{
  "abstract": "Certified cancer centers produce quality continuously but measure it discretely: Conformity is established in a periodic audit that samples a year of institutional life in 1 or 2 days, and demonstrating it costs clinician time. However, the same institution continuously emits data traces—indicator sheets, tumor board minutes, audit findings, registry submissions, trial management records—that differ in structure and in latency but already exist. We argue that they constitute an organizational digital shadow: a unidirectional, purpose-bound, deliberately incomplete projection of institutional conformity, refreshed at whatever latency each source permits and read against a versioned certification standard. We choose shadow deliberately. Organization scholars and process-mining researchers question whether a faithful, bidirectional twin of an organization is achievable at all, while engineering research distinguishes digital models, shadows, and twins by their degree of data flow integration. Applied to the certified cancer center, that taxonomy yields an actionable claim: What is technically within reach today is a shadow, and we argue that a shadow could suffice to turn quality assurance from a periodic verdict into a continuous signal. We connect three bodies of literature that address patient physiology, hospital throughput, or financial control rather than institutional conformity and propose a layered architecture, a maturity progression separating technical coupling from analytical function, and a governance analysis. Because automation earns legitimacy by relieving staff, the byproduct principle is a design constraint. Certified centers are a tractable first instantiation: Few organizations possess both a normative standard and a structured data stream to project against it.",
  "abstract_shown": true,
  "affiliations": [
    "Stuttgart Cancer Center (SCC)—Tumorzentrum Eva Mayr-Stihl, Klinikum Stuttgart, Stuttgart, Germany",
    "Comprehensive Cancer Center Augsburg, University Medical Center Augsburg and Medical Faculty, University of Augsburg, Augsburg, Germany",
    "Bavarian Cancer Research Center (BZKF), Augsburg, Germany"
  ],
  "article_type": "brief report",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Markus Knott"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Markus Krebs"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ef0r7vzcmh0yj.bib",
  "cited_by": 0,
  "doi": "10.3389/fdgth.2026.1955074",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731345/",
  "id": "ef0r7vzcmh0yj",
  "issns": [
    "2673-253X"
  ],
  "landing_url": "https://doi.org/10.3389/fdgth.2026.1955074",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Perspective"
    ],
    [
      "openalex",
      "2739|Healthcare Quality and Management"
    ]
  ],
  "openalex": "W7223105083",
  "pdf_url": "https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2026.1955074/pdf",
  "pmcid": "PMC13731345",
  "pmid": "42984712",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/ef0r7vzcmh0yj.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:21:33Z",
      "native_id": "PMC13731345",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fdgth.2026.1955074"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Healthcare Quality and Management",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "The organizational digital shadow of the certified cancer center—from yearly snapshots to continuous signals",
  "title_text": "The organizational digital shadow of the certified cancer center—from yearly snapshots to continuous signals",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:33Z",
  "url": "https://research.draconitic.com/paper/ef0r7vzcmh0yj",
  "venue": "Frontiers in Digital Health",
  "versions": []
}