The Carbon Footprint of Digital Health Interventions: The Development of a Transparency Catalogue and a Systematic Review of the Evidence

Abstract

Background: Digitisation is an important topic for healthcare providers and policymakers. Given the increasing concerns about climate change, decisions about digitisation should consider evidence about carbon footprint (CF). Currently, no established tool for assessing the evidence in healthcare is available. The aim of this study was, first, to develop a framework for assessing reporting transparency of CF analyses and, second, to assess the current evidence of CF for digital health in terms of virtual care (which includes telehealth and telemedicine). Methods: We searched for CF assessments in the databases PubMed, Web of Science, Scopus, CINAHL and EconBiz on Nov 22, 2019. We included primary studies in English or German that provided information about CF of virtual care interventions into a qualitative synthesis. To perform the latter, we developed a checklist of 22 transparency criteria based on the intersection of items contained in the norm 14067 by the International Organisation for Standardisation, the Greenhouse Gas Protocol Product Life Cycle Accounting and Reporting Standard, and the Publicly Available Specification 2050. Two reviewers independently conducted study identification, selection and extraction of items based on this checklist. For each study, we calculated a transparency score ranging from 0 to 100% and extracted study methods and results. Results: Our search yielded 1322 records. 16 records were included in a qualitative synthesis. Most studies addressed telemedicine and reported carbon savings (mean: -147·9 kg/patient (minimum: -1·133, maximum: 8, standard deviation: 288·4)). However, the mean transparency score was about 39% (minimum 14%, maximum 68%). Frequently, only carbon emissions related to travel avoidance were incorporated. Most studies neither obtained a life cycle perspective nor did they report items like system boundary, reasons for excluding unit processes or representativeness of the data incorporated in the study. Discussion: Digitisation may be a source of co-benefits, improving care and reducing CF of the healthcare sector. However, the evidence for this result is weak and CF reports are heterogeneous. The transparency checklist developed within this study may serve as a point of reference for the future development of a standard to assess the CF of virtual and other healthcare and public health services. Funding: Public funding by Leibniz ScienceCampus Bremen Digital Public Health, which is jointly funded by Leibniz Association (W4/2018), Federal State of Bremen and Leibniz Institute for Prevention Research and Epidemiology – BIPS. Declaration of Interest: None to declare.