A new study out of Kaiser Permanente found that the use of health information technology, including electronic health records, can reduce the environmental impact of the health care industry. I spoke this week with Kathy Gerwig, Kaiser Permanente’s vice president for workplace safety and environmental stewardship officer. Below are excerpts from our interview.
This study is among the first to examine the environmental benefits of electronic health records. Why was it important to look at the environmental benefits, rather than just how EHR can improve health care?
There are three reasons:
- We embed environmental considerations in everything we do. We have a vision around total health. Total health means applying the clinical, the behavioral, the community and the environmental strategies to support equitable, affordable care. In that context, we call out environmental to say: We’re a health care organization and part of that is to be aware of the effects environmental pollutants have on health. To the extent we can reduce environmental contributors to disease, that’s part of total health.
- Our health information team was pretty sure that electronic health records reduce paper use. But what about everything else? Could it be having a negative impact because we use so much computing equipment? We wanted to know for ourselves what that overall impact might be.
- Whatever we learned — good, bad or ugly — we wanted to be able to share that with the health care sector as a lesson because so many organization are going down the path of their own electronic health records.
Talk about what you found regarding the environmental impact of EHR use.
[EHR use] does reduce the use of paper by something like 1,000 tons annually. We’re not using medical charts and we’re not using paper jackets around X-ray film. That certainly has an impact on carbon emissions. We also found that we’re reducing waste, including the use of toxic chemicals. With digital X-rays, we’re not using the plastic in the film and we’re not using toxic chemicals in development. Electronic health records enable us to optimize digital imaging in that way. We found that we reduced water consumption. That relates primarily to digitized X-rays. All of those results were, in the study, put in terms of reduced carbon emissions.
Can you explain the water savings in more detail?
If you think about when you get an X-ray, if they’re using the older technology that requires developing film. Developing film requires a lot of water. It happens to be potable water. When you move to digitized X-rays, you don’t have the film. You don’t have all the chemicals and you don’t have all the water. It avoids the use of thousands of gallons of potable water for every single machine. It’s not just that you have a beautiful digitized image. You can optimize the use of that image between physicians and specialists. If I’m in Washington, D.C. and my doctor is in Oakland, California, he can get images that help me as a patient that are much higher quality and we didn’t have to use all that polluting material.
How was the study conducted?
There was a team of us who sat down with the health information technology experts. We’re promoting an eco-health footprint. Instead of thinking about our carbon emissions or our water use or waste, we wanted to have an overall footprint so when we make a decision we can balance it. When the only thing you’re interested in is carbon, you’re going to make certain decisions. If you’re interested in overall health and the environment, then you might have a different set of options. That’s where we started. We were looking at carbon emissions, but also waste and water and chemicals. That was the fundamental idea. As a team we started looking at the key features. We knew we had to look at paper. We had to look at water. We started looking at each of those piece by piece.
Had the environmental benefits of EHR been considered previously as the systems were being designed and implemented?
I don’t think anyone was thinking about it. We at Kaiser Permanente are seeing a net positive environmental effect, [but] that will not necessarily happen for any organization that puts in an EHR system. There are a couple of things everybody would have to do to optimize those benefits. Your PC technology and data center must be very energy efficient to reap positive environmental effects from this technology.
The other [aspect] has to do with using EHR and health information technology in a way that optimizes workflow and care delivery and offers alternatives to ambulatory care visits. A significant number of our members find using [secure email, phone contact and online prescription refills] more convenient and more effective than making an automobile trip to our facility. Our EHR system has reduced automobile trips. That reduces emissions and gasoline use. If you have great technology, but you don’t use it to optimize care delivery and offer more choices, you’re not going to reap the benefits we’re seeing.
What’s the next step?
The study did raise additional questions that I’d like to explore. We don’t have a study already planned at the moment. But we’d like to share this information with other health care systems. We actively collaborate on environmental initiatives with other health care systems, so I’m looking forward to their input. Perhaps together we can look at what our key questions are going forward. What are other ways in which we can look at health information technology to both improve health outcomes and benefit the environment?
Photo: Kathy Gerwig