Newborn emergency transport based on the fifth-generation wireless networks and blockchain

Jin-Wu Fang ·Wei-Jia Fu ·Rui Feng ·Hong-Tao Ni ·Yun Cao ·Cheng-Jie Ye ·Ying Gu ·Xiao-Ling Ge ·Fan Zhang ·Long-Quan Jiang ·Juan-Wei Xing ·Liang-Feng Tang ·Ying-Ying Zhang ·Jian-Guo Zhou ·Ru-Yi Zheng ·Hong Xu ·Xiao-Bo Zhang,5

Neonatal care is of great significance to health capability.Since neonatal intensive care units (NICUs) started to be established in the late 1980s in China,neonatal mortality has decreased each year to reach 3.4 ‰ in 2020 [1,2].However,the improvement for neonatal care is still on the way.More than three-fifths of deaths included critically ill neonates occur in their first 28 days [3].Critically ill neonates usually have lower gestational age and body weight,leading to high mortality or requiring specific treatment and monitoring [4].It is a common practice to transfer a critically ill newborn patient to a tertiary children’s hospital with an excellent NICU.Therefore,it is crucial to promote patients’ safety by improving the neonatal transport network services [5].Owing to the complexity and rapid changes in neonatal conditions,especially for those requiring multi-disciplinary treatment,there is a high reliance on a specialized newborn transport team [6,7].Regular pre-hospital first aid,provided by 120 First Aid Center in China,cannot fully meet the referral needs of all critically ill newborns in most areas.As reported,the newborn emergency transport service,which brings a“portable NICU”to critically ill neonates proactively and rapidly,has played a pivotal role in improving neonatal treatment[8].To meet such increasing demands,it is necessary to make the most use of state-of-the-art information technology to achieve high-quality inter-hospital transport of critically ill neonates by synchronizing data on neonates’condition and progress during the entire transfer period,hopefully striving for the greatest opportunity to save lives[9,10].

The 5-generation (5G) wireless network has been developed to deal with the limitations of previous wireless network standards and has promoted the development of the Internet of Things (IoT) [11].Moreover,the 5G technique allows multiple device connectivity with a high data rate,more bandwidth,low-latency quality of service,and low interference [12].Especially in Shanghai,China,5G wireless network is highly distributed in the whole city [13].Exploration and application of the IoT and 5G in pre-and post-hospital care have already started in several urban and rural areas [14,15];however,there is a lack of attempts on the 5G and blockchain technologies in inter-hospital newborn transport.To address the weakness of the current model and data sharing,the Children’s Hospital of Fudan University (CHFU) has developed a neonatal transport network characterized by the combination of blockchain and 5G technology with the advantage of low latency,high reliability,and extensive network bandwidth,as well as trustworthy,safe data storage.

We designed an integrated neonatal transport cabin for the newborn transport team on the ambulance.Utilizing medical devices with a 5G wireless network,this cabin could exchange information with the platform in real time.The newborn’s health data were collected by portable medical equipment containing physical sign collectors,ventilators,electrocardiographic monitors,glucometers,and point-tocare analyzers.Data could be transmitted via the 5G wireless network to the Newborn Emergency Transport Manage Platform (NETMP).By connecting to the platform through high-def inition cameras,panoramic cameras,and augmented reality (AR) glasses,the patient's situation in the ambulance will be collected by this integrated transport cabin (Fig.1).

Fig.1 Integrated newborn transport cabin.a Former use stretcher for transport; b Design an integrated cabin for ambulance vehicle;ECG,electrocardiogram

We used blockchain-enabled 5G communication to ensure a privacy-preserving mechanism of medical data sharing without privacy leaking.Blockchain organizes and encrypts data in blocks and generates them in chronological order [16].Furthermore,as a distributed database or distributed ledger technology,its non-tampering and decentralization are maintained by consensus algorithms [17,18].Relying on the advantages of the 5G private network and the characteristics of blockchain technology,we established a three-in-one data sharing mode consisting of CHFU,referral hospitals and Shanghai 120 First Aid Center to ensure the reliability,stability and safety in sharing of electronic medical data,as well as the remote video guidance throughout the transport process.

