Exploring R Esearch T Rends of e Merging T Echnologies

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Exploring research trends of emerging technologies in

Health Metaverse: a bibliometric analysis
Donghua Chen1 and Runtong Zhang2,*
(1. School of Information Technology and Management, University of International Business and Economics,
Beijing 100029, China.
2. School of Economics and Management, Beijing Jiaotong University, 100044, China.)
Corresponding Author: Runtong Zhang, rtzhang@bjtu.edu.cn
Abstract: With the development of the digital economy, Metaverse has gained wide attention being the
infrastructure of the next-generation internet. Medical and health informatics holds a promising future in
the Metaverse. This study leverages a bibliometric analysis of over 34 thousand Metaverse-related
publications in 22 years to propose a novel concept called Health Metaverse. We applied the methods of
Zipf’s Law, Bradford’s Law, and Lotka’s Law respectively to explore the research framework, challenges
and application of Health Metaverse. Four perspectives, namely knowledge, socialization, digitalization,
and intelligence, are summarized from our analysis results. The Health Metaverse framework mainly
focuses on multimodal medical information standards, medical and social data fusion, telemedicine and
online health management, and medical artificial intelligence. It also provides invaluable innovative
drive in medical education, surgical procedures, and connection between service providers and patients.
However, there are challenges in technology upgrades, gamification of medical service, protection of
patient privacy, and prevention of people from escaping from reality.
Keywords: Health Metaverse; Telemedicine; Virtual Reality; Medical Informatics; Bibliometric
Analysis
1. Introduction
With the rapidly developing digital economy, the development of Metaverse has received wide
attention (Kim, 2021). It is considered as the infrastructure of the next-generation Internet. In the past
decade, online health communities and telemedicine applications have come to life and played an
essential role in facilitating the digital economy in the health and medical field. Digital health provides
considerate benefits to stakeholders such as doctors, patients, online platforms, pharmaceutical
companies, etc. Similar to various technology buzzwords in the 21st century, such as cloud computing,
big data, artificial intelligence (AI), blockchain, etc., although difficulties and challenges remain, the
concept of Metaverse has been promoting technology advancement and industry innovation in various
fields since 2020. After Facebook rebranded itself as Meta to fully develop Metaverse in October 2021,
many tech giants speeded up to explore their Metaverse-based business models. Improper understanding
of the Metaverse makes it difficult for developers to overcome challenges and achieve genuinely
sustainable development (Lee, 2021).
First appeared in Neal Stephenson’s science fiction novel Snow Crash in 1992, Metaverse is
considered to be synchronized with the real-world and is a derivative of current social media. As a social
Electronic copy available at: https://ssrn.com/abstract=3998068

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giant, Facebook has undoubtedly become a phenomenon that defines a generation. For billions of people
worldwide, Facebook’s transformation has redefined traditional concepts of communication,
connectivity, news reporting, e-commerce, and social interaction (Hassouneh and Brengman, 2015).
Owens, Mitchell, Khazanchi and Zigurs (2011) showed that the Metaverse is characterized by social
existence, social and technological exchange, further highlighting the ability of virtual world construction.
In the medical and health field, this feature of Metaverse currently fulfills the strong needs of doctors,
patients, and other stakeholders, which opens up various novel applications of telemedicine, virtual care,
personal health management, and surgery assistance. Therefore, the Metaverse in the medical and health
field is designed to elevate virtual care from two-dimensional to three-dimensional experience in
revolutionizing medical and health informatics.
The Health Metaverse we propose in the paper has many promises. Such applications include
remotely monitoring critically ill patients, analyzing clinical patient data, blood glucose monitoring, heart
rate tracking, enhancing physical fitness tracking capabilities, and other unimaginable medical and health
services, etc. in a three-dimensional immersive way. The tech company Oculus taken over by Meta has
been helping in orthopedic surgery. At present, peer-to-peer support is becoming more and more
important during the interaction between medical professionals and patients in online health communities
(Fürstenau, Auschra, Klein & Gersch, 2019). Traditionally, the interaction effectiveness between doctors
and patients comes from the support of medical professional institutions and personnel, while an online
platform only acts as an intermediary. The emergence of the Health Metaverse changes all of this.
Professional clinical advice and treatment is still considered as a gold standard in the Health Metaverse.
Therefore, the key lies in building efficient immersive medical and health services in a three-dimensional
virtual space based on medical domain knowledge. Early Metaverse applications mainly focus on more
games and entertainment. Paying for the experience by medical and health service providers in the Health
Metaverse is a new attraction for online users.
There remains challenges and opportunities in Health Metaverse. First, patient privacy and life safety
in the Metaverse cause various questions and wide concerns (Cheung, 2020). The Health Metaverse will
significantly change medical practice from many perspectives Due to a large number of users and
innovative connections, the Metaverse inevitably produces various issues involving personal, public, and
national security (Leenes, 2007). Inappropriate handling of people’s physical and mental health-related
activities may endanger their health conditions. Considering the Health Metaverse may gamify some
healthcare applications, related constraints and regulations are necessary (Bochennek, Wittekindt,
Zimmermann & Kligebiel, 2007). Builders in the Metaverse should carefully define the entertainment of
health-related applications; otherwise, severe consequences for patients may occur. Like the Roblox
platform that shares 30% of the revenue with developers, Health Metaverse allows developers to create
content and use extended virtual technology to attract users (Sweeney, 2019). Metaverse is the fusion of
virtual and physical space that also helps overcome the limitations of medical training during the COVID-
19 pandemic. In early days, the stakeholder who started to build Health Metaverse were often tech giants
in the non-medical and health industry. The moral crisis caused by the gamification and entertainment of
medical expertise poses a colossal challenge.
This article investigates the promises of Metaverse in the medical and healthcare field through
literature review and bibliometric analysis based on over 34 thousand publications in 22 years. We
propose the novel concept of Health Metaverse and its research framework by clarifying its future
challenges and research directions through a series of quantitative methods. Further, we analyze the
metadata of related papers from scientific databases and news sources from the Internet, and then explore

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the research trends from four Health Metaverse perspectives, namely, knowledge, socialization,
digitation, and intelligence. Based on the analysis results, we finally effectively identify the conceptual
definition, research framework, challenges and future applications of Health Metaverse. We also started
an open-source project1 where more Health Metaverse-related resources and analysis tools can be found.
2. Materials and Methods

The flowchart of this bibliometric analysis of Health Metaverse-related research is illustrated in
Figure 1. First, we determine relevant keywords and then design search strategies of study from three
research categories, namely, (RC1) Metaverse itself, (RC2) the Metaverse in the field of medical and
healthcare field, and (RC3) potential applications of Health Metaverse. Second, based on the carefully
selected keywords, the Web of Science database is used to retrieve relevant publications for analysis.
Third, trend analysis and topic analysis of the Health Metaverse’s publications from four perspectives is
performed through visualization tools. Finally, we present our understanding of the concepts, research
framework, future challenges, and research directions of Health Metaverse.
Begin
Determine searching
keywords and strategies
about Health Metaverse
Existing literature
Determine data sources

of publications
Web of science
database
Examine the trends of
Metaverse-related
publications
Metaverse-related Health Metaverse-related Potential keywords-based

research analysis research analysis research analyis
Knowledge Socialization
Perspectives
Digitalization Intelligence
Challenges and futures
End
Figure 1. Flowchart of bibliometric analysis in this study
2.1 Data sources

The Metaverse-related publications from the Web of Science database published over the 22 years
1 The Health Metaverse project: https://health-metaverse.github.io

