A Quantum Edge Federated Graph Transformer for Generative and Causal Digital Twin Healthcare
Received: 4 November 2025 | Revised: 24 November 2025, 11 December 2025, 26 December 2025, 3 January 2026, and 7 January 2026 | Accepted: 9 January 2026 | Online: 4 April 2026
Corresponding author: Gangadhara Rao Kancharla
Abstract
The rapid pace of development in healthcare artificial intelligence requires architectures that transcend predictive analytics to better understand causality and generate simulations of patient trajectories. This study proposes the Quantum Edge Federated Graph Transformer (QFGT), a hybrid quantum-inspired approach aimed at empowering causal, generative, and privacy-preserving digital twin healthcare. The model incorporates quantum kernel attention for complex-amplitude feature embedding, graph transformer reasoning mechanism for relational inference over multimodal clinical entities, and federated optimization for secure multi-institutional learning. Quantum-inspired kernel mappings in Hilbert space encode entangled dependencies between laboratory, imaging, genomic, and clinical text data, while a causal regularization layer constrains learned representations to adhere to interpretable cause-and-effect relations learned from structural causal models. The generative digital-twin module uses a diffusion-based latent simulator that predicts personalized trajectories of the disease, and it supports what-if counterfactual interventions. Federated deployment at the edge healthcare nodes enables model training with data decentralization and strict compliance with HIPAA and GDPR privacy regulations. Experimental work on multimodal clinical data shows an accuracy of 98.1% with a mean early-detection window of 7.9 months and F1-scores >0.98 for all diseases, in addition to an increase in minority-cohort recall of 6.5% via equitable quantum-kernel feature sharing. The proposed QFGT framework opens up a new direction for the quantum-inspired, federated, and causally explainable digital twin systems, which lead to trustworthy, proactive, and personal healthcare intelligence at the quantum edge.
Keywords:
quantum-inspired computing, federated learning, graph transformer networks, causal inference, generative digital twins, explainable healthcare AIDownloads
References
Z. Yang, A. Mitra, W. Liu, D. Berlowitz, and H. Yu, "TransformEHR: Transformer-Based Encoder-Decoder Generative Model to Enhance Prediction of Disease Outcomes Using Electronic Health Records," Nature Communications, vol. 14, no. 1, Nov. 2023, Art. no. 7857. DOI: https://doi.org/10.1038/s41467-023-43715-z
S. Nerella et al., "Transformers in Healthcare: A Survey," 2023.
S. Nerella et al., "Transformers and Large Language Models in Healthcare: A Review," Artificial Intelligence in Medicine, vol. 154, Aug. 2024, Art. no. 102900. DOI: https://doi.org/10.1016/j.artmed.2024.102900
H. Oss Boll et al., "Graph Neural Networks for Clinical Risk Prediction Based on Electronic Health Records: A Survey," Journal of Biomedical Informatics, vol. 151, Mar. 2024, Art. no. 104616. DOI: https://doi.org/10.1016/j.jbi.2024.104616
D. Upreti, E. Yang, H. Kim, and C. Seo, "A Comprehensive Survey on Federated Learning in the Healthcare Area: Concept and Applications," Computer Modeling in Engineering & Sciences, vol. 140, no. 3, pp. 2239–2274, 2024. DOI: https://doi.org/10.32604/cmes.2024.048932
L. Han, "Addressing Distribution Shift for Robust and Trustworthy Prediction and Causal Inference in Clinical AI Settings," JAMA Network Open, vol. 8, no. 6, Jun. 2025, Art. no. e2513705. DOI: https://doi.org/10.1001/jamanetworkopen.2025.13705
A. Mohamed, R. AlAleeli, and K. Shaalan, "Advancing Predictive Healthcare: A Systematic Review of Transformer Models in Electronic Health Records," Computers, vol. 14, no. 4, Apr. 2025, Art. no. 148. DOI: https://doi.org/10.3390/computers14040148
Z. Kraljevic et al., "Foresight—A Generative Pretrained Transformer for Modelling of Patient Timelines Using Electronic Health Records: A Retrospective Modelling Study," The Lancet Digital Health, vol. 6, no. 4, pp. e281–e290, Apr. 2024. DOI: https://doi.org/10.1016/S2589-7500(24)00025-6
K. Dasaradharami Reddy and T. R. Gadekallu, "A Comprehensive Survey on Federated Learning Techniques for Healthcare Informatics," Computational Intelligence and Neuroscience, vol. 2023, no. 1, Jan. 2023, Art. no. 8393990. DOI: https://doi.org/10.1155/2023/8393990
F. Shamshad et al., "Transformers in Medical Imaging: A Survey," Medical Image Analysis, vol. 88, Aug. 2023, Art. no. 102802. DOI: https://doi.org/10.1016/j.media.2023.102802
