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Procedia Computer Science 210 (2022) 189–197

The 12th International Conference on Current and Future Trends of Information and
The 12th International Conference
Communication on Current
Technologies and Future(ICTH
in Healthcare Trends2022)
of Information and
Communication
OctoberTechnologies
26-28, 2022, in Healthcare
Leuven, (ICTH 2022)
Belgium
October 26-28, 2022, Leuven, Belgium
Metaverse and Personal Healthcare
Metaverse and Personal Healthcare
Yeong-Tae Songaa*, Jiachen Qinbb
Yeong-Tae Song *, Jiachen Qin
a,b
Dept of Computer and Information Sciences, Towson University, MD 21252, USA
a,b
Dept of Computer and Information Sciences, Towson University, MD 21252, USA

Abstract
Abstract
Metaverse refers to the virtual world in which user’s altered ego or avatar acts. With recent advancement in information
Metaverse
technologiesrefers to wearable
- IoT, the virtualsensors,
world in which user’sand
3D-modeling, altered ego or avatar
AI, metaverse has acts.
createdWithnewrecent advancement
research in information
opportunities in various
technologies - IoT, wearable
domains. Healthcare is one of sensors,
the most3D-modeling,
important andand AI, metaverse
attractive domains.has created
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pandemic, have limitedinaccess
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healthcareHealthcare is onecreated
systems, which of the most
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health problems domains.
to many. During
In this paper,thewepandemic, we have
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and concepts created
about serious
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health healthcare
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digital twin, where
maintenance our focus
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Personalized twin. In oursuch
factors approach, we proposed
as behavioral, vital to use digital
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or observed the assessment
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to
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determine potential diseaseshealth. Personalized
to monitor. risk factors
The quality of digitalsuch
twinasmay
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be determined by theor observed symptoms
completeness, frequencyare of used to
update,
determine potential
and accuracy diseases to monitor. The quality of digital twin may be determined by the completeness, frequency of update,
of data.
and accuracy of data.
© 2022 The Authors. Published by Elsevier B.V.
© 2022
© 2022 The
The Authors.
Authors. Published
Published by by Elsevier
Elsevier B.V.
B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0)
This is an open access
Peer-review article under theConference
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Peer-review under
underresponsibility
responsibilityofofthe the ConferenceProgram
ProgramChairs.
Chairs
Peer-review under responsibility of the Conference Program Chairs.
Keywords: Metaverse; Digital Twin; Healthcare; Blockchain; SaMD; risk factor; potential disease
Keywords: Metaverse; Digital Twin; Healthcare; Blockchain; SaMD; risk factor; potential disease

1. Introduction
1. Introduction
The term “metaverse” was first put forward in 1992, by American science-fiction writer Neal Stephenson in his
TheSnow
novel term “metaverse”
Crash. As awas first put forward
compound word of intranscendence
1992, by American science-fiction
meta and writer NealisStephenson
universe, metaverse referred toinashisa
novel Snow Crash.
threedimensional As aworld
virtual compound
where word of engage
avatars transcendence meta social,
in political, and universe, metaverse
and cultural is referred
activities. The twoto most
as a
threedimensional virtual world where avatars engage in political, social, and cultural activities. The two most

* Corresponding author. Tel.: +0-000-000-0000 ; fax: +0-000-000-0000 .

* Corresponding ysong@towson.edu
E-mail address:author. Tel.: +0-000-000-0000 ; fax: +0-000-000-0000 .
E-mail address: ysong@towson.edu
1877-0509 © 2022 The Authors. Published by Elsevier B.V.
This is an open
1877-0509 access
© 2022 Thearticle under
Authors. the CC BY-NC-ND
Published license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
by Elsevier B.V.
Peer-review
This under
is an open responsibility
access of the CC
article under Conference
BY-NC-NDProgram Chairs.
license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Peer-review under responsibility of the Conference Program Chairs.

1877-0509 © 2022 The Authors. Published by Elsevier B.V.

