DIgital health in Circular Economy

Project Information

DICE

Grant agreement ID: 101060184

DOI

10.3030/101060184

EC signature date 7 June 2022

Start date 1 October 2022

End date 30 September 2026

Funded under

• Food, Bioeconomy Natural Resources, Agriculture and Environment

Total cost

€ 9 210 393,54

EU contribution

€ 7 733 912,13

Coordinated by

JANSSEN PHARMACEUTICA NV
Belgium

Periodic Reporting for period 2 - DICE (DIgital health in Circular Economy)

Reporting period: 2024-04-01 to 2025-09-30

Summary of the context and overall objectives of the project

The EU’s Digital Agenda is accelerating healthcare digitisation to empower patients and improve healthcare outcomes, e.g. through the European Health Data Space Regulation (2025/327). Digital health devices, e.g. smart pill boxes and wearable sensors, are increasingly used to improve patient monitoring and care. However, this rapid adoption creates a growing challenge of electronic waste.

DiCE aims to address this by developing circular design guidance for digital health devices and creating reverse logistics systems for these devices, including those in scope of the EU Medical Device Regulation (MDR). DiCE engages value chain stakeholders, including healthcare providers and end-users, to codesign motivational strategies that increase device return rates and to identify optimal collection points. In addition, DiCE develops innovative circular business models tailored to digital health devices and formulates policy recommendations supporting the circular transitioning of healthcare.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

DiCE has delivered significant progress. The project developed Circular Recovery Flows and identified 31 potential circular design guidelines tailored to digital health devices (D2.1). Digital Display Labels (D2.2) smart pillboxes (D2.3) and an endocutter (D2.4) were redesigned to enable reuse and recycling strategies.

To support device recovery, DiCE designed and deployed 25 smart collection boxes in Belgium, Slovenia and Spain (D3.3 D3.4). These machines with real-time monitoring are equipped with sensors that detect returned items. The AI-based item detection is integrated into the reverse logistics workflow to ensure safe collection and transport to reuse and recycling partners.

Refurbishment processes were successfully tested for Digital Display Labels under simulated real-life condition, while recycling tests on multiple DiCE use cases generated recommendations for improving both product design and recycling processes. A critical raw materials assessment provided valuable insights into material recovery challenges and opportunities (D3.1 & D3.8).
Hospital pilots and a round table were conducted to understand stakeholder motivation for local and specialised reprocessing and to validate the feasibility of local reprocessing scenarios.

Citizen engagement played a central role in the project. Through Sustain-a-thons, design sprints, and co-creation sessions in the three pilot regions (D4.1) DiCE developed motivational strategies to stimulate device returns (D4.3). These strategies were tested in small-scale pilots (D4.2) and are now being validated in large-scale pilots, involving 100–150 participants per country.
To measure impact, DiCE advanced circularity and sustainability assessments across economic, social and environmental dimensions. Detailed value chains were mapped for selected the devices (D5.1) and a dashboard prototype was created to visualise circularity and sustainability performance at macro-level.

Finally, DiCE explored how business models can adapt to a circular economy. A taxonomy of four innovative circular models (D6.1) was expanded into a matrix of 12 propositions. Business models for DiCE use cases were co-developed with manufacturers and validated through stakeholder workshops. Policy analysis identified barriers to circularity and provided recommendations to remove some of the barriers as part of public consultations to the EU. To support consistent terminology and future standardization, DiCE also developed a comprehensive glossary of terms and definitions relevant to circular digital health devices.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

DiCE introduces several innovations that advance circular economy in healthcare:

• First empirically validated design guidelines for circular digital health devices, developed with stakeholder input and ready for practical adoption.
• Smart collection systems equipped with real-time monitoring and AI-based item detection, enabling efficient reverse logistics. Commercialization activities will accelerate after pilot validation.
• Reverse logistics process for both professional and household settings, including optimised collection points for device take-back.
• Refurbishment process for Digital Display Labels tested under real-life conditions. Uptake will require close engagement with clinical trials to integrate changes into standard operating procedures.
• Motivational strategies designed through co-creation and demonstrated in large-scale pilots. A guideline for nudging techniques will be shared with manufacturers to support adoption.
• Novel circular business models tailored to medical devices, supported by financial modelling and stakeholder co-development.
• Evidence-based policy recommendations to enable safe reprocessing and recycling under EU MDR.

Early work on remanufacturing, based on expertise with large hospital equipment, revealed that small digital health devices require a new circular ecosystem approach. For scale-up, recovery flows must be as short as possible – potentially replacing remanufacturing with reprocessing for certain devices.

The results are still in progress, laying the groundwork for scalable circular solutions in healthcare - reducing e-waste and conserving critical raw materials. Further uptake will require regulatory alignment, investment in reverse logistics infrastructure, and continued collaboration across the value chain. Standardization of performance assessment and harmonized definitions will be key drivers for adoption.