Public Health

Telehealth virtual visits can be a tool to fight climate change

Andis Robeznieks , Senior News Writer

Telehealth was shown to be a safe and effective way to deliver care during the COVID-19 pandemic. Data also emerged showing that it’s good for the health of the planet.

One large health system linked its 2020 growth in telehealth virtual visits to a reduction in the emissions of greenhouse gases equal to the emissions created annually by 1,200 homes.

Researchers with Northwest Permanente calculated telehealth’s impact on reducing patients’ vehicle traffic and the corresponding reduction in greenhouse gas emissions to 10.5 tonnes of carbon dioxide or equivalent greenhouse-gas emissions (CO2-eq) in 2020 from 19.6 tonnes CO2-eq in 2019.

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“It’s a win-win situation: We increase patients’ access to quality care while, literally, improving the air that they breathe when they step outside,” said Colin R. Cave, MD, Northwest Permanente’s medical director of external affairs, government relations and community health.

Last year, Dr. Cave told the The Wall Street Journal that despite the drop in use of telehealth the technology is still cutting about 7,500 tonnes from the medical group’s carbon footprint annually.

Supporting telehealth is an essential component of the AMA Recovery Plan for America’s Physicians.

Telehealth is critical to the future of health care, which is why the AMA continues to lead the charge to aggressively expand telehealth policy, research and resources to ensure physician practice sustainability and fair payment.

A former president of the Oregon Medical Association, Dr. Cave also leads the effort to enact Northwest Permanente’s Climate Action Plan.

He, his colleague Cory Ogden, MD, and former Northwest Permanente CEO Imelda Dacones, MD, along with other researchers, co-wrote “Patient transport greenhouse gas emissions from outpatient care at an integrated health care system in the Northwestern United States, 2015-20,” which was published by The Journal of Climate Change and Health.

The Kaiser Permanente Northwest integrated health system serves 600,000 members in Oregon and Southwest Washington where wildfires raged and temperatures reached 115 degrees in 2021, making climate change research particularly relevant.

A high of “115 degrees in Oregon isn't normal,” Dr. Cave said.

While the temperature didn’t hit 115 degrees last year, the National Centers for Environmental Information reported that it was Portland, Oregon’s second-warmest year on record with an average daily temperature of 56.6 degrees. The hottest day was Aug. 14, when the temperature hit 108 degrees and was part of a four-day stretch in which the thermometer topped 100.

While the proper ratio of virtual to in-person care has not been determined, Dr. Cave said telehealth is here to stay.

“Make no mistake: We’re not going back,” he said, adding that the impact “is much more than just miles driven,” as there are other results from policy and environmental points of view.

Fewer miles driven, for example, also means less wear and tear on public streets and fewer in-person patient visits allows for a reduction in health care’s footprint.

“We realized that, by increasing our virtual visits, we have been able to close two small primary care clinics, one mental health clinic and one renal clinic, and consolidate these services in other clinics, because so many of those visits were then provided by virtual care,” Dr. Cave said.

But it’s not just about miles driven.

“If you're able to remove the carbon emissions from a couple of clinics, you can then apply that emissions savings to this ambulatory visit-intensity measurement and you can make that measurement even lower,” he said. “If you are having the same number of outpatient visits, but more of them are virtual and it allows you to close physical plants, then you should get credit environmentally for reducing your carbon footprint.

“That's the next iteration of this research, and I'm pleased to see that there are a number of people in organizations that get it,” Dr. Cave added.

The Northwest Permanente study reported that, from 2015 to 2020, the medical group completed 15.6 million outpatient visits, averaging 2.6 million a year. In-person visits declined by 46.2% in 2020 while telehealth visits jumped 108.5% in 2020.

The average distance travelled for an inpatient visit was just over 17.4 miles, and the researchers used Oregon Department of Transportation estimates that 93% of “personal errand” travel in the state is done by auto while the rest is a mix of walking, bicycling and using public transit.

“The rapid and widespread adoption of telehealth during the COVID-19 pandemic has had significant environmental health benefits, primarily through reduction in transportation-associated emissions,” the authors wrote. “If the U.S. health care system were to maintain or expand upon current levels of telehealth utilization, additional reductions in GHG emissions would potentially be achieved through impacts on practice design.”

More needs to be done, Dr. Cave said.

"As hopeful as we are, and as much as we really want global warming to decrease, we're also realists," Dr. Cave said on an episode of “AMA Update.”

"We want to be able to continue our role in mitigating climate change and mitigating our effect on climate change,” he added. “We also understand that we need to be prepared to work and meet our mission of improving the health of our members and our communities in a climate-changed world."

Visit AMA Advocacy in Action to find out what’s at stake in combating the health effects of climate change and other advocacy priorities the AMA is actively working on.