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between January 2000 and December 2021 are selected to facilitate this bibliometric analysis. First, we
divide the publications into three categories (RC1, RC2, and RC3) to explore a comprehensive
understanding of this concept based on existing literature and reports. Then, searching keywords in the
Web of Science database for each category are determined, as shown in Table 1. In this process, first, we
analyze the keyword occurrence of the RC1 type as shown in Figure 2; then, a series of relevant keywords
in RC2 and RC3 types are determined empirically based on a comprehensive analysis of Metaverse topics.
Then, relevant publications of each research category are retrieved from the database. The number of
publications is 106, 7950 and 26619, respectively. Then, the papers are analyzed according to different
methods to provide insights on different levels of the Health Metaverse. To avoid the coverage limitation
of the academic database, additional searching through the Internet to obtain Metaverse-related news and
blogs is performed. We also present our online search results through the GitHub repository of Health
Metaverse 2 . Leveraging both academic publications and publicly available news sources, we finally
obtain complete coverage of bibliometric data regarding the Health Metaverse.
Table 1. Summary of search keywords used in the Web of Science database

Research category Keywords
(RC1) Metaverse itself virtual reality, augmented reality, mixed reality, virtual worlds, avatar,
3d worlds, hyper reality, digital economy, social network, gaming,
immersive experience
(RC2) The Metaverse in the telemedicine, virtual reality in health, augmented reality in health,
medical and healthcare field medical information standards, online health community, digital
health, mobile health
(RC3) Metaverse digital transformation, digital economy, blockchain, artificial
Perspectives intelligence, digital twins, wearable devices, multimodal data
Figure 2. Analysis of Metaverse-related keywords of publications in the past two decades
2 Online Health Metaverse-related sources we collected: https://github.com/dhchenx/health-metaverse

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2.2 Time trend analysis

Time trend analysis is leveraged to examine the development of Metaverse and its applications in the
medical and health field in the past 22 years. First, the trends of publications containing the keyword of
Metaverse in the past two decades are examined. There is a slight increase research between 2007 and
2012 while a dramatic increase occurred since 2020. Based on retrieved bibliometric data, a series of
essential keywords related to Health Metaverse are identified. The keywords and their numbers of
retrieved publications are virtual reality (VR), augmented reality (AR), mixed reality (MR), digital health,
Metaverse, online health community, and telemedicine, as shown in Table 2. Finally, the change of the
number of publications in each keyword is respectively illustrated.
Table 2. Summary of retrieved publications related to keywords of Health Metaverse during the
searching of the Web of Science database.
Average
Number of Number of cited Number of
Query string number of h-index
publications publications citations
citations
Metaverse 191 565 604 3.26 13
augmented reality
1089 10580 12051 11.66 51
AND health
digital health AND
785 7357 8185 10.81 41
internet
mixed reality 192 1698 1811 9.81 23
online health
370 2738 3458 11.83 33
communities
telemedicine AND
8437 87119 136410 17.65 135
internet
virtual reality 5332 59278 78032 15.9 118
2.3 Keyword analysis

We examine four perspectives of Metaverse-related research in the retrieved publications through
overlay visualization of keyword occurrence. First, essential keywords with great link strength in the
retrieved bibliometric data are identified and discussed. Second, an overlay visualization of the
Metaverse-related research from the core set of the Web of Science database is illustrated to examine the
use of Metaverse. Third, bibliometric data divided by research category are analyzed to obtain a
comprehensive understanding of the Health Metaverse. Furthermore, we summarize topics from the
keyword clusters to identify essential characteristics of the Health Metaverse. A summary of the numbers
of unique author keywords and Keywords Plus® is shown in Table 3.
2.4 Topic analysis from different perspectives

The steps of topic analysis of Metaverse-based research to promote the emerging concept of Health
Metaverse are as follows. First, we analyze the distributions of the research areas and directions in the
retrieved bibliometric data. Figure 4 shows the distribution of research fields of publications with

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different subject terms. The darker cells represent the more significant number of studies in the
corresponding field. Science and technology, life sciences, and social sciences are the main research
fields regarding the Metaverse. Then, the raw text of publication abstracts from bibliometric data is
obtained and performed in LDA topic modeling. Finally, a research framework of Health Metaverse is
explored through four perspectives, namely, knowledge, socialization, digitization, and intelligence.
Table 3. Summary of numbers of unique author keywords and keyword plus in our searching
Research Keyword Number of author Number of Keywords
category keywords Plus®
RC1 Metaverse 371 68
RC2 medical artificial intelligence 11057 5842
medical information standards 2937 1924
social network 1811 1380
virtual reality and health 5216 3989
RC3 artificial intelligence 15806 9865
blockchain 12130 3590
digital economy 6118 1669
digital transformation 8834 2956
digital twin 6667 2519
multimodal data 4918 2724
wearable device 9881 4351
Figure 3. Heat map of research directions and keywords related to Health Metaverse

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(1) Knowledge perspective

The knowledge perspective aims to explore the domain knowledge basis needed to support the
building of Health Metaverse. Because medical information standards play an essential role in medical
informatics, we identify existing use of medical information standards and their required modifications
to fulfill user needs of the Health Metaverse by analyzing bibliometric data. Keywords from relevant
publications and other publicly available sources are used.
(2) Digitization perspective

A series of keywords related to the digitization perspective is used to identify the characteristics of
participants in the Health Metaverse. Digital forms in the Health Metaverse include stakeholder roles
like virtual patients, doctors, managers, and other medical professionals. Multimodal information is also
leveraged to perform comprehensive establishing of avatars in the Metaverse. This perspective focuses
on studying the influences of digitization on Metaverse users.
(3) Socialization perspective

With publications related to social networks and platforms, the research framework of building social
networks between users in the Health Metaverse is also proposed. We firstly identify a series of research
directions related to the socialization perspectives. Then, we summarize the existing applications in the
Health Metaverse. Finally, a comparison of relationships between the traditional social platforms and the
Metaverse platform are conducted.
(4) Intelligence perspective

We firstly conduct a comparison between traditional clinical decision support and decision support
in the Health Metaverse. Then, the advantages and disadvantages of AI in the Health Metaverse are
presented. Application scenes in the Health Metaverse are also identified to facilitate the novel use of AI
in the medical and health field. Finally, we discuss how to build connections between real-world users
and AI-based avatars in Health Metaverse.
2.5 Analysis and visualization tools

A series of analysis and visualization tools are used to perform a bibliometric analysis based on the
collected data. The citation analysis tool from the online Web of Science database is used to obtain raw
publication data and basic statistics of the selected publication data. Then, VOSViewer (Van Eck &
Waltman, 2011) is used to visualize search results and examine critical information and trends of the
retrieved bibliometric data on the development of Metaverse-related studies in the medical and health
field. With the extensive use of other tools like CiteSpace (Chen, Ibekwe-San, Juan & Hou, 2010) and
our developing Python package (biblio-laws), a series of metrics to measure characteristics of publication
data are also used to identify trends of research topics in-depth.
3. Results
Based on existing research and bibliometric data, this section systematically expounds building of

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Health Metaverse, including its conceptual definition, research framework, and existing application,
which provides a reference for medical and health industry transformation to Health Metaverse.
3.1 Conceptual definition

