Optimizing Healthcare Delivery: Innovations and Economic Strategies in Medical Device Management

1. Introduction

The healthcare industry is at a pivotal moment, driven by the rapid pace of technological advancements and the increasing demand for patient-centered care. Medical devices, from basic instruments to advanced digital systems, have become critical in enhancing diagnostics, treatment, and patient management. These devices not only improve clinical outcomes but also facilitate access to care across diverse populations, particularly as healthcare moves toward more personalized and preventive models [1]. However, effectively managing these devices throughout their lifecycle—from procurement and maintenance to compliance with regulatory standards and eventual decommissioning—presents several challenges for healthcare providers [2]. These challenges are further compounded by rising healthcare costs, the need for technological integration, and the imperative of ensuring safety and efficacy in device management [3].

The overarching goal of this chapter is to provide a comprehensive strategic analysis of medical device management as a key element in optimizing healthcare delivery. This chapter will focus on the integration of technological innovations, economic strategies, and a forward-looking approach to future trends. Technological advancements such as artificial intelligence (AI), the Internet of Things (IoT), and predictive maintenance systems are transforming not only how medical devices are managed but also how healthcare is delivered. These technologies offer opportunities to reduce costs, enhance operational efficiency, and improve patient outcomes by enabling more precise, real-time, data-driven decision-making [1]. The economic implications of these advancements are equally significant, as healthcare providers must navigate the complexities of managing the high costs associated with device acquisition, operation, and maintenance while upholding high standards of care [3].

The first section of this chapter will explore the current challenges in medical device management. These challenges include escalating costs, inefficient resource utilization, limited access to advanced medical technologies, and the pressing need for regulatory compliance. The healthcare sector, in particular, faces significant hurdles in maintaining up-to-date inventories of medical devices, ensuring proper maintenance, and adhering to the regulatory requirements that govern device safety and efficacy [2]. Additionally, global disparities in access to essential medical devices, particularly in developing countries, further complicate efforts to optimize healthcare delivery [3]. The discussion will also highlight how the COVID-19 pandemic exposed vulnerabilities in global healthcare systems, particularly in medical device supply chains, amplifying the need for more resilient and innovative device management strategies [4].

Following the examination of these challenges, the chapter will present solutions through detailed case studies that demonstrate both successful and unsuccessful implementations of medical device management strategies. These case studies will offer real-world insights into how healthcare organizations have addressed operational inefficiencies, improved device utilization, and navigated regulatory barriers. For instance, the use of centralized inventory management systems has been shown to reduce device downtime and improve resource allocation in several leading healthcare institutions. Conversely, examples of failed initiatives will provide valuable lessons on the importance of stakeholder engagement, transparent communication, and the need for continuous monitoring and evaluation of medical device management systems [3].

The chapter will also delve into the critical regulatory considerations governing the medical device industry, emphasizing the importance of compliance with both national and international standards. These regulations, such as those enforced by the U.S. Food and Drug Administration (FDA) and the European Union’s CE marking, ensure the safety, efficacy, and quality of medical devices throughout their lifecycle. The complexity of these regulatory frameworks highlights the need for healthcare providers to remain informed about evolving standards, particularly as new technologies such as AI-driven diagnostic tools and IoT-enabled medical devices enter the market. Additionally, data security and patient privacy, especially concerning connected devices, remain paramount concerns that must be addressed through stringent cybersecurity measures [4].

Lastly, the chapter will examine future trends in medical device management, focusing on the potential of emerging technologies to revolutionize healthcare delivery. AI, IoT, robotics, and 3D printing are just a few of the innovations that promise to enhance device functionality, improve diagnostic accuracy, and allow for the development of personalized medical devices tailored to individual patient needs. Predictive maintenance, enabled by AI and IoT, will continue to play a crucial role in minimizing device downtime, reducing costs, and improving overall care quality [3]. These trends underscore the need for continuous investment in research and development, regulatory innovation, and workforce training to ensure that healthcare providers can fully leverage the potential of these technologies in delivering more efficient and equitable healthcare [4].

By examining these critical areas, this chapter aims to provide healthcare providers, policymakers, and industry stakeholders with actionable insights and strategies to optimize healthcare delivery through more effective and innovative medical device management. The integration of new technologies, economic strategies, and regulatory compliance will not only improve operational efficiency but also enhance patient outcomes, ultimately leading to a more sustainable and patient-centered healthcare system [4].

