BRIEF COMMUNICATION Telemedicine Can Make Healthcare Greener Peter M. Yellowlees, M.D., 1 Kathy Chorba, 2 Michelle Burke Parish, B.A., 3 Hannah Wynn-Jones, 4 and Najia Nafiz, B.A. 3 1 Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, California. 2 Center for Connected Health, Sacramento, California. 3 University of California Davis, Sacramento, California. 4 The University of Birmingham, Birmingham, United Kingdom. Abstract The American healthcare industry is generally lacking environmen- tally sustainable practices. The environmental impact of healthcare practices in the country has been largely disregarded due to ambiva- lence, ignorance, and fears of additional costs and regulations. The current practices continue to pollute the environment by requiring large amounts of travel and paperwork by both the patient and the clinician. Telemedicine and health information technology help save time, energy, raw materials (such as paper and plastic), and fuel, thereby lowering the carbon footprint of the health industry. By im- plementing green practices, for instance, by engaging in carbon credit programs, the health industry could benefit financially as well as re- duce its negative impact on the health of our planet. Companies that reduce their carbon emissions by implementing energy-saving prac- tices can sell their carbon credits to companies that emit more carbon than permissible by their legally binding commitment. These carbon profits can then be used for healthcare research or to provide health- care to the underserved. Alternatively, the savings could be used for green purchasing and to implement other carbon-reducing activities. This report reviews the numerous possible options for the American health industry to become greener and lower its carbon footprint while at the same time becoming more time- and cost efficient. Key words: telemedicine, e-health, policy, telehealth, business administration=economics Introduction H ow green is the American health industry? The answer is simple; not at all. Despite the large number of opportunities for the health industry to become greener, especially those involving the use of health information technology (HIT) and telemedicine, in the United States, relatively little activity or interest has so far been shown in this issue. A comprehensive recent review of public health issues 1 has described the environment as ‘‘today’s most pressing global issue.’’ The U.S. health industry needs to better manage the natural resources and in particular reduce its energy consumption and minimize waste. This article reviews the various opportunities available to achieve these changes and recommends future directions for action. Healthcare industry is the second largest consumer of energy among all industrial sectors in America 2 but has a poor environ- mental record. 3 Hospitals in the country use 341 trillion British thermal units for heating and cooling and 73 billion kilowatt hours ‘‘conventional’’ electricity, averaging 2.7 times the gross energy use intensity of office buildings (Commercial Buildings Energy Consumption survey [2003], published by the U.S. Energy Informa- tion Administration). Inpatient healthcare facilities are the second most energy-intensive commercial buildings in the country. While Leadership in Energy and Environmental Design 4 architectural guidelines exist to ensure that new buildings are constructed along environmentally friendly lines, only about 2% of healthcare construction in the United States are judged to be green. 5 The U.S. health industry also produces 3.4 billion pounds of solid waste each year, about 50% of which is paper and cardboard. 6 The industry has been poor not only in managing the waste it produces but also in reducing the negative impact of carbon emitted. The En- vironmental Protection Agency 7 has reported many times over the past 20 years identifying a large number of carcinogenic compounds that are emitted to the atmosphere by hospital waste systems in the country. DOI: 10.1089 =tmj.2009.0105 ª MARY ANN LIEBERT, INC. . VOL. 16 NO. 2 . MARCH 2010 TELEMEDICINE and e-HEALTH 229