e-Health Strategy for Surgical Prioritization: A Methodology Based on Digital Twins and Reinforcement Learning.

This article presents a methodological framework for elective surgery scheduling based on the integration of patient-specific Digital Twins (DTs) and reinforcement learning (RL). The proposed approach aims to support the future development of an intelligent e-health platform for dynamic, data-driven prioritization of surgical patients. We generate prioritization scores by modeling clinical, economic, behavioral, and social variables in real time and optimize access through a reinforcement learning engine designed to maximize long-term system performance. The methodology is designed as a modular, transparent, and interoperable digital decision-support architecture aligned with the goals of organizational transformation and equitable healthcare delivery. To validate its potential, we simulate realistic surgical scheduling scenarios using synthetic patient data. Results demonstrate substantial improvements compared withto traditional strategies, including a 55.1% reduction in average wait time, a 41.9% decrease in clinical risk at surgery, a 16.1% increase in OR utilization, and a significant increase in the prioritization of socially vulnerable patients. These findings highlight the value of the proposed framework as a foundation for future smart healthcare platforms that support transparent, adaptive, and ethically aligned decision-making in surgical scheduling.