2. Current challenges in healthcare delivery

The landscape of healthcare delivery is fraught with challenges, notably heightened by the expansion of international activities in the medical device industry. This globalization has prompted a push toward more efficient production processes, stringent safety and quality controls by government agencies, and cost containment strategies by healthcare providers, with significant attention on optimizing medical device management. The pivotal role of advanced medical technologies, such as intelligent devices including infusion pumps and cardiac pacemakers, has shifted the paradigm from traditional hospital-based care to more economical, patient-centered models. This shift underscores the urgency for rational device management to ensure safety, efficacy, and cost-efficiency, especially as the industry navigates increased market volatility and the evolving demands of both developed and developing economies [5, 6].

Concurrently, healthcare in the United States faces escalating expenditures, with projections suggesting an alarming rise to $6 trillion by 2027, or 19% of GDP. This surge is driven by an aging population, more expensive healthcare services and drugs, the prevalence of chronic diseases, defensive medicine practices, and substantial administrative costs. These factors collectively underscore the necessity for innovative strategies in medical device management to mitigate rising costs and improve system efficiency [7, 8]. Additionally, global access to medical devices remains uneven, highlighting disparities exacerbated by socio-economic and structural barriers, particularly in less developed territories, challenging the globalization of medical device supply and underlining the health inequalities across different populations [9, 10, 11]. This increase is multifaceted, rooted in an aging population that demands more medical services, escalating prices of healthcare services and prescription drugs, and the widespread prevalence of chronic diseases, which alone consume about 90% of the country’s healthcare spending. Moreover, the fragmented healthcare system exacerbates these costs, leading to inefficient resource use and suboptimal patient outcomes. Defensive medicine practices and the complex administrative burdens of the multi-payer insurance system further inflate these expenditures. Addressing these escalating costs is crucial, necessitating innovative approaches in medical device management to enhance efficiency and curb unnecessary spending [7, 8].

Moreover, inefficiencies in device management within healthcare facilities, such as unclear allocation processes, inadequate stock visibility, and subpar device recall management, compromise the quality of patient care and resource utilization. The absence of streamlined processes and reliance on outdated management methods underscore the critical need for improvement in inventory and asset management systems to enhance care delivery and operational efficiency [12, 13, 14].

The global disparity in access to medical devices underscores a critical yet underexplored issue in healthcare delivery. While advancements and the need for innovation in medical device development have garnered attention, particularly in economically advanced regions, this focus does not fully capture the challenges faced by many worldwide. A significant number of healthcare patients, practitioners, and providers across various regions struggle to access essential medical devices. This gap is primarily driven by the growing demand for innovative devices needed to tackle contemporary health issues—a demand influenced heavily by the rising prevalence of chronic conditions in aging populations. These challenges to the globalization of medical device manufacture and supply are further compounded by socio-economic and structural barriers, particularly in less developed areas. These regions often lack the robust healthcare infrastructure and regulatory frameworks essential for the advancement and maintenance of medical devices, thus perpetuating the divide between ‘innovator’ and ‘adopter’ countries. This not only diminishes the attractiveness of different healthcare markets to medical device manufacturers but also exacerbates health inequalities across patient populations [9, 10, 11].

Inefficient device management in hospitals, characterized by unclear allocation processes and the absence of standardized procedures, results in operational inefficiencies and increased costs. Lack of clear priorities and protocols often leaves high-demand services without essential devices, complicating emergency responses [12]. The management of device recalls suffers due to inadequate monitoring, leading to incomplete maintenance tasks and poorly regulated inventory, heightening the risk of shortages or surplus stock [13]. Additionally, the reorder process is hampered by inefficiencies such as outdated automation and lack of digitalization, further strained by improper handling of expired items, affecting inventory accuracy and storage conditions [14]. The absence of an effective asset management system and data-driven optimization exacerbates these challenges, with staff wasting time on device location and maintenance scheduling, thereby impacting patient care and device utilization.