The most representative definition of Metaverse is that the Metaverse is a virtual world parallel to
and independent of the real world. Metaverse is also considered as an online virtual world that mirrors
the real world. These two connected worlds bring more convenience to our lives (Hendaoui, Limayem
& Thompson, 2008). Metaverse is having a huge transformative effect in the field of shopping, medical
education, entertainment, social governance, and other fields. Figure 4 shows the trends of numbers of
publications and citations in 22 years. There is a small increase in number of publications between 2007
and 2012 while the number starts to increase since 2020 dramatically. Meanwhile, the yearly number of
citations has started to increase since 2017 while keeping relatively stable since 2014 substantially.
90 60
80 Number of publications
50
Number of publications
70 Number of citations
Number of citations
60 40
50
30
40
30 20
20
10
10
0 0
1995 2000 2005 2010 2015 2020 2025
Publication year
Figure 4. Time trend analysis of numbers of publications and citations related to Metaverse
The Metaverse concept at present has inspired people to incorporate various medical and health
services into the Metaverse ecosystem. Furthermore, Health Metaverse accelerates innovation in the
medical and health field. Solutions involving VR and AR technologies improve patient experience and
medical outcomes. Even simple medical procedures, such as intravenous injections and blood draws, can
benefit from technology like projecting human vein maps onto the skin (Wolitzky, et al., 2005). Many
medical companies invest billions of dollars in deciphering the AR and VR technology, allowing better
and more personalized drug delivery, and possibly even imitating physical presence, which is one of the
main limitations of the current telemedicine model. According to GrandView Research3, the global AR
market size is $17.67 billion in 2020. The numbers of researches since 2020 on technologies such as
digital health, online health communities, telemedicine, AR, and MR have dropped slightly. Metaverse-
related research has begun to develop, although this is very early-stage research.
Traditionally, medicine is considered a relationship between people. A patient firstly talks to a doctor
about their condition. The doctor then determines the symptoms based on various physiological
information of the patient, including emotional response, physical response, clinical data, etc. Finally,
the doctor makes the best treatment plan for the patient. With the development of big data and AI
3 Augmented Reality Market Size & Share Report, 2021-2028: https://www.grandviewresearch.com/industry-

analysis/augmented-reality-market

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technology, modern society has transformed everyone into a digital citizen to a certain extent. Before the
outbreak of the COVID-19 pandemic, people have tried to use digital medical and health technology to
solve personal health-related problems. The global pandemic has exacerbated this trend and promoted
medical services, wearable devices, and telemedicine services. The development of medical information
technology in the Metaverse is no longer limited to a specific medical institution or government agency.
Meanwhile, the giant leaps in technological development transform existing medical information
technology into a comprehensive Health Metaverse economic ecosystem.
The key to constructing the Health Metaverse lies in computer science, telecommunications
technology, medical and health services, and computational biology. The fields of behavioral science,
psychology, and education are also key research fields of Health Metaverse, innovating in pain
management, surgery, medical training, virtual fitness, telemedicine, and virtual patient communities.
However, challenges from technology (exchangeability, mobility), human elements (skills, resistance,
distrust), laws and regulations, and other factors remain.
Therefore, the Health Metaverse is a virtual medical and health community parallel to the real world
but independent of the real world. It is a virtual world based on authoritative knowledge in the medical
field and multimodal medical information fusion, which aims to promote multimodal intelligent medical
informatics applications. Compared with the broader conceptual definition of Metaverse, we define the
concept of Health Metaverse as knowledge, digitization, socialization, and intelligence perspectives.
Interoperability is a keyword in digital healthcare, because, in a larger space, all service providers and
stakeholders increasingly need to share portable and compatible data across systems, institutions,
platforms, and countries. Unlike today’s cumbersome online health tools, the next-generation virtual
health services based on Health Metaverse make users feel that they are in a more immersive human
interactive experience environment established on AR, VR, MR, and other virtualization technologies.
3.2 Research framework

Building a Health Metaverse requires not only existing Metaverse supporting technologies, such as
remote communication technology, VR hardware, etc., but also crucial knowledge and technologies in
the medical and health field as a foundation to professional community for virtual professional roles such
as patients and medical professionals. This section proposes a research framework based on findings
from bibliometric data in this paper, focusing on the innovative research directions of medical informatics
and promising uses in the Health Metaverse. The research framework of the Health Metaverse expounds
on four perspectives, namely, knowledge, socialization, digitization, and intelligence.
Figure 5 shows a comparison of keyword distributions based on Zipf’s Law (Wyllys, 1981) over
three research categories. The high-frequent keywords are highlighted in the subfigures, respectively.
The application of Zipf’s Law allows us to perform information tracking on the research direction of a
subject area. According to the figure, the research about keywords such as virtual world, second life,
avatar, and virtual reality is dominant in the subject area of Metaverse. Research about rehabilitation,
health, simulation, stroke, exercise, disorders, virtual patient and head injury is prevalent in the Health
Metaverse. Concerning the Metaverse perspective, main research directions include wearable,
accelerometer, sensors, activity recognition, biomedical monitoring, and mobile handsets. The results in
the figure identified high-quality keywords about our research topics. More detailed cluster topics are
summarized, which is shown in Table S1 in Supplementary Material.

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(a) Metaverse
(b) Metaverse in healthcare
(c) Metaverse perspectives

Figure 5. Zipf distribution of keywords related to Metaverse
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Table 4 shows the estimated parameters of Brookes’ equation (Brookes, 1968) followed by
Bradford’s Law (Bradford, 1948; Vickery, 1948) in different keyword-based research areas. First, we
estimate 𝑅(𝑛) = α𝑛β , 1 ≤ 𝑛 < 𝑐 and then 𝑅(𝑛) = 𝐾ln(𝑛/𝑆)), 𝑐 ≤ 𝑛 ≤ 𝑁 where n is the journal rank
number, N is the total number of journals, and the rest are parameters. A larger value of S in the table
indicates the greater scope of research related to corresponding keywords. The α in the table suggests the
numbers of relevant papers in high-rank journals. The research in medical information standards, social
networks, and blockchain has a relatively more significant value of S, implying that the research fields
cover a greater scope compared to others. The results in the table provide us with a quantitative estimation
of the trend and maturity of research area development in this bibliometric analysis.
Table 4. Estimated parameters of Brookes’ equation based on Bradford’s law

Total
Keyword of research field α β S K
year
medical artificial intelligence 1349.363 0.2823 0.0408 423.3698 12
medical information standards 55.23 0.54 5.3986 175.1293 7
social network 54.1218 0.5261 2.596 109.5951 12
virtual reality and health 849.172 0.2489 0.0098 203.9388 12
artificial intelligence 1523.286 0.3675 0 106.6891 22
blockchain 391 0.4612 7.7721 902.5541 6
digital economy 833.4573 0.2479 0.0165 212.5017 22
digital transformation 1092.483 0.277 0.0269 340.6141 21
digital twin 754.9213 0.2761 0.0673 253.5018 18
multimodal data 854.0836 0.2106 0.0004 133.4508 22
wearable device 1603.496 0.254 0.0012 295.2175 22
The Lotka’s Law (Lotka, 1926) is used to examine the scientific productivity of keyword-related
research areas. The method quantitatively estimates relationships between publications and authors by
fitting the equation lnf(x)+aln(x)=lnC, where x represents the number of papers, f(x) represents the
number of authors who published x papers, and the rest are parameters. The parameter a is a measure of
imbalance in the distribution of authors of scientific papers. Smaller a represents a large and a higher
degree of scientific research cooperation. Table 5 suggests that research about blockchain-related
research has higher degree of scientific research cooperation. Larger values of a indicate that the
publications are highly related to the fields of technology, society, and humanities science.
Table 5. Estimated parameters related to relationships between author and paper numbers using Lotka’s
law.
Keywords a C
medical artificial intelligence 3.72 0.91
medical information standards 4.36 0.94
social network 4.33 0.94
virtual reality and health 3.67 0.90
artificial intelligence 3.69 0.90
blockchain 2.77 0.80
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digital economy 4.08 0.93

digital transformation 3.37 0.88
digital twin 3.27 0.87
multimodal data 3.48 0.89
wearable device 3.29 0.88
metaverse 3.27 0.88
3.2.1 Medical information standards: Knowledge perspective

