title: Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector.
abstract: BACKGROUND
  The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers.
  
  
  OBJECTIVE
  To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector.
  
  
  METHODS
  A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases.
  
  
  RESULTS
  Replacing physical visits with telemedicine appointments resulted in a significant 40-70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car.
  
  
  CONCLUSIONS
  Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Holmner
authors.affiliation: ClimAdapt, LLC, Seattle, Washington, United States of America; Department of public health and clinical medicine, epidemiology and global health, Umeå University, Umeå, Sweden.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Ebi
authors.affiliation: Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Lutfan
authors.initials: L
authors.lastname: Lazuardi
authors.affiliation: Department of public health and clinical medicine, epidemiology and global health, Umeå University, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Nilsson
mesh_terms: D058572:Carbon Footprint / Q000191:economics / Q000706:statistics & numerical data; D057231:Climate Change / Q000191:economics; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D019981:Health Care Sector / Q000191:economics; D006785:Hospitals, University; D006801:Humans; D013548:Sweden; D017216:Telemedicine / Q000191:economics; D014195:Travel / Q000191:economics; D049269:Videoconferencing / Q000191:economics