A digital twin-enhanced cybersecurity framework for IoT in healthcare: Applications in industry 4.0

Integrating Internet of Things (IoT) technologies in healthcare has significantly enhanced service delivery and also introduced critical cybersecurity vulnerabilities, including ransomware attacks, data tampering, and unauthorised access. To address these challenges, this study proposes a Digital Twin-Enhanced Cybersecurity Framework (DT-CF) tailored for healthcare IoT systems within Industry 4.0 environments. The DT-CF employs real-time digital twins to generate synchronised replicas of physical devices (e.g., smart infusion pumps, wearable sensors), enabling continuous monitoring and predictive anomaly detection through machine learning models. The framework integrates Hyperledger Fabric blockchain and smart contracts to enforce secure access control and ensure data integrity. A conceptual case study, designed to mirror the operational dynamics of a modern healthcare facility, is presented to illustrate the framework’s practical applicability, highlighting its potential to enhance system reliability and support automated threat mitigation. Key contributions include a scalable DT-CF architecture, AI-driven analytics, and a step-by-step implementation guide for deploying context-aware digital twins in clinical environments. By bridging real-time physical–virtual synchronisation with proactive cybersecurity measures, the DT-CF offers a resilient and transparent solution to safeguard sensitive patient data and critical healthcare infrastructure.