Abstract
Precision healthcare is an emerging concept that will see technology-driven digital transformation of the health service. It enables customised patient outcomes via the development of novel, targeted medical approaches with a focus on intelligent, data-centric smart healthcare models. Currently, precision healthcare is seen as a challenging model to apply due to the complexity of the healthcare ecosystem, which is a multi-level and multifaceted environment with high real-time interactions among disciplines, practitioners, patients and discrete computer systems. Digital Twins (DT) pairs individual physical artefacts with digital models reflecting their status in real-time. Creating a live-model for healthcare services introduces new opportunities for patient care including better risk assessment and evaluation without disturbing daily activities. In this article, to address design and management in this complexity, we examine recent work in Digital Twins (DT) to investigate the goals of precision healthcare at a patient and healthcare system levels. We further discuss the role of DT to achieve precision healthcare, proposed frameworks, the value of active participation and continuous monitoring, and the cyber-security challenges and ethical implications for this emerging paradigm.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Constitution of the world health organization: Principles., 2005
W. H. Organization (1986) The Ottawa charter for health promotion
Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, Hinder S, Procter R, Shaw S (2018) Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework. BMC Med 16(1):66. https://doi.org/10.1186/s12916-018-1050-6
Greenhalgh T, Howick J, Maskrey N (2014) Evidence based medicine: a movement in crisis? BMJ 348:g3725. https://doi.org/10.1136/bmj.g3725
Bhavnani SP, Sitapati AM (2019) Virtual care 2.0—a vision for the future of data-driven technology-enabled healthcare. Curr Treat Options Cardiovasc Med 21(5):21. https://doi.org/10.1007/s11936-019-0727-2
Pritchard DE, Moeckel F, Villa MS, Housman LT, McCarty CA, McLeod HL (2017) Strategies for integrating personalized medicine into healthcare practice. Pers Med 14(2):141–152. https://doi.org/10.2217/pme-2016-0064
Karakra A, Fontanili F, Lamine E, Lamothe J, Taweel A (2018) Pervasive computing integrated discrete event simulation for a hospital digital twin, pp 1–6. https://doi.org/10.1109/AICCSA.2018.8612796
Berwick DM, Hackbarth AD (2012) Eliminating waste in US health care. JAMA 307(14):1513–1516. https://doi.org/10.1001/jama.2012.362
Makary MA, Daniel M (2016) Medical error—the third leading cause of death in the US. BMJ 353:i2139. https://doi.org/10.1136/bmj.i2139
C. I. f. H. Information (2018) National health expenditure trends, 1975 to 2018. https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
O. E. Union (2018) Health at a glance Europe 2018: state of health in the EU Cycle, Paris. https://doi.org/10.1787/23056088
O. f. N. Statistics (2019) Healthcare expenditure, UK Health Accounts: 2017. Office for National Statistics, 25/04/2019, p 27
P. D United Nations Department of Economic and Social Affairs (2017) World Population Ageing 2017. https://www.un.org/en/development/desa/population/theme/ageing/WPA2017.asp
Bryant N, Spencer N, King A, Crooks P, Deakin J, Young S (2017) IoT and smart city services to support independence and wellbeing of older people, pp 1–6. https://doi.org/10.23919/SOFTCOM.2017.8115553
W. H. Organisation (2008) Preventing chronic diseases: a vital Investment.https://apps.who.int/iris/bitstream/handle/10665/43314/9241563001_eng.pdf;jsessionid=F24F4FB0 22DCC5C9DCF70BAE5BA95C8D?sequence=1
U. D. o. H. a. S. Care (2018) Policy Paper: the future of healthcare: our vision for digital, data and technology in health and care. D. o. H. a. S. Care (ed) UK Government
Sehrawat D, Gill NS (2018) Emerging trends and future computing technologies: a vision for smart environment. Int J Adv Res Comput Sci 9(2):839. https://doi.org/10.26483/ijarcs.v9i2.5838
