Environmental Impact of a Pediatric Urology Telemedicine Program: A Lesson from the COVID-19 Pandemic
Julia B. Finkelstein, MD, MPH, Marissa Hauptman, MD, MPH, Shelby Flanagan, MPH, Dylan Cahill, BA, Heather Meyers, MBA, Carlos R. Estrada, MD, MBA.
Boston Children's hospital, Boston, MA, USA.
Background: Prior to the COVID-19 pandemic, global investigators had begun to evaluate the impact of virtual medicine on the environmental footprint. This mode of healthcare delivery has shown potential as a carbon reduction strategy, but there were barriers to its widespread application. With accelerated use of telemedicine during the COVID-19 pandemic, we sought to analyze the environmental impact of replacing in-person pediatric urology clinic visits with virtual medicine. We specifically aimed to characterize the effect on fossil fuel consumption, greenhouse gas and non-greenhouse traffic-related air pollutant emissions.
Methods: We performed a retrospective analysis of pediatric urology telemedicine services provided at a single tertiary-care children's hospital to patients and families in the state of Massachusetts from 3/16/2019 to 3/15/2020 and from 3/16/2020 to 3/15/2021. The latter period was selected due to the widespread institutional use of virtual medicine during the COVID-19 pandemic, as compared to the year prior. Though regional established patients located out-of-state were able to receive virtual follow-up care with their providers during periods of the COVID-19 pandemic, we excluded these patients from our analysis to improve generalizability and to estimate the population level impact. Primary outcomes included patient travel distance, gasoline consumption and cost, and fine particulate matter emissions. We calculated carbon dioxide (CO2) emissions associated with averted patient travel. The annual reduction in carbon dioxide emissions equivalencies were calculated using the U.S. EPA Greenhouse Gas Equivalencies Calculator.
Results: From 3/16/2019 to 3/15/2020, 2933 virtual visits (VVs) were performed with valid geocoded addresses (Figure 1). The average round-trip distance saved was 54.2 miles and a total of 15,879.3 miles. During the following year, 11,134 VVs were performed with valid geocoded addresses (Figure 2), which represents 3.6% of the hospital's virtual medicine program that year. The average round-trip distance saved was 55.6 miles and a total of 618,836.8 miles. During one year of the COVID-19 pandemic, pediatric urology virtual medicine services resulted in a total reduction of 24,883.4 gallons of fossil fuel use and $61,138.51 avoided expenditure as well as 220.1 metric tons of CO2 emitted and 7.5 kilograms of fine particulate matter. The CO2 emissions savings is equivalent to the amount of CO2 that would be sequestered in 260 acres of U.S. forests in one year.
Conclusion: Widespread use of virtual medicine can provide environmental benefits. Our findings are likely an under-estimation since we did not consider reductions in fuel consumption or emissions due to curtailment of provider travel or the reduction in power generation needed to supply in-person services. Regardless, efforts are necessary to determine how virtual medicine, when medically feasible, can be fully integrated into future healthcare delivery, as this paradigm shift may be one way to minimize exposure to air pollutants and combat climate change. 
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