The Reduced Environmental Impact of American Radium Society's 2021 Virtual Annual Meeting

Background: In response to the threat of the COVID-19 pandemic, the 2021 American Radium Society (ARS) Annual Meeting transitioned to a virtual, online conference. As medical conferences around the world have transitioned to virtual formats, numerous benefits have been uncovered;however, the environmental effect of reduced travel on carbon emissions remains largely unknown. Today, it is estimated that conference attendance accounts for 35% of a scientist's total carbon footprint [1]. Given that the climate crisis is a growing threat to human health and oncology outcomes [2], it is imperative to begin to quantify, understand, and promote sustainable practices. Objective(s): We aim to highlight the reduced travel-related greenhouse emissions associated with the transition of ARS's 2021 Annual Meeting to a virtual platform in comparison to the 2019 in-person conference in Monarch Beach, California. Method(s): Data from the attendees of the ARS Annual Meeting was collected from 2019 and 2021 (the conference was cancelled in 2020). The distance traveled per attendee to the 2019 location (Dana Point, CA) and the 2021 intended conference location (Lahaina, HI) was estimated using the location of the attendees' home institutions. The mode of transportation was hypothesized based on distance traveled (automobiles < 300 miles;airline >= 300 miles). Approximate carbon dioxide (CO2) emissions were calculated using the Environmental Protection Agency's Greenhouse Gas Tools [3,4]. For the 2021 virtual conference, it was assumed that no travel took place. Alternatively, the associated CO2 emissions were estimated based on assumed internet usage (8 hours/day for the 3-day conference period) and food delivery (5 miles) for one meal which was sent free to each attendee. Additionally, the distance that would have been traveled by attendees to Hawaii was estimated. Result(s): A total of 591 conference attendees were identified, 253 in 2019 and 338 in 2021. For the 2019 in-person conference, the total carbon footprint for all assumed methods of transportation was determined to be 187,935.9 lbs of CO2 emissions, with an average of 820.7 lbs of CO2 emissions per attendee. Total emissions were equivalent to the emissions of 18.5 passenger vehicles for one year. Alternatively, the CO2 emissions spared during the 2021 virtual conference was estimated to be 519,153.5 lbs, the equivalent of 51 passenger vehicles for one year. However, emissions related to teleconference internet streaming and food delivery accounted for a total of 2,693.0 and 1535.8 lbs of CO2. Conclusion(s): Incorporating options for virtual attendance at academic conferences has the potential to significantly reduce carbon emissions. However, many believe that virtual networking cannot replace in-person interactions particularly for early-career attendees. Regardless, our professional societies have an obligation to investigate and promote greater sustainability of our annual meetings.

The Environmental Impact of Telemedicine in a Radiation Oncology Clinic

Background: In response to the COVID-19 pandemic, our radiation oncology department was forced to rapidly integrate telemedicine into its practice. While there has been investigation into the implementation, effectiveness, cost, and perceptions of telemedicine, the environmental impact of telemedicine within radiation oncology has not yet been established. This is particularly relevant as climate change is recognized as one of the largest threats to human health, including oncologic outcomes. Yet, the healthcare sector significantly contributes to global carbon emissions, in part due to patient travel. Objective(s): The aim of this study was to assess the impact of telemedicine on travel-related greenhouse gas (GHG) emissions for a large, academic radiation oncology outpatient clinic located in a densely population suburban setting. Method(s): All in-person and telehealth visits over a consecutive 7-day period in June 2021 scheduled at our main outpatient clinic were retrospectively reviewed. Care visits with patients who resided outside of the state were excluded. Travel distance for in-person visits and miles saved for virtual visits was estimated based on patients' reported home address in the electronic medical record. Associated GHG emissions were calculated with the Greenhouse Gases, Regulated Emissions, and Energy Use in Transportation tool (https://greet.es.anl. gov) using a well-to-wheel model, which accounts for all emissions related to fuel (ie. gas, electricity) production and use. Gas, hybrid, plug-in hybrid, and electric vehicle utilization were accounted for per published statewide vehicle registration statistics. GHG emissions were converted into carbon dioxide equivalents (CO2e) using 100-year global warming potentials. Result(s): A total of 158 clinic visits were conducted over the time period. Table 1 describes visit type, telemedicine status, and primary cancer site of the included patients. Total miles traveled for in-person visits was 5,775 miles and an estimated 13,892 potential miles saved were attributed to telemedicine visits. On average, 118 travel miles were saved per telemedicine visit (CO2e, 55 kg). The forecasted annual savings of CO2e attributed to telemedicine visits is 339 metric tons, the equivalent emissions of 61.6 homes' electricity use for one year. Conclusion(s): The integration of telemedicine within a radiation oncology outpatient clinic reduces the environmental impact of patient care. Telemedicine should be considered where feasible and appropriate to establish and promote environmentally sustainable practices within the field.

