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Background: Healthcare is responsible for 4-10% of carbon dioxide (CO2) emissions worldwide, with travel-related emissions accounting for approximately 22%. Telemedicine has emerged as a potential solution, but there is a lack of comprehensive approaches to estimate carbon footprint savings, limiting our understanding of its environmental impact. The aim of this paper is to conduct a systematic review to evaluate how the carbon footprint of telemedicine is measured, report the impact of a telemedicine program, and propose an open-access calculator to estimate CO2 emissions for healthcare providers. Methods: We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the PubMed, Medline, Embase and Scopus databases to identify articles estimating the carbon footprint savings of telemedicine. We evaluated publications based on various categories, with ground travel and streamlined life cycle assessment (LCA) being the most important. Based on our findings and an example case in eyecare, we developed a Carbon Calculator for remote Care (CCrC) and applied this model to the papers included for ground travel analysis. Results: Based on a search of 1,117 records, 30 articles were included for quantitative or qualitative analysis. The median roundtrip travel distance for each patient in 23 papers examining ground transportation emissions was 131 km (interquartile range [IQR]:52-386), resulting in 26.3 kilograms CO2 (kgCO2) (IQR:10.6-94.4) emissions. Calculations including LCA had a mean emission of 2.5% less than estimates excluding LCA. In our remote eyecare example, we estimated that 411,000 kgCO2/year could be saved from travel alone, or 401,000 kgCO2/year when accounting for LCA. Conclusions: To prevent overestimation of CO2 emissions savings due to telemedicine, including LCA should be considered, although travel distance as a variable is the biggest contributor. Our CCrC is a preliminary attempt to roughly capture these factors and furthers the debate for structural measurement and calculation of CO2 in telemedicine. |
