Virtuality – From Idea to Practical Use: A Simulation Environment for Interoperable and Artificial Intelligence-Enabled Healthcare Processes
Doctoral thesis, 2026
Healthcare is increasingly dependent on digital innovations. At the same time, introducing new digital solutions into healthcare is difficult. To be useful in practice, these innovations must be able to interoperate with legacy systems, fit into existing healthcare workflows, and function under realistic clinical and organizational conditions.
This thesis investigates how a Digital Health Sandbox can be designed and implemented to support the transition from prototype to clinically relevant digital health innovation. However, the research did not begin with the ambition of developing a sandbox. Instead, it originated from the development of an interoperable Internet of Medical Things (IoMT) solution for home healthcare. As the work progressed, practical challenges related to interoperability, limited access to healthcare data and systems, dependence on third-party platforms, and the lack of realistic testing environments repeatedly emerged. These experiences gradually shifted the research towards the need for a dedicated testing environment.
Following a Design Science Research-inspired approach, the research combined literature studies, practical implementation work, interdisciplinary research projects, and iterative prototype development. This resulted in Virtuality-Care Process Simulator for simulating, testing, and evaluating interoperable digital health innovations. Together with architectural principles for Digital Health Sandboxes and methods supporting healthcare interoperability, the work demonstrates the potential of a comprehensive simulation environment, while providing practical illustrations of how future Digital Health Sandboxes can be designed, developed, and applied.
This thesis investigates how a Digital Health Sandbox can be designed and implemented to support the transition from prototype to clinically relevant digital health innovation. However, the research did not begin with the ambition of developing a sandbox. Instead, it originated from the development of an interoperable Internet of Medical Things (IoMT) solution for home healthcare. As the work progressed, practical challenges related to interoperability, limited access to healthcare data and systems, dependence on third-party platforms, and the lack of realistic testing environments repeatedly emerged. These experiences gradually shifted the research towards the need for a dedicated testing environment.
Following a Design Science Research-inspired approach, the research combined literature studies, practical implementation work, interdisciplinary research projects, and iterative prototype development. This resulted in Virtuality-Care Process Simulator for simulating, testing, and evaluating interoperable digital health innovations. Together with architectural principles for Digital Health Sandboxes and methods supporting healthcare interoperability, the work demonstrates the potential of a comprehensive simulation environment, while providing practical illustrations of how future Digital Health Sandboxes can be designed, developed, and applied.
Healthcare Interoperability
Digital Health Sandbox
HL7 FHIR
Simulation Environment
Medical Informatics
Clinical Decision Support
Artificial Intelligence
EC, Hörsalsvägen 11
Opponent: Associate Professor Laura-Maria Peltonen, Department of Health and Social Management, University of Eastern Finland, and Wellbeing Services County of North Savo, Kuopio
Author
Mattias Seth
Chalmers, Electrical Engineering, Signal Processing and Biomedical Engineering
Föreställ dig att du kommer på en briljant idé som skulle kunna förbättra hälso- och sjukvården och potentiellt hjälpa miljontals patienter.
Det finns bara ett problem.
Hur omvandlar du den idén till något som hälso- och sjukvården faktiskt kan använda?
Tyvärr räcker det inte med revolutionerande teknisk funktionalitet. Din idé måste också passa in i kliniska arbetsflöden, uppfylla regulatoriska krav och organisatoriska riktlinjer samt accepteras av de människor som faktiskt ska använda den. Det är långt ifrån enkelt. Som ett resultat misslyckas många implementerings- och utvecklingsinitiativ inom hälso- och sjukvården.
Ett sätt att öka möjligheterna till en framgångsrik implementering är att använda kontrollerade testmiljöer, så kallade sandlådor. Där kan nya idéer utvecklas och testas på ett säkert sätt utan att patienter utsätts för onödiga risker. Många befintliga sandlådor hanterar dock endast delar av de utmaningar som beskrivits ovan.
Därför presenterar denna avhandling Virtuality – Care Process Simulator, en omfattande simuleringsmiljö som har utvecklats under flera års forskning, regulatoriska drivkrafter, tvärvetenskapligt samarbete, praktiskt implementeringsarbete och projektresultat inom forskargruppen Care@Distance vid Chalmers tekniska högskola.
Även om Virtuality fortfarande är under utveckling visar arbetet i denna avhandling hur Virtuality kan stödja en mer systematisk testning och validering av digitala innovationer inom hälso- och sjukvården.