3. Importance of optimizing healthcare delivery

Optimizing healthcare delivery is increasingly recognized as a crucial step toward enhancing patient care and addressing the rising costs associated with healthcare services. This optimization is not only beneficial for achieving commercial and financial success but is fundamentally about improving patient outcomes. Effective healthcare delivery focuses on ensuring patient care takes precedence, facilitated by technological advancements and the strategic management of healthcare resources. Interoperability and seamless access to electronic health records (EHRs) significantly enhance care delivery, improving both effectiveness and efficiency across various healthcare settings. Despite challenges, such as delays in compliance and legislative pushbacks, the integration of EHRs is vital for enabling patient-centered outcomes. The drive toward optimized healthcare involves a comprehensive approach that aligns patient experiences with the expertise of medical staff and effective protocol implementation. Highlighting the complexity of this endeavor, there are substantial positive impacts achievable through meticulous planning and execution. Furthermore, leveraging advanced data analytics, including probabilistic linkage and data mining, fosters quality improvement and integrates patient records across the healthcare spectrum [15].

Enhancing patient care stands at the forefront of optimizing healthcare delivery, underlining the essence of patient-centric approaches within the healthcare system. A pivotal element in this optimization is the reduction of medical errors, a concern highlighted across various studies. For instance, research indicates that suboptimal equipment management practices significantly contribute to medical errors, with estimates suggesting that medical device issues lead to approximately 155,000 errors and 1300 fatalities annually [16]. The integration of advanced technologies, such as barcoding systems in surgical supply chains, demonstrates a tangible reduction in human errors, ensuring the correct utilization of medical equipment for each procedure and enhancing patient safety. Furthermore, intelligent systems capable of diagnosing issues and predicting equipment failures mark a substantial advancement in medical device management, moving toward a model of ‘preventive maintenance’ over traditional methods. This shift not only maximizes equipment uptime but also significantly improves clinical care quality. The deployment of such technologies since their introduction by diagnostic imaging centers reflects the critical role of innovative medical device management in bolstering healthcare delivery and patient care outcomes [17, 18].

Reducing healthcare costs while enhancing the quality of care is a pivotal goal for healthcare organizations. They aim to utilize accurate data on device use and inventory to pinpoint and eliminate inefficiencies in medical device management [19]. By cutting down on unnecessary activities and equipment redundancy, organizations can boost resource efficiency and lower overall healthcare costs without compromising care delivery or quality. This strategy emphasizes the significance of integrating technology and information advancements to enhance patient care and operational productivity [20]. However, these innovations bring their own costs, including the expense of adopting new “smart” devices equipped with advanced diagnostic and treatment capabilities. Such expenses necessitate careful planning to ensure that investments in new technology genuinely contribute to cost reduction and enhanced patient care outcomes. Engaging leaders and forming a multidisciplinary team early in the cost reduction process is critical for ensuring clinical relevance and comprehensive cost-saving strategies [21].

The evolution of medical technology, while offering significant improvements in healthcare delivery, also requires strategic management to balance innovation with cost-effectiveness. The challenge of technology obsolescence, where new models quickly replace the old, needs a planned increase in the utilization of newer models to avoid productivity dilution [22]. Furthermore, other authors emphasize the importance of leveraging new technologies for strategic cost reduction, suggesting that meaningful use and evidence-based treatment practices can offer unique value opportunities in medical device management [23, 24].

4. Innovations in medical device management

The landscape of medical device management is continually evolving, marked by significant innovations that aim to enhance healthcare delivery and patient outcomes. These advancements range from the adoption of electronic health records (EHRs) and telemedicine to the integration of the Internet of Things (IoT) in healthcare practices. EHRs, or electronic medical records (EMRs), serve as digital versions of patients’ traditional paper charts, offering a comprehensive record that supports treatment and care delivery across various healthcare settings. This digital transition not only facilitates global collaboration among healthcare providers but also reduces unnecessary patient testing and medication exposure, thereby improving patient safety and reducing costs. The proliferation of EHRs, propelled by the Health Information Technology for Economic and Clinical Health (HITECH) Act in the USA, signifies a critical shift toward digital healthcare systems that prioritize efficiency and patient privacy [25, 26, 27].

Telemedicine has emerged as a pivotal innovation, extending healthcare’s reach to remote and underserved populations while enhancing the patient-doctor relationship through cost-effective and accessible services. Supported by over 200 research articles, telemedicine’s effectiveness in managing chronic illnesses is increasingly acknowledged worldwide, fostering its adoption and global diffusion [28, 29].