In urban areas of Shanghai City,the network used in transport depends on the 5G and Mobile Edge Computing(MEC) [19].During the transport process,medical equipment in the ambulance will have access to the 5G network via a private network router.This makes it possible for various vital physical sign data of neonates monitored by the equipment to be transmitted to the NETMP via the nearest MEC node.At the same time,information of the patient shunted by MEC will only flow to the platform with blockchain,forming a closed-loop system and avoiding information leakage.

With the above technologies and equipments,we have established a three-in-one emergency transport network system,including referring hospitals,Shanghai 120 First Aid Center,and the target hospital (CHFU).They can cooperate and share data through the Newborn Emergency Transport Manage Platform (NETMP).

The physicians in the maternity hospitals can submit a transfer request via an application form to promote the transport.With a form requested with a candidate’s basic medical history,the data are uploaded to the NETMP immediately to the CHFU.For example,a neonate is considered eligible for transfer after evaluated by the specialists in CHFU from an order on the NETMP;in this case,neonatal transport team members in an ambulance with an integrated 5G neonatal transport cabin will immediately be assigned to the referral hospital.Then,the referring hospital can track the process through the NETMP to prepare the neonate for transfer in advance.During the transport,vital signs of the neonate,video signal in the ambulance,and real-time traffic conditions are collected by the NETMP to provide the ambulance with general advice including medical suggestions and driving navigations.

The ambulance dispatched by the Shanghai 120 First Aid Center is the core carrier in the newborn emergency transport process.It is the vector of emergency equipment and video monitoring system to collect data.All data generated by the devices are uploaded to the NETMP through the 5G gateway.The data will be processed and stored in the blockchain on the cloud.We built an integrated platform on the cloud.It provides safe and efficient transport information services based on the fusion application of 5G and blockchain.The main structure of this platform is made up of information transfer among the participants under the framework of blockchain.

The newborn patient’s primary data and its history of pregnancy and delivery will be uploaded from the referring hospitals at the beginning to the NETMP.The data also will be processed by the blockchain server on the cloud.Depending on the 5G gateway and integrated cabin,the neonate’s vital sign and treatment information will be uploaded through the 5G wireless network and stored in the blockchain.Any request for data by each participant will be proceeded by the blockchain server.It realizes the interconnection and interchange of clinical data among multiple shareholders through the whole process.The mechanism of the entire newborn emergency transport process is shown in Fig.2.

Fig.2 The mechanism of information transfer during newborn transport

The embedded blockchain ensures the information path and takes each link as a closed-loop subsystem.The management within the system and subsystem constitutes information gathering,decision-making,and feedback cycle that continuously improves and updates.All data will be brought into the patients’ electronic health records at the end of the transport and rescue.

A program client is set in the CHFU to visualize the full transport service.The consultant team will be alerted at once with the initial referral application with the client.The client also facilitated the consultation team to support the crew in the ambulance by the high-definition real-time video and communication.After the ambulance arrives at the receiving hospital (CHFU),the transport crews upload the transfer summary to the platform to achieve the closed-loop.Meanwhile,the medical services and medication bills during the transport could be generated automatically to facilitate charging.

Location module on the ambulance enables scheduling and management of the whole transportation process.With the real-time map location shown on the client interface,tracking and navigation can be provided to the ambulance in the traffic congestion.The interface of the client of transport application and management program in CHFU is shown in Supplemental Fig.1.

Regional cooperation and transfer of newborns aim to improve the efficiency of medical resources.It is common to transfer a critically ill neonate from an Obstetric Department to another tertiary children’s specialized hospital for better care.To promote the communication during the transport,in this study we creatively introduced the survey of local newborn transfer with two key technologies focusing on the current state-of-the-art achievements in the integration of blockchain into 5G wireless networks [20].