The foundation of medical informatics application is expert knowledge-based medical information
standards. Medical information standards have played a considerable role in the sharing, exchange, and
integrating medical information in the past. Typical medical information standard applications include
medical text analysis, laboratory test result coding, and medical image standardization, promoting more
accurate clinical decision support systems, as shown in the overlay visualization of their publications
(please see Figure S1 in Supplementary Material). Medical information standards to encode medical text
include the International Classification of Diseases (ICD) (Chen, Zhang, Zhao & Feng, 2019),
Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) (Lee, de Keizer, Lau & Cornet,
2014), and the Unified Medical Language System (UMLS) (Amos, Anderson, Brody, Ripple &
Humphreys, 2020) and so on. For example, more than 100 countries currently use the ICD as a disease
classification standard and report the coded patient data to World Health Organization. ICD-coded patient
medical records allow global disease monitoring, statistics, data sharing, reimbursement billing, and
annual appropriation plans. SNOMED CT plays a vital role in coding electronic health records in its
many member states. The core of the Health Metaverse is to virtualize and visualize all kinds of medical
knowledge and services. This process is also inseparable from medical information standards as a basis.
Otherwise, various contents generated by users in the Metaverse lack medical factual basis of the natural
world, challenging to meet target user needs in a secured virtual world.
The revision and upgrade of existing medical information standards driven by multimodal data
context promotes the innovative development of medical information applications. For example,
traditional electronic medical records use ICD codes and narrative texts to describe the patient’s condition.
Free medical text analysis based on NLP is more difficult for ordinary users to understand. Patients can
interact with an avatar constructed based on patient data in a three-dimensional environment. They can
view disease development, obtain visual diagnosis, make treatment prediction results, and clarify the
intuitive impact of different treatment options on the patient's body. Medical VR applications based on
patient conditions require high-precision multimodal medical information standards. For example,
disease coding will no longer use text encoding like ICD codes, but use three-dimensional virtual entities
to precisely describe each type of information (Sébastien, Conruyt, Courdier & Tanzi, 2009). However,
a significant problem in constructing these virtual entities is that multimodal medical information is
difficult to process and standardize (Baltrušaitis, Ahuja & Morency, 2018). Various medical and health
services have been built in the Health Metaverse should consider building multimodal medical
information standards based on existing mature and authoritative medical information standards. Using
AR and VR technology, the Health Metaverse must involve the fusion and flow of multimodal medical
information. We need to ensure the integrity and authority of medical knowledge in this process for the
credibility of Health Metaverse. For example, proposing multimodal medical information standards in
the three-dimensional environment can describe various disease entities of the Health Metaverse from
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multi-dimensions and multimodal perspectives. Therefore, traditional medical information standards

need to be gradually developed into multimodal ones to thoroughly verify and maintain knowledge
appearing in the Health Metaverse, and ensure the flow of knowledge and information in the Health
Metaverse that complies with medical technical specifications.
Applying the Health Metaverse’s medical information standards can also promote medical education.
For example, Health Metaverse can simulate medical environment and conduct a medical training for
medical students to reduce error risks in an actual environment. Some existing gamified medical training
courses also need to use medical information standards. The development of the medical simulation game
Vulabo emphasizes the necessity of introducing Metaverse in medical training (Ning, et al., 2021).
However, many professors are concerned about whether the Vulabo service complies with medical
guidelines, whether learning design and evaluation tools are thoroughly verified, and are hesitant to
introduce it. Most skilled medical professionals are over 50 years of age and not digital natives, making
it challenging to follow the literacy for using the Health Metaverse. Therefore, new technologies in
clinical care and measure effectiveness are essential to improve learning effects and satisfaction through
software feedback rather than hardware feedback in the Health Metaverse. Knowledge in medical and
healthcare domain is one of the main characteristics of the Health Metaverse.
3.2.2 Medical and social data fusion: Socialization perspective

The Health Metaverse connects medical and health stakeholders with virtualization technology to
create an efficient virtual multimodal world. Traditional social networks digitize the roles of participants
such as doctors, patients, and service providers, and integrate all users with existing social relationships
by integrating multimodal data from users, where various Health Metaverse applications are created on
this basis as shown in the overlay visualization of their publications (please see Figure S2 in
Supplementary Material). In the Health Metaverse, user relationships allow the management of internal
employees in medical institutions. For example, virtual hospitals can embody the avatar roles of doctors,
patients, nurses, and managers in the existing administrative level system.
The socialization of the Health Metaverse elevates interaction between medical staff and patients to
a new level. Traditional doctors communicate with patients in offline hospitals or online medical
communities, but these interactions are often inefficient. For example, in areas with inadequate medical
resources, patients need a longer waiting time to access high-quality medical resources. At the same time,
existing online health communities are also difficult for patients to effectively communicate with remote
doctors in real-time, which is often limited to text messaging or voice communication (Chen, Zhang,
Feng & Liu, 2020). Obviously, Health Metaverse provides a virtualized community that allows patients
to communicate with doctors face-to-face. The community uses VR technology to visualize disease data
and treatment plans during the communication process, improving the quality of medical care services
and the efficiency of doctor-patient communication (Zhao, Liu, Qiu & Luo, 2020). The Metaverse’s
wearable devices transmit patient data and reconstruct them into three-dimensional virtual entities for
medical professionals to review. In the Health Metaverse, doctors’ AI virtual entities should be widely
used to interact with patients, instead of requiring doctors to be online 24 hours a day.
In addition to the socialization of medical services, Metaverse applications related to personal health
are gradually socialized and virtualized. For example, the current sports training app builds an online
training community by sharing users' training results, which is a typical personal health social application.
In the Health Metaverse, virtual users can gather remotely, perform healthy exercises with other users,
and share their exercise results in a virtual environment, which is more visual and compelling. People
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can enjoy the thrill of playing with other people at home. Personal health entertainment and socialization
are a very promising development direction of Health Metaverse, which also reflects its advantages in
personal health exercise. The Health Metaverse-based personal exercise is no longer limited to sports
performance. Furthermore, multimodal information from the patient’s body is collected and analyzed to
provide users with a more comprehensive evaluation of personal health conditions, rather than just
roughly estimating the effect of exercise by a simple equation.
The advantage of Metaverse is interaction and socialization, also having these characteristics in the
Health Metaverse. The characteristics of socialization can also be applied to medical training. The most
significant advantage of Metaverse is to generate interaction between participants, which is different
from the existing one-way education. In medical education, the Metaverse will be used for simulation
training, not just for simple knowledge transfer. Metaverse is more effective in areas like medical training
that require advanced hand skills and interaction. It is also essential to develop VR devices with good
hand skills in surgical operations. Therefore, we can use wearable hardware or tracking technology to
build a multimodal and interactive Health Metaverse.
3.2.3 Telemedicine and online health management: Digitalization Perspective
Telemedicine and online health management are also critical applications of Health Metaverse.
Compared with socialization openness, they emphasize Health Metaverse privacy in the management of
personal diagnosis and treatment data. Figure 6 shows overlay visualization of publications related to the
digitalization perspective of Health Metaverse in the past five years, where VR is it keyword. In the
figure, main keywords from the digitalization perspective are identified, such as VR, mental health,
education, rehabilitation, and physical activity. The keywords are found most related to research about
stress, anxiety, pain, depression, obesity, and stroke.
Figure 6. Overlay visualization of publications related to the digitalization perspective of Health

