Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 13, 2022
Date Accepted: Apr 19, 2023
The Environmental Impacts of Electronic Medical Records versus Paper Records at a Large Eye Hospital in India: A Life Cycle Assessment
ABSTRACT
Background:
Health care systems are rapidly adopting electronic medical records (EMR) systems, replacing paper record-keeping systems. While there are many benefits of an EMR, the environmental emissions associated with medical recordkeeping is unknown. Given the need for urgent climate action, understanding the carbon footprint of EMR will assist in decarbonizing its adoption and use.
Objective:
To estimate and compare the environmental emissions associated with paper medical recordkeeping and its replacement EMR system at a high-volume eye care facility in southern India.
Methods:
Life cycle assessment methodology per ISO 14040, with primary data supplied by the eye care facility. Sensitivity analyses to model effects of practice variation, data uncertainty. Monte Carlo Assessment to statistically compare the two recordkeeping systems.
Results:
The EMR was found to emit substantially more GHGs than the paper medical record system (194,500 kg CO2e per year or 0.36kg per patient visit compared to 20,800 kg CO2e per year or 0.04 kg per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power, rather than the Indian electric grid, their EMR emissions drop to approximately 25,000kg CO2e, a level comparable to the paper record-keeping system. Energy efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment lifespans.
Conclusions:
The emissions associated with an EMR are heavily dependent on the sources of electricity. With a decarbonized electricity source, EMR emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. EMRs can help improve access to care while reducing patient travel, which may also impact broader environmental emissions in a way not captured by this study. Clinical Trial: This did not require a trial registration.
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