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Review
. 2022 Oct 31;24(10):e39698.
doi: 10.2196/39698.

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

David Drummond  1   2   3 , Adrien Coulet  2   4
Affiliations
Review

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

David Drummond et al. J Med Internet Res. .

Abstract

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

Keywords: artificial intelligence; child; children; chronic disease; cyber-physical; data collection; digital health; digital medicine; digital twin; eHealth; ethical; ethics; law; legal; medical cyber-physical systems; medical system; monitor; paediatric; paediatrician; pediatrician; pediatrics; personalized; privacy; sensor; young people; youth.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Digital twin systems (DTS) for children and young people with chronic diseases: (A) sensors transform the child's "physical" information into "cyber" or digital data to adapt care, either by a health care professional or autonomously; (B) first example of DTS in childhood, which analyzes the heart rhythm in real time and autonomously delivers electric shocks; (C) more complex DTS, associating continuous monitoring of blood glucose, software adapting the insulin dose, and an insulin pump to deliver this dose; (D) may emerge in the near future for childhood diseases, such as asthma, requiring monitoring of many different determinants, machine learning techniques, and provision of recommendations to different actors (eg, children and their parents, teachers, and health care professionals).
Figure 2
Figure 2
Potential benefits and risks of pediatric digital twin systems (DTS) at the individual level, which require a specific premarket assessment that takes into account not only the health impacts but also the impact of DTS on the child’s physical, mental, or social development. AI: artificial intelligence; PROM: patient-reported outcome measure.
Figure 3
Figure 3
Risks of pediatric digital twin systems (DTS) at the societal level.
Figure 4
Figure 4
Impact of digital twin systems in pediatrics at different levels and links between the different values. Green arrows indicate a positive impact, and red arrows indicate a negative impact.
Figure 5
Figure 5
Dimensions of digital twin systems for pediatrics, stakeholders involved, and stakeholders’ roles during the development and evaluation phases. AI: artificial intelligence; RCT: randomized controlled trial.
See this image and copyright information in PMC

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