Smart healthcare has been popular in the last decades to save human resources and to improve critical care quality [21].Similarly,the newborn transfer is an adapted style of IoT-based health care,and it is urgent to deal with privacy and security of patients and their families’ data storage,control and ownership [15].Blockchain has been tried to improve the safety of sharing electronic medical records[22].There is more than one data writer in the newborn transport process;therefore,it is suitable to use technologies that can provide safe and secure transactions without a trusted third party [23].The role of blockchain in our work is to protect newborn’s health information data that are dynamically shared.All the interactions of patients’ data,such as reading and writing health information through the whole transport,occur with an access control mechanism,and private data are protected from unauthorized users.On the other hand,our blockchain-based solution,including paperless retention and monitoring of treatment during transport process,can contribute to the quality of continuing care [24,25].

To facilitate the transfer of information,the fusion application of 5G and blockchain was applied in this study.Relying on a low-latency,high-reliability security private network of 5G,combined with the non-tampering characteristics of blockchain technology,the whole process of caring for critically ill neonates in first aid will be improved [26].This study created the new concept of“admission while getting into the ambulance”in accordance with the“portable NICU”[27].It moves the intensive care forward and gains maintenance of high-quality telemedicine during the whole transport with the support from the consultation team in the CHFU.With the help of cutting-edge technologies in newborn emergency transport,a scheme of treatment formulated from the consultation team according to the condition can be prepared sufficiently for early initial care by transfer crews on the ambulance.

Our study is limited to inter-hospital newborn transport in Shanghai.Undoubtedly,there are no technical barriers to expanding this service to other kinds of critically ill patient transport despite some little reconstruction on the 5G devices.For example,the extension of the referral platform can be applied to special critical conditions,such as transport under extracorporeal membrane oxygenation(ECMO) support or transport across regions over long distances.On the other hand,our innovation is based on the well-established 5G wireless network in Shanghai City.Therefore,our design has an excellent prospect to expand the service area to surrounding provinces or the Yangtze River Delta despite relying on the further development of a public 5G network.Furthermore,we envision that long-distance or helicopter newborn transport will be possible in the near future with a 5G wireless network and blockchain.

There is still a long way to go on applications of blockchain with 5G wireless networks in health care scenarios.Our study has provided a good demonstration and has laid a foundation for the high-quality emergency referral platform in the region of Shanghai.Blockchain-enabled 5G communication technology will significantly elevate the level of critically ill neonates’ rescue in more areas.

In conclusion,we used blockchain-enabled 5G wireless communication technology to facilitate newborn transport in Shanghai.By designing a transport cabin with devices based on 5G communication and by building a transfer scheduling platform,we supported the sharing of medical data and real-time consultation during the transportation.We removed the barriers of communications and data sharing among referring hospitals,the deployed transport team and supportive specialties from CHFU.Our work ensured the continuity,safety,and controllability of the care during the whole process of newborn transport.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s12519-022-00535-3.

Acknowledgements

The authors would like to acknowledge the contributions of China Telecom (Shanghai) Co.,Ltd.for providing the cloud to implement the platform and the Academy of Engineering and Technology,Fudan University for the transport cabin design.

Author contributions

RF,HX,XZ:conception and design;HX,XZ,HN:administrative support;JF,WF,HN,YC,YG,XG,FZ,LJ,JX,LT,YZ,JZ,RZ:provision of study materials;JF,WF:collection and assembly of data;JF,WF,LJ,YZ,LT,JZ:data analysis and interpretation;all authors:manuscript writing and final approval of manuscript.

Funding

The study was funded by the National Key Research and Development Program of China (No.2021ZD0113501),the Science and Technology Commission of Shanghai Municipality (No.21511104502).

Data availability

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

Declarations

Ethical approval

Because of no patients involved in this research,the ethical approval of this study is waived.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.