Gartner (2018) 5 Trends emerge in the gartner hype cycle for emerging technologies, 2018. ID G00363408, Gartner. https://www.gartner.com/document/3886564?ref=TypeAheadSearch&qid=808dc69ca889b4bd3fa85b2e3
Rahman MA, Rashid MM, Hossain MS, Hassanain E, Alhamid MF, Guizani M (2019) Blockchain and IoT-based cognitive edge framework for sharing economy services in a smart city. IEEE Access:1–1. https://doi.org/10.1109/ACCESS.2019.2896065
Pacheco J, Zhu X, Badr Y, Hariri S (2017) Enabling risk management for smart infrastructures with an anomaly behavior analysis intrusion detection system, pp 324–328. https://doi.org/10.1109/FAS-W.2017.167
Gambhir SS, Ge TJ, Vermesh O, Spitler R (2018) Toward achieving precision health. Sci Transl Med 10(430):eaao3612. https://doi.org/10.1126/scitranslmed.aao3612
Lee I, Sokolsky O, Chen S, Hatcliff J, Jee E, Kim B, King A, Mullen-Fortino M, Park S, Roederer A, Venkatasubramanian KK (2012) Challenges and research directions in medical cyber–physical systems. Proc IEEE 100(1):75–90. https://doi.org/10.1109/JPROC.2011.2165270
Laaki H, Miche Y, Tammi K (2019) Prototyping a digital twin for real time remote control over Mobile networks: application of remote surgery. IEEE Access 7:20325–20336. https://doi.org/10.1109/ACCESS.2019.2897018
Liu Y, Zhang L, Yang Y, Zhou L, Ren L, Wang F, Liu R, Pang Z, Deen MJ (2019) A novel cloud-based framework for the elderly healthcare services using digital twin. IEEE Access 7:49088–49101. https://doi.org/10.1109/ACCESS.2019.2909828
Iyawa GE, Herselman M, Botha A (2016) Digital health innovation ecosystems: from systematic literature review to conceptual framework. Proced Comput Sci 100:244–252. https://doi.org/10.1016/j.procs.2016.09.149
Robinson L, Griffiths M, Wray J, Ure C, Stein-Hodgins JR, Shires G (2015) The use of digital health technology and social media to support breast screening. In: Digital mammography. Springer, pp 105–111. https://doi.org/10.1007/978-3-319-04831-4_13
Mellodge P, Vendetti C (2011) Remotely monitoring a patient’s mobility: a digital health application. IEEE Potentials 30(2):33–38. https://doi.org/10.1109/MPOT.2010.939453
Kostkova P (2015) Grand challenges in digital health. Front Public Health 3:134. https://doi.org/10.3389/fpubh.2015.00134
W. T. Organisation (2016) Monitoring and evaluating digital health interventions: a practical guide to conducting research and assessment. ISBN 978–92–4-151176-6, Geneva. https://apps.who.int/iris/bitstream/handle/10665/252183/9789241511766-eng.pdf
W. T. Organisation (2014) A universal truth: no health without a workforce.pdf. Geneva. https://www.who.int/workforcealliance/knowledge/resources/GHWA-a_universal_truth_ report.pdf?ua=1
Terris M (1975) Evolution of public health and preventive medicine in the United States. Am J Public Health 65(2):161–169. https://doi.org/10.2105/AJPH.65.2.161
Colijn C, Jones N, Johnston IG, Yaliraki S, Barahona M (2017) Toward precision healthcare: context and mathematical challenges. Front Physiol 8:136. https://doi.org/10.3389/fphys.2017.00136
Carrasco-Ramiro F, Peiró-Pastor R, Aguado B (2017) Human genomics projects and precision medicine Gene Ther 24:551, 08/14/online. https://doi.org/10.1038/gt.2017.77
Flores M, Glusman G, Brogaard K, Price ND, Hood L (2013) P4 medicine: how systems medicine will transform the healthcare sector and society. Pers Med 10(6):565–576. https://doi.org/10.2217/pme.13.57
Tuegel EJ, Ingraffea AR, Eason TG, Spottswood SM (2011) Reengineering aircraft structural life prediction using a digital twin. Int J Aerosp Eng 2011:1–14. https://doi.org/10.1155/2011/154798
Negri E, Fumagalli L, Macchi M (2017) A review of the roles of digital twin in cps-based production systems. Proced Manuf 11:939–948. https://doi.org/10.1016/j.promfg.2017.07.198
Glaessgen E, Stargel D (2012) The digital twin paradigm for future NASA and US Air Force vehicles, p 1818. https://doi.org/10.2514/6.2012-1818
Bruynseels K, Santoni de Sio F, van den Hoven J (2018) Digital twins in health care: ethical implications of an emerging engineering paradigm. Front Genet 9(31). https://doi.org/10.3389/fgene.2018.00031
