Best practices: Circular Digital Health Devices (D2.1)

This report is the result of DiCE task 2.1 and presents designers, engineers, and researchers in the circular-med-tech field an inventory of the best practices of circular design in digital health devices, an overview of barriers and opportunities to the circular transition of these devices, and a circularity assessment of the device case studies embedded in DiCE (i.e., epaper label, smart pill box, endocutter, and wearable sensor). Based on all findings, we provide a proposal of possible circular design guidelines for digital health devices. To successfully uncover the best practices, barriers, and opportunities, we first developed a categorization framework and overview of possible circular recovery flows (CRFs) for digital health devices based on the “9 R’s” (i.e., of reuse, remanufacturing, recycling, etc). Subsequently, the devices were categorized based on their use location, economic value, and medical criticality. The detailed identified CRFs are (ordered in the intentional hierarchy): refuse, reduce, rethink, reuse, repurpose, remanufacture, recycle, regrow (including regenerate, compost, and biodegrade), and recover energy. Commonly used terms such as repair, reprocessing, and parts recovery are also part of the framework, but do not represent separate CRFs, as they are embedded in the other strategies. We developed a searching method that helped us search through over 1300 devices to collect a database of 346 digital health devices that have implemented at least one CRF. 51 of those devices we present as “best practices”, based on their level of circularity. Important findings are that all but 16 of the 346 devices are reusable, while the CRFs of repurpose and regrow only occur once. Devices of medium medical criticality used in healthcare environments seem significantly more likely to use at least one CRF. Examples of interesting strategies found, are: replacing a polluting device with a less polluting device, minimizing material and energy use, enabling sharing, offering multiple functions in one device, minimizing needed infection prevention materials, and designing for remanufacturing after reuse. Through 21 in-depth, semi-structured expert interviews and a literature review based on 91 scientific papers, we developed a list of 31 barriers and 25 opportunities for going circular. The top five most-mentioned barriers were related to 1) Perceived safety risks, infection, and contamination, 2) Inability to collect and separate devices, 3) Regulations that complicate the process, 4) Financial constraints, and 5) Unsuitable product/material characteristics for circular strategies. The five most-mentioned opportunities were related to 1) circularity stimulation through regulations, guidelines, and standardization, 2) Motivating, enabling, and creating commitment, 3) (Improved) education or training, 4) Financial benefits and effective businessmodels, and 5) (improved) collaboration amongst stakeholders. For the circularity assessment of the four DiCE case study devices, both fast-track LCAs and a circular product readiness assessment were used as a method. The results show high environmental impacts of electronic components manufacturing and a need to improve the device support service, the recirculation service (mostly related to device retrieval), and therecoverability of the devices. All results were concluded into a list of 31 potential design guidelines. Some examples ofimportant design guidelines: design for disassembly, enable extensive testing, maintain orimprove the quality and function of the device, enable traceability (with or without a digitaldevice passport), and make solutions fit within the current system or workflow.