Metaverse
The interaction between doctors and patients in telemedicine is generally conducted in a private and
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safe environment (Chen, Chen and Cui, 2019). In the Metaverse, telemedicine can establish a virtual
environment for doctors and patients to communicate, accompanied by three-dimensional VR technology
and AR technology, to show patients personal health conditions with intuitive visualization technology,
such as showing the virtual body effects before and after treatment or drug use. Therefore, existing online
health communities can realize the transition to the Health Metaverse and build a Metaverse-based virtual
interactive platform for doctors and patients. There has been the creation of a Metaverse platform that
uses medical devices. Facebook is already developing smart glasses and its famous Oculus Quest 2
headset, which costs about $299, both of which may soon become an essential part like mobile phones
or smart watches in the Metaverse. If the connected devices become an essential part for daily human
experience and their price is reduced, the critical potential applications in the medical and health field
will occur, such as remote monitoring of patients in need of intensive care, better research on clinical
outcome data, collection and tracking multimodal health information.
If the user satisfaction and the apparent effects of Health Metaverse are retrospectively confirmed,
daily users would like to open their health data for personal health management in the Metaverse. For
example, patients with chronic diseases or mental illnesses can slowly improve their health condition in
the Metaverse by reducing 38% anxiety and avoidant symptoms over six weeks, according to a study. It
inevitably derives necessary digital elements, such as virtual currency, personal credit evaluation, etc.
Existing work from tech companies focuses on games, entertainment and e-commerce, and is inseparable
from calculation of commercial benefits. However, the value system of Health Metaverse should not be
limited to virtual currency. How to construct an evaluation manifestation that reflects the value inside
Health Metaverse, such as using honor, professionalism, and social contribution as measurement value,
should be considered. Establishing a Health Metaverse value system is necessary for constructing a
sustainable, effective and healthy virtual world for healthcare.
The early-stage development of Metaverse is still limited to the construction of virtual worlds and
the application of VR technology. Metaverse is the comprehensive integration, connection, and
reorganization of various Internet-related technologies, achieving the ultimate version of the future
Internet. The decentralized expansion of reality is an essential focus of advancing building Metaverse.
Traditional tech giants in the Internet are critical builders of the Metaverse's ecosystem. The immutability
and interoperability provided by blockchain are also essential (Ryskeldiev, Ochiai, Cohen & Herder,
2018). The Metaverse transmits information to the real-world through audio, image, video, text and other
channels, and the real world transmits information to the Metaverse mainly through prediction.
Metaverse can also be used in future library services. The library's service targets in the Metaverse
include new readers such as robots and digital people that combine AI technology and biological gene
technology and roam between virtual and reality. The relationship between social activities and even the
rules of modern civilization will face enormous challenges. Digital asset management in Metaverse
provides convenience and freedom for participants' interactive operations through multivariate clustering,
resource indexing, knowledge reorganization, publishing, and sharing. It faces many ethical challenges.
We cannot achieve the digital transformation into the Metaverse overnight. Even if the existing
Metaverse technology is still incomplete, there should be no restrictions on applying new technologies
to various medical and health informatics applications in the early stage because too many regulations
may stifle the innovation in Metaverse.
3.2.4 Medical artificial intelligence: Intelligence Perspective

Although Metaverse is still in its infancy, it has enormous potential in the upgrading and improving
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medical information technology, integrating AI, VR, AR, medical Internet of Things, Web 3.0, edge and
quantum computing, and robotics, and other technologies. Critical application scenarios of Health
Metaverse are clinical decision support in hospitals and pervasive distributed medical AI.
Clinical decision support in Health Metaverse should focus on disease diagnosis and treatment, ICU
monitoring, and operating room surgery as shown in the overlay visualization of their publications
(please see Figure S3 in Supplementary Material). Extended reality technology has been used in more
than 15,000 surgical procedures. This research has gone through several stages, such as expert knowledge
base, machine learning, deep learning, and reinforcement learning in the past. Health Metaverse
promotes further innovation and development of state-of-art clinical decision support. Meta-Learning
(Hospedales, Antoniou, Micaelli & Storkey, 2020), as the current more advanced AI methodology, holds
the key to build a successful Health Metaverse. In Health Metaverse, doctors can communicate with
patients through Health Metaverse remotely and convert patient health information into digital virtual
entities, explaining patients’ condition and treatment compared to patients' or their relatives in time. The
Health Metaverse can also be used for multimodal information monitoring and virtual entity construction
of ICU patients by converting biological signals from medical devices into digital form. It allows doctors
and nurses to monitor the real-time state of the patient’s body while also allowing people who cannot be
physically active to interact with their families and friends to break through the limitations of the physical
world. Regarding discussion among medical experts, the experts can gather to demonstrate patient
condition progress to assist doctors in decision-making.
Building large-scale distributed medical AI in the Metaverse effectively promotes the innovation of
clinical decision support at present. Patient data such as the user's voice, actions, clinical data, and patient
physiological signals captured by various devices is multimodal. The multimodal patient data can also
provide a rich source of data for medical AI. Therefore, various virtual entities built-in medical AI entities
provide users with critical medical and health decision-making capabilities based on multimodal user
data and domain knowledge (Arroyo, Serradilla & Calvo, 2009). Many kinds of research at present
mainly focus on medical AI-based decision-making models with a single source and modality (Xu, et al.,
2019). These single-modal AI models are decentralized and unable to update dynamically. In the
Metaverse, all constructed medical decision support models are being dynamically updated and gradually
form a collaborative decision-making mechanism. Therefore, Metaverse should not be limited to virtual
user communication. On the contrary, it provides a virtual world of self-awareness, learning and
collaboration for all kinds of AI entities and ultimately promotes the intelligentization of the Health
Metaverse.
The Health Metaverse is not only the fusion of virtual and physical worlds in human life and work
but also a virtual environment where medical AI can develop independently and work with humans. It
can also provide people with a highly brilliant, knowledgeable and immersive AI decision-making
environment to improve people’s happiness in life; on the other hand, the Health Metaverse is a swarm
intelligence virtual space, where various medical AI entities is able to self-development and improvement
in a three-dimensional environment are conducive to overcoming some significant global medical and
health decision-making difficulties and serving all humanity.
3.3 Health Metaverse applications

The Metaverse is still in the early stage of concept formation with almost no mature application at
present (Duan, Li, Fan, Lin, Wu & Cai, 2021). Our summary results of existing Metaverse-related
applications are illustrated in Table S2 in the Supplementary Material. A study in the Business Research
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company shows that AR in the global healthcare market is expected to reach $4.15 billion by 2025,
compared to $1.42 billion in 2021. Metaverse evolution may be staged among technology giants in the
following decades or even longer. However, medical informatics can benefit from joining the Metaverse
and even enters a practical stage earlier than Metaverse itself.
Metaverse integration includes the integration of the digital and the physical worlds, the integration
of digital and real economies, the integration of digital and social life, the integration of digital and real
identities, and the integration of digital with physical assets. It includes high-speed communication
networks, the Internet of Things, AR, VR, cloud computing, edge computing, blockchain, AI, and other
technology. First of all, technology is a driving factor that promotes the transition from the current
Internet to Metaverse. Therefore, it contains eight fundamental technologies: extended reality, user
interaction (human-computer interaction), AI, blockchain, computer vision, Internet of Things and
robotics, edge and cloud computing, and future mobile networks (Lee et al., 2021). There is still a big
gap to achieve Metaverse transformation in the medical and health field. Existing platforms are still far
from an ideal Health Metaverse, requiring the efforts of all parties. There are a lot of papers on keywords
such as telemedicine, VR, AR, digital health, etc. However, there are little related literature on the
Metaverse.
Figure 7 shows a comparison of built exponential models for numbers of publications among Health
Metaverse topics. The results in the figure indicate that medical AI entities and VR-related research has
increasingly been necessary while the research about social network and medical information has smaller
increase rate. Figure 8 also examines the built exponential models for predicting the number of
publications with different keywords related to four perspectives of Health Metaverse. Blockchain and
AI-related research dramatically increase while other keywords-related research has a relatively more
minor increase.
Figure 7. Comparison of built exponential models for numbers of publications among Health
Metaverse topic keywords
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Figure 8. Comparison of built exponential models for numbers of publications among Health
Metaverse perspective keywords
The Metaverse is not an entirely new concept. On the contrary, existing technologies are the basis for
shaping Metaverse-related concepts, such as VR, AR, MR, etc. Davis et al. proposed a conceptual model
of Metaverse research, including Metaverse itself, characters/avatars, technical capabilities, behaviors,
and outcomes, which can study the practical problems of virtual teams in the Metaverse (Davis, Murphy,
Owens, Khazanchi & Zigurs, 2009). Many companies have invested heavily in the research and
development of Metaverse-related technologies in the past. According to a report, Meta has spent more
than $10 billion to develop Metaverse technologies in 2021, including VR hardware, social VR
applications like Horizon, etc. Epic used 9 billion dollars on Fortnite in 2018 and 2019, respectively. Its
Unreal Engine is the foundation of many AR and VR application experiences. Apple has also invested
heavily in AR hardware to promote the development of its App Store. There is currently no clear
architecture definition for Metaverse, which also brings up the question of whether existing architecture
can meet the requirements of running the Metaverse (Nevelsteen, 2018). Technology giants are striving
to develop related technology and strive to be the gatekeeper of Metaverse. Existing mobile application
stores, such as Google’s Google Play Store and Apple’s App Store, may become the biggest winners of
Metaverse. Technology giants use their massive apps to integrate Metaverse, effectively promoting
Metaverse development. However, Metaverse is considered to be similar to the Internet, with freedom
and openness characteristics. Tech giants controlling the growth of Metaverse face challenge of dealing
with various privacy issues. In terms of government management, the city of Seoul becomes the world's
first major government to announce its entry into Metaverse by investing $3.3 million to develop its
Metaverse platform by the end of 2022. When fully operational by 2026, the Metaverse platform will
host various public functions, including a virtual mayor’s office, a space for the commercial sector, a
financial technology incubator, and public investment institutions. The platforms often rely on the
feedback of user-generated content. For example, studies such as Kumar have found that the Metaverse
built by Second Life can continue to support more users, interaction types and authenticity, and promote
the rapid development of shared immersive experiences (Kumar, et al., 2008; Park, Kim & Whang, 2021).
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(1) Surgical procedure based on AR technology

