JMIR Publications

ABSTRACT

Background:

The ecological crisis threatens human health globally. Paradoxically, the healthcare sector substantially contributes to global warming, pollution, and waste and urgently needs to become more sustainable. Telemedicine is often considered a solution to reduce greenhouse gas emissions. However, related environmental impact assessments were mostly non-standardized and lacked relevant components such as staff travel. Moreover, assessments of its use in primary care such as nursing care are scarce.

Objective:

To quantify and compare the environmental impact of physical visits in the context of nursing care with telemedicine visits.

Methods:

We conducted a life cycle assessment following international ISO-14040/44 standards for a nursing visit per patient, either in-person at the patient’s home or via a video call using a dedicated, user-friendly tablet. The comparison included all resources required for care delivery. Anonymous user data were collected from the telemedicine company and verified with a convenience sample of four nursing organizations using the service. We used the Environmental Footprint method 3.1 to calculate environmental impacts.

Results:

On average tablets were used consecutively for two patients during 278 days. For physical visits, staff traveled 1.5 [1.0-3.0; min/max] km. between patients, of which 80% by car and 20% by bicycle. For telemedicine, staff partially worked from home (50%) and conducted 30 [20-40] telemedicine visits per day. A single telemedicine visit contributed less to global warming than a physical visit (0.1 vs. 0.3 kgCO2eq.; -60%). Results were similar for particulate matter formation (6.2*10-9 vs. 1.8 *10-8 disease incidence; -60%), use of fossil resources (1.8 vs. 4.4 MJ; -60%), and water use (6.2*10-2 vs. 9.6*10-2 m3; -40%). For mineral/metal resource use, telemedicine contributed more than a physical visit (1.1 *10-5 vs. 4.0 *10-6 kgSbeq.; +180%).

Conclusions:

In this primary care setting, nursing visits using telemedicine predominantly generated a smaller environmental impact than physical visits, except for the use of mineral/metal resources. To amplify telemedicine’s environmental benefits, telemedicine should especially be applied for longer commuting distances between patients, devices should be shared among consecutive patients, and telemedicine staff should consider working from home. These measures should urgently be implemented to reduce healthcare’s environmental impact, thereby enhancing both planetary health and human health.