Remote patient monitoring (RPM) technologies represent another significant stride in healthcare innovation, enabling real-time health data transmission from patients to healthcare providers. This technology empowers patients to actively participate in their health management, offering a blend of privacy, security, and convenience. RPM is anticipated to redefine medical practice by fostering closer patient-provider connections and facilitating home-based patient care and rehabilitation, supported by federal initiatives like the Centers for Medicare & Medicaid Services Chronic Care Management program [30, 31].

Artificial Intelligence (AI) in medical device management is revolutionizing healthcare by enhancing device efficiency and patient care outcomes. AI technologies facilitate predictive maintenance, remote monitoring, and energy optimization of medical devices, offering a smarter approach to healthcare service delivery. Despite the potential benefits, the full realization of AI in healthcare faces challenges due to the industry’s regulated nature and the hesitance of users to adopt new technologies [32, 33].

Predictive maintenance systems stand out as a cost-effective solution to medical device management, shifting away from traditional maintenance strategies to a more data-driven approach. This method improves device reliability, optimizes performance, and extends the useful life of medical equipment, aligning with the healthcare industry’s goal of enhancing efficiency and reducing costs [34].

Together, these innovations in medical device management underscore a transformative period in healthcare, driving toward a future where technology and data analytics play central roles in delivering patient-centered, efficient, and effective care.

5. Economic strategies for medical device management

Economic strategies in medical device management are pivotal for healthcare providers to navigate the complexities and high costs associated with the deployment, operation, and maintenance of these critical tools. The transition from reactive to proactive management strategies, facilitated by advancements in technology and the Internet of Things (IoT), offers a promising avenue for reducing the economic burden associated with medical devices.

Value-based purchasing emerges as a strategic approach encouraging healthcare providers to select medical devices not only based on cost-effectiveness but also on their long-term value in patient care and operational efficiency. This method necessitates a comprehensive understanding of device lifecycle costs, demanding an initial investment and potentially additional staff training to achieve optimal outcomes. The emphasis on long-term patient care impact and efficiency aligns with a broader industry shift toward value-oriented healthcare delivery [35, 36].

Equipment standardization represents another key strategy, advocating for uniformity in device selection to streamline operations, reduce training requirements, and minimize maintenance complexity. Despite its initial perceived limitations, standardization can lead to significant long-term benefits, including cost savings through bulk purchasing agreements and improved operational efficiency [37].

Asset tracking and utilization, facilitated by digital systems, provides real-time insights into device location and usage patterns. This strategy enhances the ability to allocate resources effectively, ensuring devices are utilized where they are most needed and supporting strategic planning for future purchases based on actual usage data. Such granular visibility into device utilization patterns is instrumental in optimizing patient care delivery and operational efficiency within healthcare settings [38].

These economic strategies, encompassing maintenance optimization, lifecycle cost analysis, and strategic device placement, require careful consideration of the unique needs of patient populations and healthcare providers. They must be tailored to fit within the broader regulatory, financial, and technological landscape of the healthcare industry. Successful implementation hinges on the adaptability of healthcare providers to these innovative strategies, promising significant benefits in terms of cost savings, improved patient outcomes, and enhanced operational efficiency [39].

The exploration of these strategies within this chapter underscores their potential to transform medical device management in healthcare. By adopting a comprehensive, forward-thinking approach to purchasing, standardization, and asset tracking, healthcare organizations can navigate the challenges of high costs and complex logistics associated with medical devices, moving toward a more efficient, patient-centered, and economically sustainable model of care delivery.

6. Integration of technology in healthcare delivery

The integration of technology into healthcare delivery heralds a pivotal transformation toward a system that is more efficient, accessible, and tailored to individual needs. The inception of this transformation began with the digitalization of healthcare facilities, aiming for a “paperless” environment. This foundational shift made possible the development and integration of advanced technologies such as artificial intelligence (AI), virtual clinics, and natural language processing (NLP) into the healthcare system. These technologies have significantly enhanced the direct interaction between patients and care providers through the adoption of standardized health informatics and telemedicine systems.

