Environmental Impact of Digital Health Care Technologies in Reducing Carbon Footprints: Scoping Review
Journal of Medical Internet Research ·
Background: Globally, the carbon footprint of the health care sector is significant and growing, and digital health care technologies (DHTs) offer unique opportunities to reduce the carbon footprint 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, focusing on reducing their carbon footprint and evaluating methods for assessing that impact. Methods: This scoping review followed the method outlined by Arksey and O’Malley, adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The databases of MEDLINE, Scopus, and Web of Science were searched for studies published in English with no time limitation. Search terms were categorized under three broader concepts: “Digital Health Technologies,” “Health and Care,” and “Carbon Footprint.” Studies were included based on screening titles and abstracts, followed by review of full-text papers by at least 2 reviewers. Narrative synthesis was used to report the findings. Results: The database search yielded 4274 studies. Following screening and reference list checks, 70 studies were selected for inclusion. The earliest included study was published in 2007, with the majority originating from the United States (n=26) and the United Kingdom (n=12). Most studies assessed telemedicine or 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 or 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, carbon footprint measurements were based on assumptions, with calculations relying on published emission factors or calculators. Some studies have expressed CO emissions using emission equivalencies, such as equivalent carbon sequestration and equivalent CO emissions. Overall, DHTs demonstrated positive environmental impacts by reducing carbon footprint. However, negative impacts, especially electricity consumption and the lifecycle impacts of digital devices, were also noted. Conclusions: DHTs are associated with reductions in carbon emissions and related environmental benefits, with telemedicine showing potential to lower the carbon footprint of the health care sector. However, evidence highlights the negative impacts associated with energy demand and the full lifecycle of digital devices. Given the substantial heterogeneity in assessment methods and outcome measures across studies, these findings should be interpreted with caution. To capture the true environmental implications of digital health, more rigorous, standardized, and comprehensive assessment methods are required. Bridging these methodological gaps is essential to ensure that DHTs not only support sustainable health care delivery but also make a meaningful contribution to mitigating global climate change. Trial Registration: OSF Registries osf.io/gdnve; https://osf.io/gdnve/overview