Detecting Dependability Failures in Healthcare Scenarios via Digital Shadows

In healthcare systems, practitioners are responsible for making decisions when a patient’s health, or even life, are at stake. Real-time data-driven modeling, analysis, and prediction approaches, such as the Digital Shadow (DS) paradigm, inform and support decision-makers in such critical situations. We introduce GENGAR, a DS-based methodology to identify critical scenarios in a patient-device-physician (PDP) triad with human agents and cyber-physical devices interacting under uncertainty. The proposed solution relies on automata-based modeling and formal analysis techniques to predict and inform the practitioner of critical contingencies that may compromise patient safety, enhancing the system’s dependability. In particular, it leverages automata learning to infer and evolve a realistic patient model from clinical logs. GENGAR then exploits mutational and searchbased fuzzing to generate scenarios and detect failure cases, i.e., those violating predefined dependability requirements. Failure scenarios are then filtered using qualitative criteria on clinical plausibility, yielding up to $60 \%$ realistic cases.