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Keywords: While Digital Twin finds its applications in many fields, mainly in advanced manufacturing, PLM (Product Life-
Human digital twin cycle Management), and smart healthcare, attempt of using Digital Twin in full lifecycle management of human
Augmented digital twin being is discussed. The concept of Augmented Digital Twin is put forward as the basis of the concept of Human
Smart healthcare
Digital Twin (HDT), which is the core idea of the paper. With the experiences of Digital Twin application in
smart manufacturing, PLM and smart healthcare, and the development of other related technologies such as Data
Mining, Data Fusion Analysis, Artificial Intelligence, especially Deep Learning and Human Computer Science, a
conclusion can be drawn naturally, that HDT is an enabling way of full lifecycle health management and it is pos-
sible to construct Human Digital Twin, particularly from the technology view. Comparison between Digital Twin
and Human Digital Twin demonstrates the possibility. The concept, conceptual model and characteristics of HDT
are presented for preparation of its construction. How to construct Human Digital Twin is discussed by proposing
Human Digital Twin System Architecture and Implementation Approach. Also, it is pointed out that there will be
a long way to go because of not only its extreme complexity, but also so many aspects being involved, especially
the security and social ethics problem.
1. Introduction per is mainly about the possibility to construct Human Digital Twin, its
architecture, security and other main issues. The remains of this paper
In modern society, people pay more attention to their healthcare. are organized as follows. Section 2 reviews the origin of Digital Twin,
Especially in China, with its economy development and living level im- and presents the concept of Augmented Digital Twin (ADT), an extended
provement in recent decades, Chinese people have taken healthcare into Digital Twin which is the basis of Human Digital Twin that will be dis-
consideration gradually. Therefore, high level healthcare and medical cussed in Section 4. Section 3 describes Digital Twin applications and
resources are required. The demand for medical treatment has changed recent researches mainly in smart manufacturing, PLM and healthcare.
from extensive and batch diagnosis to fine and customized services. In Section 4 emphasizes the concept, conceptual model and characteristics
the past, when a patient went to a hospital, there was only a short time of Human Digital Twin and the similarities and differences between it
for a doctor to make diagnoses and treatment, at some times, only a and Digital Twin are executed in Section 5. Section 6 mainly refers to
few minutes, because each doctor had to deal with dozens of patients how to construct Human Digital Twin while at last conclusion is drawn
or even more than 100 in a work day. That can’t satisfy people’s needs. in Section 7.
Using modern data management, Artificial Intelligence, Remote Diagno-
sis and other technologies can alleviate the contradiction between more 2. Augmented digital twin
patient healthcare demands and less doctor services. Human being is
a complex system. Health management is required to help us manage 2.1. Origin of digital twin
our health situation which can reduce the number of times to hospitals
and improve the quality and efficiency of diagnosis and treatment. So, The germination of the idea of Digital Twin can be traced back to
nowadays, more and more attention is paid to smart medicine and health Apollo Program launched by NASA (National Aeronautics and Space
management. To achieve these, the use of Digital Twin (DT) is an effec- Administration) in 1970s. In that program, at least two identical space
tive way to solve complex problems. Digital Twin has been mainly used vehicles were built to allow mirroring the conditions of one of them
in manufacturing, product life cycle management, industry 4.0 and so during the mission [3]. But the concept of Digital Twin would be con-
on since it was put forward. But can it be used for human [1,2]? This pa- tributed to Professor Grievers who used the concept in Product Lifecycle
Management. In 2003 in the course of Product Lifecycle Management at
✩
This document is supported by key scientific research project plan of higher school in Henan Province (20B520001).
∗
Corresponding author at: Anyang Institute of Technology, Huanghe Road, Anyang City, Henan Province 455000, China.