H. Yuan, S. Zhou, and S. Yu, "EHRDiff: Exploring Realistic EHR Synthesis with Diffusion Models." arXiv, 2023.
A. A. Naseer et al., "ScoEHR: Generating Synthetic Electronic Health Records using Continuous-time Diffusion Models," in Proceedings of the 8th Machine Learning for Healthcare Conference, New York City, NY, USA, Aug. 2023, vol. 219, pp. 1–22.
M. Tian, B. Chen, A. Guo, S. Jiang, and A. R. Zhang, "Reliable Generation of Privacy-Preserving Synthetic Electronic Health Record Time Series via Diffusion Models." arXiv, 2023. DOI: https://doi.org/10.1093/jamia/ocae229
R. Tuwani and A. Beam, "Safe and Reliable Transport of Prediction Models to New Healthcare Settings Without the Need to Collect New Labeled Data." Health Informatics, Dec. 14, 2023. DOI: https://doi.org/10.1101/2023.12.13.23299899
A. N. Angelopoulos and S. Bates, "A Gentle Introduction to Conformal Prediction and Distribution-Free Uncertainty Quantification." arXiv, 2021.
G. Kutiel, R. Cohen, M. Elad, D. Freedman, and E. Rivlin, "Conformal Prediction Masks: Visualizing Uncertainty in Medical Imaging," in Trustworthy Machine Learning for Healthcare, vol. 13932, H. Chen and L. Luo, Eds. Cham: Springer Nature Switzerland, 2023, pp. 163–176. DOI: https://doi.org/10.1007/978-3-031-39539-0_14
Z. L. Teo et al., "Federated Machine Learning in Healthcare: A Systematic Review on Clinical Applications and Technical Architecture," Cell Reports Medicine, vol. 5, no. 2, Feb. 2024, Art. no. 101419. DOI: https://doi.org/10.1016/j.xcrm.2024.101419
N. Rana and H. Marwaha, "Role of Federated Learning in Healthcare Systems: A Survey," Mathematical Foundations of Computing, vol. 7, no. 4, pp. 459–484, 2024. DOI: https://doi.org/10.3934/mfc.2023023
C. H. Lee, K. H. Lim, and S. Eswaran, "A Comprehensive Survey on Secure Healthcare Data Processing with Homomorphic Encryption: Attacks and Defenses," Discover Public Health, vol. 22, no. 1, Apr. 2025, Art. no. 137. DOI: https://doi.org/10.1186/s12982-025-00505-w
Z. He, W. Yang, L. Wu, and Z. Guan, "SecureBadger: A Homomorphic Encryption-based Framework for Secure Medical Inference," Digital Communications and Networks, Aug. 2025, Art. no. S2352864825001312. DOI: https://doi.org/10.1016/j.dcan.2025.08.006
J.-W. Lee et al., "Privacy-Preserving Machine Learning with Fully Homomorphic Encryption for Deep Neural Network," IEEE Access, vol. 10, pp. 30039–30054, 2022. DOI: https://doi.org/10.1109/ACCESS.2022.3159694
A. S. Bhatia and D. E. B. Neira, "Federated Hierarchical Tensor Networks: A Collaborative Learning Quantum AI-Driven Framework for Healthcare." arXiv, 2024.
