Blockchain-enabled digital twin systems in healthcare: a systematic scoping review of architectural integration, privacy, governance, ethical challenges, and regulatory solutions under GDPR and HIPAA.
Abstract
Background and objective: The integration of blockchain and digital twin (DT) technologies is increasingly recognised as a promising approach for improving healthcare data integrity, interoperability, privacy, and clinical decision support. While digital twins enable dynamic patient modelling and predictive healthcare applications, blockchain provides secure data governance through decentralised trust, auditability, and access control. However, existing research remains fragmented, with limited synthesis of the architectural integration, regulatory readiness, ethical governance, and interoperability of blockchain-enabled healthcare digital twin systems. This systematic scoping review addresses these gaps by providing a comprehensive architectural and compliance-oriented analysis of the current evidence.
Methods: A systematic scoping review was conducted following PRISMA 2020 guidelines using Scopus, PubMed, and Web of Science. From 148 identified records, 55 eligible studies published between 2020 and 2025 were included after duplicate removal and eligibility screening. Data were extracted on digital twin functionality, blockchain architecture, healthcare application domains, consensus mechanisms, privacy-preserving strategies, and regulatory and ethical alignment. Structured Python-based visual mapping and comparative analyses were performed to identify architectural, governance, and compliance patterns across the literature.
Results: The findings demonstrate that…
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Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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