The Environmental Impact of Telemedicine in a Radiation Oncology Clinic

ABSTRACT

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.