Ambitionen är enkel: att hjälpa lovande idéer att ta sig bortom prototypstadiet och ett steg närmare en framgångsrik klinisk implementering.
Det finns bara ett problem.
Hur omvandlar du den idén till något som hälso- och sjukvården faktiskt kan använda?
Tyvärr räcker det inte med revolutionerande teknisk funktionalitet. Din idé måste också passa in i kliniska arbetsflöden, uppfylla regulatoriska krav och organisatoriska riktlinjer samt accepteras av de människor som faktiskt ska använda den. Det är långt ifrån enkelt. Som ett resultat misslyckas många implementerings- och utvecklingsinitiativ inom hälso- och sjukvården.
Ett sätt att öka möjligheterna till en framgångsrik implementering är att använda kontrollerade testmiljöer, så kallade sandlådor. Där kan nya idéer utvecklas och testas på ett säkert sätt utan att patienter utsätts för onödiga risker. Många befintliga sandlådor hanterar dock endast delar av de utmaningar som beskrivits ovan.
Därför presenterar denna avhandling Virtuality – Care Process Simulator, en omfattande simuleringsmiljö som har utvecklats under flera års forskning, regulatoriska drivkrafter, tvärvetenskapligt samarbete, praktiskt implementeringsarbete och projektresultat inom forskargruppen Care@Distance vid Chalmers tekniska högskola.
Även om Virtuality fortfarande är under utveckling visar arbetet i denna avhandling hur Virtuality kan stödja en mer systematisk testning och validering av digitala innovationer inom hälso- och sjukvården.
Ambitionen är enkel: att hjälpa lovande idéer att ta sig bortom prototypstadiet och ett steg närmare en framgångsrik klinisk implementering.
Imagine you come up with a brilliant idea that could improve healthcare and potentially help millions of patients.
There is just one problem.
How do you turn that idea into something healthcare can actually use?
Unfortunately, revolutionary technical functionality alone is not enough. Your idea must also fit into clinical workflows, comply with regulations and organizational policies, and be accepted by the people who will use it. This is not trivial. As a result, many implementation and development initiatives in healthcare fail.
One way to maximize the chances of successful implementation is through controlled testing environments, known as sandboxes. These allow digital innovations to be safely developed and tested without exposing patients to unnecessary risks. However, many existing sandboxes support only parts of the challenges described above.
Therefore, this thesis presents Virtuality – Care Process Simulator, a comprehensive simulation environment that has evolved through several years of research, regulatory drivers, interdisciplinary collaboration, practical implementation work, and project outcomes within the Care@Distance research group at Chalmers University of Technology.
Although Virtuality is still under development, the work presented in this thesis demonstrates how Virtuality can support more systematic testing and validation of digital health innovations.
The ambition is simple: to help promising ideas move beyond the prototype stage and one step closer to successful clinical implementation.
There is just one problem.
How do you turn that idea into something healthcare can actually use?
Unfortunately, revolutionary technical functionality alone is not enough. Your idea must also fit into clinical workflows, comply with regulations and organizational policies, and be accepted by the people who will use it. This is not trivial. As a result, many implementation and development initiatives in healthcare fail.
One way to maximize the chances of successful implementation is through controlled testing environments, known as sandboxes. These allow digital innovations to be safely developed and tested without exposing patients to unnecessary risks. However, many existing sandboxes support only parts of the challenges described above.
Therefore, this thesis presents Virtuality – Care Process Simulator, a comprehensive simulation environment that has evolved through several years of research, regulatory drivers, interdisciplinary collaboration, practical implementation work, and project outcomes within the Care@Distance research group at Chalmers University of Technology.
Although Virtuality is still under development, the work presented in this thesis demonstrates how Virtuality can support more systematic testing and validation of digital health innovations.
The ambition is simple: to help promising ideas move beyond the prototype stage and one step closer to successful clinical implementation.
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Subject Categories (SSIF 2025)
Medical Modelling and Simulation
Information Systems, Social aspects
Computer Sciences
Medical Informatics Engineering
Information Systems
Areas of Advance
Information and Communication Technology
Health Engineering
Driving Forces
Innovation and entrepreneurship
DOI
10.63959/chalmers.dt/5938
ISBN
978-91-8103-481-3
Doktorsavhandlingar vid Chalmers tekniska högskola. Ny serie: 5938
Publisher
Chalmers
EC, Hörsalsvägen 11
Opponent: Associate Professor Laura-Maria Peltonen, Department of Health and Social Management, University of Eastern Finland, and Wellbeing Services County of North Savo, Kuopio