Evaluating CFIR 2.0 in Identifying Digital Twin Implementation Challenges in Healthcare: Bridging the Dichotomy between Engineering and Healthcare Communities

Md Doulotuzzaman Xames^1*Taylan G. Topcu¹Sarah H. Parker²Vivian Zagarese²John W. Epling²

• ¹Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, United States
• ²School of Medicine, Virginia Tech Carilion, Roanoke, Virginia, United States

Background: Digital twin (DT) technology holds significant promise for healthcare systems (HSs) due to real-time monitoring based on streaming operational data and a priori analysis capabilities without interrupting clinical workflows. However, the sociotechnical complexity of HSs presents challenges for effective DT implementation. A dichotomy also exists between the engineering and implementation science (IS) communities regarding DT implementation challenges. This study assesses the efficacy of the updated Consolidated Framework for Implementation Research (CFIR 2.0) in identifying DT implementation challenges, aiming to bridge the knowledge gap between IS and DT communities.Methods: This study presents findings from a DT implementation case study in a family medicine clinic, an operational healthcare microsystem. It adopts CFIR 2.0 to guide semi-structured interviews with four key stakeholder groups (e.g., family medicine specialists, engineers, organizational psychologists, and implementation scientists). Participants (N=8) were purposively sampled based on their roles in DT implementation. Thematic coding categorized interview data into seven themes: technological, data-related, financial and economic, regulatory and ethical, organizational, operational, and personnel. Thematic data were then cross-analyzed with challenges documented in DT literature to assess how effectively CFIR 2.0 identifies DT implementation challenges.Results: Challenges were grouped into three categories: (i) shared challenges captured by both IS and DT communities, (ii) CFIR 2.0-identified challenges overlooked in DT literature, and (iii) challenges documented in DT research but not captured through CFIR 2.0-guided interviews.While there was strong overlap between the communities, a formidable gap also remains. CFIR 2.0 effectively identified a diverse set of issues -predominantly in organizational, financial, and operational themes -including many overlooked by the DT community. However, it was less effective in capturing technological and data-related barriers critical to DT performance, such as modeling, real-time synchronization, and sensor reliability.Conclusions: CFIR 2.0 effectively identifies organizational and operational barriers to DT implementation in healthcare but falls short in addressing technological and data-related complexities. This study highlights the need for interdisciplinary collaboration for the successful transition of emerging DT technologies into practice to maximize their impact on HS efficiency and patient outcomes.