Assessing the carbon footprint of digital health interventions: a scoping review

Abstract

Objective Integration of environmentally sustainable digital health interventions requires robust evaluation of their carbon emission life-cycle before implementation in healthcare. This scoping review surveys the evidence on available environmental assessment frameworks, methods, and tools to evaluate the carbon footprint of digital health interventions for environmentally sustainable healthcare. Materials and Methods Medline (Ovid), Embase (Ovid). PsycINFO (Ovid), CINAHL, Web of Science, Scopus (which indexes IEEE Xplore, Springer Lecture Notes in Computer Science and ACM databases), Compendex, and Inspec databases were searched with no time or language constraints. The Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA_SCR), Joanna Briggs Scoping Review Framework, and template for intervention description and replication (TiDiER) checklist were used to structure and report the findings. Results From 3299 studies screened, data was extracted from 13 full-text studies. No standardised methods or validated tools were identified to systematically determine the environmental sustainability of a digital health intervention over its full life-cycle from conception to realisation. Most studies (n = 8) adapted publicly available carbon calculators to estimate telehealth travel-related emissions. Others adapted these tools to examine the environmental impact of electronic health records (n = 2), e-prescriptions and e-referrals (n = 1), and robotic surgery (n = 1). One study explored optimising the information system electricity consumption of telemedicine. No validated systems-based approach to evaluation and validation of digital health interventions could be identified. Conclusion There is a need to develop standardised, validated methods and tools for healthcare environments to assist stakeholders to make informed decisions about reduction of carbon emissions from digital health interventions.

Nursing Informatics' Contribution to One Health

“…The environment is in the metaparadigm of nursing, but both the literature and the society reports lacked discussion around environmental impacts of digitalisation and health technologies. This aligns with previous research stating a gap in research on the systemic effects of digital health [77]. The provision of tools to permit assessment and development of environmentally sustainable use of technologies allows better contribution to One Health.…”

Designing digital health applications for climate change mitigation and adaptation

“…These effects touch on the digital health consumer, the supply chains of DHT production and use, multiple health mobile phone applications (apps) and the internet of things (a network of objects with sensors), activity trackers and telehealth equipment, and data transmission and storage 4 . Subsequently, we must consider DHT interventions as an ecosystem of their own, requiring environmentally sustainable production and recycling processes reflective of the principles of climate justice 5 . In this ecosystem, health services have an impact on environmental sustainability through their choice of DHT.…”

“…Critically, digital health has the potential to directly contribute to climate change adaptation and mitigation 3,5,12 . In the context of Australia, inhabitants are exposed to diverse climatic conditions, such as drought, heatwaves, floods and bushfires.…”

“…DHT is inevitably one strand in a process of adaptation to climate change impacts, and this transformation lies within wider policy environment and health care contexts, which may require change or adaptation. The current gaps call for a more rigorous commitment to forms of climate justice and empowering approaches as integral to the process 3,5 . Health care professionals and consumers must be part of this transformation at every level.…”

“…On an individual level, clinicians must be suitably aware and motivated to address these challenges through their own education and then educating and empowering their colleagues to create change 31 . On a system level, the key to success is in interdisciplinary approaches involving all stakeholders in expanding sustainable and impactful DHT interventions through responsible, equitable design, and in assisting health care professionals in accurately measuring and mitigating the impact of these interventions on the environment 5,10,12 …”