Telemedicine and remote patient monitoring stand out as key examples of how technology can extend healthcare beyond traditional settings. Leveraging rapid internet access and advancements in technology, these systems enable continuous, real-time monitoring of patients through wearable and portable devices. This has facilitated care delivery in a variety of settings, thereby improving access to expert healthcare advice and enhancing the personalization of healthcare services. The evolution toward modern maintenance strategies for medical devices, shifting from reactive to predictive maintenance enabled by AI and the Industrial Internet of Things (IIoT), exemplifies this trend. Predictive maintenance systems anticipate the needs for device maintenance, significantly reducing downtime and associated costs, which in turn improves the quality of patient care [40].

Electronic Health Records (EHRs) have become a cornerstone in this technological integration, providing a longitudinal digital record of patient medical histories that can be shared across various healthcare settings. The widespread adoption of EHRs, spurred by the Health Information Technology for Economic and Clinical Health (HITECH) Act, emphasizes the critical role of digital records in improving care coordination, enhancing diagnosis and patient outcomes, and ensuring patient safety. This transition toward digitalization aligns with broader trends toward optimizing healthcare delivery through innovations in medical device management, highlighting the emphasis on efficiency, data analytics, and a patient-centered approach to care [41].

Furthermore, telemedicine epitomizes the technological integration in healthcare by reducing medical costs and enhancing the accessibility of services. It provides a cost-effective model for healthcare delivery by reducing patient travel and facility capital investment, thereby improving service quality and flexibility. This modality is particularly beneficial in outpatient and home settings, indicating a shift toward more accessible and efficient healthcare delivery modalities [42].

The Internet of Things (IoT) introduces a network of interconnected devices capable of collecting and exchanging data, ranging from wearable technologies to implantable medical devices. The potential benefits of IoT in healthcare are vast, offering improved patient monitoring, preventive care, and insights into disease progression, which can contribute to a shift toward a more personalized healthcare system. Nonetheless, the realization of IoT’s full potential in healthcare necessitates addressing challenges related to data management, privacy, and regulation of IoT devices [43, 44, 45, 46, 47].

As these technologies continue to advance and become further integrated into healthcare delivery, the vision of a healthcare system that is more efficient, accessible, and personalized becomes increasingly attainable. The ongoing innovation and adoption of digital health technologies, underpinned by advancements in AI, telemedicine, and IoT, promise a future where healthcare delivery is optimized to meet the varied needs of patients and providers alike.

7. Regulatory considerations in medical device management

Navigating the regulatory landscape is crucial for ensuring the safety, efficacy, and quality of medical devices throughout their lifecycle. This complex environment encompasses a variety of national and international standards and regulations that manufacturers and healthcare organizations must adhere to, from product development to post-market surveillance [48].

The regulatory framework varies significantly across different jurisdictions, highlighting the importance of a nuanced approach to compliance. For instance, in the United States, the Food and Drug Administration (FDA) sets forth rigorous guidelines for device registration, approval, and quality controls [49]. Similarly, the European Union requires medical devices to attain CE Marking as a demonstration of safety and performance, underlining the global diversity in regulatory requirements [50].

Intelligent medical devices, which are increasingly prevalent in healthcare for applications like remote monitoring, must not only meet safety and performance standards but also ensure data accuracy and protection. This necessitates robust security measures and standards to safeguard sensitive patient information and justify clinical decisions based on device-generated data [51].

Manufacturers must also navigate the challenges posed by technological advancements, ensuring that devices on the market remain compliant through active post-market surveillance. This involves systematic data collection and analysis to monitor product performance and safety and to take corrective actions if necessary [52].

Compliance with FDA regulations, a cornerstone of medical device management in the U.S., involves several key steps, including premarket notification (510(k)), premarket approval (PMA), and the De Novo classification for novel devices. These processes underscore the complexity of bringing medical devices to market and the critical role of compliance in safeguarding patient health [53].

Data security and privacy are paramount, with regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. setting standards for the protection of personal health information. The increasing threat of cyber-attacks on the medical device sector amplifies the need for comprehensive cybersecurity risk management strategies to protect patient data [54].

Quality assurance (QA) and quality control (QC) are integral to maintaining high standards in medical device management, focusing on process and product quality to ensure that devices are safe, effective, and fit for their intended use. Adherence to global medical device regulations and standards, such as those set by the FDA and CE marking, is essential for patient safety, regulatory compliance, market access, and organizational reputation in the healthcare sector [55, 56, 57, 58].

Overall, the regulatory considerations in medical device management encompass a broad spectrum of activities and standards, from compliance and data security to quality assurance and control, underscoring the critical role of regulation in ensuring the safe and effective use of medical devices in healthcare.