This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0)
Peer-review under responsibility of the Conference Program Chairs
10.1016/j.procs.2022.10.136
190 Yeong-Tae Song et al. / Procedia Computer Science 210 (2022) 189–197
2 Author name / Procedia Computer Science 00 (2022) 000–000

important concepts around metaverse are the virtual world and the avatar. Former is the objective carrier of
metaverse and users in the real world connect to it using AR, VR, or any other technologies as a medium. The latter
is the active subject, avatar, in a metaverse. From the birth of the internet, mostly text-based information in the early
90’s quickly becomes multimedia based information. We are now on the verge of moving into new dimension of the
Internet – every user becomes a part of the internet using avatar or digital twin for our purpose.
Recent pandemic forced people to change their view about their health in totally different way. It is no longer an
optional thing to consider. As the quality of people’s standard of living improves, they now have higher standards
and more requirements for their healthcare. Traditional medical practices may not satisfy people’s increasing
requirements anymore. As results, newly developed therapies and various advanced clinical technologies are
developed and introduced e.g., informatics & data-driven medicine, eHealth and mHealth, software as a medical
device (SaMD), and digital health [4] just to name a few. What’s more, instead of traditional way of seeing doctor
when they are sick, people today are willing to find out potential disease and possibly prevent it before it is too late.
Such advanced clinical technologies demand rigorous research on healthcare and related technologies. In this paper,
we are surveying on metaverse based personal healthcare related technologies.
In a healthcare related metaverse, there can be several representative technologies including VR, AR or digital
twin. Regardless of which technology we may use, there are links that connect physical space to virtual space
through data and information or insight.

• VR technology
Virtual reality technology is aimed to create an immersive three-dimensional (3D) environment that a human can
experience and interact with the 3D environment in a realistic way through VR devices.
VR devices consist of a mixture of hardware and software. Hardware components include head-mounted displays
(e.g., VR glasses and VR helmet), motion input device, hand-based input device and non-hand-based input device
(e.g., eye-tracking device, head-tracking device, etc.). Software components consist of scene and object recognition
software, sound and speech recognition software, scene and object generation software and motion rendering
software.

• Digital Twin
Digital twin is a virtual representation of a physical existence which has dynamic connection with corresponding
virtual one. In industry domain, digital twins are used for real time monitoring, operational control, predictive
analytics, etc. In the field of healthcare, digital twin can help people keep abreast of their health condition and find
out potential problems early so they can take necessary actions and possibly prevent condition from worsening.
Such a digital twin can be built by using data from various sources such as sensors that continuous collect date from
human body, electronic health records from medical institutions, subjective feeling or observed symptoms provided
by patients and other relevant information (e.g., education, physical activities, socioeconomic status, etc.).

Table 1. Major data sources for digital twins.

Category Data examples
Electronic Health Records Lab test results, immunization record, medical history,
surgery, etc.
Sensor (vital signs) SpO2, blood pressure, blood glucose, ECG, temperature, etc.
Observed symptoms Chest pain, dizziness, nausea, light headedness, high fever,
etc.
Risk factors Tobacco use, alcohol abuse, chronic diseases, family
history, obesity, sexual behavior, abnormal vital readings,
etc.
Health environment Education, socioeconomic status, nutrition, etc.
Personal Health Records Allergies, medications, immunization history, exercise and
dietary habits, etc.
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Author name / Procedia Computer Science 00 (2018) 000–000 3

The purpose of having various data sources is to help detecting potential diseases early, keep track of existing
chronic disease and eventually achieve the goal of improving quality of life. For this purpose, EHRs from various
medical institutions, real time data from sensors and user input data are collected and stored in digital twin for
further analysis. Digital twin data may be selected for analysis on a regular basis or based on the risk factors of
corresponding physical entity for efficiency and relevancy. Upon analysis, insightful advice or warning messages
may be delivered to physical entity with selected medium such as text message or multimedia presentation.
As a digital copy of physical entity, digital twin’s data should be of high accuracy, completeness, and frequent
data upload in order to be useful for healthcare purpose. Design considerations to achieve a high quality digital twin
should include high synchronization rate between digital twin and physical entity with timely and relevant data.
Once synchronized, digital twin can be used for comprehensive analysis instead of physical entity – a human.