E-mail address: weishengli401@126.com
https://doi.org/10.1016/j.cmpbup.2021.100014
Received 23 February 2021; Received in revised form 6 May 2021; Accepted 18 May 2021
2666-9900/© 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
W. Shengli Computer Methods and Programs in Biomedicine Update 1 (2021) 100014
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W. Shengli Computer Methods and Programs in Biomedicine Update 1 (2021) 100014
3. Application of digital twin [29]. Camille Nebeker et al. investigate what should be done to advance
digital health research by using health data and Artificial Intelligence
3.1. Why is digital twin so important? [30]. Literature [31] discusses Cardiovascular Disease Prevention and
Management by using wireless technology, sensors, apps, and data. A
The intelligent or smart manufacturing is one of advanced manufac- decision-making checklist tool is developed to support technology se-
turing and it is the development direction in the future and the goal that lection in digital health research in [32]. Literature [33] reviews the
human beings have pursued forever. Essentially intelligent manufactur- latest application of digital intelligent diagnosis and treatment technol-
ing is an open information system. In the whole manufacturing process, ogy related to liver surgery in the hope that it may help to achieve
a variety of informations are transported, exchanged, treated, and so it accurate treatment of liver surgery diseases. Adam Palanica et al. de-
is actually a system for treating informations. The most important way scribe a VR(Virtual Reality) technology Health Voyager which can pro-
to achieve smart manufacturing is cyber physical integration which be- vide patients with engaging visuals and a VR simulation of their indi-
comes possible with the development of Internet of Things (IOT), Cloud vidual clinical findings and help them know more effective transfer of
Computing (CC), Big Data Analytics (BDA), and AI [16]. But cyber phys- medical knowledge and comprehension of treatment information [34].
ical integration is not an easy thing to achieve. It needs a right way to Costas Boletsis et al. test the assumption that the use of smartwatches
realize cyber–physical integration. Digital Twin is consider as the en- for monitoring physical health aspects of dementia patients can benefit
abling technique for solving the fusion of CPS (Cyber Physical System) formal home-based care [35]. Wen-Tsung Ku’s research is about the at-
[15]. And Qinglin Qi etc. believe that it is the key technology of in- titude of Taiwanese Middle-Aged and Elderly Patients’ Acceptance and
formation integration for smart manufacturing and it can pave a way Resistance toward the Health Cloud [36]. A Cardio Twin architecture
for the cyber physical integration, which has been regarded as an im- for Ischemic Heart Disease detection designed to run on the Edge is pre-
portant bottleneck to achieve smart manufacturing before [17]. Digital sented by Roberto Martinez-Velazquez et al. [37]. While maintaining
Twin can break the barriers between the physical world and the cyber a food record is an essential means of health management, Kiyoharu
world of manufacturing [18]. Aizawa has developed the smartphone application “FoodLog,” as a new
Now the development of current technology, such as Mathemati- framework for food recording [38]. The advent of Artificial Intelligence
cal Modeling, Artificial Intelligence, Cloud Computing, Block Chain, Big methodologies paves the way towards smarter healthcare by exploit-
Data, Data Analysis, IOT, high-speed network, 5G and so on, provide the ing new concepts such as Deep Learning. Literature [39] presents an
possibility for the development of Digital Twin. From this view, Digital overview of Deep Learning techniques that are applied to smart health-
Twin will find wide use in the future. care. Since emotion situation is important to people’s healthcare, lit-
erature [40] discusses emotional states’ detection approaches by using
3.2. Main applications and researches in manufacturing Machine and/or Deep Learning techniques and existing physiological
databases for emotion recognition, and also highlights the challenges
Digital Twin is mainly used in smart manufacturing, PLM, and aero and future research directions in this field. Hadi Habibzadeh et al. study
craft etc. Violeta Damjanovic-Behrendt et al. discuss the design of a the emerging trends in smart healthcare applications as well as the key
Digital Twin demonstrator for smart manufacturing, following an open technological developments that give rise to these transitions, partic-
source approach for implementation [19]. Claudio Mandolla et al. ana- ularly emphasize threats, vulnerabilities, and consequences of cyber-
lyze the way to build a Digital Twin through the exploitation of Block attacks in modern smart healthcare systems and last investigates their
Chain used in aircraft industry theoretically and practically for additive corresponding proposed countermeasures [41]. Amrata Bagaria, et al.
