Using digital twins in health care to stave off the grim reaper

VentureBeat caught up with NTT Research Medical & Health Informatics Lab director Dr. Joe Alexander, who elaborated on his view of the future of “bio digital twins,” which promise to improve precision medicine and bring digital transformation to the health care industry.

Japanese telecom giant NTT has launched a major initiative to improve digital health through precision medicine using digital twin technology. This project is part of NTT Research, a new R&D hub focused on basic research. The goal is to address long-term technological challenges with solutions that, once achieved, can positively impact wider ranges of businesses and many parts of our lives. These projects are not tied to specific product roll-out plans but could lead to much more significant long-term improvements than conventional incremental research conducted by enterprises.

The why behind the digital twin application

VentureBeat: What exactly is medical and health informatics — where does it fit into the landscape of other enterprise medical software like EHRs, diagnostics, telemedicine, and research?

Dr. Joe Alexander: Medical informatics is the sub-discipline of health informatics that directly impacts the patient-physician relationship. It focuses on the information technology that enables the effective collection of data using technology tools to develop medical knowledge and to facilitate the delivery of patient medical care. The goal of medical informatics is to ensure access to critical patient medical information at the precise time and place it is needed to make medical decisions. Medical informatics also focuses on the management of medical data for research and education.

The acquisition, storage, retrieval, and use of health care information to foster better collaboration among a patient’s various health care providers is the study of health informatics. It plays a critical role in the push toward health care reform. Health informatics is an evolving specialization that links information technology, communications, and health care to improve the quality and safety of patient care. EHRs help providers better manage care for patients and are an important part of health informatics.

Telemedicine has more to do with the access and sharing of medical information for the purpose of treating patients remotely. The term “diagnostics” can be applied to any process or device that involves techniques for (medical) diagnoses.

One current area of research that is of particular interest to our team is precision cardiology. This includes the cardiovascular bio digital twin as well as heart-on-a-chip technologies.

Research at MEI Labs does not currently target EHR software development or telemedicine per se. Our work does support remote monitoring, diagnostics, and advanced therapeutics.

VentureBeat: What is the bio digital twin initiative, and how do you plan to advance it?

Alexander: A bio digital twin is an up-to-date virtual representation (an electronic replica) which provides real-time insights into the status of a real-world asset to enable better management and to inform decision-making. This concept has been applied to the preventive maintenance of jet engines and may be applied as well to the predictive maintenance of health.

The Bio Digital Twin (BioDT) initiative aims to individualize and revolutionize health care by use of BioDT technologies. We will first realize precision cardiology on multiple scales through development of a cardiovascular BioDT (CV BioDT) and heart-on-a-chip platforms. The CV BioDT is at the whole organ physiological system level, whereas the heart-on-a-chip is at a microfluidics level, making use of an individual’s stem cells to make in vitro organs.

For the CV BioDT, we will begin with acute conditions (acute myocardial infarction and acute heart failure) and progress to chronic cardiovascular conditions and their co-morbidities and complications. The latter requires heavy dependence on organ systems other than the heart. Ultimately, based on our accumulating knowledge of underlying physiological and pathophysiological mechanisms (together with advanced sensing technologies), we will be able to move into wellness and prevention.

Can digital twins in health care save a life?

VentureBeat: What is the value of a digital twin, and how does it build upon other technologies for capturing and managing medical data or simulating things?

Alexander: We expect that our bio digital twin will best enable individualized care. By reproducing an individual’s entire physiology based on causal mechanisms, we should be able to predict health issues as well as provide recommendations for therapies in complex patients through “what if” scenario testing.

Autonomous therapies — delivered by the bio digital twin — become possible, where the physician would simply monitor autonomous devices. Virtual clinical trials in populations of bio digital twins also become feasible and would dramatically accelerate drug (or vaccine) development.

What we are proposing is not evolutionary, but revolutionary. An ambitious project of this scope and scale will take time. We will certainly need continuously to inventory the evolving trajectories of clinical and technology landscapes for facilitatory impact points.

VentureBeat: Why did you decide to start with the heart, and how will this complement other, similar efforts?

Alexander: We started with cardiovascular disease because it is the global leading cause of death. One of the principal missions of NTT Research is to provide long-term benefits to humanity; this is fundamental to deciding what projects to pursue.

Our immediate cardiovascular disease targets will be acute myocardial infarction (AMI) and acute heart failure (acute HF). We will pursue chronic heart failure and other conditions afterwards.

VentureBeat: What’s next in digital twins and why?

Alexander: Following development of the CV BioDT, our next pursuit will be neurodegenerative diseases, e.g., Alzheimer’s disease and Parkinson’s disease. Our reasoning here is similar: neurodegenerative diseases are the 2nd leading cause of death, at least in the U.S.

Organs on a chip

VentureBeat: What kinds of things are you working on with nano and microscale sensors and electrodes?

Alexander: MEI Lab is developing “organ-on-a-chip” microfluidics platforms as well as three-dimensionally transformable and implantable electrodes. This work involves the exploration and examination of new materials that include nanofibers and nanofiber-based paper electrodes.

VentureBeat: Which ones show the most promise in the short term and possibility in the long term?

Alexander: This is a difficult question for me to answer since I am not directly involved in the research. However, all our targets tend to be long term. Based on current progress, microscale three-dimensionally transformable electrodes for sensing are more promising in the shorter term, followed by similar types of electrodes for both stimulating and sensing. Organ-on-a-chip platforms will likely mature in the longer term.

VentureBeat: What are some of the key developments in digital biomarkers, wearable technologies, and remote sensing you are exploring?

Alexander: While we are in an ongoing background process of doing a clinical and technical landscape inventory of such devices, we have not yet developed a strategy within the MEI Lab to point us in any particular directions. Our focus right now is on acute conditions where patients are hospitalized and well-instrumented for access to the directly observable data necessary for early model building, verification, and validation.