Security-by-Design Reference Architecture for Data Governance in Healthcare Digital Twins

Digital Twins (DTs) are increasingly adopted in healthcare to enable real-time patient monitoring, predictive analytics, and decision support. However, their deployment relies on highly distributed and heterogeneous infrastructures, where sensitive medical data are continuously exchanged across multiple components. This raises critical challenges for secure data governance, including the protection of data across its lifecycle, compliance with regulatory frameworks, and interoperability among existing systems. Despite the growing body of research on healthcare DTs, existing approaches lack a systematic integration of security, privacy, and compliance mechanisms within a unified architectural model. In particular, no reference architecture currently addresses security concerns across data in transit, at rest, and in use in a comprehensive and reusable manner. In this paper, we address this gap by proposing a security-by-design reference architecture for data governance in healthcare Digital Twins. The architecture is derived through a combined research-driven and threat-driven methodology, explicitly linking requirements to data lifecycle threats and to relevant standards (e.g., GDPR, HIPAA, ISO). To assess feasibility, we implement a prototype based on a microservices architecture and evaluate it in a representative healthcare scenario. The results show how the proposed solution supports secure data management across data in transit, at rest, and in use, while preserving interoperability and compliance. It can thus be considered as a practical and reusable foundation for secure data governance in healthcare DTs.