JMIR Publications

ABSTRACT

Background:

There is significant pressure on health systems globally to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting is regarded as one means by which such targets might be achieved, largely through reduced patient travel. However, little is currently known about the ways in which different forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programmes at scale that can support rapid adoption and increased environmental sustainability.

Objective:

To understand the impact of virtual consulting on environmental sustainability in healthcare, and what can we learn from current evaluations that can inform future reductions in carbon emissions.

Methods:

We conducted a systematic review of published literature according to PRISMA guidelines. We searched Medline and PubMed using a mixture of key terms relating to “carbon footprint”/ “environmental impact” and “telemedicine”/ “remote consulting”, using citation tracking to identify additional articles. Articles were screened and full texts of articles that met the inclusion criteria were obtained. Data on the carbon footprinting approach and opportunities and challenges associated with the environmental sustainability of virtual consultations was extracted into an Excel spreadsheet, analysed thematically, and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework that considers multiple influences interacting dynamically and unfolding over time.

Results:

A total of 1672 papers were identified, and after removing duplicates and screening for eligibility, 23 papers were included in the review. Studies focused on a range of virtual consulting equipment across different clinical conditions and services. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel to face-to-face appointments. Papers used a range of methods and assumptions to determine carbon savings, reporting savings using different units and across varied sample sizes, limiting the ability to make comparisons between papers. Only five studies reported on the carbon footprint of a virtual consultation. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors influencing the use of virtual consultations (e.g., patient suitability, clinical indication, organisational infrastructure) or of the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (e.g., risk of missed diagnoses from virtual consultations that result in the need for future in-person consultations or admissions and associated carbon emissions).

Conclusions:

There is overwhelming evidence that virtual consulting can reduce healthcare carbon emissions, largely (though not exclusively) through reducing travel to in-person appointments. However, current evidence fails to look at system factors associated with implementing virtual healthcare delivery and wider research into carbon emissions across the entire clinical pathway.