manufacturing [20]. Guivarch et al. present a new approach to develop give an overview of the existing literature on Digital Twin for personal
Digital Twin of helicopter dynamic systems [21]. Qinglin Qi, Fei Tao health and well-being [42]. Literature [43] provides an overview of
review and compare Digital Twin and Big Data, and discuss how to in- Medical Cyber Physical Systems and the data flow through them which
tegrate them to promote smart manufacturing [17]. In order to improve are platforms to gather, process data from patients with IOT, ML, Cloud
the accuracy and efficiency for green material optimal-selection in prod- Computing etc., to monitor patients’ healthcare remotely, and to im-
uct, a new method driven by Digital Twin is proposed in literature [22]. prove quality of life of patients. Document [44] encompasses a brief
Literature [23] discusses an object-oriented, event-driven simulation us- literature review on TEC (Technology-Enabled Care) challenges, with
ing Digital Twin of a flexible assembly cell coordinated with a robot a focus on the key technologies enabling the development of wearable
to perform assembly tasks alongside human. Literature [24] presents solutions for remote human motion tracking. Document [45] explores
a data-driven Digital Twin model based on Deep Learning to predict the most relevant aspects in relation to the outcomes and performances
machining tool condition. In paper [25], a new method for product de- of the different components of a healthcare system with a particular fo-
sign, manufacturing, and service driven by Digital Twin is proposed. cus on mobile healthcare applications. Electroencephalography (EEG)
The paper [26] presents a concept for the composition of a database motor imagery signals have recently gained significant attention due to
and proposes guidelines for the implementation of the Digital Twin in its ability to encode a person’s intent to perform an action. Researchers
production systems in small and medium-sized enterprises. In literature have used motor imagery signals to help disabled persons control de-
[27], an AR application that uses Microsoft HoloLens to visualize the vices, such as wheelchairs and even autonomous vehicles. Hence, the
Digital Twin data of a CNC milling machine in a real manufacturing accurate decoding of these signals is important to Brain–Computer In-
environment is presented. terface (BCI) systems. Deep Learning methods, such as the Convolution
Neural Network (CNN), have achieved remarkable success in computer
3.3. Applications and researches in healthcare vision tasks. Literature [46] proposes a multiple-CNN feature fusion
architecture to extract and fuse features by using subject-specific fre-
Digital Twin is not only used in areas above mentioned, it also can quency bands. Abdulmotaleb El Saddik presents a Digital Twin called
find its application in healthcare area. With technology development Ecosystem-Dtwin to promote human health and well-being [47]. Health-
and the application of Big Data, smart healthcare is put forward and get care applications depend on voluminous data containing rich and impor-
more and more focus. As the enabling method of smart healthcare, Digi- tant insights that can support predictive analysis by discovering these
tal Twin has been paid much attention, and there are a lot of researches patterns using Machine Learning algorithms. Unfortunately this data is
about it. Neeraj Kavan Chakshu et al. develop a semi-active human Dig- not always available for multiple reasons including lack of unified and
ital Twin model for detecting severity of carotid stenosis from head vi- standardized architecture for distribution/dissipation of such data. Doc-
bration [28]. Vera Yakovchenko et al. discuss automated texting system ument [48] proposes a framework for Cloud based architecture of a dig-
on mobile phone text messaging to promote patient self-management
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W. Shengli Computer Methods and Programs in Biomedicine Update 1 (2021) 100014
health assessment will be fed back to the real person and his doctors 2) People’s reactions are both objective and subjective which can be
in a hospital as prediction, suggestion, guidance, alarm, or treatment supported by research on psychology and human behavior.
schedule. These information allows the real person to make certain 3) Human beings are more complex entities and more difficult to rep-
improvements, such as strengthening exercise, improving food struc- resent in cyber space. Modeling, Data Analysis and Data Fusion re-
ture, further treatment, etc. In case of emergency, his hospital will quire much more knowledge than what needed when constructing
dispatch an ambulance immediately and first aid measure will be Digital Twin. For general Digital Twins, modeling depends on math-
taken. ematics, physics, chemistry, mechanics, materials science, etc. and
8) One or his authorized people can login his Human Digital Twin sys- building HDT models need to focus on physiology, psychology, bi-
tem to look into the content. Through VR/AR technology, it can pro- ology, chemistry, mathematics and other disciplines or rules. People
vide a vivid 3D image of the real person, and can display the health know more about laws of physics, chemistry, mechanics, material
situation dynamically, visually. One even can observe his internal science, etc. but know little about laws of human beings. Many laws
organs which are generated by 3D Reconstruction Technology. of human beings are statistical, not rigid expression.