In addition to providing virtualized training scenarios for medical students, Health Metaverse can
also offer highly realistic virtual environments for remote online doctors in real surgical procedures
(Desselle, Brown, James, Midwinter, Powell & Woodruff, 2020). For a long time, successfully avoiding
complicated human structures to locate lesions has been a major difficulty in traditional surgery. If there
is realistic simulation teaching or precise guidance before surgical procedure, the simulation reduces
actual operating risk as much as possible. At present, many surgical operating rooms have adopted
advanced surgical robots, such as the first Da Vinci robot in 1997. Doctors can operate on patients by
remotely operating surgical robots. Utilizing Health Metaverse can further provide doctors with an
immersive scene, allowing doctors to enter virtual patient’s body during the operation and perform high-
precision operating on subtle parts of the body's organs (Penza, Soriero, Barresi, Pertile, Scabini &
Mattos, 2020). The development of Health Metaverse further improves surgery accuracy and complex
surgery flexibility. Therefore, Health Metaverse may also become the first training testbed for the next
generation of surgical robots. Through AI, surgical robots learns how to perform operations on the human
body.
(2) Socialization and gamification of medical and healthcare services

Currently, the applications of the Metaverse are primarily derived from social and gaming platforms.
As platforms like Roblox, which now has 37 million unique daily users and is available in 180 countries,
change people's perceptions of gamification of services, more and more users are looking for ways to
collaborate and connect with other users. Now anyone can imagine, create or have fun with friends
through such a platform. However, gamification is mainly limited to health management and fitness
applications in the medical and health field at present. For example, AR technology can introduce virtual
coaches and more brilliant exercise methods to people. In the future, Health Metaverse connects
stakeholders, such as doctors, patients, administrators, and governments, where user relationships are
virtualized and gamified (Aulisio, Han & Glueck, 2020). Medical stakeholders use medically meaningful
virtual images, 3D models, MR, spatial environment and other asset categories together with their
metadata to form secure and encrypted content packages used to construct Health Metaverse.
(3) Dynamic monitoring of personal health management and sports training

Health Metaverse-related technologies can also improve patients' health management capabilities in
many places. For example, VR technology can help improve the quality of life of patients with dementia.
Then it allows patients with chronic diseases such as diabetes and hypertension to continuously improve
their health. The technology also allows bedridden patients to virtually visit different world attractions
and set up other scenes to help patients retrieve old memories or improve mood (Anderson & Molloy,
2020). During surgery, the preoperative and postoperative evaluation of patients can also benefit from
the Health Metaverse by importing patient multimodal data into the hospital’s Metaverse. The Health
Metaverse constructs digital patients and optimizes surgical procedures with more personalized
interventions result. In personal health management, exercise training and diet control are also the
applications giving full play to Health Metaverse capabilities.
(4) Novel use of VR and AR technology in medical education

Medical professionals and teachers is using VR technology to train medical students. Medical
professionals is also able to learn in the human body to obtain a 360-degree view of disease to simulate
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the real-world disease progress. Medical schools at present have also begun incorporating AR technology
into medical training courses to provide students with valuable practical learning opportunities. AR
programs are used to simulate surgical conditions, enabling medical students to see an actual situation
and practice new techniques. In addition, combined with hospital equipment information, immersive
experience in a virtual world allows students to replay the experience of actual operation as if they were
a surgeon themselves (Dedillia, Sotiropoulos, Hanrahan, Janga, Dedeilias & Sideris, 2020). During
patient operations, the Health Metaverse platform can also provide medical students with various
suggestions and domain knowledge to reduce error risks in actual operations.
4. Discussion
In the larger space of the Health Metaverse, all medical and health service providers and stakeholders
need to increasingly share portable and compatible data across systems, institutions, platforms, and
countries. The promotion and application of Healthy Metaverse create future opportunities and also face
many challenges.
4.1 Problems and challenges

According to past experience, the medical and health industry generally has slow progress in
accepting, promoting, and implementing emerging information technology. Every time a new technology
is introduced, the technology impact on patients will be assessed carefully. The challenges may involve
multiple aspects, such as technology (interoperability, portability, stakeholder customization), human
factors (skills, resistance, distrust, cyber-attacks), legislation, and regulation.
In the future, the problems and challenges facing the Health Metaverse include:
(1) Existing online platforms need further upgrades to meet virtual user needs.
The global COVID-19 pandemic has essentially promoted the innovative development of digital and
mobile health, but the authority and effectiveness of these platforms are still worth exploring. Unlike the
existing platforms like Mayo Clinic, Epic, and Optum, the Health Metaverse platforms should be
regarded as extraordinarily usable and capable of achieving extensive interoperability. It can widely
accept the access of various virtual entities including individuals and companies. Meanwhile, medical
professionals and medical institutions participate in the Metaverse. Not everyone should be allowed to
create their diagnosis and treatment standards because ordinary users may lack clinical knowledge in the
Metaverse. Existing online platforms are still unable to integrate medical knowledge into the decision-
making of platform users.
(2) Gamification and entertainment of health-related services have adverse effects.

Gamification of serious health-related services sometimes produces a medical ethics crisis. Its social
consequences may be severe and even endanger the life and health of patients. Many people still consider
Metaverse a platform for fast and immersive learning based on games, but this understanding is
dangerous (Getchell, Oliver, Miller & Allison, 2010). We cannot simply let game companies or social
companies create, define and maintain critical Health Metaverse content. For example, Roblox is a VR
platform compatible with virtual worlds, casual games, and user-generated content, which looks very
close to the concept of Metaverse. However, the entertainment characteristics of the platform are not
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suitable for the Health Metaverse. It needs to be further reformed and supervised. Health Metaverse is
established based on user-generated content that should be professional and authoritative to avoid
misinformation. Like existing online health community’s effectiveness evaluation strategies, we have to
investigate the virtual three-dimensional experience post-diagnosis evaluation mechanism with doctors
and patients from one-to-one or one-to-many interactions in the Metaverse.
(3) Concerns about user privacy, safety, and personalization issues remain.
The promising applications of Health Metaverse significantly change the way of medical practice.
However, building the Metaverse in the early stage needs to consider protecting user privacy, physical
and psychological safety. The Metaverse with massively connected devices and people inevitably to have
significant loopholes in security, raising a question of what supervisory measures can ensure proper moral
restraint (Blobel, 2020; Kim et al., 2019). The technology stack of Health Metaverse also shows the risks
and difficulties of maintaining a system that cannot be compromised by hackers. Such risks threaten the
personalized nature of the doctor-patient relationship. Early rapid promotion of the Metaverse may be
able to obtain great benefits. With the passage of time, supervision, and implementation, Metaverse will
eventually serve doctors and patients better. The data of current citizens are collected and processed by
multiple companies for commercial purposes, such as leveraging big data of personal information to
benefit at present. Avoiding the situation in the future is a question that needs to be considered.
(4) Pushing people to escape reality results in various social consequences.