The Impact of Telemedicine on Indirect Patient Costs in an Outpatient Radiation Oncology Department

Patients incur more than medical-related expenses when attending necessary consultation and follow-up visits, including time and travel costs. With the rapid integration of telemedicine in response to the COVID-19 pandemic, our department gained another tool that has the potential to reduce the financial burden of cancer care for our patients. The aim of this study was to estimate the indirect cost savings (time, travel costs, opportunity costs) resulting from the use of telemedicine at a large, academic radiation oncology outpatient clinic located in a densely populated suburban setting. We hypothesize that telemedicine provides time- and cost-savings for patients. All telemedicine and in-person visits scheduled at our main outpatient clinic over a one-week period in June 2021 were retrospectively reviewed. Care visits with patients residing outside of the state were excluded. Travel distance and time calculations were estimated using Google Maps and based on patients' reported home address. Travel cost was calculated using the IRS 2021 standard mileage rate of $0.56 per mile. Opportunity cost was calculated by multiplying round-trip travel time with estimated hourly wage, derived by median household income per census block group and in the context of a 40-hour work week. Annual projections were calculated by multiplying weekly cost savings by 52. A total of 156 patients had scheduled visits in our department over one week, 115 of which were via telemedicine. There was no difference in gender, race, ethnicity, and insurance status between telemedicine and in-person visits. Those attending telemedicine vs in-person visits were younger in age (61 vs 68 yrs, p=0.03). There was no significant difference between distance or time traveled to the cancer center between telemedicine and in-person cohorts. For telemedicine visits, median per-visit round-trip travel time saved was 66 minutes (IQR, 39-168 minutes) with a travel cost savings of $33.60 (IQR, $17.92 - $100.80), opportunity cost savings of $67.04 ($42.97 - $118.56), and overall cost savings of $110.57 (IQR, $59.94 - $202.04). Annually, telemedicine visits are estimated to save patients a total travel time of 12911.6 hours, travel costs of $402,684, opportunity costs of $530,588, and overall cost savings of $933,272. Telemedicine benefits patients with time- and cost-savings in an outpatient radiation oncology clinic. Our estimates are likely under-representative of the entire financial impact, as costs related to childcare, parking, tolls, hotels, and meals were not captured in our analysis. These unmeasured costs are likely amplified for those patients who live further from the clinic. Despite this, travel distance was not associated with utilization of telemedicine. In clinically appropriate situations, patient-centered metrics such time- and cost-savings should be considered when informing the choice between telemedicine and in-person visits. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Medical Scribe Impact on Provider Efficiency in Outpatient Radiation Oncology Clinics Before and During the COVID-19 Pandemic

Purpose/Objective(s): Medical documentation has become increasingly challenging for providers, particularly with time constraints and changes to office visit formats during the ongoing COVID-19 pandemic. Medical scribes may help mitigate this burden. Our objective was to determine how scribes affect provider workflow efficiency during the COVID-19 pandemic compared to pre-pandemic controls. Materials/Methods: Providers completed a survey in February 2020 (S1, pre-pandemic) and one year into the COVID-19 pandemic in February 2021 (S2, during-pandemic). Standardized surveys administered during S1 evaluated perceived impact of scribes on clerical work, medical documentation, and efficiency during office visits using the Likert Scale. Surveys administered during S2 also addressed scribe use during telemedicine visits, in addition to office visits. Provider perception of time spent on documentation with or without a scribe was evaluated using a 5-level ordinal scale. Provider response was assessed using descriptive frequency statistics. Fisher's exact test was used to compare categorical variables. Analysis was performed using SAS version 9.4 (SAS Institute Inc, Cary, NC). All tests were two-sided with an alpha level of 0.05. Results: Fifty-eight providers responded to the surveys: 36 (62%) for S1, 22 (38%) for S2. Scribe use decreased perceived clerical work, facilitated chart review, recording of physical exam findings, note documentation and improved efficiency, both before and during the pandemic (P = 0.5, P = 0.7, P = 0.8, P = 0.8, P = 0.9 respectively). Scribe use significantly decreased perceived time to complete documentation pre-pandemic (P = 0.002) and during the pandemic for both in person (P = < 0.0001) and telemedicine visits (P = 0.0004). More providers took over 60 minutes to complete medical documentation without the use of a scribe pre-pandemic (72% versus 30% with a scribe, P = 0.006) and during the pandemic, for both in person (40% versus 0% with a scribe, P = 0.002) and telemedicine visits (35% versus 0% with a scribe, P = 0.002). Even with increased telemedicine visits during the pandemic, 17 (77%) providers strongly agreed that scribe use decreased their daily clerical work and improved efficiency and 18 (82%) strongly agreed scribes were just as helpful during telemedicine visits as during in person visits. Conclusion: Scribe use decreases provider time spent on medical documentation and improves overall efficiency. This improvement in clinical efficiency was similar before and during the COVID-19 pandemic for both in person and telemedicine clinic visits. Integration of scribes into radiation oncology clinics may improve provider satisfaction by reducing burden of documentation and may improve provider well-being.