PDF(Pubmed)
Abstract：
BACKGROUND: Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use.
OBJECTIVE: We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India.
METHODS: We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources.
RESULTS: This location\'s EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories.
CONCLUSIONS: The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system\'s GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care.
OBJECTIVE: We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India.
METHODS: We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources.
RESULTS: This location\'s EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories.
CONCLUSIONS: The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system\'s GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care.
摘要：
背景：全世界的医疗保健提供者正在迅速采用电子病历（EMR）系统，取代纸质记录保存系统。尽管EMR有很多好处，与医疗记录保存相关的环境排放是未知的。鉴于需要采取紧急气候行动，了解EMR的碳足迹将有助于使其采用和使用脱碳。
目的：我们旨在估算和比较与纸质医疗记录保存及其替代EMR系统相关的环境排放，该系统位于印度南部的一家高容量眼部护理机构。
方法：我们根据ISO（国际标准化组织）14040标准进行了生命周期评估方法，主要数据由眼部护理机构提供。关于纸张记录保存系统的数据包括生产，使用,并在2016年处置纸张和书写用具。EMR系统于2018年在该地点采用。EMR系统上的数据包括资本设备(如计算机和路由器)的分配生产和处置；生产，使用,以及纸张和书写用具等消耗品的处置；以及运行EMR系统所需的电力。我们排除了建筑基础设施和冷却负荷(例如。建筑物和通风)来自两个系统。我们使用敏感性分析对实践变化和数据不确定性的影响进行建模，并使用蒙特卡洛评估对这两个系统进行统计比较，有和没有可再生电力来源。
结果：发现该地点的EMR系统比纸质病历系统排放的温室气体（GHGs）要多得多（每年195,000kg二氧化碳当量[CO2e]或每次患者就诊0.361kgCO2e，而每年20,800kgCO2e或每名患者0.037kgCO2e）。然而,敏感性分析表明，电源的影响是确定哪个记录保存系统排放更少的温室气体的主要因素。如果研究医院的所有电力都来自太阳能或风能等可再生能源，而不是印度电网，他们的EMR排放量将降至24,900千克二氧化碳(每名患者0.046千克二氧化碳)，与纸质记录保存系统相当的水平。节能EMR设备（如计算机和显示器）是影响排放的第二大因素。其次是设备寿命。多媒体附录1包括其他排放影响类别。
结论：与EMR系统相关的气候变化排放在很大程度上取决于电力来源。有了脱碳电源，EMR系统的温室气体排放量与纸质医疗记录相当，脱碳电网可能会给社会带来更广泛的利益。尽管我们发现EMR系统比纸质记录保存系统产生更多的排放，这项研究没有考虑到EMR潜在的扩大的环境收益，包括扩大获得护理的机会，同时减少患者旅行和运营效率，从而减少不必要或多余的护理。
目的：我们旨在估算和比较与纸质医疗记录保存及其替代EMR系统相关的环境排放，该系统位于印度南部的一家高容量眼部护理机构。
方法：我们根据ISO（国际标准化组织）14040标准进行了生命周期评估方法，主要数据由眼部护理机构提供。关于纸张记录保存系统的数据包括生产，使用,并在2016年处置纸张和书写用具。EMR系统于2018年在该地点采用。EMR系统上的数据包括资本设备(如计算机和路由器)的分配生产和处置；生产，使用,以及纸张和书写用具等消耗品的处置；以及运行EMR系统所需的电力。我们排除了建筑基础设施和冷却负荷(例如。建筑物和通风)来自两个系统。我们使用敏感性分析对实践变化和数据不确定性的影响进行建模，并使用蒙特卡洛评估对这两个系统进行统计比较，有和没有可再生电力来源。
结果：发现该地点的EMR系统比纸质病历系统排放的温室气体（GHGs）要多得多（每年195,000kg二氧化碳当量[CO2e]或每次患者就诊0.361kgCO2e，而每年20,800kgCO2e或每名患者0.037kgCO2e）。然而,敏感性分析表明，电源的影响是确定哪个记录保存系统排放更少的温室气体的主要因素。如果研究医院的所有电力都来自太阳能或风能等可再生能源，而不是印度电网，他们的EMR排放量将降至24,900千克二氧化碳(每名患者0.046千克二氧化碳)，与纸质记录保存系统相当的水平。节能EMR设备（如计算机和显示器）是影响排放的第二大因素。其次是设备寿命。多媒体附录1包括其他排放影响类别。
结论：与EMR系统相关的气候变化排放在很大程度上取决于电力来源。有了脱碳电源，EMR系统的温室气体排放量与纸质医疗记录相当，脱碳电网可能会给社会带来更广泛的利益。尽管我们发现EMR系统比纸质记录保存系统产生更多的排放，这项研究没有考虑到EMR潜在的扩大的环境收益，包括扩大获得护理的机会，同时减少患者旅行和运营效率，从而减少不必要或多余的护理。