Being immersed in a complete virtual world for a long time, people may face highly realistic virtual
scenes from advertisements, television, gambling, pornography, etc., that change people’s thinking. It
further promotes people's willingness to escape their reality. The rapid development of the mobile
Internet in the past decades exposes the problems of data rights, data security, radicalization,
misinformation, and platform abuse. Excessive use of digital technology on users produces various
mental health problems, such as physical symptoms, depression, paranoid beliefs, and severe mental
illness. Considering that most people currently rely heavily on mobile devices such as mobile phones
and tablets, people who are more fully engaged in the Metaverse may mean more isolation, suicide,
mental health distress, poor physical health, etc. Pesce (2021) believes that public policies should be
followed up in time to support technological innovation that maintains the sustainability of the Health
Metaverse, rather than pushing people to enter the virtual worlds further to escape from reality.
(5) Censorship and regulation contradict equality and freedom of the Metaverse.
Metaverse is currently mainly promoted by certain technology giants such as Facebook, Microsoft,
and so on. At the time when Metaverse is ready, people inevitably accept all kinds of censorship and
become victims of all sorts of commercial interests. Zhou et al. found that the design of the Metaverse
business model is more biased towards platform owners, thereby weakening other competitors, which is
often not conducive to the sustainable development of the platform (Zhou, Leenders & Cong, 2018). The
Metaverse was initially conceived as a place where people face reality without experiencing reality,
trying to create a world to replace the real world. Metaverse uses its technology and massive user
advantages to take the lead in developing its Metaverse platform all over the world, raising concerns
about data security, sovereignty, privacy, and ethics. These problems are particularly prominent in the
Health Metaverse containing massive multimodal and sensitive medical and health data. Similar to online
health communities, the related technologies in the Health Metaverse over time will gradually become a
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safe, reliable and patient-centric environment to effectively serve the needs of patients. However, the
social price that needs to be paid in this process is worth addressing in the future.
4.2 Future
The recent COVID-19 pandemic has sharply highlighted global population vulnerability in medical
and health management. The building of Metaverse based on advanced information technologies such as
big data, cloud computing, 5G communication, AI, and VR provides innovative solutions to global
problems. A study4 in 2021 suggested that 40% of the world’s total population remain unable to have
access to the Internet. It may take decades or even longer to fully implement the Metaverse application
in science-fiction. However, a Health Metaverse based on existing technology may occur earlier than the
Metaverse. All aspects of the global medical health ecosystem require profound digital transformation
and subversion in terms of process, workflow, practice, and delivery methods in the medical and health
field. The realization of the Health Metaverse provides such a foundation.
In the future, Health Metaverse needs to further consolidate essential technologies and applications
from the following four aspects:
(1) Promoting essential technology research and development of Health Metaverse

The digital, virtual, and hyper-connected Health Metaverse relies on a mixture of existing and new
technologies (Ning, et al., 2021). In this platform, VR, AR, and MR technologies are combined with the
Internet of Things, blockchain, 5G, and even low-latency space-based internet, robots, AI, cloud
computing, edge computing, and quantum computing. Integrated into the process of disease prevention,
diagnosis, and treatment in the medical and health field, technology-driven innovation will quickly
promote the development of a Health Metaverse.
(2) Pushing transformation of medical and health-related service providers

Health Metaverse adopts new personalized digital identities, avatars, and smart cities for healthcare.
In addition, medical payment, medical insurance, medical data governance, medical privacy, and security
must also be transformed and adapted to the needs of the Metaverse society. Industrial revolution
experience in the past has shown that the process of the transition into a Health Metaverse-driven
ecosystem is slow. Its initial stage is a mixed medical education, consultation process, and hospital care.
Company decision-makers should set up plans to encourage employees to learn new Metaverse
technologies and prepare for Metaverse transformation of their workforces (Muntaner, 2018).
(3) Establishing digital economic value system of Health Metaverse

Many medical and health services have already turned to digital solutions. Soto-Acosta (2020) found
that the COVID-19 pandemic has intensified this digital transformation trend. Due to epidemic
prevention and control, we often have to accept these online medical and health services by providing
sensitive personal information. When online users have become more and more confident in remote
consultation and many digital and remote services offered by data, personal devices, and wearable
devices, a comprehensive Health Metaverse ecosystem is established. Health Metaverse has the functions
of data interconnection, digital twins, simplified providers, and payment methods to provide patients
4Global digital population as of January 2021: https://www.statista.com/statistics/617136/digital-population-

worldwide/
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with more authentic consultation, personalized care, treatment, and diagnosis. The Roblox platform
currently has its digital currency with real-world value. Promoting and accepting innovations and
technologies, a digital value-exchange system will be gradually formed in the Health Metaverse.
(4) Changing social governance and health concepts in the Health Metaverse
The Metaverse is a new concept that brings many dimensions of fresh thinking to the public. Because
large tech giants combine different VR and immersive experience aspects, this primarily affects all
aspects of the medical and health industry that is good at maintaining traditions. The public and
government decision makers will further discuss the challenges and potential applications of Health
Metaverse. These discussions are not only limited to data privacy and business models but how to get
along with automated medical AI entities, how to prevent people from using Health Metaverse to escape
reality, and other major social issues in a highly virtualized and intelligent environment.
5. Conclusions
We conduct a bibliometric analysis to examine the Metaverse development in the field of medical
and health field by analyzing over 34 thousand relevant papers in 22 years from the Web of Science
database. Based on our results, we clarify the conceptual definition, research framework, application,
challenges, and future research directions of the Health Metaverse. We believe that Health Metaverse
should be a highly safe, effective, and professional medical and health service ecosystem based on the
Metaverse, which has characteristics of knowledge, socialization, digitalization, and intelligence
perspectives. Stakeholders in the medical and health industry, such as doctors, patients, ordinary people,
government decision-makers, and other roles, will benefit from Health Metaverse. The Health Metaverse
application can promote innovative medical education, surgery, medical treatment, and online health
management. However, the Health Metaverse also has problems and challenges such as difficulty in
protecting patient privacy, data security, gamification of services, impact on users' mental health,
monopoly of technology giants, and reliability of medical AI. Technological innovation and regulatory
supervision are required. The proposed concept and framework of Health Metaverse redefines the
practice of traditional medical informatics and promotes the transformation of social governance and
public thinking in the medicine and healthcare field.
Author contributions
Chen Donghua: Conceptualization, Data curation, Methodology; Writing - original draft. Zhang
Runtong: Funding acquisition; Investigation; Supervision; Writing - review & editing.
Acknowledgements
This work was supported in part by the Fundamental Research Funds for the Central Universities in
UIBE with grant numbers 20QD22 and CXTD12-04, and National Natural Science Foundation of China
with grant numbers 62102087 and 62173025.
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Statement on conflicts of interest

