From Prediction to Action: Population Health World Model for Digital Medicine

Medical world models offer a framework for extending medical artificial intelligence beyond static prediction by representing evolving patient states and modelling how they change over time and in response to clinical interventions. This Review defines the conceptual boundaries, technical foundations, application domains, and evidence requirements of the field through a structured narrative synthesis with reproducible evidence mapping. We screened 1,455 unique records and assembled a corpus of 98 sources, including 14 studies that met a strict empirical definition of a medical world model. The field is organised around four capabilities: patient state representation, temporal dynamics modelling, intervention-conditioned simulation, and clinician-supervised planning. Evidence spans medical imaging, longitudinal electronic health records, treatment response modelling, physiological and multimodal state modelling, ultrasound and surgical interaction, and population and health-system simulation; clinical digital twins are treated as a cross-cutting integration framework. Current studies provide early evidence of technical feasibility for trajectory forecasting and comparison of candidate interventions, but most remain retrospective, task-specific, or preclinical. The evidence base is further limited by incomplete longitudinal intervention data, inconsistent action semantics, limited causal identifiability, long-horizon error accumulation, inadequate uncertainty estimation, and limited external validation. Clinical translation will therefore depend on precise intervention representations, robust causal and mechanistic grounding, calibrated trajectory-level uncertainty, safety-constrained planning, and prospective multicentre validation against clinically meaningful endpoints.

Medical diagnosis and treatment are dynamic processes in which patient states evolve over time and clinical interventions alter future outcomes. Although current medical AI can detect disease, estimate risk and generate reports, many systems still return static labels or scores, offering limited insight into how illness may progress or how alternative interventions may reshape its trajectory. Medical world models adapt the world-model idea from artificial intelligence to healthcare by learning internal simulators of patient-state dynamics. Their long-term goal is to help clinicians anticipate deterioration, compare treatment-conditioned futures and tailor care to individual patients. Yet relevant work remains scattered across foundation models, longitudinal modelling, disease simulation, treatment-effect estimation, reinforcement learning and digital twins. To bridge this gap, this review outlines a roadmap for advancing medical AI from isolated diagnosis and prediction toward medical world models that simulate disease evolution and support intervention decisions. This roadmap is organized around three coupled capabilities: patient-state construction, clinical dynamics modelling and intervention decision support. Across representative systems, the comparison highlights what each capability contributes and how partial components can be integrated into more mature perception--dynamics--planning systems. Finally, we identify the challenges involved in turning plausible rollouts into clinically useful simulators. Related literature is available at https://github.com/1999kevin/awesome_medical_world_models.

Digital direct-to-consumer (DTC) health campaigns are usually measured after the fact. In-flight forecasting commonly relies on a separate classifier for every cutoff and horizon. We treat this task as a dynamic-system problem and build a compact patient world model. The architecture maintains a latent state per patient, learns exposure-conditioned state dynamics jointly with a weekly conversion hazard, and rolls forward into future conversion curves. We evaluate it on a US campaign dataset with 147{,}173 patients and 5.2 million at-risk person-weeks. In a retrospective evaluation conditioned on recorded future exposures, the model forecasts the remaining new-to-brand prescription volume through week 52 with a relative error of 2.9% from a week-4 cutoff and 0.8--2.6% from cutoffs at weeks 8--26. The strongest non-recurrent baseline, a pooled-hazard gradient boosting model given the same survival rollout and information, has relative errors of 13.6--33.1%. Per-horizon classifiers perform substantially worse. A Fisher-information analysis motivates dense next-exposure supervision when conversions are rare. Removing this auxiliary objective increases prescription-volume error by approximately $2$--$14\times$, while providing no consistent disadvantage on the more common specialist-visit outcome. We also evaluate scenario simulation. Switching all future exposure off raises predicted conversion from 0.31 to 0.89, a pattern consistent with selection effects in observational exposure data. This result highlights the limits of interpreting exposure-conditioned rollouts causally.