JMIR Publications

ABSTRACT

Background:

In interfacility emergency care, the mismatch between ambulance response levels and the availability of critical patient data during transport requests presents significant challenges. Instances where an inappropriate critical care transport unit is dispatched can lead to delays in patient care, posing life-threatening risks, particularly for patients requiring urgent medical attention. Currently, clinicians manually input static information related to patient transport needs, such as ECG monitoring, oxygen requirements, and other necessary equipment. However, the existing system lacks the capability to integrate patient data from electronic health records (EHR) into the transfer request process, primarily due to the privacy concerns and sensitivity surrounding EHR data. As a result, data sharing predominantly occurs via radio communication at the time of the transport request. The situation becomes even more precarious when the request originates from a hospital outside of the established network, where little to no patient information is accessible, further complicating the task of matching the appropriate care unit to the patient’s needs.

Objective:

Our goal was to enhance information sharing between hospitals and critical care transport providers at the time of transport request and throughout the patient’s journey to the receiving facility. The research aims to support the implementation of systems that enable real-time, secure data exchange, thereby improving critical medical decision-making during the transport of patients to definitive care facilities, such as intensive care units and emergency departments. These systems are designed to uphold patient privacy and ensure data security throughout the process.

Methods:

We propose a permissioned blockchain-based network among hospitals involved in interfacility transport care to facilitate the sharing of patient data during transport requests and throughout the journey to the receiving facility. Data transactions (TX) will be processed automatically, eliminating the need for human intervention or direct connection to the sending facility’s EHR. Each node in the network represents a hospital or emergency medical service and connects to a smart contract (chaincode in Hyperledger Fabric) to verify the sender’s identity and record patient data on the ledger. The patient data will be accessible through a web-based portal at the receiving facility as soon as the transport request is made. If paramedics are permitted to view the full or partial patient data, they can also add care information during transport, which will then be visible to the receiving facility. The system utilizes an AWS cloud-based Hyperledger Fabric permissioned blockchain network to ensure scalability, performance, and cost-effectiveness. To secure data on the ledger, the system employs public/private key infrastructure, digital signatures, a consensus mechanism, and other built-in security features.

Results:

In collaboration with the University of Maryland Main Hospital, we developed PatientsTrack, a blockchain-based system designed to monitor and track patients’ health conditions during transport requests and throughout their journey. This system supports informed decision-making, ensuring that the appropriate transport care unit is dispatched to the sending facility, particularly for patients requiring urgent care. The prototype was built on Hyperledger Fabric, a permissioned blockchain technology. Hyperledger smart contracts (chaincode) were utilized to facilitate data sharing transactions (TXs) among all authorized members of the network, including critical care units at the receiving hospital and emergency transport units, in real-time during the transport. The solution was deployed in an AWS cloud environment to ensure performance, scalability, and cost-effectiveness. We tested the system in a distributed cloud environment using pseudonymized patient data.

Conclusions:

In this paper, we conducted an on-site investigation and virtual interviews with individuals involved in interfacility transport care (ITC) to address the challenges of sharing patients’ critical data during transport requests and throughout the journey to the receiving facility. The findings from our investigation align with the issues identified in the literature review. We designed and developed an interfacility confederate blockchain network, utilizing a membership service provider, public/private key infrastructure, consensus mechanisms, and other security measures discussed in the paper. The primary objective of this blockchain solution is to address the information security and privacy challenges inherent in existing information-sharing systems, including healthcare information systems, which pose significant barriers to data sharing. To ensure scalability, performance, and cost-effectiveness, we implemented the solution on the AWS cloud environment.