Gartner (2018) Hype cycle for emerging technologies, 2018. ID G00340159. https://www.gartner.com/document/3885468?qid=eaeac87a4acbfd43931fc95&ref=solrAll&refval= 224658212&toggle=1
Lee J, Bagheri B, Kao H-A (2015) A cyber-physical systems architecture for industry 4.0-based manufacturing systems. Manuf Lett 3:18–23. https://doi.org/10.1016/j.mfglet.2014.12.001
Tao F, Cheng J, Qi Q, Zhang M, Zhang H, Sui F (2018) Digital twin-driven product design, manufacturing and service with big data. Int J Adv Manuf Technol 94(9–12):3563–3576. https://doi.org/10.1007/s00170-017-0233-1
Cox WE (1967) Product life cycles as marketing models. J Bus 40(4):375–384
Sacco M, Pedrazzoli P, Terkaj W (2010) VFF: virtual factory framework, pp 1–8. https://doi.org/10.1109/ICE.2010.7477041
Rosen R, Von Wichert G, Lo G, Bettenhausen KD (2015) About the importance of autonomy and digital twins for the future of manufacturing. IFAC-PapersOnLine 48(3):567–572. https://doi.org/10.1016/j.ifacol.2015.06.141
Schluse M, Rossmann J (2016) From simulation to experimentable digital twins: Simulation-based development and operation of complex technical systems, pp 1–6. https://doi.org/10.1109/SysEng.2016.7753162
Canedo A (2016) Industrial IoT lifecycle via digital twins, pp 1–1
Schroeder GN, Steinmetz C, Pereira CE, Espindola DB (2016) Digital twin data modeling with automationML and a communication methodology for data exchange. IFAC-PapersOnLine 49(30):12–17. https://doi.org/10.1016/j.ifacol.2016.11.115
Smarslok B, Culler A, Mahadevan S (2012) Error quantification and confidence assessment of aerothermal model predictions for hypersonic aircraft, p 1817. https://doi.org/10.2514/6.2012-1817
Bielefeldt B, Hochhalter J, Hartl D (2015) Computationally efficient analysis of SMA sensory particles embedded in complex aerostructures using a substructure approach, pp V001T02A007–V001T02A007. https://doi.org/10.1115/SMASIS2015-8975
Qureshi B (2014) Towards a digital ecosystem for predictive healthcare analytics. In: Proceedings of the 6th international conference on Management of Emergent Digital EcoSystems, Buraidah, Al Qassim, Saudi Arabia, pp 34–41. https://doi.org/10.1145/2668260.2668286
León MC, Nieto-Hipólito JI, Garibaldi-Beltrán J, Amaya-Parra G, Luque-Morales P, Magaña-Espinoza P, Aguilar-Velazco J (April 27, 2016) Designing a model of a digital ecosystem for healthcare and wellness using the business model canvas. J Med Syst 40(6):144. https://doi.org/10.1007/s10916-016-0488-3
Pramanik MI, Lau RYK, Demirkan H, Azad MAK (2017) Smart health: Big data enabled health paradigm within smart cities. Expert Sys Appl 87:370–383. https://doi.org/10.1016/j.eswa.2017.06.027
Huang G, Fang Y, Wang X, Pei Y, Horn B (2018) A survey on the status of smart healthcare from the universal village perspective, pp 1–6. https://doi.org/10.1109/UV.2018.8642125
Haughey H, Epiphaniou G, al-Khateeb HM (2016) Anonymity networks and the fragile cyber ecosystem. Netw Secur 2016(3):10–18. https://doi.org/10.1016/S1353-4858(16)30028-9
Boyes HA, Isbell R, Norris P, Watson T (2014) Enabling intelligent cities through cyber security of building information and building systems, pp 1–6. https://doi.org/10.1049/ic.2014.0046
Augusto V, Murgier M, Viallon A (2018) A modelling and simulation framework for intelligent control of emergency units in the case of major crisis, pp 2495–2506. https://doi.org/10.1109/WSC.2018.8632438
Chen M, Yang J, Zhou J, Hao Y, Zhang J, Youn C (2018) 5G-smart diabetes: toward personalized diabetes diagnosis with healthcare big data clouds. IEEE Commun Mag 56(4):16–23. https://doi.org/10.1109/MCOM.2018.1700788
Oleshchuk V, Fensli R (2011) Remote patient monitoring within a future 5G infrastructure. Wirel Pers Commun 57(3):431–439. https://doi.org/10.1007/s11277-010-0078-5
Mattos WD d, Gondim PRL (2016) M-Health solutions using 5G networks and M2M communications. IT Professional 18(3):24–29. https://doi.org/10.1109/MITP.2016.52
Rahman MA, Hossain MS, Hassanain E, Muhammad G (2018) Semantic multimedia fog computing and IoT environment: sustainability perspective. IEEE Commun Mag 56(5):80–87. https://doi.org/10.1109/MCOM.2018.1700907