A. R. C. Araujo, O. D. Okey, M. Saadi, P. Adasme, R. L. Rosa, and D. Z. Rodríguez, "Quantum-assisted federated intelligent diagnosis algorithm with variational training supported by 5G networks," Scientific Reports, vol. 14, no. 1, Nov. 2024, Art. no. 26333. DOI: https://doi.org/10.1038/s41598-024-71826-0
A. S. Bhatia, S. Kais, and M. A. Alam, "Quantum Federated Learning in Healthcare: The Shift from Development to Deployment and from Models to Data," IEEE Journal of Biomedical and Health Informatics, pp. 1–15, 2025. DOI: https://doi.org/10.1109/JBHI.2025.3596156
B. H. Tudor et al., "A Scoping Review of Human Digital Twins in Healthcare Applications and Usage Patterns," npj Digital Medicine, vol. 8, no. 1, Sep. 2025, Art. no. 587. DOI: https://doi.org/10.1038/s41746-025-01910-w
H. Khoshfekr Rudsari et al., "Digital Twins in Healthcare: A Comprehensive Review and Future Directions," Frontiers in Digital Health, vol. 7, Nov. 2025, Art. no. 1633539. DOI: https://doi.org/10.3389/fdgth.2025.1633539
T. R. Oh, "Integrating Predictive Modeling and Causal Inference for Advancing Medical Science," Childhood Kidney Diseases, vol. 28, no. 3, pp. 93–98, Oct. 2024. DOI: https://doi.org/10.3339/ckd.24.018
J. Abécassis, É. Dumas, J. Alberge, and G. Varoquaux, "From Prediction to Prescription: Machine Learning and Causal Inference for the Heterogeneous Treatment Effect," Annual Review of Biomedical Data Science, vol. 8, no. 1, pp. 381–404, Aug. 2025. DOI: https://doi.org/10.1146/annurev-biodatasci-103123-095750
A. Moore, B. Orset, A. Yassaee, B. Irving, and D. Morelli, "HEalthRecordBERT (HERBERT): Leveraging Transformers on Electronic Health Records for Chronic Kidney Disease Risk Stratification," ACM Transactions on Computing for Healthcare, vol. 5, no. 3, pp. 1–18, Jul. 2024. DOI: https://doi.org/10.1145/3665899
R. Rong et al., "A Deep Learning Model for Clinical Outcome Prediction Using Longitudinal Inpatient Electronic Health Records," JAMIA Open, vol. 8, no. 2, Art. no. ooaf026, Mar. 2025. DOI: https://doi.org/10.1093/jamiaopen/ooaf026
H. K. Ibrahim, N. Rokbani, A. Wali, K. Ouahada, H. Chabchoub, and A. M. Alimi, "A Medical Image Classification Model based on Quantum-Inspired Genetic Algorithm," Engineering, Technology & Applied Science Research, vol. 14, no. 5, pp. 16692–16700, Oct. 2024. DOI: https://doi.org/10.48084/etasr.8430
M. Waqas, F. Smarandache, M. Yasir, F. Arslan, and A. Ali, "CViTLNN: A Hybrid Approach Based on Vision Transformer and Liquid Neural Network for COVID-19 Detection," Engineering, Technology & Applied Science Research, vol. 15, no. 3, pp. 23183–23188, Jun. 2025. DOI: https://doi.org/10.48084/etasr.10735
V. Havlíček et al., "Supervised Learning with Quantum-Enhanced Feature Spaces," Nature, vol. 567, no. 7747, pp. 209–212, Mar. 2019. DOI: https://doi.org/10.1038/s41586-019-0980-2
M. Schuld and N. Killoran, "Quantum Machine Learning in Feature Hilbert Spaces," Physical Review Letters, vol. 122, no. 4, Feb. 2019, Art. no. 040504. DOI: https://doi.org/10.1103/PhysRevLett.122.040504
S. Lloyd, M. Schuld, A. Ijaz, J. Izaac, and N. Killoran, "Quantum Embeddings for Machine Learning." arXiv, 2020.
A. E. W. Johnson et al., "MIMIC-IV, A Freely Accessible Electronic Health Record Dataset," Scientific Data, vol. 10, no. 1, Jan. 2023, Art. no. 1. DOI: https://doi.org/10.1038/s41597-022-01899-x
[42] T. J. Pollard, A. E. W. Johnson, J. D. Raffa, L. A. Celi, R. G. Mark, and O. Badawi, "The eICU Collaborative Research Database, A Freely Available Multi-Center Database for Critical Care Research," Scientific Data, vol. 5, no. 1, Sep. 2018, Art. no. 180178. DOI: https://doi.org/10.1038/sdata.2018.178
J. Irvin et al., "CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison," Proceedings of the AAAI Conference on Artificial Intelligence, vol. 33, no. 01, pp. 590–597, Jul. 2019. DOI: https://doi.org/10.1609/aaai.v33i01.3301590
C. Sudlow et al., "UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age," PLOS Medicine, vol. 12, no. 3, Mar. 2015, Art. no. e1001779. DOI: https://doi.org/10.1371/journal.pmed.1001779
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Copyright (c) 2026 Naga Sai Ram Narne, Gangadhara Rao Kancharla

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