Technical, Ethical, Legal, and Societal Challenges With Digital Twin Systems for the Management of Chronic Diseases in Children and Young People

Abstract

Advances in digital medicine now make it possible to use digital twin systems (DTS), which combine (1) extensive patient monitoring through the use of multiple sensors and (2) personalized adaptation of patient care through the use of software. After the artificial pancreas system already operational in children with type 1 diabetes, new DTS could be developed for real-time monitoring and management of children with chronic diseases. Just as providing care for children is a specific discipline—pediatrics—because of their particular characteristics and needs, providing digital care for children also presents particular challenges. This article reviews the technical challenges, mainly related to the problem of data collection in children; the ethical challenges, including the need to preserve the child's place in their care when using DTS; the legal challenges and the dual need to guarantee the safety of DTS for children and to ensure their access to DTS; and the societal challenges, including the needs to maintain human contact and trust between the child and the pediatrician and to limit DTS to specific uses to avoid contributing to a surveillance society and, at another level, to climate change.

The effectiveness of digital twins in promoting precision health across the entire population: a systematic review

“…Digital twins play a crucial role in achieving precision health 25 . They serve as virtual models of human organs, tissues, cells, or microenvironments, dynamically updating based on real-time data to offer feedback for interventions on their real counterparts 26 , 27 . Digital twins can solve complex problems in personalized health management 28 , 29 and enable comprehensive, proactive, and precise healthcare 30 .…”

Children’s views on artificial intelligence and digital twins for the daily management of their asthma: a mixed-method study

“…In terms of researcher characteristics and reflexivity, AG is a junior paediatric pulmonologist, and DD is a senior one, both following children with asthma. However, AG had no previous experience of AI and DTS applications in childhood asthma, whereas DD is developing several research projects linked with these topics and anticipated both the potential advantages and risks of DTS for children [ 5 ]. Thus, the analyses were conducted by two researchers with different backgrounds, reducing the risk of a biased analysis of the children’s responses.…”

“…a live digital replica of the patient, more commonly known as a “digital twin” (DT) [ 3 , 4 ]. The combination of AI in DTs could lead to digital twin systems (DTS): DTS comprise a physical element—the patient, a digital element—the patient’s DT, and 2-way interactions between the physical and digital elements: sensors transform the patient’s signal into the patient’s DT, and software processes them to act on the patient’s management through recommendations to the physician or automated adaptations [ 5 ]. Compared to existing mobile applications, DTS integrate multiple data sources to provide as complete an assessment of the patient as possible, collect most of the data in real time, and automatically adjust management when possible and alert medical teams when not.…”

Home monitoring in asthma: towards digital twins

“…Applied to healthcare, digital twin systems comprise the patient (the physical element), the patient's digital twin (its virtual counterpart, based on computer models) and bidirectional interactions between the patient and its digital twin: sensors transform the patient's signal into the patient's digital twin, and clinical decision support systems translate these signals into actuators, that is readily applicable treatment suggestions for the patient (Fig. 2) [9 ▪ ]. Digital twin systems go beyond classic remote patient monitoring by adding data-driven artificial intelligence systems and rapid data synchronization between the patient and their virtual counterpart, allowing to obtain a live meaningful representation of the patient, which can be used to monitor, diagnose or adjust treatment [10 ▪▪ ].…”