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, yet translating these innovations into clinical practice remains challenging. This thesis investigates how a Digital Health Sandbox can be designed and implemented to support the transition from promising ideas towards clinical implementation. Following a Design Science Research-inspired approach, the work combines literature studies, triple-helix collaborations, and iterative implementation work.
The research began with a protocol and subsequent scoping review of Internet of Medical Things (IoMT) platforms for home and prehospital care (Papers A–B), revealing a heterogeneous landscape of technologies and standards, with limited support for higher levels of interoperability. A study of health information system procurement (Paper C) identified six recurring challenges in specifying interoperability requirements. Together with challenges encountered during practical implementation and AI integration work (Papers E–F), and emerging regulatory requirements, these findings revealed the need for a controlled testing environment. Together, these findings informed the development of a testing environment (Paper D and G).
Building on this work, the central contribution of this thesis is the design and implementation of Virtuality – Virtual Care Process Simulator, a process-oriented simulation environment built around a modular and interoperable architecture. The architecture combines a Scenario Engine for configuring simulations with reusable Building Blocks representing data providers, services, and user-facing applications (consumers). Through standardized interfaces, explicit data contracts, and validation mechanisms, these components can be connected into executable simulation pipelines that represent complex healthcare processes. Virtuality's separation of build-time and run-time environments supports both the creation and execution of simulation scenarios.
The architecture's applicability was explored through two healthcare use cases involving AI-based trauma triage and stroke assessment. Together, these contributions establish a foundation for testing digital health innovations before clinical deployment, with the potential to support safer AI integration, greater end-user involvement, and ultimately better patient care.
The research began with a protocol and subsequent scoping review of Internet of Medical Things (IoMT) platforms for home and prehospital care (Papers A–B), revealing a heterogeneous landscape of technologies and standards, with limited support for higher levels of interoperability. A study of health information system procurement (Paper C) identified six recurring challenges in specifying interoperability requirements. Together with challenges encountered during practical implementation and AI integration work (Papers E–F), and emerging regulatory requirements, these findings revealed the need for a controlled testing environment. Together, these findings informed the development of a testing environment (Paper D and G).
Building on this work, the central contribution of this thesis is the design and implementation of Virtuality – Virtual Care Process Simulator, a process-oriented simulation environment built around a modular and interoperable architecture. The architecture combines a Scenario Engine for configuring simulations with reusable Building Blocks representing data providers, services, and user-facing applications (consumers). Through standardized interfaces, explicit data contracts, and validation mechanisms, these components can be connected into executable simulation pipelines that represent complex healthcare processes. Virtuality's separation of build-time and run-time environments supports both the creation and execution of simulation scenarios.
The architecture's applicability was explored through two healthcare use cases involving AI-based trauma triage and stroke assessment. Together, these contributions establish a foundation for testing digital health innovations before clinical deployment, with the potential to support safer AI integration, greater end-user involvement, and ultimately better patient care.
Clinical Decision Support
Simulation Environment
Artificial Intelligence
Medical Informatics
Digital Health Sandbox
Healthcare Interoperability
HL7 FHIR
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
Technologies for Interoperable Internet of Medical Things Platforms to Manage Medical Emergencies in Home and Prehospital Care: Protocol for a Scoping Review
JMIR Research Protocols,;Vol. 11(2022)
Review article
Technologies for Interoperable Internet of Medical Things Platforms to Manage Medical Emergencies in Home and Prehospital Care: Scoping Review
Journal of Medical Internet Research,;Vol. 27(2025)
Review article
Reviewing Challenges in Specifying Interoperability Requirement in Procurement of Health Information Systems
Studies in Health Technology and Informatics,;Vol. 310(2024)p. 8-12
Journal article
Introducing Virtuality - Virtual Care Process Simulator: A Concept Utilizing Synthetic Data and a Digital Health Sandbox for Care Process Simulations
Proceedings of the 18th International Joint Conference on Biomedical Engineering Systems and Technologies,;Vol. 1(2026)p. 1127-1135
Paper in proceeding
FHIR Data Mapping Quality Assessment: A Scoping Review and Suggested Requirements for Future Pre-Mapping Frameworks – Mattias Seth, Fanny Apelgren, Anna Bakidou, Peter Lundgren, Hans Blomberg, Bengt Arne Sjöqvist, Stefan Candefjord
Introducing FHIR Mapping Assessment and Performance Score (F-MAPS) – A Pre-Mapping Quality Assessment Tool – Mattias Seth, Fanny Apelgren, Anna Bakidou, Peter Lundgren, Hans Blomberg, Bengt Arne Sjöqvist, Stefan Candefjord
From Concept to Implementation: Design and Architecture of Virtuality — A Virtual Care Process Simulation Environment – Mattias Seth, Fanny Apelgren, Anna Bakidou, Peter Lundgren, Hans Blomberg, Bengt Arne Sjöqvist, Stefan Candefjord
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 – Virtual 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 – Virtual 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 – Virtual 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 – Virtual 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