To achieve the goals of digital twins in healthcare, the following technologies and concepts may be helpful.

• Sensor technology: wireless sensor networks (WSN) are used to connect various sensing nodes – clinical
measurement sensors. WSN plays a role of connecting physical space and virtual space. Sensor data are collected
from low-cost sensing nodes such as wearable devices or handheld devices and uploaded to digital twin for
synchronization. These devices together with WSN play an essential role in the digital twin management. Sensor
data may include pedometer, activity-tracking data, temperature, heart rate, SPO 2, blood pressure or blood sugar. As
more advanced sensor technology develops, the kind and accuracy of data can be continuously improved. As results,
accurate and comprehensive digital twin would be created. Some of the trends in industry are: Toshiba [9]
developed an artificial intelligence system composed of wrist-worn wearable sensors and a PDA, monitoring and
analyzing the user’s health, daily activities (eating, exercising, etc.), and personal habits accurately according to
wrist movement, pulse rate, and electrodermal activity. It can help correct bad habit and reduce lifestyle-related
diseases by sending reminders and advice to individuals based on their specific data. The AMON project [10]
worked to develop a wearable tele-monitoring and alert system which can continuously collect and evaluate data,
detect and manage a medical emergency, and help connect to a medical center. ST Microelectronics and Mayo
Clinic [11] developed an innovative telemedicine platform for the management of chronic cardiovascular diseases. It
can keep monitoring patients’ health condition without disturbing their daily activities and provide appropriate
treatment advice based on specific clinical information and physiological parameters. A study [12] from the
University of Malaga and the University of Almeria proposed a real-time WSN with a specially designed pulse
oximeter, using software installed on a PC or PDA to monitor the pulse and peripheral oxygen saturation (SpO 2) of
different patients at the same time, achieving great simplicity at a low cost.

• Blockchain: Digital twins may need to handle huge amount of data. Instead of traditional way of storing
data in a centralized database, data security can be better guaranteed via blockchain, which stores data in distributed
ledgers. Such decentralization feature of blockchain makes it harder for hackers to target critical data since hackers
would need to compromise all digital twins, which is nearly impossible. Furthermore, any digital twin that behaves
suspiciously is instantly expelled from the blockchain, which keeps the system in constant safety and security [56].

• Cloud computing: Cloud computing is the delivery of computing services—including servers, storage,
databases, networking, software, analytics, and intelligence—over the Internet (“the cloud”) to offer faster
innovation, flexible resources, and economies of scale. When applied to digital twin, cloud computing can help keep
monitoring and analyzing large quantity of data without adding size and storage of users’ device.

2. Related Work

2.1. AR/VR

In a healthcare metaverse, AR/VR devices can be used to provide highly individualized therapeutic treatments. In
the paper on the future of healthcare [1] conducted four major research areas of VR aided therapy --- post-traumatic
stress disorder (PTSD), anxiety and fear related disorder (A&F), diseases of the nervous system (DNS) and pain
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4 Author name / Procedia Computer Science 00 (2022) 000–000

management. In the study, they considered related medical conditions, therapies, methods, and outcomes. [2]
introduced an array of applications other than direct therapy in healthcare with AR,VR devices such as consulting,
science popularization, education and training, self-care and geriatric nursing, quality control in medicine, etc.

2.2. Avatar

When it comes to avatar, digital twin can be a good research area in healthcare. [3] introduced a few digital twin
consortia and software tools - the medical and health industry-focused Swedish Digital Twin Consortium:
“https://www.sdtc.se/#consortium” and the Digital Twin Consortium, which caters for all industries:
“https://www.digitaltwinconsortium.org/index.htm”. [13] gives thoughts about the requirements of building digital
twins --- Information technology, making use of the Internet of Things, body sensor networks, modeling, simulation
and artificial intelligence are the basis for the design of digital twins. [14], [15], [16], [17] summarize technologies
and tools utilized in the creation of DT models, reference models and standards. [18] gives design considerations for
digital twins, including clear data visualization, plain language, accessibility, prioritization of interventions, ease of
adding and removing data sources, ability to add context, integration into clinical workflow and logical longitudinal
use of phase shifts.