The authors have no competing interests to declare.
Supplementary Materials
Table S1. Cluster topic analysis in different keyword-related papers
Table S2. Early platform, technology and application of the Health Metaverse
Figure S1. Overlay visualization of publications related to the knowledge perspective of Health
Metaverse
Figure S2. Overlay visualization of publications related to the socialization perspective of Health
Metaverse
Figure S3. Overlay visualization of publications related to the intelligence perspective of Health
Metaverse
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Supplementary Material
Table S1. Cluster topic analysis in different keyword-related papers
Number of
Keywords papers in cluster topics
cluster
237 artificial intelligence methodology
218 e-commerce
213 clinical decision support
148 data mining and software
artificial intelligence
97 healthcare improvement
31 medicine
31 expert systems
25 environment
314 bitcoin
189 communication and networks
blockchain
168 privacy and security
108 smart life
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87 telemedicine
62 business applications
50 internet of things
17 industry 4.0
3 5G networks
1 lightning network
1 cyberattack
55 competence
47 product development
44 digital trade
35 sharing economy
31 knowledge economy
29 business models
digital economy
27 economic security
26 industry 4.0
21 smart city
19 education
11 fintech
12 component
153 online platform
116 smart city
68 intelligent health
65 supply chain management
61 smart factory
digital transformation
56 business intelligence
49 service innovation
37 smart contract
17 public administration
16 entrepreneurship
123 process control
73 industry 4.0
49 virtual reality
47 cyber physical systems
39 fault-diagnosis
38 product design
digital twin
27 virtual factory
25 decision support systems
16 quality control
17 industrial robots
11 process optimization
1 industrial internet
68 emotion recognition
multimodal data
57 artificial intelligence models
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44 healthcare decision making

41 medical image analysis
40 biomedical signal processing
39 image fusion
25 face recognition
20 action recognition
20 telemedicine
6 health management
179 hardware technology
145 mobile device
118 sensors
103 telemedicine
101 face recognition
wearable device
85 medical devices
68 health monitoring
27 stress detection
16 diseases
15 activity monitory
Table S2. Early platform, technology and application of the Health Metaverse
Types Company/Product Description
Microsoft's mixed reality platform makes digital life similar to
Microsoft Mesh
real life, teaching, learning and completing tasks remotely.
As a social giant, Meta claimed to focus on development of the
Meta (Facebook)
Metaverse in the future.
An online game developed by Epic Games, with many similar
Platform Fornight
elements of the Metaverse.
Online video game company that helps create unique
Roblox
experiences in an increasingly digital world.
It is an American video game and software development
Epic Games
company that developed Unreal Engine (Unreal Engine).
NVIDIA NVIDIA studied the use of GPU for radioactive image
Omniverse recognition and aimed to transform the medical industry.
In addition to being a cross-platform 2D and 3D game engine,
UNITY it is also widely used as a creative tool for interactive content
Software
such as architectural visualization and real-time 3D animation.
A global leader in design and manufacturing technology, its
AUTODESK software is also used to build virtual worlds for games and
entertainment.
Meta's VR equipment company provides Oculus Rift as a
Oculus
realistic VR head-mounted display.
Hardware
This is a research project of Facebook Reality Labs, which aims
Project Aria
to develop wearable devices.
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It aims to achieve augmented reality by mapping the light field

Magic Leap
to the retina.
A robotic system that provides robot-assisted surgery for
Da Vinci system
patients in the operating room.
It applies VR technology immersion and gamification strategies
MedRoom to create a health education experience for universities and
educational institutions.
Learners can experience improved clinical performance,
Vulabo improved clinical reasoning, improved critical thinking, and
simulate interactive digital patient system.
It enhances medical procedures, diagnosis, treatment, and
Veyond
expands global access through our proprietary cloud platform to
Metaverse
save patients' lives and improve the standard of care.
It uses growing potential of technology and big data to establish
Mayo Clinic
connections that were previously difficult to achieve and to
Platform
innovate in new ways to have a global impact.
It provides proprietary software development kits, APIs and
AmWell system integration that enable customers to embed telemedicine
into existing workflows used by providers and patients.
It focuses on the five capabilities of data and analysis, pharmacy
Optum care services, population health, healthcare services and
healthcare operations.
Applications The platform converts 2D medical images into 3D spatial
ImmersiveTouch
models to enhance surgical planning, training and collaboration.
It improves the attention of children aged 8-12 with ADHD
EndeavorRX
through immersive video game therapy.
The platform hires the world's best mental health clinicians and
Rey translates their methods into user-friendly automated digital
treatments.
The use of VR exposure therapy aims to relieve post-traumatic
Therapeutic VR
stress.
The development of XVision allows surgeons to see the patient’s
Augmedics anatomy through the skin and tissues as if they had “X-ray
vision”.
It designs a medical imaging solution that allows medical staff
AccuVein to view the peripheral vein map on the skin surface and improve
the venipuncture and vascular access procedures.
It solves the shortcomings of traditional 2D courses through
GigXR
cutting-edge immersive teaching and training solutions.
It is a virtual clinic where caring clinicians and advanced
XRHealth
technology are combined to help you feel your best.
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Figure S1. Overlay visualization of publications related to the knowledge perspective of Health
Metaverse
Figure S2. Overlay visualization of publications related to the socialization perspective of Health
Metaverse
31

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Figure S3. Overlay visualization of publications related to the intelligence perspective of Health
Metaverse
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Exploring research trends of emerging technologies in

Donghua Chen1 and Runtong Zhang2,*

Electronic copy available at: https://ssrn.com/abstract=3998068

Electronic copy available at: https://ssrn.com/abstract=3998068

2. Materials and Methods

Determine data sources

Metaverse-related Health Metaverse-related Potential keywords-based

Challenges and futures

Figure 1. Flowchart of bibliometric analysis in this study

2.1 Data sources

1 The Health Metaverse project: https://health-metaverse.github.io

Electronic copy available at: https://ssrn.com/abstract=3998068

Table 1. Summary of search keywords used in the Web of Science database

Figure 2. Analysis of Metaverse-related keywords of publications in the past two decades

2 Online Health Metaverse-related sources we collected: https://github.com/dhchenx/health-metaverse

Electronic copy available at: https://ssrn.com/abstract=3998068

2.2 Time trend analysis

2.3 Keyword analysis

2.4 Topic analysis from different perspectives

Electronic copy available at: https://ssrn.com/abstract=3998068

Electronic copy available at: https://ssrn.com/abstract=3998068

(1) Knowledge perspective

(2) Digitization perspective

(3) Socialization perspective

(4) Intelligence perspective

2.5 Analysis and visualization tools

Electronic copy available at: https://ssrn.com/abstract=3998068

3.1 Conceptual definition

3 Augmented Reality Market Size & Share Report, 2021-2028: https://www.grandviewresearch.com/industry-

Electronic copy available at: https://ssrn.com/abstract=3998068

3.2 Research framework

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(b) Metaverse in healthcare

(c) Metaverse perspectives

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Table 4. Estimated parameters of Brookes’ equation based on Bradford’s law

Electronic copy available at: https://ssrn.com/abstract=3998068

digital economy 4.08 0.93

3.2.1 Medical information standards: Knowledge perspective

Electronic copy available at: https://ssrn.com/abstract=3998068

multi-dimensions and multimodal perspectives. Therefore, traditional medical information standards

3.2.2 Medical and social data fusion: Socialization perspective

Electronic copy available at: https://ssrn.com/abstract=3998068

3.2.3 Telemedicine and online health management: Digitalization Perspective

Figure 6. Overlay visualization of publications related to the digitalization perspective of Health

Electronic copy available at: https://ssrn.com/abstract=3998068

3.2.4 Medical artificial intelligence: Intelligence Perspective

Electronic copy available at: https://ssrn.com/abstract=3998068

3.3 Health Metaverse applications

Electronic copy available at: https://ssrn.com/abstract=3998068

Electronic copy available at: https://ssrn.com/abstract=3998068

Electronic copy available at: https://ssrn.com/abstract=3998068

(1) Surgical procedure based on AR technology

(2) Socialization and gamification of medical and healthcare services

(3) Dynamic monitoring of personal health management and sports training

(4) Novel use of VR and AR technology in medical education

Electronic copy available at: https://ssrn.com/abstract=3998068

4.1 Problems and challenges

(2) Gamification and entertainment of health-related services have adverse effects.

Electronic copy available at: https://ssrn.com/abstract=3998068

(4) Pushing people to escape reality results in various social consequences.