JMIR Publications

ABSTRACT

Background:

Globally, the carbon footprint (CF) of the healthcare sector is significant and growing, and digital healthcare technologies (DHTs) offer unique opportunities to reduce the CF of health and care systems. However, their environmental impact has not been adequately investigated.

Objective:

This scoping review aims to explore the environmental impact of DHTs, with a focus on reducing the CF and evaluating methods for assessing the CF.

Methods:

This scoping review followed the method outlined by Arksey and O’Malley, adhering to Systematic Review and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The databases of Medline, Scopus, and Web of Science were searched for studies published in English with no time limitation. Search terms were categorised under three broader concepts: ‘Digital Healthcare Technologies’, ‘Health and Care’, and ‘Carbon Footprint’. Inclusion of studies was based on a screening of titles and abstracts, followed by a review of full-text articles by at least two reviewers. Narrative synthesis was used to report the findings.

Results:

The database search yielded 4,274 articles. Following screening and reference list checks, 70 articles were selected for inclusion. The review encompassed studies published between 2007 and 2025, with the majority originating from the USA (n = 26) and the UK (n = 12). Most studies assessed telemedicine/telehealth interventions. Retrospective analyses predominated, although prospective, cross-sectional, mixed-method, and life cycle assessment (LCA) designs were also reported. Environmental impact was most often evaluated through travel-related carbon savings, with some studies incorporating energy use, medical equipment/resources, infrastructure, or waste. LCA studies applied process-based approaches that included detailed activity- and product-specific data, as well as Environmentally Extended Input-Output (EEIO) models. In most cases, CF measurements were based on assumptions, with calculations relying on published emission factors or calculators. Some studies have expressed CO₂ emissions using emission equivalencies, such as equivalent carbon sequestration and equivalent CO₂ emissions. Overall, DHTs demonstrated positive environmental impacts by reducing CF. However, negative impacts, especially electricity consumption and the lifecycle impacts of digital devices, were also noted. F

Conclusions:

DHTs are associated with reductions in carbon emissions and related environmental benefits, with telemedicine showing potential to lower the CF of the healthcare sector. However, evidence highlights the negative impacts linked to energy demands and the full lifecycle of digital devices. To capture the true environmental implications of digital health, more rigorous, standardised, and comprehensive assessment methods are required. Bridging these methodological gaps is essential to ensure that DHTs not only support sustainable healthcare delivery but also make a meaningful contribution to mitigating global climate change. Clinical Trial: https://doi.org/10.17605/OSF.IO/GDNVE