As the healthcare community continues to adapt to new technologies and looks for ways to better serve patients in large or remote geographic areas, telemedicine is becoming a more popular and accepted healthcare delivery alternative. Allowing patients to see primary care physicians or specialists with videoconferencing and reducing added travel time—for both patient and provider—in some cases also makes for a more efficient healthcare delivery system. The use of telemedicine also has the capability to help a healthcare system become more environmentally sustainable by reducing its net carbon footprint. The benefits include a net reduction in energy usage, a reduction in raw material consumption (paper, plastic) and even an ability to provide greater resiliency in the face of climate related events.
Travel time and costs and lack of access to convenient healthcare providers can present a substantial burden for patients, especially those living in rural and, in some cases, urban areas, but it also impacts physicians who spend a lot of time traveling back and forth between large medical centers as well as smaller clinics. A substantial amount of research has been done over the years highlighting the environmental benefits of telemedicine, with specific analytical studies focused on the reduced travel time and costs associated with telemedicine.
The National Center for Biotechnology Information (NCBI), at the US National Library of Medicine has a large amount of data on this trend gong back to 2007. One article, Estimating Travel Reduction Associated with the Use of Telemedicine by Patients and Healthcare Professionals: Proposal for Quantitative Synthesis in a Systematic Review (1), published in 2011, used the example of teledermatology, and looked at 20 studies involving 5,199 patients. It found that the mean percentage who avoided travel was 43% for store and forward studies (where patient clinical information was acquired at one location and stored on a cloud based platform, analyzed at another location, and then sent back with a diagnosis and treatment plan to the patient), and 70% for real time studies (live, online audio-video consults). It acknowledged the complexity of this kind of analysis and that there were many factors influencing travel for any given telemedicine application, such as: setting (home, primary care, hospital), location (rural, metropolitan), travel distance (long—greater than an hour, short—less than an hour), age, urgency, purpose (diagnosis, management monitoring and treatment) and type of health system (private, public).
Woman sending her blood pressure and pulse information to virtual doctor. At the same time, telemedicine physician is looking at her CT x-ray on the screen.
Another article cited by the NCBI, Carbon Footprint of Telemedicine Solutions – Unexplored Opportunity for Reducing Carbon Emissions in the Health Sector (2), published in 2014, described a study which looked at two rehab units at Umea University Hospital in Sweden. It compared carbon emissions created by telemedicine appointments with standard in-person care practices. A range of emissions scenarios were created, and analysis done to account for different teleconferencing setups and types of healthcare cases to isolate the most important contributors to emissions and determine a threshold for when telemedicine starts to become most advantageous. The results of the study showed that telemedicine appointments resulted in a 40-70 times decrease in carbon emissions by replacing physical visits. There were multiple factors that contributed to the range of emissions such as meeting duration, equipment bandwidth, and use rates, but at the low-end scenario, the telemedicine appointment becomes a more sustainable choice when the travel distance is only a few miles.
Perhaps one of the most widely cited, largest and recent studies, Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants (3), published in the Value in Health Journal in 2017, was done at UC Davis in California. Researchers at the university examined 18 years of UC Davis’s clinical records from 1996-2013, evaluating in and outpatient interactive video visits for 19,246 patients. In a typical scenario, the patient would visit their primary care physician and then together they would consult a specialist over video. The difference in travel, cost and environmental impact was based on travel to a telemedicine center near their home versus going to the UC Davis Health in Sacramento. The overall results of the study showed that collectively patients saved 9 years of travel time, and 5 million miles, and on an individual level, over 20 years, one person could reduce driving distance 278 miles. This data was then converted to the carbon footprint environmental impact. Telemedicine implementation reduced emissions by approximately 2,000 metric tons of carbon dioxide, 50 metric tons of carbon monoxide, 3.7 metric tons of nitrogen oxides and 5.5 metric tons of volatile organic compounds.
Although telemedicine access in rural areas appears to offer the biggest environmental benefit in terms of emissions reductions as compared to urban areas, people in urban areas sometimes lack access to close by healthcare services and timely in-person appointments. The added travel requirement (such as across city travel) has a direct, adverse consequence on the environment. The use of telemedicine in urban settings—inherently more congested and often experiencing poorer air quality than most rural areas—will also have a positive impact on the environment and patient quality of life.
The use and acceptance of telemedicine is growing and offers both convenience and financial benefits in healthcare—to both patient and the industry. Acknowledging the benefit to the environment should also be broadly acknowledged and promoted, as should its multiplicative benefit to society.
Stay tuned for our upcoming guide on Building the Infrastructure to Support Telemedicine Delivery, coming next week!
References:
(1) Dullet, N. W., Geraghty, M. E., Kaufman, T., Kissee, J. L., King, J., Dharmar, M., & Smith, A. (2017, April 14). Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants. Retrieved from Value in Health Journal: https://www.valueinhealthjournal.com/article/S1098-3015(17)30083-9/fulltext
(2) Holmer, A., Ebi, K. L., & Lazuardi, L. (2014, September 4). Carbon Footprint of Telemedicine Solutions – Unexplored Opportunity for Reducing Carbon Emissions in the Health Sector. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154849/
(3) Wicklund, E. (2017, June 21). ATA Task Force to Study Environmental Effects of Telemedicine. Retrieved from Health Intellegence: https://mhealthintelligence.com/news/ata-task-force-to-study-environmental-effects-of-telemedicine
(4) Wootton, R., Bahaadinbeigy, K., & Hailey, D. (2011, 8 8). Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review. Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178488/
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