Rahman MA, Hossain MS (2017) M-therapy: a multisensor framework for in-home therapy management: a social therapy of things perspective. IEEE Internet Things J 5(4):2548–2556. https://doi.org/10.1109/JIOT.2017.2776150
Fortino G, Guerrieri A, Russo W, Savaglio C (2014) Integration of agent-based and cloud computing for the smart objects-oriented IoT, pp 493–498. https://doi.org/10.1109/CSCWD.2014.6846894
Nastic S, Sehic S, Le D-H, Truong H-L, Dustdar S (2014) Provisioning software-defined IoT cloud systems, pp 288–295. https://doi.org/10.1109/FiCloud.2014.52
Ma Y, Li G, Xie H, Zhang H (2018) City profile: using SMART data to create digital URBAN spaces. ISPRS Ann Photogramm Remote Sens Spati Infor Sci 4:75–82. https://doi.org/10.5194/isprs-annals-IV-4-W7-75-2018
Orozco A, Pacheco J, Hariri S (2017) Anomaly behavior analysis for smart grid automation system, pp 1–7. https://doi.org/10.1109/ROPEC.2017.8261614
Do Q, Martini B, Choo K-KR (2018) Cyber-physical systems information gathering: a smart home case study. Comput Netw 138:1–12. https://doi.org/10.1016/j.comnet.2018.03.024
Ahmadi-Assalemi G, al-Khateeb H, Epiphaniou G, Cosson J, Jahankhani H, Pillai P (2019) Federated blockchain-based tracking and liability attribution framework for employees and cyber-physical objects in a smart workplace. https://doi.org/10.1109/ICGS3.2019.8688297
al-Khateeb H, Epiphaniou G, Reviczky A, Karadimas P, Heidari H (2018) Proactive threat detection for connected cars using recursive Bayesian estimation. IEEE Sensors J 18(12):4822–4831. https://doi.org/10.1109/JSEN.2017.2782751
Glaa B, Hammadi S, Tahon C (2006) Modeling the emergency path handling and emergency department simulation, pp 4585–4590. https://doi.org/10.1109/ICSMC.2006.384869
Sinreich D, Marmor YN (2004) A simple and intuitive simulation tool for analyzing emergency department operations, pp 1994–2002. https://doi.org/10.1109/WSC.2004.1371561
Kammoun A, Loukil T, Hachicha W (2014) The use of discrete event simulation in hospital supply chain management, pp 143–148. https://doi.org/10.1109/ICAdLT.2014.6864108
Alwan A (2011) Global status report on noncommunicable diseases 2010. World Health Organization, Geneva. http://apps.who.int/iris/bitstream/handle/10665/44579/9789240686458_eng.pdf;jsessionid=1D70E16CE9E288647B273D604E1D8991?sequence=1
C. f. D. C. a. P (2019) Chronic diseases: the leading causes of death and disability in the United States. 01/08/2019. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
Richard AA, Shea K (2011) Delineation of self-care and associated concepts. J Nurs Scholarsh 43(3):255–264. https://doi.org/10.1111/j.1547-5069.2011.01404.x
Barnes C, Mercer G (2010) Exploring disability, 2nd edn, Cambridge, 2nd ed. Cambridge
W. H. Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines
Cohn S (2015) ‘Trust my doctor, trust my pancreas’: trust as an emergent quality of social practice. Philos Ethics Humanit Med 10(1):9. https://doi.org/10.1186/s13010-015-0029-6
Gemmill M (2008) Research note: chronic disease management in Europe “employment, social affairs and equal opportunities” unit E1-social and demographic analysis. European Commission Directorate-General
Fuchs S, Henschke C, Blümel M, Busse R (2014) Disease management programs for type 2 diabetes in Germany: a systematic literature review evaluating effectiveness. Dtsch Arztebl Int 111(26):453. https://doi.org/10.3238/arztebl.2014.0453
Gapp O, Schweikert B, Meisinger C, Holle R (2008) Disease management programmes for patients with coronary heart disease—an empirical study of German programmes. Health Policy 88(2–3):176–185. https://doi.org/10.1016/j.healthpol.2008.03.009
Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, Jack L Jr, Isham G, Snyder SR, Carande-Kulis VG, Garfield S (2002) The effectiveness of disease and case management for people with diabetes: a systematic review. Am J Prev Med 22(4):15–38. https://doi.org/10.1016/S0749-3797(02)00423-3
Kummar S, Williams PM, Lih C-J, Polley EC, Chen AP, Rubinstein LV, Zhao Y, Simon RM, Conley BA, Doroshow JH (2015) Application of molecular profiling in clinical trials for advanced metastatic cancers. JNCI: J Natl Cancer Inst 107(4). https://doi.org/10.1093/jnci/djv003
