Evaluating CFIR 2.0 in identifying digital twin implementation challenges in healthcare: bridging the dichotomy between engineering and healthcare communities.

Background: Digital twin (DT) technology holds significant promise for healthcare systems (HSs) due to real-time monitoring based on streaming operational data and Methods: This study presents findings from a DT implementation case study in a family medicine clinic, an operational healthcare microsystem. It adopts CFIR 2.0 to guide semi-structured interviews with four key stakeholder groups (e.g., family medicine specialists, engineers, organizational psychologists, and implementation scientists). Participants ( Results: Challenges were grouped into three categories: (i) shared challenges captured by both IS and DT communities, (ii) CFIR 2.0-identified challenges overlooked in DT literature, and (iii) challenges documented in DT research but not captured through CFIR 2.0-guided interviews. While there was strong overlap between the communities, a formidable gap also remains. CFIR 2.0 effectively identified a diverse set of issues-predominantly in organizational, financial, and operational themes-including many overlooked by the DT community. However, it was less effective in capturing technological and data-related barriers critical to DT performance, such as modeling, real-time synchronization, and sensor reliability. Conclusions: CFIR 2.0 effectively identifies organizational and operational barriers to DT implementation in healthcare but falls short in addressing technological and data-related complexities. This study highlights the need for interdisciplinary collaboration for the successful transition of emerging DT technologies into practice to maximize their impact on HS efficiency and patient outcomes.