The rapid adoption of healthcare Internet of Things (IoT) devices necessitates robust solutions to ensure secure information exchange between patients and trusted entities. This study proposes a novel device authentication design tailored for healthcare IoT systems, integrating trust-driven evaluation with Fast Healthcare Interoperability Resources (FHIR) to address both security and interoperability challenges. This mechanism leverages Physical Unclonable Functions (PUFs) for hardware-based device authentication and incorporates contextual trust assessment to enhance reliability. It maintains compliance with FHIR standards, ensuring seamless integration with existing healthcare information systems. By addressing the unique requirements of medical device authentication, such as vulnerability to cyber threats and interoperability constraints, the design provides a scalable and efficient solution for healthcare IoT environments. This research employs a systematic approach, combining analytical modeling with practical design considerations to establish a robust conceptual foundation. This work not only addresses immediate technical challenges but also lays the groundwork for future research by proposing design principles tailored to the complexities of healthcare IoT authentication. Future efforts will focus on practical implementation, empirical validation, and performance evaluation to ensure authentication scheme’s effectiveness in real-world healthcare settings. By bridging the gap between security and interoperability, this study contributes to the development of secure, reliable, and interoperable healthcare IoT systems, fostering trust and collaboration among stakeholders.