By Cecilia Butini

Virtual doctor’s appointments are helping healthcare companies reduce carbon emissions, though sustainability is mostly seen as a side benefit of telehealth rather than its main driver. 

The use of telehealth picked up considerably during the Covid-19 pandemic, with virtual visits increasing 38 times from their prepandemic levels and then largely stabilizing, according to 2021 figures provided by McKinsey. At first the practice was seen mostly as a way to improve patient access and convenience while reducing costs, but as the trend stabilized, healthcare companies started viewing virtual consultations as an opportunity to improve their carbon footprint. 

Telehealth can cut costs as some healthcare providers are willing to accept lower reimbursement rates since, for example, fewer personnel are employed or doctors can perform some consultations from home, said Cynthia Cox, vice president and program director on the Affordable Care Act at health policy researcher KFF. 

The healthcare industry is responsible for about 5% of global greenhouse-gas emissions, of which the U.S. healthcare system alone accounts for a quarter. The urgent round-the-clock nature of medical care means that there is a limit to how much emissions can be reduced. 

Energy, food and water consumption in hospitals and other facilities, production of pharmaceuticals and chemicals, along with waste management are the biggest sources of carbon emissions for the American healthcare industry, according to a 2020 study cited by the U.S. Agency for Healthcare Research and Quality. Scope 3 emissions—those in the supply chain beyond the operations and energy usage of the reporting units—account for about four fifths of the total greenhouse-gas emissions of the U.S. healthcare sector, according to the study. Similarly, in England, medicines, buildings, equipment and other supply-chain items generate most of the National Health Service’s emissions, according to official NHS figures. 

While some health providers had started sketching out sustainability strategies before the pandemic—including, for example, using solar panels and energy from renewable sources—the increased uptake in telemedicine made them realize that emissions could also be saved by avoiding transport to and from healthcare facilities.

Kaiser Permanente, one of the biggest nonprofit healthcare organizations in the U.S., started examining the environmental impact of driving to and from its 39 hospitals and 623 medical offices in 2016, but it was during the pandemic that both the benefits of telehealth and the possibility to reduce those emissions really crystallized. 

“[Virtual care] has now created an expectation of our [patients] that they will have access, responses, information, and care virtually, that a lot of people didn’t expect before,” said Dr. Colin Cave, medical director of external affairs, government relations and community health at Northwest Permanente Medical Group. In this sense, patient convenience emerged as the first and primary purpose of virtual visits, but it also led to different considerations. “We understand that climate is health, so it became apparent that there could also be an advantage with regards to the environment,” Cave said. 

Telehealth use is able to reduce Kaiser Permanente’s Northwest region carbon footprint by about 7,500 metric tons a year, according to the company. “It isn’t huge, but it’s something that we have the power to make work,” Cave said.

Kaiser Permanente emits 800,000 metric tons of carbon dioxide yearly from Scope 1 and 2 emissions. Scope 3 emissions are not included, it said. During the past years, the company has been trying to cut emissions by purchasing utility-scale electricity from renewable sources, installing solar arrays, improving building efficiency and buying carbon offsets, it said.

For BUPA, a U.K.-based provider of private health insurance and care, telehealth has emerged as an asset in the company’s broader digitization strategy, which in turn is seen as a way to reduce Scope 3 emissions and eventually get to its goal of net-zero emissions by 2040. 

The company has designed an app for teleconsultations that is able to show patients the carbon emissions avoided through that consultation. BUPA patients in Spain—where the app has been rolled out—were able to save about 6,655 net tons of carbon dioxide via their teleconsultations in 2020 and more than 8,000 net tons in 2022, the company said.

“I think it’s not the silver bullet that’s going to solve our scope 3,” said Glyn Richards, BUPA’s group director of sustainability, suggesting that a broader redesign of healthcare might be needed instead, for example by harnessing remote technology to monitor patients’ conditions. Allowing physicians to access health information in real time through wearable devices would enable them to make earlier interventions and potentially reduce hospital visits, cutting emissions associated with treatment and travel, BUPA said. 

CommonSpirit Health, another nonprofit healthcare group in the U.S., which manages around 140 hospitals in more than 20 states, also said that convenience is the main factor that drove up telehealth utilization in recent years, but that the uptick made the organization realize the sustainability potential it could have.

“As we started with telehealth visits as part of the pandemic response, we quickly realized what a difference this would make overall for our environmental sustainability,” said Marijka Grey, CommonSpirit Health’s system vice president of ambulatory transformation and innovation, physician enterprise. 

Last calendar year, CommonSpirit Health saved 7,662 metric tons of carbon dioxide through telehealth use, as travel to and from facilities was avoided, according to Grey. The organization estimated the emissions saved per telehealth appointment using an average travel distance of 25 miles and the average car fuel efficiency. 

Other measures that CommonSpirit Health has been taking to slash its emissions include choosing energy-efficient technologies, such as LED lighting, and analyzing and fine-tuning their energy expenditure in buildings to make them more efficient. In line with national data, the company said its Scope 3 emissions account for 75% of its total emissions.

Healthcare providers in the U.S. and Europe are convinced that telehealth is here to stay, but its environmental benefits don’t necessarily factor as the number one reason why companies are pushing for it. 

“It is a side benefit, not the main benefit for most organizations,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association. “If [telehealth] wasn’t the clinically appropriate thing to do, it would be irrelevant.”