is used as a serial port, it bypasses the internal analog hardware and goes straight to the digital APU (Analog-block Processing Unit) and onward to the DPU. For a parameter using the internal analog hardware, the analog signals need to be converted to digital before it can go to the APU for digital processing.

 

 

Life Scope TR Bedside Monitors

 

After Life Scope J monitor, NIHON KOHDEN went on to develop the Life Scope TR (BSM-6000 series) monitors; they are versions of Life Scope J bedside monitor using a built-in display, instead of an external display. The development team continued to shy away from the difficult task of working on a new measurement LAN to do away with the yellow MULTI sockets as camouflage. Life Scope TR was thus a decision to continue investing in weakness, throwing good money after bad. Life Scope G9, Life Scope G5 and Life Scope G7 bedside monitors inherit the input units from the Life Scope TR series bedside monitors.

 

In other words, the magic show continues.

 

Life Scope TR main unit can hold one input unit plus an attached expansion box

Since the Life Scope PT transport monitors are versions of Life Scope TR Input Units with a screen, so let's take a closer look at the AY-663P Input Unit (using Nihon Kohden SpO2 algorithm) which is shown below. These same input units are made use of by replacement models, Life Scope G5 series (CSM-1501, CSM-1502) bedside monitors.

 

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 physical sockets, why would anyone need such a skewed input unit? This is actually worse than the Life Scope VS bedside monitors, and obviously incomplete.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 availability ratio. 

 

A skewed input unit delivering pain of insufficient physical connection sockets

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.

 

The BIS, Second SpO2, ETCO2 and NMT parameters are self-contained kit sets with processed digital serial data using the MULTI sockets as pass-through paths to the monitor, they have no reason to queue for the scarce yellow MULTI sockets. It was done merely to show the flexibility of the MULTI sockets.

 

The image below shows a Life Scope TR bedside monitor main unit (on the right) with the input unit (AY-663P) on the immediate left of its side. On the extreme left is the satellite box with four additional MULTI sockets (AA-674P) that can be integrated to the MPU of the AY-663P Input Unit.

 

The AA-674P box adds four physical connection sockets together with four channels of IBP hardware to AY-663P input unit

 

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

 

Like Life Scope J bedside monitor, the manufacturer wanted to show scalability by taking out some of the needed physical sockets in the Input Unit and placed them in an optional expansion box. 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.

What the market really wants is scalability of patient-monitoring parameters, not more or less flexible sockets.

It is clear the three physical MULTI sockets on the AY-663P Input Unit are not enough for use, which means the customers have to buy the AY-663P Input Unit and AA-674P expansion box as a mandatory requirement. 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, and you should not be buying more than what you need.

 

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. By the way, that means eleven channels of IBP monitoring!

 

When placing the Life Scope PT transport monitor on a DAU unit, four additional MULTI sockets are made available on the JA-694PA DAU. The Life Scope G5 bedside monitor can also make use of the AA-174P expansion unit, noting expansion sockets cannot be more than four.

 

Four yellow MULTI sockets can be found on JA-694A DAU

 

Sharing must make economic sense

 

Elaborate time-sharing should be 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 optimizes the use of expensive hardware, not the cheap sockets

 

 

Case Study

 

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, and the extension or expansion are made using analog interface.

 

 

The MMS modules are capable of further linking to a

real-time measurement LAN (Ethernet) network for expansion

 

While the Philips MMS modules can be upgraded using analog extensions, each also has an IP address for linking onto the digital Measurement Ethernet LAN 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 LAN Network; in the same way, expensive modules can be shared.

On the contrary, NIHON KOHDEN failed to realize a working digital Measurement LAN Network. 

 

The Input Units of Life Scope G5 series monitors do not have IP addresses for digital networking. There is no way to scale monitoring parameters or sharing expensive modules using digital 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 digital measurement LAN

 

END