Digital Twin Governance: IoT-Driven Real-Time Regulatory Auditing in Smart Hospital Architectures

In this paper, we attribute a new framework of Digital Twin Governance (DTG) where regulatory auditing is conducted in the same manner as in Smart hospital with the help of IoT and edge technologies used to be a reality in real time. Old healthcare audit systems are retrograde and mix up with exhibiting lack of ability to intercept the contravention of policy at an early enough stage thus causing a threat of damage and nonconformance. This gap will be occupied by our contribution that allows marrying digital twin models with explainability engines, powered by AI, rule engines to drive the workflow guiding the compliance with regulatory requirements, and blockchain logging where the most critical services in secure administration are offered. DTG was implemented in a designed mimicked smart hospital structure in which more than 5,000 virtual patients and various IoMT gadgets were utilized along with edge-cloud orchestration. Empirical findings confirmed that there was reduction in breach detection latency as the value arrived at 83 minutes to 0.32 minutes, and time of auditor review also reduced that is 17 minutes to 3.4 minutes per incident. The predictive audit based on an ensemble model distinguished a compliance violation rate at the rate of 95.4% within the abilities of an ensemble model outperforming the rates of a baseline model such as XGBoost or MLP. In the range of scale-out hospital workloads, the system revealed sub-60ms latencies regarding alerts. The above findings demonstrate that DTG is plausible and effective as far as offering proactive, elastic, and transparent audit is concerned. The architecture not only automates compliance activities but it also increases the trust between the stakeholders since the audit trail is blockchain anchored. The paper ends by providing architectural details, measures of scalability, and implications of governance should be adopted in implementing the digital twin-led auditing system in the healthcare sector in a real-life scenario.