Table 2. types of digital twins and references.

Types of Digital Twins Description References
• Whole body A dynamic digital representation of a whole human body [3], [13], [14], [15], [16], [17],
built from numerous data points using noninvasive clinical [18]
sensors and self-reported data such as observed symptoms or
pain.
• Body system Represents all or part(s) of 11 basic organ systems that [19], [20], [21], [22], [35]
controls all the basic body functions including the
integumentary system, skeletal system, muscular system,
lymphatic system, respiratory system, digestive system,
nervous system, endocrine system, cardiovascular system,
urinary system, and reproductive systems.
• Organ Human organ level digital twins are used for in silico testing [23], [24], [25], [26], [27], [28],
and/or finding patient-specific substance or surgery method. [34], [36], [44], [45]
• Cellular Digital twins of human cells can be used to evaluate how [26], [27]
cells respond to drug candidates in silico.
• Molecular Molecular dynamics such as human genome sequencing can [6], [7], [8]
be used as simulation using machine learning.
• Disease Digital twin of immune system can be used for various [28], [29], [30], [31], [32], [33],
ailment. [37], [38], [42], [43], [48]
• Personal healthcare Various treatment simulation, diagnosis, continuous [39], [40], [41]
monitoring, insight, guidelines.
• Population health - Identify factors affecting population health. [46], [49], [50], [51], [52]
- Promote population wellness.
- Track, control and prevent disease outbreaks and
epidemics.

2.3. Applied Areas of DT

There has been broad application of digital twins in healthcare so far. Following are some universal applications:
1. Real time monitoring---collecting DT data on SPO2, heart rate, blood pressure, blood sugar and many other
data continuously. When data monitored becomes abnormal, warning signal will be sent. Senior people or patients
with some disability may fall and faint at home. If no one is near them, it could be a dangerous situation. Data
monitored can be used to determine if such situation has happened and ambulance can be called automatically if no
 Yeong-Tae Song et al. / Procedia Computer Science 210 (2022) 189–197 193
Author name / Procedia Computer Science 00 (2018) 000–000 5

one replies to the device. What’s more, with predictive algorithms and real-time data, digital twins have the potential
to detect anomalies and assess health risks before a disease develops or becomes symptomatic.
2. Decision making --- make cure decision through personal health record displayed by digital twins. In
particular, when someone fell and faint, it can help make quick decision so that the risk can be reduced.
3. Cloud computing --- DT data collected from various sources including sensor data can be computed in the
cloud so that the insight from the data collection can be extracted and shared with the users.
4. Big data analytics---compare one’s own digital twin with large samples of others to analyze relative health
condition and prediction.
5. Predictive analytics---simulate on digital twins to find out a best medical scheme from medical device
selection (position, orientation, dimension…) to surgical variable determination (magnitude, angle, shape…) or
simulate an invasive clinical procedure to predict the outcome before the therapy is selected.
6. Management through digital twins---with digital twins from majority of people, population density or even the
exact number of people in different places can be computed. When flu explodes, it helps us keep safe distance from
crowd. By examining digital twins, flu infected people can be marked so when you get nearer to these people, you
may receive warning message. People who got in touch with these people can be traced and checked without hassle
[46].
7. Security with Blockchain Data security is an important factor when applying digital twin to healthcare. Data
security can be guaranteed by making health records anonymous, applying edge computing and using blockchain to
store and share medical data. [48] gave five aspects highlighting the benefits of combining digital twins, blockchain,
and data analytics technologies and introduced a blockchain-based collaborative digital twins framework for
decentralized epidemic alerting to combat COVID-19 and any future pandemics.

