OAKLAND, CA — For a field whose putative motto is "First, do no harm," the health care industry has a significant environmental footprint. From energy, water and waste-intensive high-tech hospitals to reams upon reams of paper used to print medical records and the other copious paperwork that goes with a visit to the doctor, medicine may have come a long way in curing ailments, but is only just beginning to recognize its need for greener practices.
Kaiser Permanente, which has long been working on green initiatives across its operations -- from buildings to purchasing to supply chain -- today is announcing its first efforts at measuring those impacts.
The company has published the results of an audit of its years-long shift to electronic health records (EHRs), chronicling the positives and negatives of moving away from paper records to computerized systems.
"We just didn't know what the impacts were, we made assumptions about our reductions in paper, but we didn't know what to expect with other impacts," Kathy Gerwig, Kaiser Permanente’s vice president for Workplace Safety and environmental stewardship officer, explained in an interview. "We were fascinated with the results."
The results from switching 8.7 million members over to EHRs include:
- Eliminating 1,000 tons of paper records;
- Eliminating 68 tons of x-ray film by switching to digital x-rays;
- Eliminating about 38 tons of toxic chemical used to process film x-rays;
- 71.5 million gallons of water saved per year;
- Saving 3 million gallons of gasoline per year from avoided medical visits.
Though these figures are rough assumptions, and the assumptions are detailed in the company's audit report, the impacts are significant. And to its credit, Kaiser also details the negative impacts of the switch: Over 87,000 megawatt-hours of energy is needed to power the computers and data centers that make the EHR system work. And those computers add up to an additional 250 tons of e-waste generated by switching to EHRs.
The e-waste and energy findings were not surprising, Gerwig said. "We use a lot of computers and a lot of data centers, and we know that computers have plastics, heavy metals, and toxics in them, and we wanted to look at those impacts as well."
But knowing the impacts adds further impetus for expanding efforts to address that area. Gerwig said Kaiser has long required green IT purchasing -- all of the company's desktops and laptops are EPEAT Gold certified -- and has been working on improving the energy efficiency of its data centers as well.
And Kaiser's secondary goal for conducting this study is to be able to help other organizations make the greenest transition to EHRs possible.
"Lots of other organizations are moving to EHRs, and we wanted to share some of our learnings," Gerwig said. "It was not just about figuring it out for ourselves, but to help others figure it out."
In the findings of the report, the authors extrapolate that, if EHRs were to be implemented nationwide following Kaiser's example, the net reduction in CO2 emissions from healthcare would be 1.7 million metric tons. Although that is a drop in the bucket of the industry's 434-million-ton footprint, it is still preferable to a scenario where the healthcare industry transitions to EHRs without reducing hospital visits, a situation that could lead to a 653,000-ton increase in emissions.
Image courtesy of Kaiser Permanente.