Suite DH, La Bril R, Primm A, Harrison-Ross P (2007) Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. J Natl Med Assoc 99(8):879–885
Bajramovic E, Waedt K, Ciriello A, Gupta D (2016) Forensic readiness of smart buildings: preconditions for subsequent cybersecurity tests, pp 1–6. https://doi.org/10.1109/ISC2.2016.7580754
Skopik F, Settanni G, Fiedler R (2016) A problem shared is a problem halved: A survey on the dimensions of collective cyber defense through security information sharing. Comput Secur 60:154–176. https://doi.org/10.1016/j.cose.2016.04.003
He H, Maple C, Watson T, Tiwari A, Mehnen J, Jin Y, Gabrys B (2016) The security challenges in the IoT enabled cyber-physical systems and opportunities for evolutionary computing & other computational intelligence, pp 1015–1021. https://doi.org/10.1109/CEC.2016.7743900
Coppinger R (2016) Design through the looking glass [digital twins of real products]. Eng Technol 11(11):58–60. https://doi.org/10.1049/et.2016.1106
Wurm J, Jin Y, Liu Y, Hu S, Heffner K, Rahman F, Tehranipoor M (2017) Introduction to cyber-physical system Security: a cross-layer perspective. IEEE Trans Multi-Scale Comput Syst 3(3):215–227. https://doi.org/10.1109/TMSCS.2016.2569446
Wu W, Kang R, Li Z (2015) Risk assessment method for cyber security of cyber physical systems, pp 1–5. https://doi.org/10.1109/ICRSE.2015.7366430
Shafi Q (2012) Cyber Physical Systems Security: A Brief Survey, pp 146–150. https://doi.org/10.1109/ICCSA.2012.36
Gallagher S (2014) Photos of an NSA “upgrade” factory show Cisco router getting implant
Pagliery S (2015) Lenovo slipped ‘Superfish’ malware into laptops. CNN
Al Ameen M, Liu J, Kwak K (2012) Security and privacy issues in wireless sensor networks for healthcare applications. J Med Syst 36(1):93–101. https://doi.org/10.1007/s10916-010-9449-4
Krombholz K, Hobel H, Huber M, Weippl E (2015) Advanced social engineering attacks. J Inform Secur Appl 22:113–122. https://doi.org/10.1016/j.jisa.2014.09.005
Gupta BB, Tewari A, Jain AK, Agrawal DP (2017) Fighting against phishing attacks: state of the art and future challenges. Neural Comput Appl 28(12):3629–3654. https://doi.org/10.1007/s00521-016-2275-y
Kammüller F, Nurse JRC, Probst CW (2016) Attack tree analysis for insider threats on the IoT using Isabelle, pp 234–246. https://doi.org/10.1007/978-3-319-39381-0_21
Cheh C, Keefe K, Feddersen B, Chen B, Temple WG, Sanders WH (2017) Developing models for physical attacks in cyber-physical systems. In: Proceedings of the 2017 workshop on cyber-physical systems security and privaCy, Dallas, pp 49–55. https://doi.org/10.1145/3140241.3140249
European Union Agency For Network And Information Security (ENISA) (2017) Baseline security recommendations for IoT in the context of critical information infrastructures. https://doi.org/10.2824/03228
N. I. o. S. a. T. (NIST) (2016) NIST Special Publocation 800-183 Nentworks of ‘Things’. Department of Commerce, USA
U. D. o. H. Security (2016) Strategic principles for security the Internet of Things (IoT). US Homeland Security
U. S. D. o. H. a. H. S. F. a. D. A. F. C. f. D. a. a. R. Health (2018) Postmarket management of cybersecurity in medical devices
Internet of Things (IoT) Cybersecurity Improvement Act of 2017 Standard S. 1691, 2017–2018
E. g. o. E. i. S. a. N. T. t. t. E. Commission (2015) The ethical implications of new health technologies and citizen participation. Brussels. https://doi.org/10.2872/633988
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ahmadi-Assalemi, G. et al. (2020). Digital Twins for Precision Healthcare. In: Jahankhani, H., Kendzierskyj, S., Chelvachandran, N., Ibarra, J. (eds) Cyber Defence in the Age of AI, Smart Societies and Augmented Humanity. Advanced Sciences and Technologies for Security Applications. Springer, Cham. https://doi.org/10.1007/978-3-030-35746-7_8
Download citation
DOI: https://doi.org/10.1007/978-3-030-35746-7_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-35745-0
Online ISBN: 978-3-030-35746-7
eBook Packages: Computer ScienceComputer Science (R0)