Towards the Operationalization of Health Technology Sustainability Assessment and the Early Eco Design of the Internet of Medical Things.

An increasing number of scholars are raising concerns about the sustainability of digital health, calling for action to prevent its harmful effects on the environment. At this point, however, the comprehensive appraisal of emerging technology in the health sector remains theoretically challenging, and highly difficult to implement in practice and in ecological design. Indeed, background factors such as the rapid evolution of technology or effectiveness-efficiency tradeoffs complicate the task of distinguishing the benefits of digital health from its drawbacks, rendering early Health Technology Sustainability Assessment (HTSA) extremely complex. Within this context, the aim of this article is to draw attention to the pragmatism that should be adopted when anticipating the sustainability of technological innovation in the medical field, while simultaneously proposing an assessment framework grounded in a structural and conceptual dissection of the fundamental purpose of smart technologies and the Internet of Medical Things (IoMT). Building on this, we demonstrate how our framework can be strategically applied through a rapid back-of-the-envelope assessment of the economic and ecological balance when introducing IoMT prototypes for treating a specific condition, based on a preliminary simulation of a defined clinical outcome. In this manner, the article presents evidence that challenges two primary hypotheses, and also encourages reflection on the central role of information and its interpretation when addressing key barriers in the HTSA of digital health. Thereby, it contributes to advancing cost-benefit and cost-effectiveness evaluation tools that support eco design strategies and guide informed decision-making regarding the integration of sustainable IoMT systems into healthcare.