8. Case studies in optimizing healthcare delivery

Case studies are valuable tools for understanding how theoretical strategies can be successfully or unsuccessfully applied in real-world scenarios. This section presents two contrasting case studies that highlight both the benefits and challenges of medical device management. Through these examples, we explore how different healthcare organizations implemented centralized and decentralized device management strategies, offering insights into best practices and lessons learned.

9. Future trends in medical device management

The healthcare landscape is rapidly evolving, with emerging technologies poised to transform the management of medical devices and revolutionize healthcare delivery. In the coming decade, innovations such as artificial intelligence (AI), the Internet of Things (IoT), robotics, and personalized medical devices are expected to significantly improve operational efficiency, reduce costs, and enhance patient outcomes. These advancements promise to address some of the most pressing challenges in healthcare, including the rising costs of care, the need for real-time monitoring, and the growing demand for personalized treatment options.

10. Conclusion

Optimizing healthcare delivery is essential for enhancing patient care and addressing rising healthcare costs. This chapter has highlighted the critical role of strategic medical device management, facilitated by technological advancements such as artificial intelligence (AI), the Internet of Things (IoT), and predictive maintenance systems. By adopting these innovations, healthcare organizations can improve both operational efficiency and patient outcomes.

A primary focus in healthcare delivery optimization is enhancing patient care through better management processes. The integration of AI and IoT into medical device management offers significant advantages, such as predictive maintenance systems, which can reduce device downtime and improve safety. Predictive analytics also enable proactive identification of device failures, ensuring critical equipment remains operational and improving clinical care quality. The incorporation of these advanced technologies fosters a safer and more efficient healthcare environment [16, 17, 18].

Reducing medical errors is another crucial goal. Research shows that improper device management contributes significantly to medical errors, with estimates suggesting that device-related issues lead to approximately 155,000 errors and 1300 fatalities annually. Implementing barcoding systems in surgical supply chains and healthcare operations can minimize human error, ensuring proper device usage and improving patient safety. By adopting preventive maintenance strategies, healthcare providers can further reduce equipment failures and maximize device uptime, directly enhancing patient care [16, 17, 18].

From an economic perspective, optimizing device management not only improves safety but also leads to substantial cost savings. Investing in value-based purchasing, which considers the long-term value of devices in addition to their upfront costs, is key to sustainable healthcare delivery. Moreover, standardizing medical devices across healthcare facilities can streamline operations, reduce training times, and simplify maintenance, all while minimizing operational expenses. Effective asset tracking systems provide real-time data on device usage, improving resource allocation and reducing unnecessary expenditures [19].

Looking ahead, emerging technologies such as robotics, 3D printing, and advanced data analytics will further reshape the healthcare landscape. These innovations promise to personalize patient care, improve diagnostic and therapeutic precision, and make healthcare more accessible and cost-effective. However, their successful adoption will require careful planning, regulatory compliance, and investment in workforce training and infrastructure [66].

Recommendations: To fully realize the benefits of optimized healthcare delivery, healthcare providers and policymakers should focus on:

1. Predictive maintenance: Invest in AI-driven predictive maintenance systems to reduce equipment downtime and ensure critical devices are operational when needed.

2. Regulatory compliance: Prioritize compliance with national and international regulatory standards to ensure safety and quality in device management.

3. Technology integration: Embrace AI, IoT, and robotics to improve device management and healthcare delivery. These technologies not only enhance operational efficiency but also contribute to better patient outcomes.

4. Resource allocation: Implement data-driven asset tracking and resource allocation strategies to optimize device usage and reduce operational inefficiencies.

5. Standardization and interoperability: Standardize medical devices and ensure seamless integration of electronic health records (EHRs) to improve care coordination and patient outcomes [67].

In conclusion, optimizing healthcare delivery requires a multifaceted approach that integrates advanced technologies, patient-centered care, and strategic resource management. By focusing on predictive maintenance, regulatory compliance, and technological innovation, healthcare providers can enhance patient safety, reduce costs, and improve overall system efficiency. This chapter underscores the importance of addressing these areas to ensure that healthcare delivery is not only optimized but also sustainable and equitable [67].

Acknowledgments

The authors acknowledge the use of Grammarly Writing Assistant for language polishing of the manuscript.