3. Personal Healthcare with DT

The usefulness of DT depends on the quality of data it contains. As shown in the table 1, there are 6 different
categories of data sources for DT – EHRs, observed symptoms, sensor data, risk factors, health environment and
personal health records (PHRs). Some data items may overlap with other categories but typical data examples for
each category are introduced in the table. A fully synchronized digital twin with such data can be used for health
assessment, risk factor analysis, potential disease identification, and population health. More in-depth digital twin
such as cellular or molecular can also be used for in silico testing for finding most appropriate drug for each
individual.

3.1. Patient generated health data vs. Electronic health records (EHRs)

Ever since the US enacted Health Information Technology for Economic and Clinical Act (HITECH) in 2009, the
access to patients’ health records, medical mistake rate, and patient outcome were improved greatly thanks to
interoperable electronic health records. The adoption rate of a certified electronic health records systems by
officebased physicians is about 72.3% as of 2021. Most of hospitals allow patients to view some of their own
medical records such as lab test results, appointments, etc. in EHRs. However, when it comes to personal healthcare,
those records may not be sufficient as the information is typically outdated, fragmented, and doesn’t provide any
guidance nor the reflection of current health conditions precisely. Since there is no way for patients to contribute to
their own EHRs, clinicians have no knowledge of patients’ current health condition because they don’t have up to
date patient generated health data. Even if they do have the access to patient generated health data, there will be
credibility issue as well as accuracy of measurement. In such case, digital twin may be used to combine both patient
generated data and electronic health records.

3.2. Health risk factors

In order for general public to maintain their own health, the first thing to concern about is their own health risk
factors. Different person may have different set of risk factors that may be revealed from various data sources such
as behavioral aspect, family history, their own medical history, sensor readings, and self-assessed health conditions
194 Yeong-Tae Song et al. / Procedia Computer Science 210 (2022) 189–197
6 Author name / Procedia Computer Science 00 (2022) 000–000

such as chest pain. DTs can be used to manage risk factors as they are synchronized with multiple personal data
sources that can be used to analyze risk factors and provides insight based on the provided data. Health risk factors
may be identified explicitly by using a generic comprehensive questionnaire typically used for a new patient by
doctor’s office or hospitals or implicitly by analyzing synchronized data. Behavioral aspects such as smoking,
drinking, and physical activity of general public can be identified by using behavioral risk factor surveillance system
(BRFSS) questionnaires (http://www.cdc.gov). Such questionnaire data can be used to create a behavioral risk
model. Personal behavioral data can be used to run the model using a statistical package such as MATLAB ® to
identify personal risk factors.

Fig. 1. Digital twin for potential disease monitoring. Fig. Fig. 2. Potential disease in SNOMED CT and matching ICD 10.

3.3. Symptom checker for finding potential disease

The symptom checking can be done using self-assessed conditions or readings from sensors or mobile apps. Any
abnormal readings or observed symptoms can be collectively considered symptoms. The algorithm for the checking
can be as follows:
For each observed abnormal symptom(condition) or abnormal readings from sensors
Search for corresponding SNOMED CT code, S // e.g., check pain on breathing -> 274664007
Check with major symptoms, mj of each disease, *Dk (in ICD-10-CM code) // m is a major
symptoms of disease D – there can be more than one matching disease, where 1≤j≤m, 1≤k≤n)
If there is a match (S == mj )
Check with observed vital signs and/or risk factors for accuracy
If matches
Pd = Pd + Dk // Pd = potential disease set initialized as empty set
This algorithm checks to see if there is any matching disease with given symptom. If matches, checks out
corresponding vital signs and risk factors for more supporting information. SNOMED CT codes represent all
possible medical concepts in human body. There are about 300K codes plus more than 1.4 million relationships
among the codes. ICD-10-CM codes represent international classification for diseases by WHO.