9) To maintain privacy, password, fingerprint, iris recognition, autho- 4) Human beings have the characteristics of heredity and variation and
rized login, block chain encryption, authentication, identification, so a special Data Structure or Class is needed to incorporate these
and other technology can be used for encryption to prevent tamper- attributes. It is more difficult to construct HDT models. From the
ing. Each HDT needs an account and password to log in and to view view of computers, the HDT models in cyber space is a Data Struc-
across it. For adults, the account and password can be controlled ture, commonly a Class with inheritance attributes just as referred
by themselves. For children, the account and password can be con- in C++ or Java. Each Class comes from a base Class and can inherit
trolled by their parents or guardians. When necessary, doctors or methods and variables from its parent Class. Each Class needs an ID
professionals can be authorized to inquire about or modify it. to distinguish from others. Not only the Class variables and meth-
10) Other security mechanism: for trusted access, medical institutions ods can be inherited, but also the values of some variables, even the
and individual need to carry out identity authentication and vulner- values of Cross Variables (for example, some eigenvalues come from
ability detection to login the HDT system. For secure trusted com- both parents, even grandparents) can be inherited. How to design
munication connection, real address authentication, and fixed path this Class to better describe human genetic relationship should to be
transmission and authentication are needed, that is, medical institu- take into consideration. For example, how recessive gene/dominant
tions and home IP addresses are usually fixed and need to be regis- gene can be inherited automatically in a Class is a subject worthy of
tered; communication path and routing path are usually fixed. For study.
secure and reliable data access, using Edge Computing and cross line 5) Human beings are social creatures and more social ethics and inter-
access control to provide data access security. Now medical institu- personal relationships need to be considered.
tions, families and personal data nodes have the computing power 6) Human beings are easily affected by the environment and easily in-
and storage capacity and can run security algorithms to ensure se- fluenced by the region diet. Compared with the machines which can
curity and verification. In order to ensure the reliability, medical be affected by temperature, humidity, noise, human being can be af-
institutions, families, node devices, routing devices and personal ter- fected by the atmosphere, mood, virus, bacteria and air quality and
minals need to be registered, and each address identity is embedded so on.
into the address for traceability. After listening to the address assign-
ment in the access network, the device IP and communication port 6. Constructing a HDT
are dynamically bound to realize the source address trust worthiness.
In this section, how to construct HDT is discussed. In order to in-
5. Comparison between DT and HDT terpret the way to construct HDT system, the information flowchart of
HDT system is produced firstly, and then HDT Application Layer Ar-
5.1. Commons between DT and HDT chitecture and its detailed Architecture are presented. At last, System
Implementation Approach is elaborated.
There are some similarities between Human Digital Twin and Digital
Twin. 6.1. Information flow chart of HDT system
1) They are all digital replica in virtual cyber space of its real entity in
the physical space. Fig. 4 illustrates the information flowchart of HDT system. A HDT in
2) Both need two-way information transmission. It needs to detect the the cyber space is responding to the real person in the physical space. All
entity parameters and send them to the cyber space, and the cyber kinds of data e.g. age, weight, height, ECG, blood pressure, diet, mood
space needs to send feedback information to the entity. etc. are collected by numerous IOT devices which are common nowa-
3) Models need to be built. Digital Twin is the representation or model days, and may become more widespread, more intelligent, smarter and
of the real entity, which is the most important work when construct- transmitted to a network Sink Center(commonly a smart phone to un-
ing Digital Twin. The model simulate the working mechanism of the dertake the job), which transfer all the data to the remote Cloud Server.
entity. It analyzes, summarizes and judges the input data, and gives The Sink Center can also execute Edge Computing sometimes when it is
feedback to the entity, and the whole system constitute a closed loop. necessary [37]. In literature [37], a Deep Learning model is constructed
4) Security technology is needed to ensure privacy, reliability and in- based on Tensor Flow to deal with the ECG coming from the person,
tegrity. then judge if the person has a coronary heart disease. If it believes the
5) They share some common technologies, such as Cloud Server, Net- person being at the risk of coronary disease, it send alarm to the person,
work, Data Collection, Data Clustering Analysis, Big Data, Edge Com- his family and the nearest emergency hospital to implement a treatment.
puting, Deep Learning, etc. This is very important, because early detection and early treatment will
achieve better therapeutic effect.
5.2. Differences between DT and HDT
6.2. HDT system architecture
1) Human beings have mental activities which can be reflected by the
fusion of blood pressure, respiration, heart rate, hormone levels and HDT is usually deployed in the Cloud (SaaS, PaaS or IaaS Platform
other data. Detection of mental activities usually relies on biosensors provide by infrastructure suppliers, such as Azure, Baidu, etc. as illus-
and brain computer science. trated in Figs. 5 and 6) which is supported by remote distributed com-
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W. Shengli Computer Methods and Programs in Biomedicine Update 1 (2021) 100014
Fig. 6. Detailed HDT application layer architecture. 6.3. System implementation approach
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W. Shengli Computer Methods and Programs in Biomedicine Update 1 (2021) 100014
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