3.4. Software as Medical Device (SaMD)

There are about 318,000 health and fitness mobile apps available in Apple store and 52,565 apps in Google play
store in the Q1 of 2022. A list of relevant mobile apps can be identified according to the potential diseases as shown
in the Fig. 1. Relevant mobile apps may be selected based on the criteria (https://www.gov.uk/government/
publications/health-app-assessment-criteria) such as Evidence of effectiveness, Regulatory approval, Clinical safety,
Privacy and confidentiality, Security, Usability and accessibility, Interoperability and Technical stability.
 Yeong-Tae Song et al. / Procedia Computer Science 210 (2022) 189–197 195
Author name / Procedia Computer Science 00 (2018) 000–000 7

The selected mobile apps can be used to monitor user’s health condition continuously. App data log files may be
used to report data. The resulting list of mobile apps may be termed software as a medical device (SaMD). The data
collected from the list of mobile apps will be synchronized with digital twins in Fast Healthcare Interoperability
Resources (FHIR) standards – HL7 standard for EHRs. Clinical sensors are also used to collect user’s health
condition data. Clinical sensors can be wearables such as smart watches or patchable such as Biostiker or external
sensors as shown in the Fig. 3.

Fig. 3. clinical sensors and an application for data acquisition. Fig. 4. A layered model of digital twin for personal healthcare.

3.5. Layered model of DT

Digital twins for personal healthcare can be represented as a layered model as shown in the Fig. 4.
- Data acquisition layer is responsible for collecting various data sources. Depending on the type of data source,
data collection can be either direct or indirect.
- Transport layer is responsible for the synchronization of digital twin with physical entity. The layer utilizes
wireless
- Sensor network (WSN) for continuous synchronization, Bluetooth for the communication between sensors and
smartphones, and LAN and TCP/IP for the upload to the cloud
- Data model layer defines the structure of collected data items. The layer is used to analyze the uploaded
(synchronized) data items.
- Application layer is about the applications that utilize data models. Applications can be any purposes. They can
range from personalized application to population health.

4. Discussions

DT for personal healthcare is still in its infancy level. More mature technologies need to be in place, related
standards need to set and agreed, or digital equity needs to be resolved through socioeconomic system, and related
regulations need to be provided for DTs in order to be practical. The fully synchronized DTs should have effective
analytics applications to be used on the personal healthcare and population health. On the technology side, there are
several challenges that we need to deal with – continuous data synchronization, data encryption, role and
permission-based data sharing, secure data storage, data quality, and data privacy, just to name a few. As discussed
in the introduction, blockchain technology may be used to solve some of the challenges. The fabric blockchain
network provides chaincode and ledger service to applications so as to control ownership, membership and the
access to the blockchain where the sensitive data can be stored. It also provides add only transactions to a private
and permissioned network. By storing clinical-medical-health data to the ledgers, the quality of care can be
increased. Also when stored in standard based format such as HL7, SNOMED CT, and ICD-10, personal health data
can also be interoperable. The distributed nature of blockchain technology allows increased data availability,
efficiency, transparency, and trust. The hash function based link among blockchains makes it a lot harder for hackers
to gain access to the blocks. When blockchain technology is used to manage all data models of a digital twin, the
access can be shared without compromising data security and integrity. As for continuous data synchronization of a
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8 Author name / Procedia Computer Science 00 (2022) 000–000

digital twin, wearable sensors and patchable sensors can be used to report readings without user’s intervention. Of
course, not all sensors report readings automatically. Some of the external sensors as shown in the Fig. 3 need an
application that upload readings to the cloud.

5. Conclusions

Metaverse is still in a process of defining itself. However, with big tech companies such as Meta ® and Microsoft®
’s involvement, metaverse is getting more accessible to general public than ever before. We surveyed more than 100
metaverse related articles especially on healthcare domain. We identified that there are two different types of
technologies used in metaverse healthcare – AR/VR and digital twins. AR/VR based healthcare technology is
getting closer to its maturity but digital twin-based technology is still in its infancy. In this paper, we proposed
digital twin based personal healthcare framework that is standard based and blockchain based. The future direction
of the paper would be in maturing digital twin based personal healthcare technologies so general public can take
care of their health without getting much help from clinicians.

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